THEORETICAL FOUNDATION IN NURSING
Benner’s Stages Of Nursing Expertise Nursing Philosophies
Patricia Benner (1984-1989)
 “The Primacy of Caring Model”
(From novice to expert nursing
model.)
 "Nursing is an integrative science
that studies the relationships
between mind, body, and human
worlds.
 Nursing is concerned with the social
sentient body that dwells infinite
human worlds: that gets sick and
recovers; that is altered during
illness, pain, and suffering; and that Most Recent Books:
engages with the world differently
upon recovery"
 Caring is central to human expertise,
to curing, and to healing.
 Caring is primary for the following
reasons:
 What matters to people sets up not
only what as stressful but also what
options are available for coping.
 It enables a person to notice salient
aspects of a particular situation, to
discern problems, and to recognize
potential solutions.
 It sets up possibilities for giving and
receiving help.
History and Background
 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
 Ph.D. from the University of
California, Berkeley, in Stress and
Coping and Health under the
direction of Hubert Dreyfus and
Richard Lazarus.
Books
 Author of nine books including
“FROM NOVICE TO EXPERT” named
an American journal of nursing book
of the year for nursing education and
nursing research in 1984
 The Primacy of Caring, co-authored
with Judith Wrubel, named book of
the year in 1990
 Interpretative Phenomenology:
Embodiment, Caring and Ethics in
Health and Illness and The Crisis of
Care, with Susan Philips, both
published in 1994
 Expertise in Nursing Practice: Caring,
Clinical Judgment and Ethics, with
Christine Tanner and Catherine
Chesla, also named a Book of the
Year in 1996
 Caregiving, with Suzanne Gordon and
Nel Noddings, also published in 1996.
 Clinical Wisdom and Interventions in
Critical Care: A Thinking-In Action
Approach, with Pat Hooper-Kyriakidis
and Daphne Stannard (W.B.
Saunders), published in December
1998
 Dr. Benner is an internationally noted
researcher and lecturer on health,
stress and coping, skill acquisition
and ethics. Her work has had wide
influence on nursing both in the
United States and internationally, for
example in providing the basis for
new legislation and design for
nursing practiceand education for
three states in Australia. She was
recently elected an honorary fellow
of the Royal College of Nursing. Her
work has influence beyond nursing in
THEORETICAL FOUNDATION IN NURSING
Benner’s Stages Of Nursing Expertise Nursing Philosophies
the areas of clinical practice and
clinical ethics.
 She has been a staff nurse in the
areas of medical-surgical,
emergency room, coronary care,
intensive care units and home
care. Currently, her research
includes the study of nursing
practice in intensive care units
and nursing ethics.
Dr. Benner’s Stages of Clinical Competence
 A NOVICE is a beginner with no
experience. They are taught general
rules to help perform tasks, and their
rule-governed behavior is limited
and inflexible. In other words, they
improves decision-making. These
nurses learn from experiences what
to expect in certain situations, as
well as how to modify plans as
needed.
 EXPERT nurses no longer rely on
principles, rules, or guidelines to
connect situations and determine
actions. They have a deeper
background of experience and an
intuitive grasp of clinical situations.
Their performances are fluid,
flexible, and highly-proficient.
Benner’s writings explain that
nursing skills through experience are
a prerequisite for becoming an
Stage V, Expert
expert nurse.
Stage IV, Proficient

are told what to do and simply Benner’s Stage of Nursing Expertise

Stage III, Competent
follow instruction.
Stage II, Advanced beginner
 The ADVANCED BEGINNER shows
Stage I, Novice
acceptable performance, and has
gained prior experience in actual
nursing situations. This helps the
nurse recognize recurring
meaningful components so that
principles, based on those
experiences, begin to formulate in
order to guide actions.
 A COMPETENT nurse generally has
two- or three-years’ experience on
the job in the same field. For
example, two or three years in
intensive care. The experience may
also be similar day-to-day situations. Overview of Patricia Benner’s Philosophy in
These nurses are more aware of Nursing
long-term goals, and they gain
Benner proposed seven domains of nursing
perspective from planning their own
practice which are as follows:
actions, which helps them achieve
greater efficiency and organization  The helping role.
 The teaching-coaching function.
 A PROFICIENT nurse perceives and
understands situations as whole  The diagnostic and patient-
parts. He or she has a more holistic monitoring function.
understanding of nursing, which
THEORETICAL FOUNDATION IN NURSING
Benner’s Stages Of Nursing Expertise Nursing Philosophies
 Effective management of rapidly  this refers to competencies
changing situations. in ongoing assessment and
 Administering and monitoring anticipation of outcomes.
therapeutic interventions and (Evaluate the patient)
regimens.
 Monitoring and ensuring the quality
of health care practices.
 Organizational and work-role
competencies. 4. The effective Management of
Rapidly Changing Situations Domain
Benner’s Domains of Nursing Practice
 this includes the ability to
1. The Helping Role Domain contingently match
COMFORT MEASURES demands with resources and
 Provide clean, quiet, to assess and manage care
uncluttered environment during crisis situations
 Provide warmth, coolness as (emergency).
indicated
 Provide personal hygiene: 5. The Administering and Monitoring
keep the patient dry and Therapeutic Interventions and
clean, linen change, oral care Regimens Domain
 Provide activity like TV, radio,  this includes competencies
reading materials relate to preventing
 Explain all procedures, test, complications during drug
hospital routines therapy, wound
 Facilitate family visits and management and
support hospitalization.
 Check with patient at regular
intervals about his or her Ways in Preventing Complication If the
discomfort/comfort. Patient Have Diabetes
 Keep call light within reach 1. Diet, healthy lifestyle
and encourage patient to call
you if needed. 2. Don’t smoke
2. The Teaching-Coaching Function
3. Advice to keep their blood pressure
Domain
and cholesterol under control
 this includes timing,
4. Schedule regular physical and eye
readying patients for
exam
learning, motivating,
change, assisting with 5. Keep the patients’ vaccine up to
lifestyle alterations, and date
negotiating agreement on
goals. 6. Advice the patient to take care of
their teeth
3. The Diagnostic and Patient
Monitoring Function Domain 7. Advise them to pay attention to
their feet.
THEORETICAL FOUNDATION IN NURSING
Benner’s Stages Of Nursing Expertise Nursing Philosophies
WAYS IN PREVENTING COMPLICATION IN
PREGNANCY
1. Avoid taking medications without
prescription
2. Advise them to attend
appointments and check-up
regularly
3. Avoid smoking and drinking liquors
4. Maintain healthy weight (manage
blood pressure) – to avoid
preeclampsia (condition marked by
high blood pressure that can
directly affect the baby’s ability to
receive blood and oxygen in the
womb.)
6. The Monitoring and Ensuring the
Quality of Health Care Practices
Domain
 this includes competencies
with regard to maintenance of
safety, continuous quality
improvement, collaborative
and consultation with
physicians, self- evaluation, and
management of technology.
7. The Organizational and Work-Role
Competencies Domain
 this includes competencies in
priority setting, team building,
coordinating, and providing for
continuity.
3 KEYS IN PRIORITY SETTINGS
1. Severity
2. Patient benefit
3. Cost-Effectiveness