Nursing Levels of Competency Theory(from Ignorance to Mastery) Introduction The image of nursing is changing. Images of angels in starched skirts and nursing caps eagerly awaiting guidance from physicians has long since been replaced by images of competent, independent men and women of diverse backgrounds. Gordon (2005) described the historical, stereotypical (iconic) view of the nurse as that of a physician’s handmaiden, dependent on the physician for direction. She explained that the nursing profession has been negligent in sharing with the public the importance of nurses’ critical thinking, problem-solving, and research skills. Nurses have failed to help the public understand that nurses’ actions involve more than nurturing; they also include assessing, surveying for risks, identifying client goals, planning independent actions, and prioritizing care. Gordon (2006) has stated that in order to gain and maintain the respect of the public and other healthcare professionals, nurses must emphasize and communicate the knowledge and skills required for professional nursing. It is also imperative that those responsible for reimbursement of nursing care understand that nurses “save lives, prevent complications, prevent suffering, and save money” (para. 5). O’Mara (1999) has argued that in order to assure reimbursement and access to needed resources nurses need to articulate the cognitive abilities nurses need in order to provide competent care. Benner, Sutphen, Leonard, and Day (2010), too, have written that nurses must learn to emphasize the tangible benefits of nurses, beyond that of caring. Nursing education plays a central role in the ability to practice effectively. It follows that an optimally educated nursing workforce begets optimal patient care. But the learning process, wherein the nurses acquire skills and knowledge, has often become more difficult than necessary because of the bad feelings nurses get when they make mistakes in learning. The bad feelings come from judgments like, "not doing it right," "not good enough," "can never learn this," etc. Ironically, not doing it right and making mistakes are vital steps in the learning process. Yet too often our attention goes to trying to avoid the bad feelings, rather than to the learning at hand. Understanding the stages of learning a skill can help keep the learning process focused on learning to do something, and not feeling bad about ourselves for not already knowing how. Nurses must overwhelmingly acknowledged Learning as a major factor in nursing competence. The importance of the Learning process in nursing indicates that knowledge and Skills are required to prevent untoward patient outcomes. It also identified competence as o An integrated practice/learning competency model will positively impact patient safety and improve patient care Nursing practice should be differentiated according to the nurse’s educational preparation and level of practice and further defined by the role of the nurse and the work setting Practice environments that support and enhance professional competence are essential o o The nurse of the future will be proficient in a core set of competencies. or unconscious of their incompetence. they consciously acquire a skill then consciously use it.in all dimensions. Eventually. As they recognize their incompetence. Concepts and Relationships Learning and practice partnerships are key to developing an effective model. Major Assumptions. “it makes patients want you to take care of them and patients and health professionals trust competent nurses.prerequisite to establishing trust with others. provides a model for learning. It suggests that individuals are initially unaware of how little they know. o There is a differentiation in competencies among practicing nurses at various levels Competence is developed over a continuum and can be measured o .” And competence “addresses patients holistically .” Philosophical/ Theoretical Underpinnings This theory was originally acquired and attributed to Abraham Maslow. The Four Stages of Learning. Competence is important because. the skill can be utilized without it being consciously thought through: the individual is said to have then acquired unconscious competence. Conceptual Model Unconscious Incompetence Nursing Unconscious Competence Conscious Incompetence Conscious Incompetence The Nursing Competency Model Explanation of the Model Four Levels of Competence: Stage 1 – Unconsciously Incompetence (Novice) the nurse is not aware of the existence or relevance of the skill area the nurse is not aware that they have a particular deficiency in the area concerned the nurse might deny the relevance or usefulness of the new skill the nurse must become conscious of their incompetence before development of the new skill or learning can begin. the aim of the learner and the trainer is to move the person into the 'conscious competence' stage. by demonstrating the skill or ability and the benefit that it will bring to the nurse's effectiveness Stage 2 – Consciously Incompetence (Apprentice) the nurse becomes aware of the existence and relevance of the skill . describing a nurse's path from ignorance to mastery. and to move to the 'conscious competence' stage Stage 3 – Consciously competence (Journeyman) the nurse achieves 'conscious competence' in a skill when they can perform it reliably at will the nurse will need to concentrate and think in order to perform the skill the nurse can perform the skill without assistance the nurse will not reliably perform the skill unless thinking about it . ideally by attempting or trying to use the skill the nurse realizes that by improving their skill or ability in this area their effectiveness will improve ideally the nurse has a measure of the extent of their deficiency in the relevant skill.you do it well. . The four-stage model is intriguingly simple.it becomes 'second nature' It becomes possible for certain skills to be performed while doing something else. but is unlikely to be able to teach it well to another person the nurse should ideally continue to practice the new skill. although after some time of being unconsciously competent the nurse might actually have difficulty in explaining exactly how they do it .the skill is not yet 'second nature' or 'automatic' the nurse should be able to demonstrate the skill to another. the skill becomes so practiced that it enters the unconscious parts of the brain . assessing the pulse rate and respiratory rate at the same time. the nurse is therefore also aware of their deficiency in this area. and if appropriate commit to becoming 'unconsciously competent' at the new skill Practice is the single most effective way to move from stage 3 to 4 Stage 4 – Unconsciously competence (Master) You're so successful it's "automatic" -. the nurse might now be able to teach others in the skill concerned.the skill has become largely instinctual this arguably gives rise to the need for long-standing unconscious