Patricia Benner Philosophy on Nursing

Patricia Benner’s philosophy of nursing is based upon the notion that each nurse moves

through a continuum in terms of their experience and skills acquisition. According to Benner,

there are five different levels of development for the nurse. These levels are novice, advanced

beginner, competent, proficient, and expert. As the nurse moves through the continuum, there are

different aspects that change in their performance as a nurse. The nurse moves from relying on

principle and rules to the use of past experiences, and from rule-based thinking to intuition. The

nurse also becomes able to distinguish between relevant and less relevant pieces of information,

and instead of being a detached observer becomes fully engaged in the situation at hand. This

philosophy and model is situation-based, meaning that the nurse may move back and forth

through the continuum given the situation, and their familiarity with that situation (Alligood,

2014).

Scenario

“A 35-year-old woman presents to the emergency room by herself complaining of acute onset

right lower quadrant abdominal pain and nausea; she has vomited 3 times. Her color is ashen, her

oral temperature in 99.2, her pulse is 118 beats per minute, her respirations are 24

breaths/minute, and her blood pressure is 90/50 mm Hg. She is diagnosed with a ruptured right

ovarian cyst.”

Intervention / Rationale

The first thing we will do is verify patient's past medical history, past medications and

allergies should be verified to ensure that the interventions selected are not contraindicated. We

know from the patient’s ashen color, tachycardia, tachypnea, slight hypotension and elevated

temperature that the patient may be going into shock due to a rupture of the cyst and bleeding
into the abdomen. For this reason, the patient should be hooked up to continuous monitoring for

vital signs so we can better know where they stand throughout treatment. We will keep the

patient NPO because of the nausea and vomiting and because we know the patient is probably

going to be going to the operating room soon. In addition, we will offer the patient an emesis

basin and suction to contain any incidence of vomiting.

We then address the low blood pressure issue by starting an IV and administering

prescribed fluids to stabilize their blood pressure as well as replenish fluids lost due to vomiting.

Because we know the patient is probably bleeding a fair amount we will want to insert at large

gauge IV. We will try to place an 18-gauge needle if possible, but at the very least we will need a

20 gauge because we suspect we may need to transfuse the patient. While inserting the IV we

will draw blood samples to send to the lab. We will collect samples to send off for a type and

screen so we can find out the patient’s blood type. We will send a cross match so we can have

blood ready for the patient in the blood bank if we need it. We will also send off a complete

blood count (CBC) to because we are concerned about the patient’s hemoglobin, hematocrit and

platelets because she is bleeding. Additionally, we will get a urine sample from the patient so we

can check for pregnancy to make sure the patient isn’t pregnant as this will be an important

factor if she goes to surgery.

Once we have sent off the labs we will perform a physical assessment and check for any

visible blood loss. While the patient does have increased respiratory rate of 22, we do not believe

she requires oxygen. The increased rate could be due to the pain she is experiencing or shock.

We will place a pulse oximeter on her to ensure that she has adequate oxygen saturations and

will make sure to have oxygen tubing in the room in case we need to put her on oxygen quickly.

Because the patient is in pain we will want to help control that. We will administer prescribed
pain medication keeping in mind that she is bleeding internally and will likely undergoing

surgery soon. For these reasons, we need to ensure the prescribed pain medication is not

something that will thin her blood or cause more bleeding. We will also need to be careful not to

administer any narcotics for pain as it may hinder her ability to sign surgical consent when

necessary. If ordered, Tylenol would be a good choice for the pain as it will not cause more

bleeding or disorient the patient and may additionally bring down the patient’s slight

temperature. We will also administer any prescribed ant nausea and antiemetic to control her

nausea and vomiting.

In addition to these medical interventions, we notice that the patient has come in alone, so

we will ensure that I make the patient feel comfortable and provide support. We will try to get a

family member or friend, if available, to come be with her. If there is no one available we should

get a phone number of someone the doctor could call after the surgery to keep updated on her

progress.

Conclusion

In considering this scenario using Benner’s philosophy, we as a group of nurses all with

differing levels of experience, approach the situation in relation to our personal experience as a

nurse as well as our experience with the situation at hand. While some of us have experience

with ruptured ovarian cysts, none of us have the experience of a nurse in the emergency room.

Through collaboration we can piece meal our experiences together and help each other achieve

the highest level of nursing for the present situation.

All the above interventions were determined based on knowledge learned in school, as

well as some we have learned from past work experiences. By working together, nurses at

different stages of Benner’s nursing continuum we can holistically provide care from the all our
different levels of knowledge. This exercise and summary proves Benner’s philosophy as those

of us who are fresh out of nursing school will learn from those of us with a bit more experience

and we will all approach a similar situation differently than we first did alone.

References

Alligood, M. R. (2014). Nursing theorists and their work. St. Louis, MO: Elsevier Mosby.