1. Patriacia Benner

From Novice to Expert

Patricia Benner

“Nursing is concerned with the social sentient body that dwells with the finite human worlds; that gets sick and recovers; that is altered during illness, pain and suffering ; and that engages with the world differently upon recovery.”

Getting to know the theorist…• Born in Hampton, Virginia, and spent her childhood in

California, where she had her early and professional education.

• In 1964 she Received her Bachelor’s Degree in Nursing from Pasadena College

• 1970 Master’s Degree in Medical Surgical Nursing from the University of California, San Francisco

• Ph.D from University of California, Berkeley• Complete her doctorate in 1982

Getting to know the theorist…• In 1989 she achieved the position of Associate

Professor in the Department of Physiological Nursing in the School of Nursing at the University of California, San Francisco.

• Became tenured professor in 1989• Moved to the department of Social and Behavioural

Sciences at UCSF in 2002. where she is a professor and the first occupant of the Thelma Shobe Cook Endowed Chair In Ethics and Spirituality

Nursing Metaparadigm:

Client/ Person

• “The 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 a life.”- Dr. Benner

• major aspects of understanding that the person must deal with as:– The role of the situation– The role of the body– The role of the personal concerns– The role of temporality

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.

Environment/Situation

• Benner uses situation rather than environment because situation suggests a social environment with social definition and meaning.

• She used the phenomenological terms of being situated and situated meaning, which are defined by the persons engaged interaction, interpretation and understanding the situation.

Nursing

• Nursing is described as a caring relationship, an “enabling condition of connection and concern.” -Dr. Benner

• Dr. Benner viewed nursing practice as the care and study of the lived experience of health, illness, and disease and the relationships among the three elements.

Skill Acquisition in Nursing:

From Novice to Expert

EXPERT

PROFICIENT

COMPETENT

ADVANCED BEGINNER

NOVICE

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 the situation.

• Generally this level applies to nursing students.

Advanced Beginner• Has a sufficient experience to

easily understand aspects of the situation. Unlike attributes and features, aspects cannot be objectified completely because they require experience based on recognition in the background of the situation.

• Nurses functioning at this level are guided by rules and oriented by task completion. Benner places most newly graduated nurses at this level.

Competent• The competent stage is the most

pivotal in clinical learning because the learner must begin 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 on the basis of the relevant facts of that situation.

Proficient • The performer perceives the situation

as a whole rather than in terms of aspects and performance.

• Proficient level is a qualitative leap beyond the competent.

• In this level, the performer identifies the most significant aspects and has a better understanding of the situation based on background understanding.

• Show an increased confidence in their knowledge and skills. In this stage, there is much more involvement with the patient and family.

Expert

• Fifth stage of the Dreyfus model is achieved when “the expert performer no longer relies on analytical principles to connect her or his understanding of the situation to an appropriate action.

• There is qualitative change as the expert performer “knows the patient”, which means that knowing typical patterns of responses and knowing the patient as a person.

Key aspects of the expert nurse practice are as follows ( Benner et al., 1996):

• Demonstrating a clinical grasp and resource-based practice.

• Possessing embodied knowledge

• seeing the big picture

• Seeing the unexpected

Seven domains of nursing practice

• Helping role

• Teaching or coaching function

• Diagnosis client- monitoring function

• Effective management of rapidly changing situations

• Administering and monitoring therapeutic interventions and regimens

• Monitoring and ensuring quality health care practices

• Organizational and work- role competencies

Acceptance by the Nursing Community

Practice• Describe nursing practice using an interpretive

approach. The model has been used to aid in the development of clinical ladders of promotion, new graduate orientation program and clinical knowledge development seminars.• Greatly contributed in the competency ladders and

promotions in the nursing service organization.

Education»Benner’s seven domains of nursing

practice have the greatest influence and impact on nursing education with regards to her works.

Research»Her researches have been used in

studying the impact of nursing and its seven domains in every aspect of the profession.

analysis …

Simplicity» Benner’s model is comparatively simple about the five

stages of skill acquisition. It gives a relative guide for classifying levels of nursing practice, from individual nurse description and observations to actual nursing practice.

Generality» Benner’s model has universal characteristic for the reason

that it is not restricted by age, illness, health, or location of nursing practice. However, the characteristic of theoretical universality involve properties of functionality for prediction that is not part of this perspective.

Empirical precision» Benner’s model was tested using qualitative

methodologies. Succeeding researches suggest that the framework is applicable and useful in providing knowledge of the description of nursing practice.

Derivable consequences» The usefulness of Benner’s model gives a general

framework for identifying, defining, and describing clinical nursing practice. She uses phenomenological approach to express and obtain meaning and abilities from interactions in life situation.

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