Caring, Clinical Wisdom, and Ethics in Nursing Practice

Credentials and Background of Patricia Benner

In the year 1964 she received baccalaureate from the Pasadena College, she then received
master’s degree major in medical-surgical nursing from the University of California, Berkeley,
received a PhD from the University of California, Berkeley. Patricia Benner is the author of
Novice to Expert. Visiting professor at the University of Pennsylvania School of Nursing in
2009 and Seattle University School of Nursing with her husband and colleague, Richard
Benner. Benner was appointed as Nursing Education Study Director for the Carnegie
Foundation’s Preparation for the professions Program (PPP).

Philosophical Sources
It is influence by Virginia Henderson. Benner studied the clinical nursing practice to discover
and learn about the embedded nursing practice. Benner differentiated the practical knowledge
and theoretical knowledge. Practical knowledge or “know-how” is a knowledge that is acquired
with experiences, whereas theoretical knowledge or “knowing that” is acquired by the present
theories, manuals, investigation. Theoretical is commonly acquired by reading and
investigation.

Major Concepts and Definitions

In Benner’s theory which is the Novice to Expert it has a five stages of nursing practices the (1)
novice, advance beginner, competent, proficient, and expert. In which contains a different level
of experience, knowledge, and copping with the specific situation.
I. Novice- doesn’t have a background experience. It can apply to those nursing
students who still have difficulty to identify whether it is relevant or irrelevant
aspect of situation. Follows the instructions and rules precisely.

II. Advance Beginner- has a small amount of experience that can take action some
of the aspect of situation but has a difficulty of grasping a larger perspective, can
demonstrate a marginally acceptable performance.

III. Competent- the nurse or learner begins to recognize patterns and determine which
element of the situation needs more attention and can be ignored. In this level they
are encourage to perform and decide without the presence of guidance and rules,
anxiety at this stage is more extreme rather than novice and advance beginner.

IV. Proficient- learners are more confident on their knowledge and abilities at this
stage. They have much more involvement with patients and family as they can
grasp situation based om their background understanding.

V. Expert- can effortlessly solve a problem or aspects of situation, they give

alternative and solutions of the present situation for they know appropriate action
in every clinical situation.
MAJOR CONCEPTS AND DEFINITIONS- cont’d
 Aspects of a Situation- can address specific situation because of the experience.

 Attributes of a situation- can address specific situation even without experience.

 Domain- area of practice having a number of competencies.
 Exemplar- example of clinical situation that conveys one or more functions can be
translated to other clinical situation.
 Experience- active process of refining and changing preconceived theories, notions, and
ideas when confronted with actual situation.
 Maxim- skilled performance that requires certain amount of experience.
 Paradigm Case- create new clinical understanding and open new clinical perspective
and alternatives.
 Salience- embodied knowledge whereby aspects of situation stands out what is more or
less important.
 Ethical Comportment- it is socially embedded, lived, and embodied in practices.
 Hermeneutics- theoretical examples that focuses on the meanings of experiences in
individual’s life
 Formation- development of moral character, self- understanding, and identity as nurse.
 Situated Coaching- the teacher describe his/her understanding of the situation for
students
Table 9.1

Major Assumptions
Nursing- Describe as a caring profession that enables condition of connection and concern. The
moral art of ethics of responsibility and care. The care and study of the live experiences of
health, illness, and diseases.
Person- According to Visintainer (1962) the goal is to overcome Cartesian dualism that mind
and body are distinct and separate entities. A person understands the self in the world
effortlessly and unreflective.
Health- Benner and Wrubel (1989) a person may have diseases and not experience illness,
because illness is the human experience of loss or dysfunction, whereas disease is what can be
assessed at the physical level. Health is describe not just the absence of diseases and illness.
Situation- instead of environment Benner and Wrubel used the term situation. It conveys aThe
current situation influenced by the person’s experiences that includes her or his own personal
meanings, habits and perspective (Benner and Wrubel, 1989)

Logical Form
Benner use the Dreyfus model of skill acquisition to understand better the clinical nursing
through qualitative descriptive research
• In Benner’s perspective the different skill level guide the reader to understand the nursing
practice.
• The Novice to expert (1984) is developed into Clinical Wisdom and Interventions in
Acute and Critical Care: A Thinking-in-Action Approach
Acceptance by the Nursing Community

 Practice- ullery (1984) present its usefulness for conducting annual excellence symposia
where nurses present their clinical narratives to recognize and further develop clinical
knowledge. It is to decrease health care errors and aiding the blaming of health care
system culture.

 Education- domains of clinical practice as basis for studying skilled performance of

clinical nurse specialist (CNSs). Expertise in Nursing Practice: importance of learning the
skills of involvement through practical experience.

 Research- Emphasizes identification and description of meaning embedded in clinical

practice. A guide to understand the strategies and processes of the approach, and
selection of studies that conveys its resemblance and variations.

Further Development
I. Separation of academic course work from clinical learning
II. Nursing education to hospital schools then college and universities
III. Nursing faculty and students come to be regarded as “guests in the house”

Critique
Clarity- the novice to expert model gives clarity of clinical wisdom and varying
levels of clinical expertise that is use among nurses around the world.
Simplicity- It is simple with the 5 stages of skill acquisition that describe the level
of knowledge and experience of the clinical nurses. comparative guide for
identifying levels of nursing practice.
Generality
 Can be use in any human being
 Age
 Illness/ health
 Location of nursing practice
Accessibility
The clinical nurses worldwide uses the novice to expert in order for them to
identify what level they are and their action.