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PATRICIA BENNER

A Professor Emerita at the University of California, SanFrancisco


BA in Nursing- Pasadena College/Point Loma College
Masters Degree in Med/Surg. Nursing from UCSF

Achieved her Ph.D at UCSF and UC Berkeley in 1970 and,and has done researches in
the same university since1979

Published 9 books and numerous articles

Published Novice to Expert Theory 1982

Introduced the concept that expert nurses develop skillsand understanding of patient care
over time through a
sound educational base
as well as a
multitude ofexperience

Proposed that one could gain knowledge and skills


(knowing how) without ever learning the theory(knowing that)

She conceptualizes in her writing about nursing skills asexperience is a prerequisite for
becoming an expert.

Proposed that the development of knowledge in applieddisciplines such as medicine and


nursing is composed ofthe extension of practical knowledge (know how) throughresearch
and the characterization and understanding of
the know how of clinical experience.
PATRICIA BENNER

A Professor Emerita at the University of California, SanFrancisco

BA in Nursing- Pasadena College/Point Loma College

Masters Degree in Med/Surg. Nursing from UCSF

Achieved her Ph.D at UCSF and UC Berkeley in 1970 and,and has done researches in
the same university since1979

Published 9 books and numerous articles

Published Novice to Expert Theory 1982

Introduced the concept that expert nurses develop skillsand understanding of patient care
over time through a
sound educational base
as well as a
multitude ofexperience

Proposed that one could gain knowledge and skills


(knowing how) without ever learning the theory(knowing that)

She conceptualizes in her writing about nursing skills asexperience is a prerequisite for
becoming an expert.

Proposed that the development of knowledge in applieddisciplines such as medicine and


nursing is composed ofthe extension of practical knowledge (know how) throughresearch
and the characterization and understanding of
the know how of clinical experience.
5 levels of nursing experience:
1.

Novice2.
Advance Beginner3.
Competent4.
Proficient5.
Expert
Novice

Beginner with no experience

Taught general rule to help perform tasks

Rules are: context-free, independent of specific cases andapplied universally

Rule-governed behavior is limited and inflexible

Eg: Tell me what I need to do and Ill do it


Advance Beginner

Demonstrates acceptable performance

Has gained prior experience in actual situations torecognize recurring meaningful


components

Principles, based on experiences, begin to be formulatedto guide actions


PATRICIA BENNER

A Professor Emerita at the University of California, SanFrancisco

BA in Nursing- Pasadena College/Point Loma College

Masters Degree in Med/Surg. Nursing from UCSF

Achieved her Ph.D at UCSF and UC Berkeley in 1970 and,and has done researches in
the same university since1979

Published 9 books and numerous articles

Published Novice to Expert Theory 1982

Introduced the concept that expert nurses develop skillsand understanding of patient care
over time through a
sound educational base
as well as a
multitude ofexperience

Proposed that one could gain knowledge and skills


(knowing how) without ever learning the theory(knowing that)

She conceptualizes in her writing about nursing skills asexperience is a prerequisite for
becoming an expert.

Proposed that the development of knowledge in applieddisciplines such as medicine and


nursing is composed ofthe extension of practical knowledge (know how) throughresearch
and the characterization and understanding of
the know how of clinical experience.
5 levels of nursing experience:
1.
Novice2.
Advance Beginner3.
Competent4.

Proficient5.
Expert
Novice

Beginner with no experience

Taught general rule to help perform tasks

Rules are: context-free, independent of specific cases andapplied universally

Rule-governed behavior is limited and inflexible

Eg: Tell me what I need to do and Ill do it


Advance Beginner

Demonstrates acceptable performance

Has gained prior experience in actual situations torecognize recurring meaningful


components

Principles, based on experiences, begin to be formulatedto guide actions


Competent

Typically a nurse with 2-3 years experience on the job inthe same area or in similar dayto-day situations

More aware of long-term goals

Gains perspective from planning own actions based onconscious, abstract and analytical
thinking and helps toachieve greater efficiency and organization.
Proficient

Perceives and understands the situations as whole parts

More holistic understanding improves decision-making

Learns from experiences what to expect in certainsituations and how to modify plans

Have a 5-year experience


Expert

No longer relies in principles, rules or guidelines toconnect with situations and determine
actions

Much more background of experience

Has intuitive grasp of clinical situations


Performance is now fluid, flexible and highly proficient
7 Domains of Nursing Practice
Helping role2.
Teaching of coaching function3.
Diagnostic client-monitoring function4.
Effective management of rapidly changing situations5.
Administering and monitoring therapeuticinterventions and regimens6.
Monitoring and ensuring quality of health carepractices
7.
Organizational and work-role competencies
METAPARADIGM

Nursing Benner described nursing as an


enablingcondition of connection and concern
which shows a

high level of emotional involvement in the nurse-client relationship. She viewed nursing
practice asthe care and study of the lived experience of health,illness and disease and the
relationships among thesethree elements.

