Patricia Benner
R.N., Ph.D., F.A.A.N., F.R.C.N.
NURSING THEORIST
FROM NOVICE TO EXPERT
Patricia Benner
(photo by Robert Foothorap)
Kelly Lockhart
Sara Young
NURS 324
Spring 2013
Patricia Benner
R.N., Ph.D., F.A.A.N, F.R.C.N.
Patricia Benner
http://www.bing.com/images/search?q=Nursing+Symbols
&FORM=RESTAB#
• Current Professor Emerita at
the University of California, San
Francisco
• Has taught and been involved in
research since 1979.
• Well published in journals and
books.
• Named one of the American
Academy of Nursing’s “Living
Legends” in August, 2011.
• Introduced her “Novice to
Expert” theory in 1982.
• Many publications refer to her
nursing practice model.
Purpose
• Basic overview of nursing theory
• Explanation of Patricia Benner’s work “From Novice to
Expert” model
• Relation of Benner’s work to current practices
Photo courtesy http://www.123rf.com/search.php?word=abstract_nursing&start=0&searchopts=&itemsperpage=60
What is nursing theory?
• “A nursing theory is a set of concepts, definitions,
relationships, and assumptions or propositions derived
from nursing models or from other disciplines and
project a purposive, systematic view of phenomena by
designing specific inter-relationships among concepts for
the purposes of describing, explaining, predicting,
and/or prescribing.”
• Many nursing theories incorporate the four paradigms:
nursing, person, health and environment
(Nursing Theories, 2012)
Why is theory important?
• When nursing practice is built on sound theories, the
profession is strengthened
• Using theory in nursing helps us to:
•
•
•
•
•
Think critically
Analyze information and make clinical judgments
Assist in decision making
Support excellence in practice
Assist novices in becoming experts therefore improving patient care
Photo courtesy http://blogs.hpedsb.on.ca/hjc/1213nevan/
(Black, 2011)
From Novice to Expert Nursing Model
“Patricia Benner developed a concept known as “From Novice
to Expert”. This concept explains that nurses develop skills
and an understanding of patient care over time from a
combination of a strong educational foundation and personal
experiences.” Benner’s theory identifies five levels of nursing
experience: novice, advanced beginner, competent,
proficient, and expert.
(Nursing Theory, 2011)
Benner’s Motivation for Novice to Expert
• Nursing practice has been studied primarily from a
sociological perspective as opposed to the study of nursing
practice itself
• Nursing knowledge is accrued over time; it is embedded in
expertise. Thoughts are based on the Dreyfus model.
• Knowledge has gone uncharted and unstudied because
differences between practical and theoretical knowledge have
been misunderstood
• Well charted nursing practice and observation are essential
for theory development
(Benner, 2001, p. 1)
Benner’s Philosophy
• Benner “proposed that a nurse could gain knowledge and
skills without actually learning a theory” Described as
“knowing how” without “knowing that”
• Development of knowledge in nursing is “a combination of
knowledge through research and understanding through
clinical experience”
Photo: http://www.canstockphoto.com/nurse-word-cloud-concept-11506014.html
(Nursing Theory, 2011)
Benner’s influences
• Virginia Henderson
• Benner has acknowledged that her “thinking has been
influenced greatly by Virginia Henderson.”
• Dreyfus model of Skill acquisition
• Developed in 1980
• Describes five levels of skill acquisition and development
• Model showed advancement through the stages by changes in
performance
• Developed by studying chess players and pilots
• Benner adapted the Dreyfus model for clinical nursing
practice, basis for her work: Novice to Expert.
(Tomey & Alligood, 2006)
Dreyfus Model of Skill Acquisition
Skill Level
Mental
function
Novice
Competent
Proficient
Expert
Master
Recollection
Nonsituational
situational
Situational
Situational
Situational
Recognition
decomposed
decomposed
Holistic
Holistic
Holistic
Decision
analytical
analytical
Intuitive
Intuitive
Intuitive
awareness
monitoring
monitoring
monitoring
Monitoring
absorbed
Table 1: The model in 1980 shows how skill acquisition changes for the given
mental functions throughout advancement in the given skill levels. (Dreyfus
& Dreyfus, 1980)
Dreyfus
Dreyfus model including the 5 levels as
of 1986 (moleseyhill.com)
vs.
