NURSING PHILOSOPHIES: PATRICIA BENNER THEORY

Arrenged in order to completing the assignment for Philosophy and Theory of Nursing course

By:

Class C (International) / Semester I / Batch 2020

Fuzna Dahlia Mudzakiroh (I1J020010)

DEPARTMENT OF NURSING

FACULTY OF HEALTH SCIENCES

GENERAL SOEDIRMAN UNIVERSITY

DECEMBER

2020
 CHAPTER I
INTRODUCTION

A. Background

Philosophy is a basic belief held by a person and becomes the basis for thinking about
doing, making decisions, a reference in achieving goals, and reference material in making
considerations if there is a problem / dilemma. In the context of nursing, nursing philosophy
is a belief that comes from the values, ethics and morals contained in a nurse's understanding
that underlies the nature, behavior and actions of nursing in providing nursing services to
those in need. The philosophy becomes the main foundation in looking at what nursing is,
and how nurses should act. With a good understanding of the philosophy of nursing, a nurse
will be able to display the attitudes and behavior of a professional nurse and provide excellent
service to clients.

To develop a philosophy, it is necessary to have the role of a theory. Theory is a series

of interrelated concepts that specify the relationship between variables. Meanwhile, nursing
theory is a series of statements about interrelated phenomena that are very useful for
mentioning, explaining, predicting, and controlling (Walker & Avant, 1995, 2004). Nursing
theory is a group of concepts that describe a process, event or incident concerning nursing
which is based on the facts that have been observed.

One of the nursing theories which is included in the level of philosophy / philosophy
is the theory "from novice to expert" which was compiled by Patricia Benner. At the core of
this theory is the importance of competency development and continuing education for a
nurse. Benner divides the competency level of nurses into 5 levels, namely novice, advance
beginner, competent, proficient, and expert. This theory is explained by Patricia Benner by
adapting the Dreyfus model to clinical nursing practice (Tomey and Alligood, 2006). Benner
proposes that nurses can gain knowledge and skills without actually learning theory. She
describes this as a nurse "knowing how" without "knowing that."

Given the importance of understanding nursing philosophy and theory, it is necessary

to discuss discussions, analyzes, and disseminate the latest knowledge about nursing
philosophy and nursing theory to every aspect of the profession so that nursing
professionalism can truly be realized. Philosophy andNursing theory is a key part of the
development of nursing science and the development of the nursing profession, so it is
important to learn. With this, it is able to assist the problem-solving process in nursing by
providing clear directions for the goals of nursing action so that all forms and actions can be
considered. In addition, nursing theory also provides a basis for nursing assumptions and
philosophies so that knowledge and understanding in nursing actions can continue to grow
and develop. In addition, it is also able to provide guidance in nursing care correctly,
precisely and quickly to clients.

B. Formulation of the problem:

a. What is the biography of Patricia Benner?
b. Where does the philosophy put forward by Patricia Benner come from?
c. What is the nursing paradigm according to Patricia Benner?
 d. What is the weakness of Patricia Benner's theory?

C. Purpose
 General purpose
Able to understand the "novice to expert" nursing theory model according to Patricia
Benner.
 Special Purpose
The objectives in writing this report are:
a. Understanding Patricia Benner's Curriculum Vitae
b. Understand the philosophy put forward by Patricia Benner
c. Understand the nursing paradigm according to Patricia Benner
d. Identify accepted theory and theoretical weaknesses
e. Understand about the domain of nursing diagnoses from Patricia Benner

CHAPTER II
DISCUSSION
PATRICIA BENNER BIOGRAPHY

Patricia Benner was born in Hampton, Virginia, America in August 1942 and spent
her childhood in California where she received her primary and professional education
(Alligood, 2014). Benner received his bachelor's degree in nursing from Pasadena College in
1964. He earned a Master of Nursing with a specialty in medical surgical nursing from the
University of California at San Francisco (UCSF) School of Nursing in 1970 and earned a
PhD in coping and health from University of California at Berkeley in 1982. Benner has
extensive clinical experience including positions in acute medical surgery, critical care and
home health care. Where in the late 1960s.
Benner has a strong background in research and began his career from 1970 to 1975
as a Research Associate at the University of California at the San Francisco School of
Nursing, after which he became Research Assistant to Richard S. Lazarus at the University of
California at Berkeley. 1979 to 1981 as Project Director at the San Francisco Consortium /
University of San Francisco for an intraprofessional consensus, assessment, and evaluation
project. Since 1982, Benner has worked in research and teaching at the University of
California at San Francisco School of Nursing and accepted a position as Associate Professor
in the Department of Social Physiological Nursing at USCF and has been a permanent
professor from 1989 to the present. Benner has published nine books, including From Novice
to Expert,

SOURCE OF PHILOSOPHY PATRICIA BENNER

Benner acknowledged that nursing was heavily influenced by Virginia Henderson.

Benner learns about clinical practice of nursing. He tries to find and illustrate that science is
incorporated into nursing practice. Benner argues that science arises from time to time in
practical disciplines and is developed through experimental learning and situation thinking
and practice reflection in certain situations (Alligood & Tomey, 2014).
 This work by Benner refers more to articulation, meaning as a description / depicting,
illustration / depicting and communicating in areas of practical policy, skills about knowing
and how and explaining good practice and (Alligood & Tomey, 2014).
One of Benner's first philosophies is that there is a difference between practice and
theology. He argues that science is built into the discipline of practice. "Practical science
refers to knowing and how through theory based on scientific discovery".