Person Benner stated that


a self-interpretingbeing, that is, the person does not come in to theworld predefined but
gets defined in the course of
living a life. A person also hasan effortless and non
-reflective understanding of the self in the world
.
The person is viewed as a participant in common
meanings.
Benner conceptualized that major aspects ofunderstanding that a person must deal with
as:1.
The role of the situation.2.
The role of the body.
3.
The role of personal concerns.4.
The role of temporality.

Health

Benner focused
on the lived experience ofbeing healthy and ill
.
She defined health as what canbe assessed, while well-being is the humanexperience of
health of wholeness. Well-being andbeing ill are recognized as different ways of being
inthe world. Health is described as not just the absenceof disease and illness. Also, a
person may have adisease and not experience illness because illness isthe human
experience of loss or dysfunction,whereas disease is what can be assessed at thephysical
level.

Environment


instead of using the term
environment, benner used the term situation,
because it suggests a social environment with socialdefinition and meaning. She used
thephenomenological terms of being situated and
situated meaning, which are defined by the persons
engaged interaction, interpretation andunderstanding of the situation.
ANALYSISSimplicity
Benners model is comparatively simple about the
five stages of skill acquisition. It gives a relative guide forclassifying levels of nursing
practice, from individual nursedescriptions and observations to actual nursing practice.
Theinterpretations are validated by agreement or by generalacceptance.Clinical knowledge
is relational and deals with local,specific, historical issues. Benner uses narrative accounts
ofactual clinical situations and preserves that the modelenablers the reader to recognize
similar intents and
meanings, although the objective circumstances may be quitedifferent.
Generality
Benners model has universal characteristic for the
reason that it is not restricted by age, illness, health, orlocation of nursing practice.
However, the characteristic oftheoretical universality involve properties of functionality
forprediction that is not a part of this perspective.The descriptive model of nursing
practice has thepotential for universal application as a framework; howeverthe
descriptions are limited by dependence on the actualclinical nursing situations from which
they must be used. Itdepends on the understanding of the five levels ofcompetency and
the ability to identify the characteristicintentions and meanings intrinsic at each level of
practice.
Empirical Precision
In terms of empirical precision, Benners model was
tested using qualitative methodologies. Succeedingresearches suggest that the
framework is applicable anduseful in providing knowledge of the description of nursing
practice. The strength of Benners model is that data
-basedresearch contributes to the science of nursing.
Derivable Consequences
The usefulness of Benners model gives a general
framework for identifying, defining and describing clinicalnursing practice. She uses a
phenomenological approach toexpress and obtain meaning and abilities from interactions in
life situation. The implication of Benners research findings
lies on her conclusion
that a nurses clinical knowledge is
relevant to the extent to which its manifestation is nursing

skill makes a difference in patient care and patient outcome.


ACCEPTANCE BY THE NURSING COMMUNITYPractice
The model has been used to aid in the developmentof clinical ladders of promotion, new
graduateprograms and clinical knowledge developmentseminars
Education
Nursing educators have realized that learning needsat the early stages of clinical
knowledge developmentare different from those required at later researches.
Research
Her researches have been used in studying theimpact of nursing and its seven domains in
everyaspect of the profession.Nurses have a clear vision of the competenciesrequires in order for them to climb up into
theleadership ladder.
REFERENCES

Dracup and Bryan-Brown. From Novice to Expert toMentor Shaping the Future - American
Journal of CriticalCare. 2004;13: 448-450.

Jane Corrigan Wandel. The Institute for NursingHealthcare Leadership Conference:


Reflections on theImpact of Patricia Benner's Work. MedscapeNurses. 2003;5(2).
Accessed on 5-04-2010fromhttp://www.medscape.com/viewarticle/462607 Prepared
by:Jezrel Oberes

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