Patricia Benner, R.N., P.h.D., FAAN,F.R.C.N.

“Knowledge development in a practice discipline consists of extending practical knowledge

(know-how) through theory based scientific investigations and through the clinical experience
in the practice of that discipline” (Benner, 1984)

• Patricia Benner is a Professor in the Department of Physiological Nursing in the School of

Nursing at the University of California, San Francisco.

• Dr. Benner received her bachelor's degree in nursing from Pasadena College, her master's
degree in medical surgical nursing from the University of California, San Francisco, and the
Ph.D. from the University of California, Berkeley, in Stress and Coping and Health under the
direction of Hubert Dreyfus and Richard Lazarus.

• Dr. Benner’s Theory

• Dr. Benner categorized nursing into 5 levels of capabilities: novice, advanced beginner,
competent, proficient, and expert.

• She believed experience in the clinical setting is key to nursing because it allows a nurse to
continuously expand their knowledge base and to provide holistic, competent care to the
patient.

• Her research was aimed at discovering if there were distinguishable, characteristic differences
in the novice’s and expert’s descriptions of the same clinical incident.

Four Domains of Nursing Paradigm:

Client/ Person

• “The person is a self-interpreting being, that is the person does not come into the world
predefined but gets defined in the course of living a life.”- Dr. Benner

Health

• Dr. Benner focuses on the life experience of being healthy and being ill.

• Health is defined as what can be assessed, whereas well being is the human experience of
health or wholeness.

• Well being and being ill are understood as distinct ways of being in the world.
Environment/Situation

• Benner uses situation rather than environment because situation conveys a social environment
with social definition and meanifulness.

• “To be situated implies that one has a past, present, and future and that all of these
aspects….influence the current situation.”- Dr. Benner

Nursing

• Nursing is described as a caring relationship, an “enabling condition of connection and concern.”

-Dr. Benner

• “Caring is primary because caring sets up the possibility of giving and receiving help.”

• Nursing is viewed as a caring practice whose science is guided by the moral art and ethics of care
and responsibility.

• Dr. Benner understands that nursing practice as the care and study of the lived experience of
health, illness, and disease and the relationships among the three elements.

• Nursing theory as a framework for practice…

Dr. Benner presented her research in: From Novice to Expert: Excellence and Power in Clinical Nursing
Practice.

Novice, Advance Beginner, Competent, Proficient, and Expert are the different components
explained in her research.

Novice

• Beginner with no experience

• Taught general rules to help perform tasks

• Rules are: context-free, independent of specific cases, and applied universally

• Rule-governed behavior is limited and inflexible

• Ex. “Tell me what I need to do and I’ll do it.”

• The person has no background experience of the situation in which he or she is involved.

• There is difficulty discerning between relevant and irrelevant aspects of the situation.

• Generally this level applies to nursing students.

Advanced Beginner

• The advance beginner stage in the model develops when the person can demonstrate
marginally acceptable performance having coped with enough real situations to note, or to have
pointed out by mentor, the recurring meaningful components of the situation.

• Nurses functioning at this level are guided by rules and oriented by task completion.

• Demonstrates acceptable performance

• Has gained prior experience in actual situations to recognize recurring meaningful components

• Principles, based on experiences, begin to be formulated to guide actions

Competent

• Typically a nurse with 2-3 years experience on the job in the same area or in similar day-to-day
situations

• More aware of long-term goals

• Gains perspective from planning own actions based on conscious, abstract, and analytical
thinking and helps to achieve greater efficiency and organization

• The competent stage is the most pivotal in clinical learning because the learner must begin to
recognize patterns and determine which elements of the situation warrant attention and which
can be ignored.

• The competent nurse devises new rules and reasoning procedures for a plan while applying
learned rules for action on the basis of the relevant facts of that situation.

Proficient

• The performer perceives the information as a whole (total picture) rather than in terms of
aspects and performance.

• Proficient level is a qualitative leap beyond the competent.

• Nurses at this level demonstrate a new ability to see changing relevance in a situation including
the recognition and the implementation of skilled responses to the situation as is it evolves.

• More holistic understanding  improves decision-making

• Learns from experiences what to expect in certain situations  and how to modify plans

Expert

• No longer relies on principles, rules, or guidelines to connect situations and determine actions
 • Much more background of experience

• Has intuitive grasp of clinical situations

• Performance is now fluid, flexible, and highly-proficient

• This stage is achieved when “the expert performer no longer relies on analytical principals to
connect her or his understanding of the situation to an appropriate action

SIGNIFICANCE OF THE THEORY

• These levels reflect movement from reliance on past abstract principles to the use of past
concrete experience as paradigms and change in perception of situation as a complete whole in
which certain parts are relevant

• Each step builds on the previous one as abstract principles are refined and expanded by
experience and the learner gains clinical expertise.

• This theory changed the profession's understanding of what it means to be an expert, placing
this designation not on the nurse with the most highly paid or most prestigious position, but on
the nurse who provided "the most exquisite nursing care.

• It recognized that nursing was poorly served by the paradigm that called for all of nursing theory
to be developed by researchers and scholars, but rather introduced the revolutionary notion
that the practice itself could and should inform theory.