Patricia Benner, R.N., P.h.D., FAAN,F.R.C.N.

Knowledge development in a practice discipline consists of extending practical knowledge(know-how) through theory based scientific investigations and through the clinical experiencein the practice of that discipline (Benner, 1984)

Patricia Benner is a Professor in the Department of Physiological Nursing in the School of Nursing at the University of California, San Francisco.

Dr. Benner received her bachelor's degree in nursing from Pasadena College, her master'sdegree in medical surgical nursing from the University of California, San Francisco, and thePh.D. from the University of California, Berkeley, in Stress and Coping and Health under thedirection of Hubert Dreyfus and Richard Lazarus. Dr. Benners Theory

Dr. Benner categorized nursing into 5 levels of capabilities: novice, advanced beginner,competent, proficient, and expert.

She believed experience in the clinical setting is key to nursing because it allows a nurse tocontinuously expand their knowledge base and to provide holistic, competent care to thepatient.

Her research was aimed at discovering if there were distinguishable, characteristic differencesin the novices and experts descriptions of the same clinical incident. Four Domains of Nursing Paradigm:Client/ Person

The person is a self-interpreting being, that is the person does not come into the worldpredefined but gets defined in the course of living a life. Dr. Benner Health

Dr. Benner focuses on the life 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 conveys a social environmentwith social definition and meanifulness.

To be situated implies that one has a past, present, and future and that all of theseaspects.influence the current situation.Dr. Benner Nursing

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

Caring is primary because caring sets up the possibility of giving and receiving help.

Nursing is viewed as a caring practice whose science is guided by the moral art and ethics of careand responsibility.

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

Nursing theory as a framework for practice

Dr. Benner presented her research in: From Novice to Expert: Excellence and Power in Clinical NursingPractice.

Novice, Advance Beginner, Competent, Proficient, and Expert are the different componentsexplained in her research.

Novice

Beginner with no experience

Taught general rules to help perform tasks

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

Rule-governed behavior is limited and inflexible

Ex. Tell me what I need to do and Ill do it.

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

The advance beginner stage in the model develops when the person can demonstratemarginally acceptable performance having coped with enough real situations to note, or to havepointed out by mentor, the recurring meaningful components of the situation.

Nurses functioning at this level are guided by rules and oriented by task completion.

Demonstrates acceptable performance

Has gained prior experience in actual situations to recognize recurring meaningful components

Principles, based on experiences, begin to be formulated to guide actions Competent

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

More aware of long-term goals

Gains perspective from planning own actions based on conscious, abstract, and analyticalthinking and helps to achieve greater efficiency and organization

The competent stage is the most pivotal in clinical learning because the learner must begin torecognize patterns and determine which elements of the situation warrant attention and whichcan be ignored.

The competent nurse devises new rules and reasoning procedures for a plan while applyinglearned rules for action on the basis of the relevant facts of that situation. Proficient

The performer perceives the information as a whole (total picture) rather than in terms of aspects and performance.

Proficient level is a qualitative leap beyond the competent.

Nurses at this level demonstrate a new ability to see changing relevance in a situation includingthe recognition and the implementation of skilled responses to the situation as is it evolves.

More holistic understanding improves decision-making

Learns from experiences what to expect in certain situations and how to modify plans Expert

No longer relies on principles, rules, or guidelines to connect situations and determine actions