competence to be checked periodically against new standards. and a measure of what level of skill is required for their own competence the nurse ideally makes a commitment to learn and practice the new skill. without thinking about it. for example. Environment.unaware or insensitive of skills and knowledge one lacks Learning.Concepts and Definitions Competence .addresses patients holistically . and experience relevant to the care situation.repeated performance or systematic exercise for the purpose of acquiring skill or proficiency Conscious. structured learning experience. and wholeness. and worldviews. It developed nursing competency that requires practice and clinical simulation which provides a safe.inner and outer state of wellness. integrity. and External environment. also referring to available resources.g. values. embedded in social. but on the nurse who provided “the most exquisite nursing care”. psychological development. illness and disease from an individual Nursing. or experience Meta-paradigms / Theory Assertions Person. Internal environments include the individual’s state of mind. It introduced the revolutionary assumption that the practice itself could and should inform theory. political. This theory changed the profession's understanding of what it means to be an expert. training.one receiving therapeutic levels of care Health.situated caring shaped by one’s level of development (e. training. training and experience. moral-ethical development) and the context of the situation.in all dimensions. Usefulness (Application of Theory) Each step builds on the previous one as abstract principles are refined and expanded by experience and the learner gains clinical expertise.without adequate skill or knowledge Practice. societal and professional norms.internal and external environments of both the nurse and the patient/client. and economic systems.individual sense of recognition or awareness of competence within oneself Unconscious.. placing this designation not on the nurse with the most highly paid or most prestigious position.the act or process of acquiring knowledge or skill through practice. intention and personal beliefs (including personal philosophy of nursing or what nurses “do”). . their level of relevant skill. Incompetence. Manggahan Elementary School. And as if by cue. and coupled by my mother's words of wisdom. wherein my mom chose my line of profession. I am a single parent. I have to maintain my high grades for my scholarship and eventually it paved off and I became one of the top students and graduated with honors and awards. My father was a former PUJ driver and currently has no source of income. At the age of 19. Elaisa Mae Celada delos Santos. I went to Eastern Samar to continue my second year with the same course. With the motivation to improve the kind of life that we lived. I was given the privilege to study at Grace of Shekinah School. It was my last year when I got impregnated by my long-time boyfriend. Cruz. Sta. I am the eldest of their three offsprings.Background of the Theorist My beginning as a legally recognized individual occurred on May 26. it would seem improbable that any student of my age would be able to go through such sacrifices and endeavor. However I am still making the effort which is conceivable. my mother went to work abroad. I studied in one of the nursing schools in Manila. By the time I went to college. Thus I have high hopes that I will achieve something of value through my current studies or with any new ideas that come in the future to help my family and my aspirations for my child’s future with God's grace and guidance. In high school. who eventually left me. But due to financial stability. I was granted a scholarship because of my academic achievements. I gave birth to a healthy baby boy. But God is still good and blessed me with a loving family who supported me and my baby financially and emotionally. Bulacan. My mom’s visa t o work in Canada was approved. and it was difficult and very depressing. We live a prudent life but sometimes what we have was not enough to support our daily living. I will be able to gain or achieve certain goals as a student of this institution. wherein I graduated with honors and awards. and I was given the name. a private school where doors of opportunity were opened for me. My parents are Jessie and Myra delos Santos. I got my primary education at a public school. our life got better. that I will do my best to accomplish my goals and finish my studies. I hope with my continued pursuance.NURSING. 1991 in Santa Maria District Hospital. hard work and hope for a brighter future for me and my baby. I have no choice but to stop schooling and went back here in Santa Maria. She got a high-paid salary job that was able to support us. . Statistically. gordontraining. Faculty of Nursing. & Balita. (2005). Gordon. Teaching excellence in nursing education: a caring framework. 1984. Philadelphia. media stereotypes. Harder BN (2009). San Francisco. A. Benner. Pullen RL Jr.References O’Mara.scribd. (2006). Care Groups: a model to mentor novice nursing students. PhD.com/viewarticle/520714 Benner P. NY: Cornell University. Menlo Park. Boggs. University of Manitoba. 6. What do nurses really do? Topics in Advanced Practice Nursing eJournal. Arnold. P. Morris AH. pp. Theoretical Foundations of Nursing: The Philippine Perspective. USA..F. Leonard. Sawatzky JA. (1999). Interpersonal relationships: Professional communication skills for nurses (3rd ed. 496-523). L.wikipedia. Rhodes MK.com/doc/18624149/Theoretical-Foundations-of-Nursing . Sutphen. M. University of Pennsylvania.E. Octaviano. Canada. Olga F. U. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. V. S. & K . (2008).medscape. The Integrality of Situated Caring in Nursing and the Environment. Gordon.. CA: Jossey-Bass. Nursing Resource Center. Jarrin. E. AL. Davis PL. Calif: Addison-Wesley. Enns CL. Murray PH. Communicating with other health professionals. Retrieved from http://www. Nursing against the odds: How health care cost cutting. Auburn University Montgomery School of Nursing. (2010). Philadelphia. USA. Winnipeg. C. McGee KS (2001). Ithica. Lazenby RB (2011). Educating nurses: A call for radical transformation. School of Nursing. Montgomery. MB. TX 79178.com/doc/27103958/Benner-Theory-Novice-to-Expert http://www.. Computer Testing Center. Center for Health Policy and Outcomes Research. & Day. RN (2012. PA: Saunders.com/free-workplace-articles/learning-a-new-skill-is-easier-saidthan-done/ http://en.scribd. In E. and medical hubris undermine nurses and patient care.org/wiki/Four_stages_of_competence http://www. Philippines: Ultimate Learning Series http://www. Ashcroft TJ. Nursing at its best: competent and caring. S.. Amarillo College. Regie P. delos Santos Submitted to: Prof. de Jesus. MAN .In partial fulfillment of the requirements in Theoretical Foundations of Nursing NURSING COMPETENCY THEORY (from Ignorance to Mastery) Submitted by: Elaisa Mae C. RN.