Benner
Benner’s Stages of Nursing
Proficiency (nursinginformatics.ca)
Novice to Expert
Benner’s stages of Nursing Proficiency
• Novice
• Advanced Beginner
• Competent
• Proficient
• Expert
Photo courtesy http://nursetopia.net/2011/06/29/star-wars-flavor-to-dr-patricia-benners-novice-to-expert/
The Novice
• Begins with no prior experience
• Taught rules to perform tasks
• Rule governed behavior is limited and inflexible
• Being a novice is not exclusive to students- any nurse
entering a setting without prior experience with that
particular patient population may be limited to the novice
level
Photo: http://shop.atozteacherstuff.com/downloads/daily5-self-evaluation-novice-apprentice-practitionerexpert.html
(Benner, 2001, pp. 20-21)
The Advanced Beginner
• Can demonstrate marginally acceptable performance
• Has gained prior experience in actual nursing situations
• Formulation of guidelines or principles from prior
experiences provide guidance in future experiences
Photo courtesy http://youthvoices.net/discussion/nursing
(Benner, 2001, pp. 22-23)
The Competent Nurse
• Has been on the job in similar situations for 2-3 years
• Aware of long term goals-- gain perspective from planning
their own actions
• Become more efficient and organized
Photo courtesy http://libguides.gvltec.edu/nursing
(Nursing Theory, 2011)
The Proficient Nurse
• Perceives and understands situations as whole parts
• Views patients holistically
• Has learned what to expect in certain situations and
how to modify plans as needed
(Nursing Theory, 2011)
The Expert Nurse
• No longer relies on principles, rules or guidelines to
connect situations and determine actions
• Performances are fluid, flexible, and highly proficient
• Expertise comes naturally
http://www.abstractbrokers.com/Buyers/IndustryLinks/tabid/62/Default.aspx
(Black 2011, p. 137)
(Nursing Theory, 2011)
Benner’s Explanation of the Four Paradigms
• Nursing
• Person
• Health
• Environment
Photo courtesy http://www.emporia.edu/nursing/nursing-mission.html
Nursing
Benner viewed nursing as the care and study of the
lived experience and the relationship of these three
elements:
• Health
• Illness
• Disease
Photo courtesy http://cnx.org/content/m13589/latest/
(Nursing Theories, 2013)
Person
“…the person does not come into the world predefined
but gets defined in the course of living a life”
Benner believed that there are significant aspects that
make the being. She conceptualized these as the roles
of:
• the situation
• the body
• personal concerns
• temporality
Photo courtesy http://www.bing.com/images/search?q=nurse+images&qs=HS&form=QBIR&pq=&sc=80&sp=2&sk=HS1#view=detail&id=8B0FC4FBC4E9A78296B556430D55638F7399DF6D&selectedIndex=832
(Nursing Theories, 2013)
Health
Benner focused “on the lived experience of being
healthy and being ill”
• Health can be assessed
• Well-being is the human experience of health or wholeness
• Illness is the human experience of loss or dysfunction
(Tomey & Alligood, 2006, p. 151)
Photo courtesy http://learningfundamentals.com.au/resources/
Environment
Benner uses the term situation rather than environment.
“Personal interpretation of the situation is bounded by the
way the individual is in it.”
A person’s past, present, and future influences their current
situation
Photo courtesy http://www.howtolearn.com/2012/01/whatdid-we-learn-about-health-and-happiness-in-2011
http://bizchicks.org/2011/02/the-emotion-health-connection/
(Tomey & Alligood, 2006, p. 151)
Relationship of Paradigms to Benner’s Model
The culmination of the four paradigms of nursing
create experiences that nurses utilize to advance
through the stages of Benner’s model From Novice to
Expert
Photo courtesy
http://www.pearsoned.co.uk/Book
shop/detail.asp?item=229360
Photo courtesy
http://www.clker.com/clipartnurse-icon.html
Using Benner’s Model in Practice
Examples of use in practice:
• Preceptorship
• Orientation processes
• Nursing educational programs
• Professional advancement ladders
http://www.galaxyhealth.net/
• Interdepartmental job changes (e.g. medical-surgical nurse
transitioning to an intensive care unit)
Benner in Action
American Association of Critical-Care Nurses (AACN)
Synergy Model
• Developed as a basis for nursing
practice
• Development utilized use of Benner’s
Novice to Expert stages of
development
• Combines nursing competencies with
characteristics of patients to “enhance
optimal patient outcomes” (Kaplow,
2002)
• Patient outcomes will be different at
the different levels of the nurse’s
expertise.
