Using the Dreyfus Model of Skill Acquisition to Describe and Interpret Skill Acquisition and Clinical Judgment in Nursing Practice and Education

Abstract

Three studies using the Dreyfus model of skill acquisition were conducted over a period of 21 years. Nurses with a range of experience and reported skillfulness were interviewed. Each study used nurses'narrative accounts of actual clinical situations. A subsample of participants were observed and interviewed at work. These studies extend the understanding of the Dreyfus model to complex, underdetermined, and fast-paced practices. The skill of involvement and the development of moral agency are linked with the development of expertise, and change as the practitioner becomes more skillful. Nurses who had some difficulty with understanding the ends of practice and difficulty with their skills of interpersonal and problem engagement did not progress to the level of expertise. Taken together, these studies demonstrate the usefulness of the Dreyfus model for understanding the learning needs and styles of learning at different levels of skill acquisition.

The impact of a musculoskeletal masters course: Developing clinical expertise

“…Deep conceptual understanding with integration of all types of knowledge and an ability to critically evaluate knowledge is considered characteristic of expertise (Sandberg, 2000;Benner, 2004;Higgs and Jones, 2008) and enabled them to become more patient centred.…”

“…They were able to not only operate in the messy and unpredictable world of clinical practice, but were able to learn from it. This capability to learn in, and from, practice is considered essential not only to develop but also to maintain clinical expertise (Eraut, 1994;Fish and Coles, 1998;Daley, 1999;Martin et al, 1999;Benner, 2004).…”

User's Guide for Tactical Thinking Behaviorally Anchored Rating Scales

“…"integrated rapid response" (Benner, 1984(Benner, , 2004 " How to intuitively assess the situation Dreyfus & Dreyfus, 1986). (Benner, 2004;Dreyfus & Dreyfus, 1986).…”

“…on the unique array of cues and factors in the -Is automatic, and the rationale for actions is often situation (Benner, 2004). difficult to articulate (Benner, 1984).…”

“…0 Reflects an inability to see newly relevant cues due to the organizing plan or structure that directs attention (Benner, 2004). N Reflects an emotionally involved performer who takes ownership of successes and failures (Dreyfus & Dreyfus, 1986).…”