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Nursing philosophy and practices follow a set of well defined principles and certain code of conduct which declare them a very organized pattern of working. These philosophies of nursing are thoughts and describe the nature of nursing practices through number of researchers by eminent scholars. Theories are vital to understand the underlying contexts of various fields including clinical nursing experiences. These theories followed by a conceptual network to guide the progress of clinical practices and to explain the impact of various factors on conduct of these practices.

On the other hand, in order to check appropriateness of these models they need to be evaluated on the selected criteria. A suitable model can be applied after a careful analysis of the available information. This paper is comprised of some important conceptual frame works in clinical nursing. They are going to be analyzed on set criteria of their relevance to the clinical practices, clarity of concepts, easiness in application, and completeness of material. This process will elaborate the importance of these theoretical frameworks and their role in daily experiences of clinical nurses. These models assist nurses to enhance their competence in specialized skills.

Conceptual frameworks of Clinical Nursing

Some important conceptual frameworks are discussed in the following pages to demonstrate their vital approaches for the betterment of the clinical practices.

In Betty Neuman's 'System Model' the person or individual is treated as a whole system (Neuman, 2007). This system is comprised of set of interrelated physical, social, and psychological factors which enhance the integration and working of various components of the system. This model proposed the system context of nursing operations which facilitates the variety of nursing practices. These approaches also enhance the education management and research and development in this area of clinical nursing implementation.  The conceptual frame work of this model encompasses different health care issues and professional roles at various levels of clinical nurses. This model is holistic and multidimensional to introduce the perspective of a complete system in nursing practices and educational procedures designing. The Neuman system model is relevant and reliable to a great extent but on the other hand it gives ales room for individual exceptions. This model is following by wide variety of nursing practices globally; its approach is conservative but effective in most of the situations.

The 'Nursing as Caring' model of Anne Boykin and Sarvina O. Schoenhofer is another vital conceptual framework in clinical nursing (Bulfin & Mitchell, 2005). The key assumptions of this theoretical framework consider the caring of people by virtue of their human attribute, treating them as whole in the particular moment, and taking their whole life embarked with caring. Personhood is improved through contributing in cultivating associations with compassionate feelings for others. This model treated clinical nursing as together a 'discipline and a profession' (Boykin & Schoenhofer, 2001, p.11). The expression of caring in nursing profession is a life long process which can serve all practical purposes in this area. This model is emotionally very attractive to motivate the nurses but lacks rational and systematic procedures to demonstrate caring. Therefore caring can be taken as an essence of this profession but is very difficult to demonstrate in a structural diagram with set principles of caring.

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Another important model is Nola J. Pender's 'Health Promotion Model' which integrate all variable affect health in general. The findings of nursing are attached with public health and psychology research to form a holistic approach to solve the patient's issues. Pender described the multiple aspects are responsible for health problems in human, and they cannot be treated by medicine and nursing alone. This model is comprehensive but too complicated to apply in clinical nursing experiences as they need quick and easy approaches to adopt. The multiple variable models can be used at other higher levels of decision making. That's why this framework is utilized in devising the nursing protocols and intercession.

The Ernestine Wiedenbach's 'Helping Art of Clinical Nursing' framework is another important model in clinical nursing. It comprises of four components of 'philosophy, purpose, practice, and the art of nursing' (Sitzman & Eichelberger, 2003). This model is based on the conceptual network of patients' needs identifications, symptoms' exploration, discomfort causes, and patients' ability to solve problems determination. The intervention of nurses requires their complete understanding of the situation and all related factors. The proper training and education of clinical nurses are must to achieve desired results in this framework. The practical approach of the nurses and the perception of patients are vital to provide competent care in this model.

Findings of the Research    

All models discussed above are relevant but have some issues in easy implementation at clinical levels. Either their variables are complex or the approach is not contemporary to meet the rapidly changing requirements of today's nursing care. The model selected in this research is Patricia Benner's conceptual framework of clinical nursing experiences. According to Brykczynski (2002), Benner's model is 'an interpretive, descriptive study that led to the use of Dreyfus' five levels of competency to describe skill acquisition in clinical nursing practice' (169).

In clinical nursing, skilled performance and career development is based on the experience and proper education. Benner's model proposed that nurses go through a transformation phase from a 'novice to expert' in their formal education and training (Benner, 2005). This development is comprised of five development levels including 'beginner (novice), advanced novice, competent, proficient, and expert' (Benner, 2005). This transition of career levels involves the development of three skills sets.

In this framework, the transition from novice to expert can be taken as the transformation from rational rule-operated attitude to intuitive, proactive determined behavior. On the other hand this transition from novice to expert is not must for every nurse as not all nurses become experts. It is also evident that Benner's and Dreyfus's model is particularly focussed at recommending a feasible substitute to conventional conduct of considerate exercise, hypothesis and information; not to undervalue disciplines of medicine.

Conceptual Framework

The structural diagram below shows the complete picture the above discussed research findings by Benner (2005). In the Related Learning Experience (RLE) of student nurses, following diagram shows all the acted factors on the output performance.

Analysis of the conceptual framework

In this conceptual framework, above structural diagram shows that in the first step, assessment of input data is done by the nurses. It includes the socio-demographic profile of the participants, which include age, gender, social class, and average monthly family unit income along with the variables that influence the RLE presentation, in order to understand the relationship among the variables. Statistical procedures are used to correlate the input data and training and output RLE performance of student nurses. The problems of patients and their results are also interlinked in this model.  This theory driven model provides a pragmatic structure to facilitate nurses and their management to enhance the skill set of nurses.

Recommendations & Suggestions:

The recommendations for the further improvement of this model are listed as follows:

This research paper is written to explore the prevailing theoretical and conceptual frameworks in clinical nursing. The thesis is supported by major theories and models of eminent scholars in the respective fields. Many clinical nursing models have been analyzed and the novice to expert model of Patricia Benner has been selected for thorough discussion. The structural diagram of this model is also presented along with some example and recommendations for the improvement in the model.

The evidence of proper education and training to clinical nurses has been collected from the models discussed above. Proper communication and complete coordination can bring the positive change in prevailing clinical nursing practices. The research models and frameworks can keep on changing and incorporating new features simultaneously to meet the challenging needs of the patients.

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