Novice

to
Expert
Patricia Benner

Reporters:
Jo Shiela Damole
Fernando Jose Costillas
Today's Discussion

Topic Outline

01. Credential & Background

02. Theoretical Sources
03. Major Concepts & Definition
04. Use of Empirical Evidence
05. Major Assumption
06. Theoretical Assertions
07. Application by the Nursing Community
08. Summary

Patricia Benner's Background

 Biography
Born August 1942
Hampton, Virginia, United States

 Education
Bachelor’s Degree in Nursing from Pasadena College (1964)
Master’s Degree in Medical Surgical Nursing from the University of California, San Francisco
(1970)
Postgraduate nurse researcher in the School of Nursing at UCSF
Doctor of Philosophy in the University of California, Barkley (1982)

Patricia Benner's Credentials

 Profession

- Fields: Nursing theory, Nursing Education

- 1984 - Wrote the “From Novice to Expert: Excellence and Power in Clinical Nursing Practice
- Benner adapted the Dreyfus model of skill acquisition
- Associate Professor in the Department of Physiological Nursing at the University California, San
Francisco and became tenured professor (1989)
- Henderson commented that because of the nature and scope of Benner’s from Novice to Expert:
Excellence and Power in Clinical Nursing Practice, it had the potential materially affect practice and
preparations of nurses for practice
- Moved at Department of Social and Behavioral Sciences at (UCSF, 2002)
- Appointed Nursing Education Study Director for the Carnegie Foundation’s Preparation for the
Professions Program PPP (2004)

 Accomplishment as a Researcher

- Published 9 books and written many articles.

- She received Book of The Year Award from AJN (The American Journal of Nursing) in
1984,1990, 1996 and 1999, 2011
- In 1989, she received the Linda Richards Award for Leadership in Education, and Excellence in
Nursing Research/Education Award in 1990.
- Inducted into the Royals Danish Nursing Society as an Honorary member in 2012.
- Received an award of Outstanding Contributions to the profession from the National Council of
State Boards of Nursing in 2002.
 Theoretical sources

 Benner acknowledges that her thinking in nursing was influenced by Virginia Henderson.
 Benner’s work as applied to the nursing profession is adapted from the Dreyfus Model of Skill
Acquisition.

Major Concepts and Definitions

 Novice
 Advance beginner
 Competent
 Proficient
 Expert

5 Stages of Benner's model

 Novice

 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 a situation.
 Generally, this level applies to students of nursing, but Benner has suggested that nurses
at higher levels of skill in one area of practice to be classified at the novice level if placed
in an area or situation unfamiliar to them.

 Advance Beginner

 Develops when the person can demonstrate marginally acceptable performance, having
coped with enough real situations to note, or to have pointed out by a mentor, the
recurring meaning full components of the situation.
 The advanced beginner has enough experience to grasp aspects of the situation.
 They have difficulty to grasping the current patient situation in terms of the larger
perspective.
 Nurses functioning at this level are guided by rules and are oriented by task completion.
 Clinical situations are viewed by nurses in the advance beginner stage as a test of their
abilities and the demands of the situation placed on them rather than in terms of patient
needs and responses.

 Competent

 Through learning the actual practice situations and by following the actions of others, the
advance beginner moves to the competent level.
 Consistency, predictability, and the time management are important in competent
performance. A sense of mastery is acquired through planning and predictability.
 There is an increase level of efficiency, but " the focus in on time management and the
nurse's organization of the task world rather than on timing in relation to the patient's
needs”.
 The competent nurse may display hyper-responsibility for the patient, often more than is
realistic, and may exhibit an ever-present and critical view of self.
 The competent stage is most pivotal in clinical learning, because the learner begins 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 based on relevant facts of that situation.
  Proficient

 The performer perceives the situation rather than in terms of aspects, and the performance is
guided by maxims.
 The proficient level is a qualitative leap beyond the competent. Now the performer
recognizes the most salient aspects and has an intuitive gasps of the situation based on
background understanding.
 Nurses at this level demonstrate a new ability to see changing relevance in a situation
including recognition of skilled responses to the situation as it evolves.

