PATRICIA BENNER

Prepared by: JOAN BALITON- TAROMA,MSN,RN

Lecturer
 CARING, CLINICAL WISDOM,
ETHICS IN NURSING PRACTICE
• Caring practices are imbued with knowledge
and skill about everyday human needs, and
that to be experienced as caring, these
practices must be attuned to the particular
person who is being cared for and to the
particular situation as it unfolds.
• Benner philosophy of nursing practice is a
dynamic, emerging holistic perspective that
holds philosophy, practice, research, and
theory as interdependent , interrelated, and
hermeneutic.
 PHILOSOPHICAL SOURCES
• Acknowledges that her thinking in nursing was
influenced greatly by Virginia Henderson.
• Adapted the Dreyfus model to clinical nursing
practice
BENNER’S MODEL: 5 Levels of skill
acquisition and development:
1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. expert
 MAJOR CONCEPTS AND
DEFINITIONS
5 LEVELS:
1. NOVICE
- Context- free rules and objective attributes
must be given to guide performance.
- Difficulty discerning bet. Relevant and
irrelevant aspects of a situation.
2. 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 meaningful components of the
situation.
3. COMPETENT
- Conscious and deliberate planning
that determines which aspects of
current and future situations are
important and which can be
ignored(Benner, 1984a)
- 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.
4. PROFICIENT
- The performer perceives the situation as a
whole( the total picture) rather than in terms of
aspects, and the performance is guided by
maxim.
5. EXPERT
- Is achieved when the performer no longer
relies on analytical principle (Rule, guideline,
maxim) to connect an understanding of the
situation to an appropriate action(Benner,
1984a)
MAJOR CONCEPTS AND DEFINITIONS
• ASPECTS OF A SITUATION
- ASPECT are the recurring meaningful
situational components recognized and
understood in context bec. The nurse has
previous experience(Benner, 1984a).
• ATTRIBUTES OF A SITUATION
- Attributes are measurable properties of a
situation that can be explained without
previous experience in the
situation(Benner, 1984a).
• COMPETENCY
- Is an interpretively defined area of skilled
performance identified and described by its intent,
functions, and meaning”
• DOMAIN
- Is an area of practice having a number of
competencies with similar intents, functions, and
meanings(Benner, 1984a).
• EXEMPLAR
• EXPERIENCE
- Is not a mere passage of time, but an
active process of refining and changing
preconceived theories, notions, and
ideas when confronted with actual
situations.
• MAXIM
- Is a cryptic description of skilled performance that
requires a certain level of experience to recognize
the implications of the instructions(Benner, 1984a).
• PARADIGM CASE
- Is a clinical experience that stands out and alters the
way the nurse will perceive and understand future
clinical situations(Benner, 1984a)
• SALIENCE
- Describes a perceptual stance or embodied
knowledge whereby aspects of a situation
stand out as more or less important(Benner,
1984a)
• ETHICAL COMPORTMENT
- Is good conduct born out of an engagement in
a particular situation and entails a sense of
membership in the relevant professional group.
• HERMENEUTICS
- Means “interpretive”.
- The term derives from biblical and judicial
exegesis.
- As used in research, refers to describing and
studying “meaningful human phenomena in a
careful and detailed manner as free as
possible from prior theoretical assumptions,
based instead on practical
understanding”(Packer,1985)
• FORMATION
- Address the development of sense, esthetics,
perceptual acuities, relational skills, knowledge and
dispositions that take place as student nurses form
professional identity.
• SITUATED COACHING
- Was identified as the signature pedagogy in nursing
from the educating Nurses study.(Benner et.al, 2010)
 METAPARADIGM
• PERSON
- Benner and Wrubel(1989) use Heidegger’s
phenomenological description of person,
which they describe as:
- A 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 life.
 Four major aspects:
• The role of the situation
• The role of the body
• The role of personal concerns
• The role of temporality
• HEALTH
- What can be assessed, whereas
Well-being- is the human experience of health or
wholeness.
• NURSING
- Is described as a caring relationship an “enabling
condition of connection and concern”
• ENVIRONMENT
- Used the term SITUATION, because situation
conveys a social environment with social
definition and meaningfulness.
- Use the phenomenological terms being
situated and situated meaning, which are
defined by the person’s engaged interaction,
interpretation, and understanding of the
situation.
 THEORETICAL ASSERTIONS
• 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 synthesizes
and adapts theory in caring nursing practice.
 ACCEPTANCE BY THE NURSING
COMMUNITY
• PRACTICE
- Describes its usefulness for preceptor development,
orientation programs, and career development ;
Huntsman et al.(1984).
- Detail their implementation of a clinical ladder to
recognize and retain experienced staff nurses; Ullery
(1984) presents its usefulness for conducting annual
excellence.
• Balasco and Black (1988) and Silver (1986a,
1986b) used Benner’s work as a basis for
differentiating clinical knowledge
development and career progression in
nursing.
• Neverveld(1990) used Benner’s rationale and
format in the development of basic and
advanced preceptor workshops.
• Farrell and Bramadat(19900 used Benner’s
paradigm case analysis in a collaborative
educational project between a university
school of nursing and a tertiary care teaching
hospital to better understand the
development of clinical reasoning skills in
actual practice situations. Crissman and
Jelsma(1990) applied Benner’s findings to
develop a cross-training program to address
staffing imbalances.
• EDUCATION
- Benner (1982)critiqued the concept of
competency based testing by contrasting it.
- Competency- based testing seems limited to
the less situational, less interactional areas of
patient care where the behaviour can be well
defined and patient and nurse variations do
not alter the performance criteria”
• RESEARCH
- Maintains that there is excellence and power in
clinical nursing practice made visible through
articulation research.
Articulation research
- Dictates data be collected through situation- based
dialogue and observation of actual practice
 CRITIQUE
• CLARITY
- Novice to Expert model has led to its use
among nurses around the world.
- An identification with the idea of clinical
wisdom and varying levels of clinical expertise
development progressed very quickly.
• SIMPLICITY
- Developed interpretive descriptive accounts of
clinical nursing practice.
- The model is relatively simple with regard to
the five stages of skill acquisition, and it
provides a comparative guide for identifying
levels of nursing practice from individual nurse
descriptions validated by consensus.
• GENERALITY
- Has universal characteristics; that is, it is not
restricted by age, illness, health, or location of nursing
practice.
• Reference: Alligood, Martha. Nursing Theories
and their works, 9th edition.