Patricia Benner

The Primacy of Caring Model

"From Novice to Expert Nursing Model"
 
 Nursing is an integrative science of relationships between mind, body, and human
world
 Nursing is concerned with the social sentiment body that dwells infinite human
worlds
 Caring is central to human expertise, curing, and healing
a. What matters to people sets up what options are available for coping
b. Notice aspects of a situation (discern problem and recognize possible
solution)
c. Sets up possibilities for giving and receiving help
History and Background
 Born in Hampton, Virginia
 Childhood in California
Education
 Nursing degree from Pasadena College
 Master's Degree in Medical-Surgical Nursing from University of California, San Francisco
 Ph.D. in stress and coping and health from University of California, Berkeley, under Hubert
Dreyfus and Richard Lazarus.
Books
 From novice to Expert(1984, Nursing book of the Year)
 1994, Interpretative Phenomenology and the Crisis of Care (Susan Philips)
 Expertise in Nursing Practice (Tanner and Chesla) (1996, Book of the Year)
 Caregiving (1996) (Suzanne Gordon, Nel Noddings)
 Clinical Wisdom and Interventions in Clinical Care (1998)
5 Levels of Acquisition
Novice
 Beginner with no Experience
 Always follows instruction
 Has limited Performance
 Students of Nursing
 Advanced Beginner
 Marginally accepted performance
 Gained prior experience in actual nursing
 Have less questioning
 Competent
 2-3 Year Experience
 More-aware of long-term goal
 Planning own action
 Proficient
 3-5 years experience
 Perceives decision making to modify plans as needed
  Expert
 No rules and guidelines needed
 Have deeper background experience
 Flexible and highly proficient performances
 Intuitive grasp of situation
 Patterns on Basis Deep Experiential Background
 Aspects of Situation
 recurring meaningful situational components
 Attributes of Situation
 Measurable properties
 Competency
 Skilled performance by intent, functions, meanings
 Domain
 Area of practice
 Exemplar
 Example of clinical situation
 Maxim
 Cryptic description of skilled performance
 Paradigm Case
 Way to perceive and understand clinical situations
 Salience
 Embodied knowledge
 Ethical Comportment
 Individualized relationship with the patient
 Hermeneutics
 interpretive
 Formation
 Development of a nursing student into professional
 Situated Coaching
 Signature Pedagogy
 
Domains of Nursing Practice
1. The Helping Role Domain
 Established healing relationship
 Provide comfort measures
 Inviting active patient participation and control in care
2. The Teaching-Coaching Function Domain
 Readying patients for learning, motivation, change
 Assist lifestyle alterations
 Negotiating agreement goal
3. The Diagnostic and Patient-Monitoring Function Domain
 Competencies in ongoing assessment and outcome anticipation
4. Effective Management of Rapidly Changing Situations Domain
 Ability to contingently match demands with resources
  Assess and manage care during crisis
5. The Administering and Monitoring Therapeutic Interventions and Regimes
Domain
 Prevention of complications in drug therapy, wound management, and
hospitalization
6. The Monitoring and Ensuring the Quality of Health Care Practices Domain
 Maintenance of safety
 Collaboration and consultation with physicians
 Self-evaluation
7. The Organizational and Work-role Competencies Domain
 Priority setting
 Team building
 Coordinating