LEVEL OF PROFICIENCY ACCORDING TO

P. BENNER
NOVICE TO EXPERT MODEL
 NOVICE TO EXPERT MODEL

• The theory is
also known as
BANNER’S
STAGES OF
CLINICAL
COMPETENCE

ST
1 LEVEL - NOVICE
• Student nurse
• No background experience
• Instructor provides clear
directions
• Working to acquire nursing
knowledge & skills
• Prefers to get instructions
and
follows it step by step
• Students are coached and
need supervision
ND
2 LEVEL – ADVANCED BEGINNER
• Newly qualified nurse
• Maybe 6 months experience
• Now have full legal and professional
responsibilities
• Style of evaluation still lacks
• Continues to rely on textbooks and
protocol & oversight from colleagues
recognizing subtle variations
• Is able to give a marginally
acceptable performance — i.e. can
perform a task as asked, but cannot
think ahead, change course or
prioritized
 RD
3 LEVEL - COMPETENT
• 2-3 years experience in the same area
• Able to provide independent care
• Assumes greater responsibility
• Characterized by conscious deliberate
planning
• Able to make long range plans , to be
efficient and organized.
• The competent stage is the MOST
PIVOTAL IN CLINICAL LEARNING
because the learner must begin to
recognize patterns and determine
which elements of the situation warrant
attention and which can be ignored.
 TH
4 LEVEL - PROFICIENT
• 3+ years experience
• Able to recognize and respond to
rapidly changing clinical situations
e.g. unstable patients
• Can see beyond the moment,
taking in the patient. total needs
and care.
• Proficient level is a qualitative leap
beyond the competent level.
• The nurse possesses a deep
understanding of situations as they
occur,
 5TH LEVEL - EXPERT
• 5+ years experience
• Intuitive management of
complex cases
• Patient advocate
• Has an intuitive grasp— no
longer needs to use analysis
or
rules.
• Is able to recognize. patterns
and quickly make decisions
FIELDS OF
NURSING
NURSING IN PRIMARY CARE SETTING • Nursing in
primary care setting
• Primary: initial health care for general complaints
• Usually the person’s 1st contact with the health care delivery system •
Managing current health care needs, and preventing further problems.
1. Public health nursing
2. Occupational nursing
3. Clinic nursing
4. School nursing
5. Private duty nursing
6. Military nursing
 7. Ambulatory care nursing
8. Nursing in correctional facilities

NURSING IN SECONDARY CARE SETTING

• Institutional nursing: Hospital Nursing
• Director of Nursing
• Clinical coordinator
• Head Nurse
• Staff Nurse
• OB-Gyne nursing
• Pediatric nursing
• Orthopedic nursing
• OR nursing
• Med-surgical nursing
• Psychiatric nursing
• ER nursing
 • Critical care nursing
• Flight nurse
• Infection-surveillance nurse

NURSING IN TERTIARY CARE SETTING

1. Skilled Care Setting
2. Rehabilitation Setting
3. Advanced Practice Nursing (APN)
• Clinical nurse specialist
• Nurse anesthetist
• Nurse educator
• Nurse administrator
• Nurse researcher

FIVE FOLDS NURSING

FUNCTIONS
 FIVE FOLD NURSING FUNCTIONS

• Promoting Health and Wellness

• Preventing Illness

• Pain/suffering alleviation

• Restoring Health

• Creation of a spiritual environment

FIVE FOLD NURSING FUNCTIONS

• PROMOTING HEALTH AND WELLNESS

 • WELLNESS: STATE OF WELL-BEING.
• Engaging in attitudes and behavior that enhance the quality of

life and maximize personal potential • For both healthy and ill
• Involve individual and community activities to enhance healthy
lifestyle, such as improving nutrition and physical fitness,
preventing drug and alcohol misuse, restricting smoking, and
preventing accidents and injury in the home and workplace.

FIVE FOLD NURSING FUNCTIONS • PREVENTING

ILLNESS
 • The goal is to maintain optimal health by
preventing diseases
• Nursing activities includes immunizations,
prenatal and infant care, and prevention of
sexually transmitted disease.

