PATRICIA BENNER

FROM NOVICE TO EXPERT MODEL: STAGES OF NURSING EXPERTISE NURSING

PHILOSOPHIES
BIOGRAPHY & CAREER
 Born on August 31, 1942, in Hampton, Virginia
 1964, earned her Bachelor of Arts in Nursing from Pasadena College
 1960, worked in nursing field
 1970 – 1975, research associate at the University of California at San Francisco School of
Nursing
PUBLISHED BOOKS
 Caring, Clinical Wisdom, and Ethics in Nursing Practice
 From Novice to Expert Model: Stages of Nursing Expertise Nursing Philosophies
 The Primacy of Caring Model
CO-AUTHORED BOOKS
 Expertise in Nursing Practice: Caring, Clinical judgment, and Ethics
 Clinical Wisdom in Critical Care: A Thinking-in-Action Approach
METAPARADIGM
1. Nursing
- Described as an “enabling condition of connection and concern” which shows a high
level of emotional involvement in the nurse-client relationship.
- Viewed nursing practice as the care and study of the lived experience of health, illness,
and disease and the relationships among these three elements.

2. Person
- Stated that “a self-interpreting being, that is, the person does not come into the world of
predefined but gets defined in the course of living a life. A person also has an effortless
and non-reflective understanding of the self in the world. The person is viewed as a
participant in common meanings.”
- Believed that there are significant aspects that make up a person.
- She had conceptualized the major aspects of understanding that the person must deal with
as:
 The role of the situation.
 The role of the body.
 The role of personal concerns.
 The role of temporality.

- Goal: Overcome the Cartesian dualism, the view that the mind and body are distinct,
separate entities.
 - Embodiment is the capacity of the body to respond to meaningful situations.

5 DIMENSIONS OF THE BODY (MERLEAU, PONTY & DREYFUS)

 The unborn complex
 The habitual skilled body
 The projected body
 The actual projected body
 The phenomenal body

3. Health
- Focused “on the lived experienced of being healthy and ill.”
- Defined health as what can be assessed, while well-being is the human experience of
health or wholeness.
- Well-being and being ill are recognized as different ways of being in the world.
- Health is described as not just the absence of disease and illness. Also, a person may have
a disease 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.

4. Environment
- Used the term “situation” instead, because it suggests a social environment with social
definition and meaning.
- Used the phenomenological terms being situated and situated meaning, which are defined
by the person’s engaged interaction, interpretation and understanding of the situation.

5 LEVELS OF SKILL ACQUISITION AND SKILL DEVELOPMENT

1. Novice
- This would be a nursing student in his or her first year of clinical education: behavior in
the clinical setting is very limited and flexible.
- Novices have a very limited ability to predict what might happen in a particular patient
situation.
- Signs and symptoms, such as change in mental status, can only be recognized after a
novice nurse has had experience with patients with similar symptoms.

2. Advance beginner
- Those are the new grads in their first jobs; nurses have had more experiences that enable
them to recognize recurrent, meaningful components of a situation.
- They have knowledge and the know-how but not enough in-depth experience.
 3. Competent
- These nurses lack the speed and flexibility of proficient nurses, but they have some
mastery and can rely on advance planning and organizational skills.
- Competent nurses recognize patterns and nature of clinical situations more quickly and
accurately than advanced beginners.

4. Proficient
- At this level, nurses are capable to see situations as “wholes” rather than parts.
- Proficient nurses learn from experience what events typically occur and are able to
modify plans in response to different events.

5. Expert
- Nurses who are able to recognize demands and resources in situations and attain their
goals.
- These nurses know what needs to be done.
- They no longer rely solely on rules to guide their actions under certain situations.
- They have an intuitive grasp of the situation based on their deep knowledge and
experience.
- Focus is on the most relevant problems and not irrelevant ones.
- Analytical tools are used only when they have no experience with an event, or when
events don’t occur as expected.

MAJOR CONCEPTS AND DEFINITIONS

1. Aspects of a Situation
- The recurring meaningful situational components recognized and understood in context
because the nurse has previous experience.

2. Attribute of a Situation
- Measurable properties of a situation that can be explained without previous experience in
the situation.

3. Competency
- It is “an interpretively defined area of skilled performance identified and described by its
intent, functions, and meanings.”

4. Domain
- An area of practice having a number of competencies with similar intents, functions, and
meanings.

5. Exemplar
- An example of a clinical situation that conveys one or more intents, meanings, functions,
or outcomes easily translated to another clinical situation.
 6. Experience
- An active process of refining and changing preconceived theories, notions, and ideas
when confronted with actual situations; implies there is a dialogue between what is found
in practice and what is expected.

7. Maxim
- Cryptic description of skilled performance that requires a certain level of experience to
recognize the implications of the instructions.

8. Paradigm case
- A clinical experience that stands out and alters the way the nurse perceives and
understands future clinical situations.
- Paradigm cases create new clinical understanding and open new clinical perspective and
alternatives.

9. Salience
- A perceptual stance or embodied knowledge whereby aspects of a situation stand out as
more or less important.

REFERENCES:
 Books
- Udan, Josie Q. (2020). Theoretical Foundation in Nursing – Second Edition

REPORTERS:
Continente, Kyra Shienelle
Miranda, Kiana Valerie