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Patricia E. Benner R.N., Ph.D., FAAN

Patricia E. Benner R.N., Ph.D., FAAN

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Patricia E. Benner R.N., Ph.D., FAAN

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  1. Patricia E. BennerR.N., Ph.D., FAAN By Courtney Madsen, Barb Lentz, Denise Lyon, Yvonne Robles, Dawn Kooiman, and Lynda Chase

  2. Historical Evolution of Theory:Novice to Expert • Born in Hampton, Virginia • Grew up in California • Degrees: • Baccalaureate~ Pasadena College- 1964 • Masters in Nursing~University of California- 1970 • PhD~ University of California- 1982 • Published From Novice to Expert- 1984 • Became a Fellow in the American Academy of Nursing- 1985

  3. Model as Framework for Patient AssessmentNovice to Expert • The Novice: First Year of Education • No background experience • Instructor provides clear directions • Students are coached and need supervision • Advanced Beginner: New Graduate • Now have full legal and professional responsibilities • Style of evaluation still lacks • Continues to rely on textbook s/s and may have difficulties recognizing subtle variations

  4. Model as Framework for Patient Assessment Cont. • Competent Stage: 1 to 2 Years in Practice • Time for planning of the immediate future related to learned information from past experiences • A nurse can now forecast using planning and analysis • More subtle s/s are now recognized

  5. Model as Framework for Patient Assessment Cont. • Proficiency: • A nurse now has an enhanced ability to read a situation • Now open to correction an discomfirmation of a situation • Responsiveness to changes and critical thinking unfolds

  6. Model as Framework for Patient Assessment Cont. • Expertise: • Now attends primarily to actions rather than assessment of signs and symptoms • The integrated rapid response is the hallmark of expertise • More proficient in an emergent situation

  7. Model used in Clinical Practice • Implement a staff development program • A clinical ladder evaluation tool • Novice: ICU nurse transferred to the OR, these require very different nursing skills • Advanced Beginner: New graduate nurse on a med-surg floor would require a much more in-depth orientation than a nurse with previous experience • Competent: An OB nurse has the ability to care for a patient on a labor and delivery unit, but if a more difficult and serious situation arises a proficient or expert OB nurse would need to step in

  8. Model used in Clinical Practice Cont. • Proficient: A cardiac rehab nurse recognizes changes in the patients ECG monitor while the patient exhibits exertion. The nurse immediately implements her skills from knowledge and expertise that appropriately prevent a worsening outcome • Expert: ICU nurse caring for a post open-heart patient in which he or she is able to anticipate needs from various tests and readings. This nurse also has the ability to teach using a through explanation to the patient and family. • An expert nurse exhibits leadership qualities and is a good preceptor to new nurses

  9. Model used in Clinical Practice Cont. • Clinical Ladder Evaluation Tool: It can be used as an advancement program for nurses. A clinical ladder helps with retention of experienced nurses • “Clinical ladders recognize and reward nurses for their clinical development and expertise, while encouraging them to remain involved in direct patient care activities” • As a nurse moves along the ladder, they need to show proof of advancement in their practice such as continuing education and leadership qualities

  10. Model within Nursing Education • The movement from novice to expert reflects learning and shows changes in three aspects of performance • Working paradigm shifts from reliance on abstract principles to concrete past experiences • Shifts from seeing situations as discreet unrelated parts, to seeing situations as part of a whole • Position shifts from detached observer to involved performer • Studies show novice professionals tend to govern their practice with rule-oriented behavior. • Must rely on rules they have learned in preparatory education to function

  11. Interested in the Dreyfus model of skill acquisition and applied it to nursingArea of concern~ not how to do nursing, but rather, “how do nurses learn to do nursing?”Worked several years in intensive care, then became a nurse researcher Studied the nature of nursing practice and how nurses gain expertiseStudied with Richard Lazarus who developed a theory of stress and copingInfluenced by Heidegger, who stressed phenomenological descriptions of people defined by their concerns, practices, and life experiences

  12. Metaparadigms • Person: Aself interpreting being that becomes defined in the course of living a life. A person is embodied • Four major aspects of understanding • The situation • Their body • Their personal concerns • The fact that they are only temporary • When caring for the person, nurses tend to all four aspects • Health • Nursing

  13. Metaparadigms cont. • Situation (Environment): Situation conveys a social interaction, interpretation, and understanding • Each situation is individual because their meanings, habits, and perspectives influence the situation • People will react differently in each situation because of their own personal interpretation (Alligood @ Tomey, 2010, p. 149) • Health: Two aspects include health and well-being • Health~ can be assessed at the physical level • Well-being~ human experience of health • Health is not just the absence of disease