(photo courtesy AACN.org)
Benner in Action
Clinical Ladder Programs
•
Most are based on
stages of clinical
competence of Benner’s
(Murphy, 2012)
•
Intention of the ladder
is to retain experienced
nurses
•
Greater rewards at the
expert levels than the
novice level
Conclusion
This model can be applied to all areas of nursing. It looks at
the education and development of a nurse and how they
become an expert.
Patricia Benner examined how nurses learn to nurse
(Nursingtimes.net, 2010)
Photo courtesy http://depositphotos.com/9744222/stock-illustration-Nursing-home-logo.html
Photo courtesy http://nursesaidetraining.blog.com/
References
American Association of Critical-Care Nurses (2013). Retrieved from www.aacn.org
Benner, P., (2001). From novice to expert: Excellence and power in clinical nursing practice (Commemorative
edition). New Jersey: Prentice Hall Health.
Black, B.P. (2011). Becoming a nurse: Defining nursing and socialization into professional practice. In K.K. Chitty
& B.P. Black (Eds.), Professional nursing: Concepts and challenges (6th ed. pp. 126-145). Maryland Heights,
MO: Saunders Elsevier.
Dreyfus, S. E., & Dreyfus, H. L. (1980). A five-stage model of the mental activities involved in directed skill
acquisition (Operations Research Center Rep. No. ORC-80-2).
Kaplow, R. (2002). The synergy model in practice applying the synergy model to nursing education. Critical Care
Nurse, 22(3), 77-81.
References
Murphy, D. (2012, September/October). Novice to expert: clinical ladder programs as a recruitment and retention
tool. Ohio Nurses Review., 16-17. Retrieved from www.ohnurses.org
Nursingtimes.net [website]. (2010, March). Nursing Times. Retrieved from http://www.nursingtimes.net/whatsnew-in-nursing/hall-of-fame/patricia-benner-us-nurse-theorist-and-author-of-from-novice-to-
expert/5012095.article
Nursing Theory. (2011). Patricia Benner: Biography of Patricia Benner. Retrieved from http://nursingtheory.org/nursing-theorists/Patricia-Benner.php
Nursing Theories. (2013). Patricia Benner: Metaparadigm in nursing. Retrieved from
http://nursingtheories.info/patricia-benner-metaparadigm-in-nursing/
Nursing Theories: a companion to nursing theories and models website. (2012). Retrieved from
www.currentnursing.com/nursing_theory
Tomey, A., & Alligood, M. (2006). Nursing theorists and their work (6th ed.). St. Louis, MO: Mosby Elsevier.
Case Study #1
Sally had the opportunity to be a nurse extern at a hospital on
a busy medical-surgical unit while she finished her
undergraduate studies. With this opportunity, Sally stated
that she had the chance to become comfortable in a nursing
role, and was able to relate nursing practice to the theory that
she was learning in class. After graduation, Sally became an
RN in the Neonatal ICU. Given her recent nursing
experience, which of Benner’s stages is Sally practicing at as a
Neonatal RN?
Case Study #2
You and Ginger have been nurses together for the last five
years. You have both worked on the Orthopedic unit since
graduating nursing school. You both easily perform the
required nursing duties, seem to have “that nursing sense”
about when something is going downhill, and act as charge
nurses on the unit. Ginger is reluctant to act as a preceptor to
newer nurses stating that “I still need to work on my
organization before trying to help others learn the way.” You
have acted and excelled as a preceptor with excellent
feedback. What stages of Benner’s model would you place
yourself and Ginger?