Benner’s Theory in Global Nursing Education

Contributors:
Harrieth Gabone-Mwalupindi, PhD, MSN. RNC-OB
Rosemary W. Eustace, PhD., RN. PHNA-BC

Benner’s Theory in Global Nursing Education

I was introduced to Benner’s theory during my nursing education. This theory has influenced my teaching at the local and global levels. The theory guided my doctoral dissertation to explore self-reported opinions of the nurse preceptors on their clinical teaching skills using the five levels of proficiency (Gabone-Mwalupindi, 2016). Dr. Patricia Benner introduced the nursing education theory From Novice to Expert where a new nurse goes through five stages of clinical competence in acquiring new knowledge and clinical skill acquisition while gaining clinical experiences and improve clinical practice (Benner, 1982) also found here.  I have since used the theory to guide my global mission work in particular, Tanzania as described in the following exemplar.

Global Nursing Education Practice based on Benner’s Theory

In the wake of Covid-19 pandemic, I directed a non-profit organization Dr. Gabone QHSC (Quality Healthcare Solutions and Consulting) Inc (501c3) to serve as a platform to provide a safe place for global health care workers to share the knowledge and skills via zoom meetings guided by Benner’s theory from Novice to Expert . Benner’s theory focuses on a novice nurse’s learning and acquiring clinical knowledge and building on clinical competence to becoming an expert when experiencing ongoing different clinical situations. In this exemplar, the theory addresses professional experts, using their current expert clinical experiences of caring for sick patients from COVID-19 as source of information to be shared with global healthcare workers who are novice in caring for this type of patients, especially in regions where expert opinions is in high demand. With limited information about the virus, how it affected the human, and how to care for patients with the new disease, it was paramount to rely on ongoing emerging clinical evidence from research as well as first hand clinical experience from frontline health care workers. The expertise for caring for COVID-19 patients was urgently needed to inform the global professional staff on how to care for patients, and to protect self, patients, and own family.  The organization recruited interprofessional teams of volunteer healthcare experts who were providing care to patients with COVID-19 to share the knowledge and experiences with “novice” healthcare providers from various areas in the United States and around the world, focusing on Tanzania healthcare providers, in particular nurses. The experts included nurses, a pharmacist, medical doctors, clinical officer, therapist, psychologists, professors, administrators, students of healthcare professionals from here in United States, Canada, United Kingdom, Norway, Australia, Tanzania, Gambia, South Africa, Kenya, and Sudan to mention a few. Ongoing zoom topics were selected from participants’ feedback.

The first meeting (which was in Kiswahili) “The Global Experiential Nursing Practice” addressed current first-hand clinical practice of Covid-19. The panelists included medical surgical, intensive care, maternity and newborn, psychiatric, community-based case management, and nursing director of the Tanzanian National Nursing Association. A painted global visual picture displayed different levels of preparedness and the lack of personal protective equipment (PPE) to protect healthcare workers. Current challenges related to evidenced-based practice protocols were discussed from the frontline healthcare providers. The lack of access to personal protective equipment (PPE) was an obvious challenge to the frontline workers. 47 participants attended this meeting.

The second meeting (also in Kiswahili) Global Experiential. Proposed Management  aimed to empower Tanzania nurses with knowledge on management of patients with COVID-19. The panelists included nurses who shared current daily shift nursing clinical care for a patient with COVID-19 including nursing interventions with medication administration and other medical proposed protocols.  A clinical pharmacist from Canada shared personal experience on current proposed medication protocols in the clinical settings and what nurses need to know as they administer and monitor COVID-19 patients. In addition, an endocrinologist and diabetic specialist from United Kingdom shared personal expertise on proposed medical protocols in the units and the current COVID-19 patients’ responses. The educational opportunity provided a visual clinical practice for those who had not cared for patients with COVID-19. 60 participants attended this meeting.