FIVE FOLD NURSING FUNCTIONS

•PAIN/SUFFERING ALLEVIATION
• The goal is to provide relief from pain to
 promote comfortable healing process
• To terminally ill patients, hospice care facilities

FIVE FOLD NURSING FUNCTIONS

• RESTORING HEALTH
• Focuses on the ILL CLIENT
• Extends from early detection of disease to helping the

client during the recovery period • NURSING

ACTIVITIES:
• Providing direct care to the ill person
• Providing diagnostic and assessment procedures
 • Consulting with other health care professionals about
client’s problems
• Teaching clients about recovery activities
• Rehabilitating clients to their optimal functional level following
physical or
mental illness, injury, or chemical addiction

FIVE FOLD NURSING FUNCTIONS • CREATION OF A

SPIRITUAL ENVIRONMENT • Provision of spiritual care
• Involves comforting and caring for people of all ages
who are dying
• Includes helping clients live as comfortable as
possible until death and helping support persons
 cope with death.
• Work in homes, hospitals, and extended
care facilities
• Hospices are specifically designed for this purpose.

EFFECTIVE
COMMUNICATION SKILL IN
NURSING PRACTICES

COMMUNICATION
• Communication is the basic element of human interactions
that allows nurses to establish, maintain and improve
contacts with others.

• Communication - a process by which two or more people

exchange ideas, facts, feelings or impressions in ways that
each gains a common understanding of meaning, intent and
use of a message.

PURPOSE OF COMMUNICATION
IN
 NURSING
1. To exchange information between nursing personnel
2. As nursing report at end of shift to personnel coming on
for the next shift
3. To initiate action - To initiate nursing action and carry
out Doctor’s orders
4. To interpret or explain - Interpret or explain
techniques and procedure through the use of nursing
procedure manuals
5. To solve problem
COMMUNICATION PROCESS
SENDER: The sender (communicator) is the originator of the
message. Sender formulates, encodes and transmits the
information which he/she wants to communicate.

MESSAGE: Is the information/desired behavior in physical

form which the communicator transmits to his audience to
receive, understand, accept and act upon

RECEIVER: Who receives messages from the sender,

decoding, interprets the meaning and giving feedback.

FEEDBACK: It is the flow of information from receiver to

the sender, the reaction to the message.
 followdelegate lineof authority

FORMAL CHANNEL OF
COMMUNICATION
communication is transmitted from superior
COMMUNICATION PROCESS
to subordinate such as orderfrom head nurse Channel of communication
to staff nurse

INFORMAL CHANNEL OF
COMMUNICATION
communication built around social
relationshipof memberand doesn’t
formal Informal
 TYPES OF
COMMUNICATION

Verbal Non
verbal
 VERBAL COMMUNICATION
WRITTEN
• Directives :- areadministrative orderorgives instruction
• Manuals of operation :- written procedure and technique are develop in
each department and kepton file asdrug formula and diet manual
• Reportsand record :- as patient record, personnel records and
administrative reports
• Requisition :- requisition for equipmentand supplies

ORAL COMMUNICATION
 .

BARRIERS OF COMMUNICATION
Nurses who are aware of the common health
care professional barriers on barriers to effective
communication will be able to anticipate and
properly react to any roadblocks. With this focus,
nurses can help ensure optimal communication
and patient care.
 HEALTH CARE PROFESSIONAL BARRIERS
1. Environmental factors such as lack of time or
support 2. Staff conflict and high workload
3. Fear and anxiety related to causing the patient to
be distressed by talking or responding to question
4. Other barriers such as a lack of skills or strategies for
coping with difficult emotions, reactions or
questions.

CRITERIA OF EFFECTIVE
COMMUNICATION
 S
7 C’ OF EFFECTIVE COMMUNICATION
• Conciseness •
• Clarity
Continuity • Credibility •
Correctness Completeness
• Commonness •

CLARITY
• There should be CONCEPTUAL AND LINGUISTIC
CLARITY in our communication.
• We should ourselves UNDERSTAND THE SUBJECT or
theme thoroughly.
 CONCISENESS
• We should use SHORT WORDS, SHORT SENTENCES,
SHORT PARAGRAPH and the whole communication
should be briefly, shortly and concisely expressed.
• But, it should NOT KILL THE GIST OR ESSENCE OF THE
COMMUNICATION
 CONTINUITY
• It means FLOW OF COMMUNICATION
• It indicates MAINTAINING A LINK BETWEEN first
sentence and second sentence, between second
sentence and third sentence, between one
paragraph and other paragraph.

