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Telephonic Case Management and Evidenced-Based Practice Education: Utilization of Benner’s
Novice to Expert Model
(I believe this area should all be together, all line double-spaced).
Anita Ludlam BSN, RN, CCM.
School of Nursing, Liberty University Online
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Telephonic Case Management and Evidenced-Based Practice Education: Utilization of
(double space here) Benner’s Novice to Expert Model
Education of new telephonic case managers utilizing evidence-based practice is a new
concept and Benner’s novice to expert model can be applied with education with new nurses.
(Can this first sentence be re-worded? “Benner’s Novice to Expert Model can be applied to the
education of telephonic case managers attempting to utilize evidence based practice.”) Case
managers telephonic assessment and coordination are (more or less) divergent than an acute care
and long- term management assessments and coordination. Nurses (must develop new skills that
require them to be flexible as they now have to) go from seeing patients and assessing the
patient from head to toe in person and to refining their acute care skills to assess a patient by
phone. Telephonic case managers ask questions, listen to how a patient sounds, assess their
support system, and how they are managing their chronic diseases at home. There is a pattern
that is noticed when introducing evidence-based practice into the telephonic assessments which
can cause conflict but after education (reword). Benner’s novice to expert theory was utilized
the education of new telephonic case managers (missing words).
Benner’s Novice to Expert Theory
Benner’s theory outlines the importance of rewarding nurses for their clinical expertise
and advancement from a novice to expert. Nursing theory is developed to explain and predict
situations. Practical experience, knowledge development, and expertise can be applied when you
refine expectations (Benner, 2002). The application of theories and evidence-based practice
assist in health care management with the current research. Benner (2002) research on nurse
competency developed into seven domains that are noted in the nursing practice: helping role,
teaching-coaching function, diagnostic and patient-monitoring function, effective management of
rapidly changing situations, administering and monitoring therapeutic interventions and
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regimens, monitoring, and ensuring the quality of health care practices, and organizational and
work-role competencies (2002). Benner developed a nursing theory (2002) using the Dreyfus
Model from novice to expert and takes us through five stages: novice, advanced beginner,
competent, proficient, and expert (2002).
Stage I: Novice
The novice stage is noted for someone that is new and without any experience or skills for the
new job. The novice needs rules to guide their performance. and that Tthe care or knowledge at
this stage is unfamiliar (Benner , 2002).
Stage II: Advanced Beginner
The advanced beginner stage is noted to demonstrate marginally accepted performance, able to
identify some aspects due to new experience with the job (Benner, 2002). Benner (2002)
describes aspects as context free attributes or procedural lists that are learned. Instruction
provides guidelines for recognizing readiness to learn and experience is needed before the next
stage can be attained. The advanced beginner stage is where the instructor can assist with
formulating goals with then new nurse to become more competent (Benner, 2002).
Stage III: Competent
The competent stage is noted to addresses a nurse that has with two or three years of experience.
and can The professional at this level of nursing often can (or has) see long range goals, has
more flexibility and speed. Repetitiveness achieves efficiency and organization (Benner, 2002).
Stage IV: Proficient
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The proficient stage is where a nurse perceives situations holistically rather than terms of aspects
or individual parts and long- term goals are made. Nurses in this stage use maxims (pieces of
small information that provide insight to a situation) and the experience gained provides
understanding and how to improve the goals. Nurses are prioritizing at this level and can see the
overall picture. The increase knowledge when cases are presented and scenarios are discussed so
that the nurse can provide reasoning utilizing experience learned (wording change? The wording
is making it difficult for me to understand this last sentence) (Benner,2002).
Stage V: Expert
The expert stage relies on largely on the background of experience, analytic principles, and
maxims to understand complex situations. Nurses have a deep understanding of total situations
in their entirety and therefore they are able to utilizes their clinical expertise and judgement to
manage situations. The expert nurse is recognized as a mentor and preceptor. Nursing research
advancement is developed, and knowledge of theory development is formed (Benner, 2002).
Telephonic Care Management and Evidenced-based practice.
Since the Affordable Care Act (ACA) was established in 2010, Medicare set a certain
payment to acute care, rehabs, and providers for certain chronic diseases management. and
tThesey healthcare entities were to split up the payments and the amount would be decreased
with each readmission. Telephonic case management was initially started to assist in these post
discharge patients and assist with any barriers they might have to decrease readmissions.
Telephonic case management has shown to be very effective in decreasing readmission rates.
Wingard et al. (2017) states that chronic kidney disease had one of the highest readmission rates
and research has shown after having telephonic case managers call patients post discharge
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decreased readmission wasere noted. Campbell et al.’s (2015) research in post-discharge mental
health showed telephonic case management did assist in readmission rates and assisted in
transitions post discharge.
(new paragraph) Evidenced-based practice (EBP) has shown an increase in chronic
disease management in chronic diseases and has been incorporated with the telephonic role.
Evidenced-Based Practice (EBP) is defined by McEwen and Willis (2019) as the practice of
delivering health care with sound information that is grounded in research and scientific findings.
EBP brings the medical practice more in line with recent data and research instead of practicing
with traditional beliefs (McEwen and Willis, 2019). Case managers and providers are finding
telephonic and teleconferencing are a big advantage during this pandemic time that has limited
face- to- face visit. Phelps (2018) evidenced-based practice plan was organized to assist patients
with heart failure and found the readmission rates decreased readmission rates and in turned
saved costs for to the patient and system.