The third meetings (also in Kiswahili) Infectious Disease. Stay Safe. Know What To Do  provided information to empower Tanzania nurses in infectious disease management and how to effectively use PPE to prevent spread of COVID-19. A United Kingdom cardiologist doctor with special interest and training in infectious diseases provided a brief background of the infectious diseases such as COVID-19 or in general virus. The discussion included ways to prevent them from spreading including actual and potential preventions challenges echoing the WHO and CDC’s current everchanging news on how this novel virus could be easily transmitted . Nurses from different countries including Tanzania, United States, Australia, and United Kingdom shared their clinical experiences on how they handle infectious diseases and also demonstrated how to use PPE correctly. With limited supplies for PPE, nurses shared ways on how to reuse some supplies while ensuring safety and efficiency. Furthermore, one nurse from Tanzania shared her expertise on the mixing correct concentrations of reagent solutions used for cleaning and handwashing to ensure effective sanitization and prevention of the surfaces contamination and transfer of the virus. The expert panelists shared handouts to attendees for future references as needed. 70 participants attended this meeting.

As the number of people who are infected and died from COVID-19 continued to skyrocket including the healthcare workers, the organization decided to host another zoom meeting on Crisis Interventions for Healthcare Workers.  The discussion focused on empowering healthcare workers with effective coping strategies during COVID-19 pandemic. Frontline nurses and doctors from various global locations shared their daily clinical practices and challenges faced daily of either being sick, diagnosed with COVID-19, or witnessing coworkers dying from the disease and fear of spreading infection to family. To protect family members from contracting the virus, many healthcare workers shared how they isolated themselves and how they were not being able to go home. A licensed professional counselor and therapist, and a board certified family psychiatric mental health nurse practitioner, both from the US provided step by step strategies that healthcare workers could use daily in preparation for work , while caring for patients, and specific rituals to routinely practice after work. Another panelist, a doctor from UK who was an expert in children psychiatry shared information on how children responded to the pandemic and how health care providers can help families deal with difficult conversation with the children about COVID-19.  90 participants from several disciplines (e.g. therapists, psychiatrist, medical and nursing professionals, children of the healthcare workers, and administrative personnel) attended the meeting.

As the normal clinical disruption continued during this COVID-19, healthcare workers were stretched to work beyond the routine daily assignments and had to take on new ones due to an increased demand. Some nurses were asked to work in units that have patients with COVID-19 that may require intensive care training.  Nurses felt that even with the pandemic, the culture of safety should be maintained. Some registrants’ requested some information on how to address this dilemma while ensuring the safety of patients and healthcare workers during pandemic. Dr. Gabone QHSC (Quality Healthcare Solutions and Consulting) Inc responded to the request by hosting another zoom meeting on Creating a Culture of Safety: Will the Patient Benefit? Experts (5 nurses and 2 medical doctors shared information on professionalism including communication, team work, accountability, and individual competence. The discussion stimulated discussions on challenges and lack of a platform to voice concern in creating a culture of safety. Some participants voiced difficulties in introducing morning interprofessional team rounding while other voiced the lack of root cause analyses to address any medication error or any challenges with patient care.  72 participants attended this meeting.

The mounting evidence and impact of the COVID-19 pandemic also revealed to affect the prospects of future healthcare professionals who attended the zoom meeting. Students shared the challenges as to either continue with their studies or change the career altogether. Dr. Gabone QHSC Inc. hosted another zoom meeting A Career in Healthcare in Light of COVID-19 (Students’ Perspectives)  to provide a platform for students to share their perspectives with each other.  A panelist of global students from pharmacy (US), nursing (Norway and US), clinical officers (Tanzania), new graduate nurses (US) with less than 3 months on a job, and nurses and doctors from United Kingdom participated in the meeting. Students shared valuable information from their concerns, worries, and reaffirmed their choices of the career at hand. New doctors and nurses also shared current employee training during COVID-19 and available resources to enhance a smooth transition into the role which. Psychiatrist and therapist were readily available to guide the discussion and shared effective coping skills needed to address the concerns. Nursing professors discussed available resources at clinical area such as employee program assistance (EPA) to support all healthcare workers. 82 participants attended this meeting.