CORRECTNESS
• It is EQUALLY IMPORTANT while communicating. •
Information communicated should be ACCURATE

COMMONNESS
• It is the CORE OF ANY COMMUNICATION • That is to
say that communication will not take place without
commonness.
• Thus communication will takes place only when the
FRAME OF REFERENCE OF BOTH THE SOURCE AND
RECIEVER IS COMMON.
 CREDIBILITY
• It is inevitable in any communication. It should be
RELIABLE
• That means the NAME IS ESTABLISHED AND IT IS THE
NAME THAT SELLS.

COMPLETENESS
 • Completeness means COVERING ALMOST ALL THE
PROBABLE ASPECTS OF THE ISSUES undertaken for
analysis.
COMMUNICATORS
DON’T’S
• Reflects on what, where, when, and how
to communicate .
• Adjusts communication style to the
DO’S
developmental needs of mentee.
• Respects the confidentiality of the
mentor-mentee relationship.
• Self-discloses one’s own professional
challenges.
EFFECTIVE • Models effective helping relationship skills.
• Do not make the conversation
 autobiographical. It is not about you! • Do not give the solution – try to get the
• Do not ask for details that are not person to find their own solution.
needed to help.

SKILLS TO IMPROVE COMMUNICATION

P-ay attention to nonverbal signals

A-ssert yourself
C-heck for STRESS level: should be
avoided E-ngaged listener
 P-AYATTENTION TO NONVERBAL SIGNALS
• PAYATTENTION TO NONVERBAL SIGNALS
• Beawareof individual differences
• Look at nonverbal communication signals as agroup
• TIPS FOR IMPROVING HOW YOU DELIVER NONVERBAL
COMMUNICATION
1. Use nonverbal signals that match up withyourwords
2. Adjustyour nonverbal signals according to the context
3. Use body language toconvey positive feelings
 A-SSERTYOURSELF
• BE PROACTIVE / be assertive in improving you
communication skills
• How To improve assertiveness:
1. Valueyourself and youroptions
2.Knowyour needs and wants
3.Express negative thoughts
4.Receive feedback positively
C-HECK FOR STRESS LEVEL: SHOULD BE AVOIDED
How to deal with stress during
communication: 1. Recognizewhen you’re
becoming stressed.
2. Take a moment to calm down
3. Bring your senses to the rescue and quickly
manage stress by taking a few deep breaths
4. Look for humorin the situation.
 E-NGAGED LISTENER
BECOMEAN ENGAGED LISTENER
• Focus fully on the speaker
• Avoid interrupting ortrying to redirectthe
conversation to your concerns
• Showyourinterest in what's being said
• Try to set aside judgement
• Provide feedback
 COMMUNICATION SKILL AT DIFFERENT LEVELS
1.Nurse – Nurse
2.Nurse – Superiors
3.Nurse – Subordinates
4.Nurse – Client/Patient
 NURSE – NURSE
• Reduce conflicts
• It is for the delivery of quality and safe care
• Depends on the type of care practices
• Nurses needs to handover reports of client to next
person involved.

