Theory-Based Nursing Practice: A Summary


A nurse’s success is the ability to balance assessment, diagnosis, and treatment with caring. As such, a nurse is exceptionally responsible to provide analytical overseen care to patients in need of inclusive healthcare (Hagedorn and Quinn, 2004, Abstract). This summary aims to reflect the practical applications of the concepts of Patricia Brenner’s five levels of practice model expressed in the book From Novice to Expert to a nurse’s practice (Rolfe, 1997).

Brenner’s model from novice to expert theory

In 1984, Patricia Brenner demonstrated the five levels model of nurse progress from a beginner to an expert nurse (Rolfe, 1997). The hypothesis had its conceptual roots from the Dreyfus model of skill acquisition (1980 after Nardi and Kremer, 2003). Nardi and Kremer (2003) defined an expert nurse as a reflective nurse who works instinctively and deals reflexively with a range of cases of different backgrounds.

Nardi and Kremer (2003) defined reflection as the retrograde recall of observations gained through years of work and learning to reveal the knowledge to use in a specific patient situation. The tools of an experienced nurse are analyzing and construing the information gained besides recalling in time of need. Rolfe (1997) called this process a reflection-on-action; in addition, an experienced nurse should possess a reflection-in-action where reflection occurs in the practice setting. In this situation, an experienced nurse may have to place an off-the-record theory about the situation and hypothesize the potential results of applying that theory.

Errors in medication administration for patients over 65 years

Medical injuries are unexpected avoidable incidents, older patients (65 years or older) are at high risk because of their comorbidity, and their health problems that may be aggravated by drug errors jeopardizing safety and threatening serious outcomes (Rothschild and Leape, 2000). The nurse being responsible for actions and errors of drug administration is at jeopardy as well (Aschurst, 2008).

Where the author works, the procedure of developing evidence-based medication administration guidelines is passed through five steps. First, the question of achieving quality and accountability was in the front position since it is the target of health services. Second, identifying the articles that answer this question and their evidence-based resources was the second step. Third, critical assessment of the evidence served many purposes, to identify and figure out how to overcome systematic barriers, ensure adequate health services, and design care based on age, gender, culture, and health condition. Finally, applying the evidence knowing that it ensures the quality and accountability of health care, with continuous monitoring to evaluate areas of limited success, and recognize areas of success (Goldman and colleagues, 2001).

There are evidence-based medication administration guidelines where the researcher works. The guidelines describe in detail how to get ready to handle, prepare, and check the medication before administering it. Besides, it describes how to monitor the patient’s response with specific emphasis on IV solutions, and allergenic drugs as ampicillin, and to notice carefully the physician’s instructions of titrating or tapering the medication, and or medication hold order.

Besides, the guidelines described the designated shift responsibility and standard medication administration times. The guidelines also describe some general considerations of strictly seeking accuracy in timing and dosage and obtaining previous medication history on admitting the patient. The guidelines end with special precautions on handling medications (e.g. refrigeration), what are medications patients allowed to take home, and the procedure on transferring to another department.

Ashurst (2008) addressed the strategies that a nurse adopts to reduce the risk of making drug administration errors. Ashurst (2008) described action plans if a medication is given to a wrong patient, administered at the wrong time; the resident loses of medications, the medication is not signed for at the time of administration, or if the resident is keeping medications in stock. Ashurst (2008) inferred it is the responsibility of a nurse to be familiar with responsibilities, committed to professionalism, and accountability in administering medications, and that workload and disturbances or any other issue is not an excuse. This commitment is within the scope of the nurse’s primary duty of care.

Watson and Foster (2003) explained the attending nurse caring model, based on Watson’s theory of human caring, which focuses on the nurse involvement with patients objectively as a scientist, and subjectively as a responsible caregiver. The model’s aim is similar to the guidelines discussed, to augment nursing values of care, and responsibility to the highest possible order of caring, accountability, and professionalism, while fulfilling the nursing practice heritage.


Nursing care and gaining experience converge to achieve quality and accountability in nursing service. An experienced nurse builds knowledge, which is the foundation of evidence-based practice, providing consistency in performance. An experienced nurse is committed to organization resources, patient care, case management and competent practice; thus capable of completing the learning process and transfer time-built experiences to newly joining nurses.


Ashurst, A. (2008). Career progression: preventing drug errors. Nursing and Residential Care, 10(8), 498-501.

Goldman, H., H., Ganju, V., Drake, R., E. et al (2001). Policy Implications for Implementation of Evidence-Based Practices. Psychiatric Services, 52(12), 1591-1596.

Hagedorn, S., and Quinn, A., A (2004). Theory-Based Nurse Practice: Caring in Action. Topics in Advanced Practice Nursing, 4(4), Abstract section. Web.

Nardi, D., A., and Kremer, M., A (2003). Learning outcomes and Self-Assessments of Baccalaureate Students in an Introduction to Nursing Course. The Journal of Scholarship of Teaching and Learning, 3(3), 44-56.

Rolfe, G (1997). Beyond expertise: theory, practice and the reflexive practitioner. Journal of Clinical Nursing, 6, 93-97.

The Public Policy Institute (AARP). (2000). The Nature and Extent of Medical Injury in Older Patients. Washington, DC: Authors. Rothschild, J. M. and Leape, L. L.

Watson, J., and Foster, R (2003). The Attending Nurse Caring Model: integrating theory, evidence and advanced caring-healing therapeutics for transforming professional practice. Journal of Clinical Nursing, 12, 360-365.