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136 UNIT II Nursing Philosophies

overlooked practitioner stories that demonstrate that 1984a) were incorporated as an interpretive
compassion can be wise and, in the long run, less framework. A critical aspect of using Benner’s
costly than ‘defensive’ adversarial commodified tech- approach is the realization that the domains and
nocures” (pp. 35-36). Benner’s work is useful in that it competencies form a dynamic evolving interpre-
frames nursing practice in the context of what nurs- tive framework that is used in interpreting the
ing actually is and does.
narrative and observational data collected. The
nurse who described this situation had approxi-
Summary mately 8 years of experience in critical care, and
Benner seeks to affirm and restore nurses’ caring she noted that this was significant to her practice
because it taught her how to integrate taking
practices during a time when nurses are rewarded care of a family in crisis along with taking care of
more for efficiency, technical skills, and measurable a critically ill patient. Thus, this was a paradigm
outcomes. She maintains that caring practices are case for the nurse, who learned many things
imbued with knowledge and skill about everyday from it that affected her future practice.
human needs, and that in order to be experienced Mrs. Walsh is a pseudonym for a woman in her
as caring, these practices must be attuned to the par- seventies who was in critical condition following
ticular person who is being cared for and to the par- repeat coronary artery bypass graft (CABG) sur-
ticular situation as it unfolds. Benner’s philosophy gery. Her family lived nearby when Mrs. Walsh
of nursing practice is a dynamic, emerging holistic had her first CABG surgery. They had moved out
perspective that holds philosophy, practice, research, of town but returned to our institution, where the
and theory as interdependent, interrelated, and her- first surgery had been performed successfully.
meneutic. Her hope voiced in the preface of From Mrs. Walsh remained critically ill and unstable for
Novice to Expert (1984a) saying that domains and several weeks before her death. Her family was
competencies would not be deified by system builders very anxious because of Mrs. Walsh’s unstable
seems to have been largely realized, as those who have and deteriorating condition, and a family member
sought to apply these concepts have honored the con- was always with her 24 hours a day for the first
textual background on which they are based. Benner’s few weeks.
work exemplifies the interrelationship of philosophy, The nurse became involved with this family
practice, research, theory, and education.
while Mrs. Walsh was still in surgery, because fam-
ily members were very anxious that the procedure
CASE STUDY was taking longer than it had the first time and
made repeated calls to the critical care unit to ask
A case study from the peer-identified nurse about the patient. The nurse met with the family
expert project that this author (Brykczynski, and offered to go into the operating room to talk
1993-1995; 1998) conducted as part of a nursing with the cardiac surgeon so as to better inform the
service clinical enhancement process is selected family of their mother’s status.
here to illustrate Benner’s approach to knowl- One of the helpful things the nurse did to assist
edge development in clinical nursing practice. this family was to establish a consistent group of
This project was undertaken to identify and nurses to work with Mrs. Walsh, so that family
describe expert staff nursing practices at our members could establish trust and feel more confi-
institution. Exemplars were obtained and par- dent about the care their mother was receiving. This
ticipant observations were conducted to yield eventually enabled family members to leave the hos-
narrative text that then was interpreted through pital for intervals to get some rest. The nurse related
Benner’s multiphase interpretive phenomeno- that this was a family whose members were affluent,
logical process (Benner, 1984a; 1994). In the educated, and well informed, and that they came in
final phase of data analysis, Benner’s domains prepared with lists of questions. A consistent group
and competencies of nursing practice (Benner, of nurses who were familiar with Mrs. Walsh’s