Nu602 Unit2 Assignment Patricia Benner

Patricia BennerPatricia BennerNurse TheoristNurse Theorist

A blog power point assignment in partial A blog power point assignment in partial fulfillment of the requirements for NU fulfillment of the requirements for NU

602 Advanced Role Theory in the 602 Advanced Role Theory in the College of Nursing University of North College of Nursing University of North

AlabamaAlabama

Patricia Benner: An Influential Patricia Benner: An Influential Nurse in the Development of Nurse in the Development of

the Profession of Nursingthe Profession of Nursing• Patricia Benner’s research and theory Patricia Benner’s research and theory work provides the profession of nursing work provides the profession of nursing with what we now know as the Novice with what we now know as the Novice

to Expert model, also known as to Expert model, also known as Benner’s Stages of Clinical Benner’s Stages of Clinical

Competence. Benner’s work as applied Competence. Benner’s work as applied to the nursing profession is adapted to the nursing profession is adapted

from the Dreyfus Model of Skill from the Dreyfus Model of Skill Acquisition.Acquisition.

Skill AcquisitionSkill Acquisition

• ““The utility of the The utility of the concept of skill concept of skill acquisition lies in acquisition lies in helping the teacher helping the teacher understand how to understand how to assist the learner assist the learner in advancing to the in advancing to the next level” next level” (McClure, (McClure, 2005)2005)

The Dreyfus Model of Skill The Dreyfus Model of Skill Acquisition is shown on the Acquisition is shown on the next slide: next slide: (Dreyfus, 2008).(Dreyfus, 2008).

““Three studies using the Dreyfus model of skill Three studies using the Dreyfus model of skill acquisition were conducted over a period of 21 acquisition were conducted over a period of 21 years. Nurses with a range of experience and years. Nurses with a range of experience and reported skill fullness were interviewed. Each study reported skill fullness were interviewed. Each study used nurses' narrative accounts of actual clinical used nurses' narrative accounts of actual clinical situations. A subsample of participants were situations. A subsample of participants were observed and interviewed at work. These studies observed and interviewed at work. These studies extend the understanding of the Dreyfus model to extend the understanding of the Dreyfus model to complex, underdetermined and fast paced complex, underdetermined and fast paced practices. The skill of involvement and the practices. The skill of involvement and the development of moral agency are linked with the development of moral agency are linked with the development of expertise, and change as the development of expertise, and change as the practitioner becomes more skillful. Nurses who had practitioner becomes more skillful. Nurses who had some difficulty with understanding the ends of some difficulty with understanding the ends of practice and difficulty with their skills of practice and difficulty with their skills of interpersonal and problem engagement did not interpersonal and problem engagement did not progress to the level of expert. Taken together, progress to the level of expert. Taken together, these studies demonstrate the usefulness of the these studies demonstrate the usefulness of the Dreyfus model for understanding the learning needs Dreyfus model for understanding the learning needs and styles of learning at different levels of skill and styles of learning at different levels of skill acquisition.” acquisition.” (Benner, 2004).(Benner, 2004).

Patricia Benner HonoredPatricia Benner Honored

• In 2003, the In 2003, the Institute for Institute for

Nursing Healthcare Nursing Healthcare Leadership Leadership

celebrated the 20celebrated the 20thth anniversary of anniversary of Benner’s work.Benner’s work.

““Introduced at the podium as ‘the person who Introduced at the podium as ‘the person who taught the world how to listen to the voice of the taught the world how to listen to the voice of the nurse’, Benner discussed the importance of nurse’, Benner discussed the importance of attending to the expertise embedded in clinical attending to the expertise embedded in clinical nursing practice. For nursing practice to flourish, nursing practice. For nursing practice to flourish, she said, nurses must deepen their understanding she said, nurses must deepen their understanding of the important knowledge that develops during of the important knowledge that develops during clinical work. Citing the often-discussed ‘theory to clinical work. Citing the often-discussed ‘theory to practice gap’ in which elements of science do not practice gap’ in which elements of science do not move into practice, she discussed the ‘practice to move into practice, she discussed the ‘practice to theory’ gap in which clinicians fail to recognize and theory’ gap in which clinicians fail to recognize and develop the knowledge that can only be gained in develop the knowledge that can only be gained in the world of experience.”the world of experience.”(Wandel, 2003).(Wandel, 2003).