  14. Metaparadigms cont. • Nursing: Nursing is viewed as a caring practice whose science is guided by the moral and ethical standards of care and responsibility

  15. Current Research Status • Benner’s model serves as a map that directs care, and is used as a tool in current nursing practice • Her work is useful in that it frames nursing practice in the context of what nursing actually is and does • Many occupations have adapted this model to benefit their employees and their customers • Benner’s call is to “increase public storytelling” to validate nursing as an ethical caring practice, and “to extend, alter, and preserve ethical distinctions and concerns” (Benner, 1991, pp. 19-20) • Her approach continues to be dynamic and specific for each institution

  16. Unique Concepts • The model is situational, based on skill level and changes in performance • Performance is a function of a nurse’s familiarity with certain situations • Performance level can only be determined by expert judges and the outcomes of the situation • Clinicians at different levels of practice live in different clinical worlds • Author & project director of Achieving Methods of Intraprofessional Consensus, Assessment and Evaluation

  17. Unique Concepts Cont. • Benner’s explanation of nursing practice goes beyond rules and theories – based on “reasonable behavior that responds to the demands of a given situation” • Incorporated Lazarus’s stress and coping theory – used this key concept to describe clinical nursing practice in terms of nurses making a positive difference by being a part of the situation in a caring way • Novice to Expert concept, shows that clinical experience becomes knowledge and theory • Benner differentiated between practical and theoretical knowledge

  18. Strengths and Limitations • Continue to learn through experience • Experience becomes a prerequisite for becoming an expert • Lays ground work for the development of preceptors and mentors • Preceptors help new nurses deal with the uncertainty of the clinical setting • Not everyone fits into this model • You need to be able to classify in order for the theory to work • No room for advancement or no opportunity for a certification in a specialty area

  19. Analysis: Benner proposes that one could gain knowledge and skills (“knowing how”) whithout learning the theory (“knowing that”) (Dracup, 2004)Accomplished by defining 5 levels of development The novice sees the patient as a list of tasksAn expert sees all of the pieces and makes a whole

  20. Insights: • This model can serve as a basis for developing a mentorship program at facilities to support new nurses as they enter the field • This is particularly important with the magnitude of nurses that graduate each year • Due to the changes in healthcare and advancements in technology more nurses will be needed • Longevity is increasing everyday and now healthcare will be available to more people in the future • Understanding this model and the five levels from Novice to Expert will assist nurses with excelling in their careers

  21. References • Acclaim Images, LLC. Nurse Clipart. Picurtes and photos. • Alligood, M .R. & Tomey, A. M. (2010). Nursing Theorists and their Work. Maryland Heights, MO: Mosby, Elsevier (978-0-323-05641-0) • Benner, P. (1982). From novice to expert. American Journal of Nursing, 82, 402-407. • Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, • California: Addison-Wesley Publishing Company. • Benner, P., & Tanner, C. (1987). Clinical judgment: How expert nurses use intuition. American Journal of Nursing, 87, 23-31. • Benner, P., Tanner, C., & Chesla, C. (1992). From beginner to expert: Gaining a differentiated clinical world in critical care nursing. ANS Advances in Nursing Science, 14(3), 13-28. • Benner, P. (2004). Using the Dreyfus Model of Skill Acquisition to Describe and Interpret Skill Acquisition and Clinical Judgment in Nursing Practice and Education. Bulletin of Science Technology Society. Vol. 24. No. 3 Pp. 188-199. Doi 10.1177/0270464604265061 • Brykczynski, Karen A (2010). Caring, Clinical Wisdom, and Ethics in Nursing Practice, A.M. Tomey, M.R. Alligood, Nursing theorists and their work (7th ed., pp.137-164) Maryland Heights, MD: Mosby Elsevier • Dracup, K. and Bryan-Brown, C. (2004) From Novice to Expert to Mentor: Shaping the Future. American Journal of Critical Care, 13 (6), 448-450. Retrieved from • Haag-Heitman, B. (1999). Clinical practice development using novice to expert theory. Gaithersburg, MD: Aspen. • Marshall, June (2006). Retain top nurses with a clinical ladder. HCPro’s Weekly Update on the ANCC Magnet Recognition Program. • University of California, San Francisco. (2006) Patricia Benner: Faculty Profile. UCSF of Nursing. Retrieved from