Implications

Global pandemics bring sets of challenges that force health information delivery systems to match current clinical practice needs in an efficient and yet effective manner. This exemplar demonstrates how effectively health information can be communicated to global health nurses through computer technology and the Internet and how likely global health care workers would be willing to seek and share their expertise with each other.  The lessons learned from these offerings include the importance of the interprofessional team approach in global nursing education and practice. In addition, the meeting provided an opportunity for networking and opened lines of future inter collegial communication to access global healthcare experts.

All meetings were offered free of charge to encourage participation and increase access. Although securing the zoom platform had a subscription costs that was covered by the organization, all the panelists and co-hosts volunteered their expertise, time, and engaged in fruitful interactive current discussion of what was happening in their clinical settings in order to empower novice global healthcare workers with their knowledge and experiences with the COVID-19 pandemic. The preparations were involving and followed Yuyet-Ming’s (2020) three planning steps for online conferences which are plan appropriate tasks, select essential resources, and perform effective delivery. The planning included collaborative group meetings to identify content and panelists to meet the diverse levels of knowledge and skills levels of attendees and address the current knowledge and clinical skills gaps. Some presentations were recorded prior to the day to ensure effective delivery of the content. During the selecting essential resources step, the organization made sure all panelists were aware of the ongoing changes and incorporated the current and recommended guidelines. Furthermore, the organization promoted effective delivery of information by increasing attendees’ engagement via zoom invites, WhatsApp group messages, group emails, organization websites, social media including Facebook, occasional twitter, and LinkedIn.

Even though the 3 conferences were offered in Kiswahili and 3 in English, the attendees were encouraged to ask questions in either language of choice. Attendees participated in demographic and content polling during the conference. They engaged in chat room by posting questions to the panelists. At the end of the meetings, all registrants received the handouts, and recorded videos. Since the conferences were between two to three hours, challenges with technology sometimes became apparent when attendees either were unable to login due to internet interruptions, or lost services, especially those in remote areas. Some registrants congregated together and used one login to listen in.

Overall, although there were challenges with technologies as discussed above, attendees appreciated the opportunity to gain knowledge and clinical skills from their counterparts around the world. The experts also appreciated the opportunity to share their knowledge and learn about the challenges faced by other health care providers. The meetings demonstrated how we are interconnected and how we face similar challenges such as lack of PPE, fear, etc. I call upon nurses to engage in global volunteerism and share their best clinical practices using online and virtual platforms with those who are less fortunate in current evidence-based knowledge and clinical skills, especially during and beyond emergent situations such as the COVID-19 pandemic.  

References

Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407

Gabone-Mwalupindi, H. (2016). Nurse preceptors’ self-reported teaching skills competencies: Training preparation survey. (Publication No. 1845299040) [Doctoral dissertation,
Capella University]. ProQuest Dissertations & Theses Global.  

Ng, Y-M., & Or, P. L. P.  (2020). Coronavirus disease (COVID-19) prevention: Virtual classroom education for hand hygiene. Nurse Education in Practice, 45(May), 1-2. https://doi.org/10.1016/j.nepr.2020.102782

About the contributors

Harrieth Gabone-Mwalupindi, PhD, MSN. RNC-OB

Dr Gabone-Mwalupindi is currently an Assistant Professor of Nursing at South University- West Palm Beach, Florida. She has 20+ years of nursing experience. She is the President & Founder of Dr. Gabone QHSC Inc, a nonprofit organization based in the United States. Dr. Harrieth is empowered to increase access to expert experience, opinion, training, and education among global health care workers.  She believes in paying forward for the common good. She would like to thank Dr Rosemary Eustace for her mentorship in preparing this information for Nursology.net.

Rosemary W. Eustace, PhD., RN. PHNA-BC

Associate Professor & Carnegie Fellow at Wright State University College of Nursing and Health. She serves in the Nursology.net Management Team  and is also a Nursology.net author