Benner’s accomplishmentsBenner’s accomplishments

• Benner’s Benner’s accomplishments are accomplishments are many, in addition to many, in addition to being a faculty member being a faculty member at UC San Francisco, at UC San Francisco, she has authored nine she has authored nine books and numerous books and numerous articles, she is an articles, she is an internationally known internationally known lecturer and researcher lecturer and researcher on health, stress, and on health, stress, and coping, skill acquisition coping, skill acquisition and ethics.and ethics.

The impetus for Ms. Benner’s The impetus for Ms. Benner’s involvement in nursing and her involvement in nursing and her important research is summarized on important research is summarized on her website:her website:• ““In a highly changing health care environment, the In a highly changing health care environment, the

core of the hospital, the core of the hospital is core of the hospital, the core of the hospital is patient care and the core of the core is the practice patient care and the core of the core is the practice of the nurses who are with patients on a 24-hour of the nurses who are with patients on a 24-hour basis. Whether the hospital finds itself in a time of basis. Whether the hospital finds itself in a time of strong or lean financial resources, or a time of strong or lean financial resources, or a time of nursing shortage or surplus, the key question is nursing shortage or surplus, the key question is whether, in this era of highly acute patients, there whether, in this era of highly acute patients, there are nurses who have an excellence of practice that are nurses who have an excellence of practice that can directly affect how a patient progresses to can directly affect how a patient progresses to discharge and reduce unnecessary recidivism.” discharge and reduce unnecessary recidivism.”

• (Benner, 2009).(Benner, 2009).

Benner’s work in applying the Benner’s work in applying the Dreyfus Model of Skill Dreyfus Model of Skill Acquisition has produced the Acquisition has produced the following five stages of nursing following five stages of nursing expertise:expertise:

Stage 1: NoviceStage 1: Novice

• ““Beginners have no Beginners have no experience of the experience of the situations in which situations in which they are expected they are expected to perform.” to perform.” (Benner, (Benner, 1984). 1984).

These inexperienced nurses function at the These inexperienced nurses function at the level of instruction from nursing school. level of instruction from nursing school. They are unable to make the leap from the They are unable to make the leap from the classroom lecture to individual patients. classroom lecture to individual patients. Often, they apply rules learned in nursing Often, they apply rules learned in nursing school to all patients and are unable to school to all patients and are unable to discern individual patient needs. These discern individual patient needs. These nurses are usually new graduates, or those nurses are usually new graduates, or those nurses who return to the workplace after a nurses who return to the workplace after a long absence and are re-educated in long absence and are re-educated in refresher programs.refresher programs.

Stage 2: Advanced BeginnerStage 2: Advanced Beginner

• ““Advanced beginners Advanced beginners are those who can are those who can demonstrate demonstrate marginally acceptable marginally acceptable performance, those performance, those who have coped with who have coped with enough real situations enough real situations to note or to have to note or to have pointed out to them by pointed out to them by a mentor, the recurring a mentor, the recurring meaningful situations meaningful situations components.” components.” (Benner, (Benner, 1984).1984).

Advanced beginners are able Advanced beginners are able to translate some didactic and to translate some didactic and clinical learning principles to clinical learning principles to individual patients, but often individual patients, but often lack the real life experiences lack the real life experiences that differentiate individual that differentiate individual patients.patients.

Stage 3: CompetentStage 3: Competent

• ““Competence, typified Competence, typified by the nurse who has by the nurse who has been on the job in the been on the job in the same or similar same or similar situations two or three situations two or three years, develops when years, develops when the nurse begins to see the nurse begins to see his or her actions in his or her actions in terms of long-range terms of long-range goals or plans of which goals or plans of which he or she is consciously he or she is consciously aware.” aware.” (Benner, 1984).(Benner, 1984).