Telephonic Case Management Education
Telephonic case management is a different concept for many acute-care nurses
transitioning from bedside nursing. Case management is a discipline that utilizes your acute care
skills, management, multi-tasking, and open-ended questioning skills to assess a patient in their
own home environment and develop goals to assist with the management of post-discharge and
chronic disease management. I have been a case manager for over eight years and am the expert
stage of Benner’s model from novice-to expert. I was precepting Susan who had over 20 years
of experience as diploma nurse in critical care and medical-surgical units. She took a telephonic
position due to health issues and was ready to learn a new position. Susan was to be with me for
three weeks and then I would be her mentor when she was out on her own. Insurance companies
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utilize a dialer or rosters of patients to call members that are post-discharge, needing yearly
assessments, or needing chronic disease management follow-up and evaluation. They are
incorporating new evidence-based practice to assist in management of chronic disease patients
and this is a new process for many nurses.
The first day was the assessment of what kind of learner was Susan (visual or learn by
listening), goals to learning ( weekly goals were set) setting weekly learning goals, how to use
the applications (technology systems), how to utilize Susan’s acute care skills into assessing
patients on the phone, and all the tools for assessment (information to uses during a patient call)
was completed in this first week (verb usage). Susan was introduced to EBP during the first week
and was given an overview. Education was provided on how to assess a patient on the phone, and
how to roll with resistance during a call. Goals were made at the end of the first week (new
goals?). Susan was overwhelmed the first few days but after listening to calls she was able to
make calls on her own by the middle of the second week.
The second week, Evidenced-based practice (EBP) was incorporated, on the second week
which produced confusion for Susan since she had no basis as a diploma nurse about research,
and what was the reasoning behind EBP incorporation. EBP explanation of process and how to
ask to incorporate questions to the patient, updating the physician if the practices were not
followed, and learning how to chart all the information (can you re-word?).
The third week Susan was becoming more efficient at talking to patients while I was
listened to the conversations. , She learneding how to navigate the system to find answers for
patients, and knew how to follow up on EBP. By tThe beginning of the fourth week, Susan was
on her own and I was stood-by as her back-up mentor. She was able to text me at a moment
notice if she had a question while on the phone with a patient. The team was able to be her other
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guide. I am one of the team’s mentors and they are always able to reach out to me or to each
other with questions. (I do not feel at this is relevant to the paper topic).
Evidenced-based practice has been a confusing and challenging concept to incorporate.
However, but once the reasoning behind the research was revealed and education was given to
the team it became easier for the nurses to explain to a provider why they must call them if this
EBP was not in place for a chronic disease management patient. Susan has been with us for
three years now and is a great asset to the team and has been increasing her knowledge and able
to assist with question for the team.
Application of Benner’s Theory to Telephonic Education
The application of Benner’s Novice to Expert is utilized in the education of Susan. A
novice pattern was noted during the first week of orientation. Wwhile Susan was not new to the
nursing field, she was a novice at a to her new telephonic position, new to evidenced-based
practice applications, and new to technology applications. Susan presented with signs of being
and advanced beginner by the second week where she could navigate through a call with me
listening but not quite ready to be on her own.
She was very confused about evidenced-based practice learning but was able to
understand how EBP was utilized and what questions to ask on chronic disease management, and
to follow-up with the providers if EBP was not followed. The third week brought Susan into the
more competent phase where she was out on her own but still needed a mentor. Benner states it
takes years to achieve this stage and Susan is still learning and in the proficient stage. She takes
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calls and assists the team with questions and team lead during our staff meetings. I am at the
expert level in this study Benner’s theory, where I am a mentor to the team. ,I am able to lead in
charge of the team, able to precept, and mentor the team when new concepts for research are
needed.
Conclusion
In closing, nursing theories are important for the advancement of education in novice and
expert nurses. Research and incorporation of evidenced-based practices improve patient
outcomes. Telephonic case managers do assist in decreasing readmission rates, and coordinate
care for patients andto assist them in remaining as independent. The application of Benner’s
theory can be utilized in an education role with case managers transitioning to a telephonic
position.
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References
Benner, P. (2002). From novice to expert: excellence and power in clinical nursing
practice (Commemorative edition.). Prentice Hall.
Campbell, M. A., Canales, D. D., Ran Wei, Totten, A. E., Macaulay, W. A. C., & Wershler, J. L.
(2015). Multidimensional evaluation of a mental health court: Adherence to the risk
need-responsivity model. Law & Human Behavior (American Psychological
Association), 39(5), 489–502. https://doi-org.ezproxy.liberty.edu/10.1037/lhb0000135
McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing - with access (5th ed).
Philadelphia, PA: Lippincott-Raven Publishers. ISBN: 9781451190311
Phelps, P. (2018). Structured telephonic consultation to decrease heart failure readmissions.
MEDSURG Nursing, 27(3), 153–172
Wingard, R. L., McDougall, K., Axley, B., Howard, A., O’’Keefe, C., Armistead, N., Lynch, J.
R., Rosen, S., Usvyat, L., & Maddux, F. W. (2017). Right TraC™ post-hospitalization
care transitions program to reduce readmissions for hemodialysis patients. American
Journal of Nephrology, 45(6), 532–539.
https://doi-org.ezproxy.liberty.edu/10.1159/000477325
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Other comments:
- great reference list
- the title and header should match, which is your actual title?