NURSE – SUPERIORS
• The nurse manager, doctors and specialist are the to the nurses
by the virtue of hierarchical level in the organization, it means
that Each Member Should Maintain Respect

NURSE – SUBORDINATES
• Subordinates means the juniors, aids or other
hospital assistance
• Much of the communication at this level is for DIRECTING
AND DELEGATION OF WORK

NURSE – CLIENT/PATIENT
• It is the core of nursing services
• Needs to be aware about different levels or age group of
the client
• Choose appropriate mode of communication to
convey message
• Should be aware that what can be communicated and
what should be kept confidential
 ETHICS OF GOOD
• L-earn to respect others
COMMUNICATION SKILL
•A-void being emotional
•M-aintain eye to eye contact
•P-resent acceptable tone of voice and
body language

•O-ffensive languages should not be used

•L-earn to listen
 GUIDELINES FOR ACTIVE &
EFFECTIVE LISTENING
S-quarely face the person
O-pen your body position (unfold and remove
obstacles or barriers between you and the other
person)
L-ean toward the person
E-ye contact. Look directly at the person.
R-elax. Anxiety interferes with information
processing

DEVELOPMENTAL CONSIDERATION
IN COMMUNICATION
• The majority of the communication will take place
between practitioners and parents. However, the
child cannot and should not be excluded.
• Make sure to incorporate active communication
strategies with the pediatric patient as well.
Incorporate an understanding of growth and
development when communicating with the
pediatric patient.
 DEVELOPMENTAL CONSIDERATION
IN COMMUNICATION
• Observe body language, facial expressions, and
other nonverbal gestures.
• Incorporate PLAY into nursing assessments and
interactions where appropriate.
• Use SPECIAL TOYS or games to assist with
assessments.
 METHODS OF COMMUNICATION
WITH CHILDREN
VERBAL—words, face-to-face interactions; infants cry, coo, and respond to their
environment; parents and caregiver need to learn the cues of the infant or child
• Be mindful of long pauses, rapid speech, and engaging the appropriate
individuals in the communication process.
• Gear communication to the cognitive and developmental level of the child.
NONVERBAL—gestures, body language, posture, eye contact. Be aware of cultural
factors
• Visual—can include signs, photos, and illustrations.
• PLAY—allows children to express feelings and concerns in a nonverbal manner.
• o Children base their views on the relationships and experiences within their
daily lives.
o Infants and children with altered hearing may have delayed
communication.
COMMUNICATING WITH INFANTS • ■ Newborn to 12
months
• ■ This is a time of rapid physical and developmental growth. • ■
Social development is influenced by the infant’s environment • ■
Infants are unable to verbalize needs, concerns, and discomforts • ■
Nonverbal behaviors, such as smiling, promote socialization. • ■
Infants display crying and cooing.
• ■ Infants cry when they are hungry, when their diapers need to be changed,
when feeling pain or discomfort, and when feeling lonely or wanting to be
held.
• ■ Separation anxiety
• ■ Fear of strangers
• ■ Temperament and disposition

COMMUNICATING WITH
TODDLERS AND PRESCHOOLERS
• ■ Younger than 5 years old
• ■ Children of this age are developing a sense of AUTONOMY. •
■ This is a time of intense exploration of the child’s environment.
• ■ This time can be overwhelming and challenging for parents and caregivers
but is an important period of development for the child.
• ■ Children of this age are typically egocentric, or unable to think from
another person’s point of view.
• ■ Use statements such as “good job” instead of “good boy/girl.”
• ■ They are fearful of unfamiliar objects and environments.
 COMMUNICATING WITH SCHOOL
AGE CHILDREN
• ■ Ages 6 to 12 years
• ■ This period of physical and psychosocial development includes many
milestones, such as entering school, communicating independently, and
beginning to conceptualize the environment.
• ■ COMMUNICATION DIRECTLY with children of this age is equally important as
communicating with their parents.
• ■ Curious
■ Used to asking questions in school when they cannot understand
• ■ Want to know why or how things happen or occur
• ■ Gain knowledge by experience and by understanding what is occurring
• ■ Enjoy having a job or task to complete
■ Eager to please, and want to complete a task independently
• ■ Work well with positive feedback

COMMUNICATING WITH
ADOLESCENT CHILDREN
• ■ Ages 13 to 18
• ■ This is a time of developing independence and maturity.
• ■ The adolescent child may seek counsel and feedback
from sources other than parents and caregivers.
• ■ Sexual development, including menstruation and
emission, has already occurred.
• ■ Adolescents are independent with activities of daily living,
but still require adult supervision and input
 GENERAL
GUIDELINES FOR TRANS
CULTURAL THERAPEUTIC COMMUNICATION