Competent nurses are able to plan and Competent nurses are able to plan and care for patients on an individual basis care for patients on an individual basis following a plan of care or the lead of a following a plan of care or the lead of a more experienced nurse. Competent more experienced nurse. Competent nurses are able to provide safe care, nurses are able to provide safe care, but are not looked upon as formal or but are not looked upon as formal or informal leaders. Their decision-informal leaders. Their decision-making abilities usually consist of making abilities usually consist of individual circumstances and rarely individual circumstances and rarely are they able to see how one situation are they able to see how one situation affects the ‘big picture’.affects the ‘big picture’.

Stage 4: ProficientStage 4: Proficient

• ““The proficient The proficient performer perceives performer perceives situations as wholes situations as wholes rather than in terms of rather than in terms of chopped up parts or chopped up parts or aspects, and aspects, and performance is guided performance is guided by maxims. Proficient by maxims. Proficient nurses understand a nurses understand a situation as whole situation as whole because they perceive because they perceive its meaning in terms its meaning in terms of long term goals.” of long term goals.” (Benner, 1984).(Benner, 1984).

The proficient nurse frequently is able to The proficient nurse frequently is able to assume charge nurse duties and lead a assume charge nurse duties and lead a group of nurses in clinical practice. They are group of nurses in clinical practice. They are frequently able to manage care of several frequently able to manage care of several patients without direct supervision. These patients without direct supervision. These nurses provide formal and informal nurses provide formal and informal leadership to the nursing unit, and are often leadership to the nursing unit, and are often the nurse that is called upon by the less the nurse that is called upon by the less experienced nurse to provide assistance.experienced nurse to provide assistance.

Stage 5: ExpertStage 5: Expert

• ““The expert performer no The expert performer no longer relies on an analytic longer relies on an analytic principle to connect his or principle to connect his or her understanding of the her understanding of the situation to an appropriate situation to an appropriate action. The expert nurse, action. The expert nurse, with an enormous with an enormous background of experience, background of experience, now has an intuitive grasp now has an intuitive grasp of each situation and of each situation and zeroes in on the accurate zeroes in on the accurate region of the problem region of the problem without wasteful without wasteful consideration of a large consideration of a large range of unfruitful, range of unfruitful, alternative diagnoses and alternative diagnoses and solutions.” solutions.” (Benner, 1984).(Benner, 1984).

The expert performs their duties without The expert performs their duties without thinking; they react automatically to thinking; they react automatically to situations and are often ‘thinking ahead’ situations and are often ‘thinking ahead’ during a situation. They frequently are during a situation. They frequently are formal leaders and are called upon to formal leaders and are called upon to provide clinical expertise to other staff provide clinical expertise to other staff members. Many times experts are able to members. Many times experts are able to function seemingly ‘without thinking’ as function seemingly ‘without thinking’ as their abilities seen to others to come as their abilities seen to others to come as second nature.second nature.

Modern TheoristsModern Theorists

• Benner is a relatively Benner is a relatively modern theorist, with modern theorist, with her work having been her work having been done in the early done in the early 1980’s. Since that time 1980’s. Since that time health care has seen health care has seen the advent of DRG’s, the advent of DRG’s, managed care, an managed care, an increase in the acuity of increase in the acuity of patients in the hospital patients in the hospital related to early related to early discharge and bounce discharge and bounce back admissions.back admissions.

Hospital SurvivalHospital Survival

• Her theory of expert nurses Her theory of expert nurses is critical today as the is critical today as the profession begins to realize profession begins to realize the aging of the members of the aging of the members of its workforce and the its workforce and the increasing age of the increasing age of the population who will require population who will require more nursing services. Her more nursing services. Her theory is applicable today, theory is applicable today, as it was at its publication, as it was at its publication, and provides us with a and provides us with a foundation to use for foundation to use for assigning clinical assigning clinical competence, a tool to use to competence, a tool to use to assess competence in the assess competence in the staff nurse.staff nurse.