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138 UNIT II Nursing Philosophies

Chesla’s (1996) research points to a gap excluded from involvement nor do they have
between theory and practice with respect to participation thrust upon them.
including families in patient care. Eckle (1996) This narrative illustrates how Benner’s ap-
studied family presence with children in emer- proach is dynamic and specific for each institu-
gency situations and concluded that in times of tion. The belief that being attuned to family
crisis, the needs of families must be addressed to involvement in care is in part a developmental
provide effective and compassionate care. The process is supported by Nuccio and colleagues’
skilled practice of including the family in care (1996) description of this aspect of care at their
emerged as significantly meaningful in the nar- institution. They observed that novice nurses be-
rative text from the peer-identified nurse expert gin by recognizing their feelings associated with
study. This was defined as an additional compe- family-centered care, while expert nurses develop
tency in the domain called the helping role of the creative approaches to include patients and fami-
nurse and was named maximizing the family’s lies in care. The intricate process of finely tuning
role in care (Brykczynski, 1998). The intent of the nurse’s collaboration with families in critical
this competency is to assess each situation as it care is delineated further by Levy (2004) in her
arises and develops over time, so that family in- interpretive phenomenological study that articu-
volvement in care can adequately address spe- lates the practices of nurses with critically burned
cific patient-family needs, and so they are not children and their families.

CRITICAL THINKING ACTIVITIES
1. Describe clinical situations from your own expe- this situation? What aspects stand out as salient?
rience that illustrate how nurses at various levels What would you say to the family at given points
of skill development from novice to expert in- in time? How would you respond to your nursing
volve patients and families in care. colleagues who may question your inclusion of
2. Discuss the clinical narrative provided above the family in care?
following the unfolding case study format to 3. Using Benner’s approach, describe what is meant
promote situated learning of clinical reasoning by the statement that caring practices, intervention
(Benner, Hooper-Kyriakidis, & Stannard, 2011). skills, clinical judgment, and collaboration skills
Regarding the various aspects of the case as they increase the visibility of nursing practice in the
unfold over time, consider questions that encour- following three senses: (1) to the individual nurse,
age thinking, increase understanding, and pro- (2) to nursing colleagues, and (3) to the health
mote dialog such as: What are your concerns in care system.

POINTS FOR FURTHER STUDY

n Brykczynski, K. A. (2002). Benner’s philosophy in n Patricia Benner home page at: http://home.
nursing practice. In M. R. Alligood & A. M. Tomey earthlink.net/,bennerassoc/
(Eds.), Nursing theory: utilization & application n The Carnegie Foundation for the Advancement of
(2nd ed., pp. 123–148). St. Louis: Mosby. Teaching, Professional and Graduate Education
n Benner, P. (2001). From novice to expert: com- at: http://www.carnegiefoundation.org
memorative edition.Upper Saddle River, (NJ):
Prentice Hall. (Re-published edition of the Videotapes
original 1984 work.) n Benner, P., Tanner, C., & Chesla, C. (1992). From
n Hubert Dreyfus home page at: http://philosophy. beginner to expert: clinical knowledge in critical
berkeley.edu/ care nursing (Video). New York: Helene Fuld