 Expert

 The expert performer no longer relies on analytical principle (rules, principle, maxim) to
connect an understanding of the situation to an appropriate action.
 Expert nurse having an intuitive grasp of the situation and as being able to identify the region
of the problem without losing time considering a range of alternative diagnoses and solutions.
 Expert nurse has the ability to recognize patterns on the basis deep experiential background.

Use of Empirical Evidence

 Seven Domains
01 The helping role
02 The teaching-coaching function
03 The Diagnostic and patient monitoring function
04 Effective management of rapidly changing situations
05 Administrating and monitoring therapeutic interventions and regimens
06 Monitoring and ensuring the quality of healthcare practices
07 Organizational work role competencies

Major Assumptions

 Nursing
 Is described as a caring relationship "enabling condition of connection and concern" "caring
is primary because caring set up the possibility of giving help and receiving help".
Understand nursing practice as the care and study of the lived experienced of health, illness,
and disease and the relationships and these three elements.

 Person
 "The 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"

 Health
 Dr. Benner focuses on the lived 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.

 Situation
 Benner uses situation rather than environment because situation conveys a social
environment with a social definition and meaningfulness.
 "To be situated implies that one has a past, present, and future and that all of these aspects,
influence the current situation", Dr. Benner.
 Theoretical Assertions

Benner (1984a) stated that there’s always more to any situation than theory predicts. The skilled practice of
nursing exceeds the bounds of formal theory. Concrete experience facilitates learning about the exceptions
and shades of meaning in a situation. The knowledge embedded in practice can lead to discovering and
interpreting theory, precedes and extends theory, and synthesized and adapts theory in caring nursing
practice.

Acceptance by the nursing community

 Practice
 Building clinical ladders for nurse (Frish,2009)
 Usefulness for preceptor development, orientation programs, and career development
(Dolan,1984)
 Benner's rationale and format in development of basic advanced preceptor workshops
(Neverveld,1990)
 Reported the use of Benner's approach in an ethnographic study of the performance of
clinical nurse-specialist (CNSs) (Fenton,1984)
 Applied Benner's findings to develop a cross-training program to address staffing imbalance
(Crissman and Jelsma, 1990)
 Education
 Benner critiqued the earlier behaviorist approach to competency-based testing as too abstract,
elemental, decontextualized, and limited for application to evaluation of professional nursing
practice (1982).
 Applied the domains of clinical nursing practice as a basis for studying skilled performance
of CNSs studied. Fenton (1984, 1985)
 Expertise in Nursing Practice, Benner and colleagues emphasized the importance of learning
the skills of involvement and caring through practical experienced, the articulation with the
practice, and the use of narratives in undergraduate education. (2009)
 Research
 Benner was the first to introduce interpretive phenomenology as a qualitative research
approach for study in the human sciences of situated, embodied intelligence, skilled know-
how, historical content, and meanings of events. (1983)
 Benner's numerous studies and projects with research colleagues and graduate students have
created a community of interpretive phenomenological scholars.
 Benner and colleagues (De Jong et al., 2010) conducted a large-scale collaborative study with
The TriService Military Service Nursing Research group to investigate knowledge
development and experiential learning from nursing practice during the Wars.

SUMMARY

Benner maintains that caring practice are imbued with knowledge and skill about everyday human needs,
and that to be experienced as caring, this practice must be attuned to the person who is being cared for and to
the particular situation as it unfolds. Benner's philosophy of nursing practice is a dynamic, merging holistic
perspective that holds philosophy, practice, research, and theory as independent, interrelated, and
hermeneutic. Her hope, voiced in the preface of From Novice to Expert (1984a), that domains and
competencies would not be reified by system builders seems to have been largely realized, because those
who have sought to apply these concepts have honored the contextual background on which they are based.
Benner's work exemplifies the interrelationship of philosophy, practice, research, theory and education and
the resources she and her colleagues have developed for teacher training, curriculum development, and
online student learning integrate practical and theoretical knowledge.