Stage 1: Novice
During this stage, the novice learns to recognize objective facts and features relevant to the skill. He also learns rules for determining actions based on these facts and features. Elements and rules of behaviors of a particular situation are clearly and objectively defined so they are “context-free”. The manipulation of unambiguously defined context-free elements by precise rules is called “information processing”.
The novice nurse is taught how to read blood pressure, measure bodily outputs and taught what to do when those measurements reach certain values.
Stage 2: Advanced beginners
Performance improves to a marginally acceptable level once the novice has considerable experience with real situations. In facing real situations, he notices meaningful elements that neither the instructor nor the learner can define in terms of context-free features. The advanced beginner starts to recognize these elements when they’re present due to their similarity to prior examples. Such elements are not “situational”, to distinguish them from context-free elements. Rules for behavior now may refer to both the new situational and the context-free components.
Stage 3: Competence
With more experience, the number of context-free and situational elements becomes overwhelming. A sense of what is important is missing. People are taught or learn to adopt a hierarchical decision-making procedure. First choose a plan to organize the situation, and then examine only the most important factors given the chosen plan, a person can simplify and improve his performance.
A competent performer sees a situation as a set of facts. He has learned that when a situation has a particular configuration of elements, a certain conclusion should be drawn, decision made, or expectation investigated.
The comptent nurse will no longer go automatically from patient to patient in a prescribed order but will assess the urgency of their needs and plan work accodingly.
The performance at the competent level requires choosing an organizing plan, which is different from novice and advanced beginners in the sense that the competent performer feels responsible for the outcome of their acts. For novice and advanced beginners, a bad outcome is just the result of inadequately specified elements or rules. The competent performer however wrestles and makes a conscious decision in a detached manner, therefore an outcome that is successfuly is deeply satisfying, and disasters are not easily forgotten.
Stage 4: Proficiency
Up to this point, the learner has made conscious choices of both goals and decisions after reflecting upon alternatives. The proficient performer will be deeply involved in his tasks and experience it from specific perspectives. Therefore, certain features will stand out while others recede into the background. As events modify relevant features, plans, expectations and the relevant features will change.
No detached choice or deliberation occurs because the proficient performer has experienced similar situations in the past and therefore the current situation triggers plans similar to those that worked in the past and anticipations of what should happen. The ability to use patterns without decomposing them into component features is called “holistic similarity recognition”. Intuition is synonymous to “know-how” and is the ability we all use all the time as we go about our everyday tasks.
The proficient performer still thinks analytically about what to do after intuitively recognizing and understanding the situation. Elements that present themselves as important will be assessed and combined by rule to produce decisions.
A proficient nurse will notice one day, without any conscious decision-making, that the patient is psychologically ready to deal with his surgery and impeding release. However, during the conversation, words will be carefully and consciously chosen.
Stage 5: Expertise
An expert generally knows what to do based on mature and practiced understanding. He does not see problems in a detached manner, nor he worries about the future and devise plans. An expert’s skill become so much a part of him that he doesn’t need to pay attention to it any more than to his own body.
When things are proceeding normally, experts don’t solve problems and don’t make decisions; they do what normally works. However, while most expert performance is ongoing and nonreflective, when time permits and outcomes are crucial, an expert will deliberate before acting. But this is not calculative problem solving but rather critically reflecting on one’s intuitions. Even then, things may not work out.
With enough experience in a variety of situations, all seen from the same perspective or with the same goal but with different tactical decisions, thhe proficient performer starts to group situations with the same goal, action or tactic together.At this point, a situation is understood and all the related decisions, actions and tactics are also simultaneously called to mind.
Expert nurses will sometimes sense that a patient lies in danger of a relapse and urge the doctor. They cannot always provide convincing, rational explanations of their intuition but frequently they turn out to be right.
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