NURSI NG THEORI ST

FROM NOVI CE TO EXPERT

Patricia Benner
R.N., Ph.D., F.A.A.N., F.R.C.N.
Kelly Lockhart
Sara Young
NURS 324
Spring 2013
Patricia Benner
(photo by Robert Foothorap)
Patricia Benner
R.N., Ph.D., F.A.A.N, F.R.C.N.
Current Professor Emerita at
the University of California, San
Francisco
Has taught and been involved in
research since 1979.
Well published in journals and
books.
Named one of the American
Academy of Nursings Living
Legends in August, 2011.
Introduced her Novice to
Expert theory in 1982.
Many publications refer to her
nursing practice model.

Patricia Benner
http://www.bing.com/images/search?q=Nursing+Symbols
&FORM=RESTAB#


Purpose

Basic overview of nursing theory

Explanation of Patricia Benners work From Novice to
Expert model

Relation of Benners work to current practices
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What is nursing theory?

A nursing theory is a set of concepts, definitions,
relationships, and assumptions or propositions derived
from nursing models or from other disciplines and
project a purposive, systematic view of phenomena by
designing specific inter-relationships among concepts for
the purposes of describing, explaining, predicting,
and/or prescribing.

Many nursing theories incorporate the four paradigms:
nursing, person, health and environment


(Nursing Theories, 2012)
Why is theory important?

When nursing practice is built on sound theories, the
profession is strengthened


Using theory in nursing helps us to:
Think critically
Analyze information and make clinical judgments
Assist in decision making
Support excellence in practice
Assist novices in becoming experts therefore improving patient care


(Black, 2011)
Photo courtesy http://blogs.hpedsb.on.ca/hjc/1213nevan/
From Novice to Expert Nursing Model


Patricia Benner developed a concept known as From Novice
to Expert. This concept explains that nurses develop skills
and an understanding of patient care over time from a
combination of a strong educational foundation and personal
experiences. Benners theory identifies five levels of nursing
experience: novice, advanced beginner, competent,
proficient, and expert.
(Nursing Theory, 2011)
Benners Motivation for Novice to Expert

Nursing practice has been studied primarily from a
sociological perspective as opposed to the study of nursing
practice itself

Nursing knowledge is accrued over time; it is embedded in
expertise. Thoughts are based on the Dreyfus model.

Knowledge has gone uncharted and unstudied because
differences between practical and theoretical knowledge have
been misunderstood

Well charted nursing practice and observation are essential
for theory development

(Benner, 2001, p. 1)
Benners Philosophy

Benner proposed that a nurse could gain knowledge and
skills without actually learning a theory Described as
knowing how without knowing that

Development of knowledge in nursing is a combination of
knowledge through research and understanding through
clinical experience
(Nursing Theory, 2011)
Photo: http://www.canstockphoto.com/nurse-word-cloud-concept-11506014.html
Benners influences
Virginia Henderson
Benner has acknowledged that her thinking has been
influenced greatly by Virginia Henderson.
Dreyfus model of Skill acquisition
Developed in 1980
Describes five levels of skill acquisition and development
Model showed advancement through the stages by changes in
performance
Developed by studying chess players and pilots
Benner adapted the Dreyfus model for clinical nursing
practice, basis for her work: Novice to Expert.
(Tomey & Alligood, 2006)
Dreyfus Model of Skill Acquisition
Skill Level
Mental
function
Novice Competent Proficient Expert Master
Recollection Non-
situational
situational Situational Situational Situational
Recognition decomposed decomposed Holistic Holistic Holistic
Decision analytical analytical Intuitive Intuitive Intuitive
awareness monitoring monitoring monitoring Monitoring absorbed
Table 1: The model in 1980 shows how skill acquisition changes for the given
mental functions throughout advancement in the given skill levels. (Dreyfus
& Dreyfus, 1980)
Dreyfus vs. Benner
Dreyfus model including the 5 levels as
of 1986 (moleseyhill.com)
Benners Stages of Nursing
Proficiency (nursinginformatics.ca)
Novice to Expert



Novice
Advanced Beginner
Competent
Proficient
Expert
Benners stages of Nursing Proficiency
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The Novice

Begins with no prior experience

Taught rules to perform tasks

Rule governed behavior is limited and inflexible

Being a novice is not exclusive to students- any nurse
entering a setting without prior experience with that
particular patient population may be limited to the novice
level
(Benner, 2001, pp. 20-21)
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5-self-evaluation-novice-apprentice-practitioner-
expert.html
The Advanced Beginner

Can demonstrate marginally acceptable performance

Has gained prior experience in actual nursing situations

Formulation of guidelines or principles from prior
experiences provide guidance in future experiences

(Benner, 2001, pp. 22-23)
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The Competent Nurse

Has been on the job in similar situations for 2-3 years

Aware of long term goals-- gain perspective from planning
their own actions

Become more efficient and organized

(Nursing Theory, 2011)
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The Proficient Nurse

Perceives and understands situations as whole parts

Views patients holistically

Has learned what to expect in certain situations and
how to modify plans as needed
(Nursing Theory, 2011)
The Expert Nurse

No longer relies on principles, rules or guidelines to
connect situations and determine actions

Performances are fluid, flexible, and highly proficient

Expertise comes naturally
(Black 2011, p. 137)
(Nursing Theory, 2011)


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Benners Explanation of the Four Paradigms


Nursing
Person
Health
Environment
Photo courtesy http://www.emporia.edu/nursing/nursing-mission.html
Nursing

