The group of specially trained OB nurses had ready access to the critical care nurses, with whom they had recently worked, thereby providing readily accessible backup for safe care. This combination of obstetric and critical care knowledge and skill en-abled them to ensure that optimal supportive care was provided. They made adjust-ments to the care plan far beyond those recommended by the physicians. Examples included bringing the baby to the mother and providing nutritional support.
One of the two nurses who described this exemplar in Brykczynski’s (1998) study reported caring for Rosa as she regained consciousness. This nurse related that she was performing the standard neurological check and noticed a slight
change in Rosa’s pupil reaction, which was nonexistent before. She rechecked the pupils and had another nurse verify that there was a slight response. The physi-cian who was summoned did not detect any pupillary reaction. Gradually, however, Rosa became more and more alert throughout this nurse’s shift and was able to be extubated. Rosa’s baby was crying in the room when Rosa regained conscious-ness. Remarkably, Rosa’s liver had regenerated; she recovered with no residual brain damage; and she was discharged home to be with her baby and the baby’s father.
This case history constitutes an exemplar of nursing provided in an open, receptive, adaptive, creative, and hermeneutic manner as described by Benner and colleagues as a reasoning-in-transition approach (Benner, et al., 1999). For teaching students this case can be presented as an unfolding case study to help students learn how clinical reasoning changes over time (Benner, Sutphen, Leonard, et al., 2010).
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CRITICAL THINKING EXERCISES
1. Reflect on a situation from your practice as a nurse that taught you to modify, refine, and embody knowledge in a very practical way. Describe the situation in narrative story form and include as many specific contextual details as possible using the following as a basis: Who? Where? When? What? Why? How? See “Guidelines for Writing Nursing Narratives” in Benner and colleagues (2011, pp. 542-544) for more information.
2. Using the novice to expert model, describe a situation illustrating how a nurse functioning primarily at a competent level of expertise can promote learning for a new graduate functioning as a novice nurse.
3. You have been asked by your nurse administrator to develop a draft revision of the institution’s nursing service clinical ladder. Use Benner’s approach and develop your draft for presentation to the administrative council.
4. As student representative to the curriculum committee in the school of nursing, how would you present the idea of using Benner’s work for enhancing and evaluating the curriculum?
5. Reflect on the approach of the physicians caring for Rosa and the reasoning-in-transition approach followed by the nurses in their care of Rosa. Consider this case in terms of evidence-based practice. Is it a useful exemplar for approaching situations in which there is little, if any, evidence or the evidence is inconclusive? How does it highlight the importance of individualizing care?
136 PART 2 Application
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