Benner’s Competency Assessment Essay Example

The three domains addressed are teaching/coaching, diagnostic/monitoring, and the helping role. The clinical setting of these experiences is the adult medical-surgical ward wherein I worked for the past 3 years. Prior to this, I had one year experience working in a children’s hospital. Based on years of experience, my competency level is proficient (Benner, 2001).

Domain #1: Teaching/Coaching

On the fifth day post-op, pre-discharge education was scheduled for a post-ostomy patient. However, her indifference towards her stoma suggested lack of acceptance of the physical change. Clearly, it was important to address her emotional status first because it is a barrier to learning. I talked with her and found out she was a swimming instructor and was a former swimmer for her high school. She was anxious of losing her job and her passion as a result of the ostomy. I recognized this as a misconception and a learning need. I then told her this issue can be addressed in the pre-discharge education, and she welcomed the opportunity. I then coordinated with the ostomy nurse for the inclusion of activity limitations in the ostomy care skills demonstration.
I consider my level of competence as proficient because I do not yet possess the extensive experience my other peers have. I became emotionally involved and considered the big picture and long-term implications of care in that the quality of patient education would impact self-care and psychological wellbeing post-discharge. Given prior experiences with post-ostomy patients, I intuitively knew that the patient’s indifference was not due to dependence or bad behavior as the newer nurses thought but because of emotions hampering psychological coping with the ostomy. I also went beyond the physiological needs to address the patient as a whole and to ensure that education was individualized to address the patient’s most pressing concerns as recommended by Ang et al. (2013) in their integrated literature review of psychological health post stoma surgery. Advancing to being an expert requires reflection on how one has responded to similar situations in the past the present. More importantly, one needs to generate principles that will guide future responses and achieve instantaneous and fluid performance.

Domain #2: Diagnostic/Monitoring

In the medical-surgical ward, a geriatric patient admitted for fever and upper respiratory tract infection had an order for increased oral hydration as there was a risk for dehydration and the patient did not have swallowing problems. A junior nurse had difficulty having the patient drink more because the patient refused it stating he was not thirsty. The nurse, in her view that patient autonomy must also be respected, did not press the matter as she also knew that thirst, and the lack thereof, are indicative of fluid balance in adults. As her informal mentor, I relayed to the nurse the difference between the older and younger adults’ physiological responses to fluid imbalance in that thirst may be blunted even during dehydration as pointed out by El-Sharkawy et al. (2014). Thus, we talked about the need to balance the ethical principles of autonomy and non-maleficence and modified the care plan based on our discussion. We went back to the patient and explained to him the risk of further dehydration and the benefits of prevention by drinking more fluids even without the perception of thirst. We collaborated with the patient as to how he can increase his fluid intake.
Again, this experience reflects a competency level of proficient. My response was more situational in recognizing the patient’s developmental stage and including this factor in the assessment and planning of care rather than relying solely on what typically occurs in adults. The ability to discriminate in regards to what makes the clinical situation different from the typical was important in identifying the relevance of preventing dehydration while also respecting patient autonomy, a fact that was not instantly recognized by the newly graduated nurse. While intravenous rehydration would have been offered and is effective when the patient transitioned to moderate dehydration, prevention was still indicative of quality care given that IV therapy causes discomfort and is invasive carrying with it the risk of nosocomial infection. The focus on immediate patient outcomes, accurately reading the situation, and ample consideration of options before choosing the best course of action characterize a proficient nurse (Benner, 2001). To further improve competence and become an expert, reflection is again important so as to gauge how one’s performance has improved from the past and set performance goals for the future. At the same time, updating one’s knowledge in relation to caring for different patient subgroups, e.g. pediatric, adult, geriatric, and ethnic minority, as well as validating information in practice promotes advancement.

Domain #3: The Helping Role

A male Mexican patient was admitted post hernia repair. During the postoperative period, a peer approached me to ask what should be done when the patient refuses pain medication stating his pain is manageable but pain is clearly affecting his appetite, ability to ambulate, and rest. Again, the ethical principle of respect for autonomy was raised as were the negative effects of poorly managed pain on wound healing and overall health. Having attended a pain management in-service activity, I immediately thought about culturally influenced responses to pain summed up in the review by Campbell and Edwards (2012). I shared how the Listen-Explain-Acknowledge-Recommend-Negotiate (LEARN) model can be used to promote optimum pain management which my colleague asked me to model.
That was my first time to apply what I learned about culture and pain and my actions reflect proficiency. My focus was on achieving positive outcomes and individualizing care towards this purpose. This meant flexibility in the approach to pain management instead of limiting the interventions to conventional medications. The patient’s cultural perspective was duly considered in order to provide culturally congruent and patient-centered pain management. Because the situation was new, however, my response was not instantaneous. Continuing openness to learning the culture of others and best practices will help me achieve expertise in culturally congruent pain management.

References

Ang, S.G., Chen, H.C., Siah, R.J., He, H.G., & Klainin-Yobas, P. (2013). Stressors relating to patient psychological health following stoma surgery: An integrated literature review. Oncology Nursing Forum, 40(6), 587-594. doi: 10.1188/13.ONF.587-594.
Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice. Upper Saddle River, NJ: Prentice Hall.
Campbell, C.M., & Edwards, R.R. (2012). Ethnic differences in pain and pain management. Pain Management, 2(3), 219-230. doi: 10.2217/PMT.12.7.
El-Sharkawy, A.M., Sahota, O., Maughan, R.J., & Lobo, D.N. (2014). The pathophysiology of fluid and electrolyte balance in the older adult surgical patient. Clinical Nutrition, 33(1), 6-13. doi:10.1016/j.clnu.2013.11.010.