Benner viewed nursing as the care and study of the
lived experience and the relationship of these three
elements:

Health
Illness
Disease
(Nursing Theories, 2013)
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Person

the person does not come into the world predefined
but gets defined in the course of living a life
Benner believed that there are significant aspects that
make the being. She conceptualized these as the roles
of:
the situation
the body
personal concerns
temporality

(Nursing Theories, 2013)
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0&sp=2&sk=HS1#view=detail&id=8B0FC4FBC4E9A78296B556430D55638F7399DF6D&selectedIndex=832
Health

Benner focused on the lived experience of being
healthy and being ill
Health can be assessed
Well-being is the human experience of health or wholeness
Illness is the human experience of loss or dysfunction


(Tomey & Alligood, 2006, p. 151)
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Environment

Benner uses the term situation rather than environment.
Personal interpretation of the situation is bounded by the
way the individual is in it.

A persons past, present, and future influences their current
situation
(Tomey & Alligood, 2006, p. 151)
Photo courtesy http://www.howtolearn.com/2012/01/what-
did-we-learn-about-health-and-happiness-in-2011
http://bizchicks.org/2011/02/the-emotion-health-connection/
Relationship of Paradigms to Benners Model

The culmination of the four paradigms of nursing
create experiences that nurses utilize to advance
through the stages of Benners model From Novice to
Expert
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shop/detail.asp?item=229360
Photo courtesy
http://www.clker.com/clipart-
nurse-icon.html
Using Benners Model in Practice

Examples of use in practice:

Preceptorship
Orientation processes
Nursing educational programs
Professional advancement ladders
Interdepartmental job changes (e.g. medical-surgical nurse
transitioning to an intensive care unit)
http://www.galaxyhealth.net/
Benner in Action
American Association of Critical-Care Nurses (AACN)
Synergy Model
Developed as a basis for nursing
practice
Development utilized use of Benners
Novice to Expert stages of
development
Combines nursing competencies with
characteristics of patients to enhance
optimal patient outcomes (Kaplow,
2002)
Patient outcomes will be different at
the different levels of the nurses
expertise.
(photo courtesy AACN.org)
Benner in Action
Clinical Ladder Programs

Most are based on
stages of clinical
competence of Benners
(Murphy, 2012)

Intention of the ladder
is to retain experienced
nurses

Greater rewards at the
expert levels than the
novice level
Conclusion

This model can be applied to all areas of nursing. It looks at
the education and development of a nurse and how they
become an expert.

Patricia Benner examined how nurses learn to nurse
(Nursingtimes.net, 2010)

Photo courtesy http://depositphotos.com/9744222/stock-illustration-Nursing-home-logo.html Photo courtesy http://nursesaidetraining.blog.com/
References
American Association of Critical-Care Nurses (2013). Retrieved from www.aacn.org
Benner, P., (2001). From novice to expert: Excellence and power in clinical nursing practice (Commemorative
edition). New Jersey: Prentice Hall Health.
Black, B.P. (2011). Becoming a nurse: Defining nursing and socialization into professional practice. In K.K. Chitty
& B.P. Black (Eds.), Professional nursing: Concepts and challenges (6th ed. pp. 126-145). Maryland Heights,
MO: Saunders Elsevier.
Dreyfus, S. E., & Dreyfus, H. L. (1980). A five-stage model of the mental activities involved in directed skill
acquisition (Operations Research Center Rep. No. ORC-80-2).
Kaplow, R. (2002). The synergy model in practice applying the synergy model to nursing education. Critical Care
Nurse, 22(3), 77-81.



References


Murphy, D. (2012, September/October). Novice to expert: clinical ladder programs as a recruitment and retention
tool. Ohio Nurses Review., 16-17. Retrieved from www.ohnurses.org
Nursingtimes.net [website]. (2010, March). Nursing Times. Retrieved from http://www.nursingtimes.net/whats-
new-in-nursing/hall-of-fame/patricia-benner-us-nurse-theorist-and-author-of-from-novice-to-
expert/5012095.article
Nursing Theory. (2011). Patricia Benner: Biography of Patricia Benner. Retrieved from http://nursing-
theory.org/nursing-theorists/Patricia-Benner.php
Nursing Theories. (2013). Patricia Benner: Metaparadigm in nursing. Retrieved from
http://nursingtheories.info/patricia-benner-metaparadigm-in-nursing/
Nursing Theories: a companion to nursing theories and models website. (2012). Retrieved from
www.currentnursing.com/nursing_theory
Tomey, A., & Alligood, M. (2006). Nursing theorists and their work (6th ed.). St. Louis, MO: Mosby Elsevier.
Case Study #1

Sally had the opportunity to be a nurse extern at a hospital on
a busy medical-surgical unit while she finished her
undergraduate studies. With this opportunity, Sally stated
that she had the chance to become comfortable in a nursing
role, and was able to relate nursing practice to the theory that
she was learning in class. After graduation, Sally became an
RN in the Neonatal ICU. Given her recent nursing
experience, which of Benners stages is Sally practicing at as a
Neonatal RN?
Case Study #2

You and Ginger have been nurses together for the last five
years. You have both worked on the Orthopedic unit since
graduating nursing school. You both easily perform the
required nursing duties, seem to have that nursing sense
about when something is going downhill, and act as charge
nurses on the unit. Ginger is reluctant to act as a preceptor to
newer nurses stating that I still need to work on my
organization before trying to help others learn the way. You
have acted and excelled as a preceptor with excellent
feedback. What stages of Benners model would you place
yourself and Ginger?