MAJOR DEFINITIONS AND CONCEPTS

Benner issued a theory called "From Novice to Expert" theory, which means levels or
stages in a profession. The concept of the theory "From Novice to Expert" developed by
Patricia Benner is taken from the "Dreyfus Model" proposed by Hubert Dreyfus and Stuart
Dreyfus. From Novice to Expert theory explains 5 levels / stages of role acquisition and
professional development including: (1) novice, (2) advanced beginner, (3) competent, (4)
proficient, and (5) expert.

CONCEPT EXPLANATION

The explanation of the five levels is as follows:

a. Novice
The Novice level in the role acquisition of the Dreyfus Model, is someone with no
background experience in the situation. Clear instructions and objective attributes must be
given to guide its appearance. Here it is difficult to see the relevant and irrelevant situation. In
general, this level is applied to nursing students, but Benner can classify higher level nurses
into novice if placed in an unfamiliar area or situation.
b. Advanced beginner
Advance Beginner in the Dreyfus Model is when a person shows an acceptable
overcoming appearance in real situations. Advance beginners have enough experience to
handle a situation. Except for attributes and traits, aspects cannot be seen completely because
they require experience based on recognition in the context of the situation.
The function of the nurse in this situation is guided by the rules and orientation of task
completion. They will find it difficult to hold certain patients in situations that require a
broader perspective. The clinical situation is presented by the nurse at the advanced beginner
level as a test of his abilities and the demands of the patient's situation and response. Advance
beginners have a greater responsibility to manage the care of patients, before they have more
experience. Benner places fresh graduated nurses at this point.
c. Competent
Completing learning from actual practice situations by following other activities,
advance beginners will become competent. The competent stage of the Dreyfus model is
characterized by the ability to consider and make plans that are necessary for a situation and
that can be released. Consistency, predictability, and time management are performance at
the competent stage. Competent nurses can show more responsiveness to patient responses,
are more realistic and can display critical abilities in themselves. The level of competence is
an important level in clinical learning, because teachers must develop patterns for elements or
situations that require attention that can be ignored. The competent must know the reasons for
making plans and procedures in clinical situations.
An important learning point from active teaching and learning at the competent level is to
train nurses to make the transition from competent to proficient.
d. Proficient
At the proficient stage of the Dreyfus model, the performer perceives the situation as a
whole (the total picture) rather than in terms of aspects, and the performance is guided by
maxims. The proficient level is a qualitative leap beyond the competent. Now the performer
recognizes the most salient aspects and has an intuitive grasp of the situation based on
background understanding (Benner, 1984a). Nurses at this level demonstrating a new ability
to see changing relevance in a situation, including recognition and implementation of skilled
responses to the situation as it evolves. They no longer rely on preset goals for organization,
and they demonstrated increased confidence in their knowledge and abilities (Benner,
Tanner, & Chesla, 1992). At the proficient stage, there is much more involvement with the
patient and family.
e. Expert
Benner explained that at this level expert nurses have an intuitive grip of the situation
so that they are able to identify areas of the problem without losing time consideration for
making alternative diagnoses and solutions. The qualitative change in the expert is "knowing
the patient" which means knowing the type of response pattern and knowing the patient as a
human being. The key aspects of an expert nurse are:
1) Shows clinical guidelines and practical resources
2) Realizing the know-how process
3) See the broad picture
4) Seeing the unexpected
Patricia Benner and Wrubel developed a skill acquisition model that includes the
concept of caring in nursing practice. Benner and Wrubel define and explain the concepts of
caring, nursing, humans, health, stress coping and the environment published in 1989 in their
book the primacy of caring: stress and coping in health and illness, and use examples of
nurse-patient interactions to describe the process. and concept.

DOMAIN THEORY OF PATRICIA BENNER

She identifies at least seven domains that every nurse should know perfectly and keep
in mind her professional progress in the field of nursing. They are as follows.
1. Patient diagnosis
2. Perform and monitor interventions performed
3. Maintain continuity and safety in the quality of health care practices
4. Training-teaching function
5. Effective management of unexpected situations
6. The role of patient assistance
7. Work organization based on competence
MAIN ASSUMPTIONS

a. Nursing
Nursing is defined as a relationship based on networking in a variety of situations and
conditions that allow and become a concern. Nursing as a guide through the arts and ethics of
care and responsibility. Nurses promote healing through service to patients in maintaining
human relationships. This is a human relationship where people can provide medication when
they are sick, the relationship between health and illness and disease refers to Benner and
Wrubel's views in nursing practice (Benner & Wrubel, 1989 in Sitzman & Eichelberger
2011).
Sitzman & Eichelberger (2011) explain that caring is defined as something that is
related and has a problem with unifying thoughts, feelings and actions, caring regulates what
is most important to a person / human. Therefore, resolving stress and how someone can
handle it. Benner and Wrubel (1989) stated that caring arises from linkages and has some
things that are more important than others. "Without dating someone will be cause for
concern".
Attitude characteristics related to caring are empathy, support, wanting to comfort
others and nurturing. When a nurse provides services to clients, where the service creates
stress / problems, what needs to be done is an emotional assessment and the engagement
process. Engagement with clients enables the nurse to diagnose a problem and identify
solutions and create a trusted environment.
Caring According to Benner and Wrubel, it is important because it can create an
environment where nurses can provide care to clients.
Caring important because:
1) Creating what will happen, what is the problem and what are the right options to
solve.
2) Creating an enabling environment, what is connected and what is the goal
3) Creating what is possible when giving and getting help.
b. Human
Benner and Wrubel's interpretation of human beings is based on the existence of a
philosophy and human unity or wholeness. So that Benner describes humans as creatures that
interpret themselves, that is, humans do not appear by themselves to a predetermined natural
world but through the process of a life journey. Humans are seen as something creative,
generative beings who live in a context and are able to act and have a comprehensive
understanding. According to Benner and Wrubel, human characteristics are those who have
to deal with situations, bodies, individual problems and events that are temporary in nature
(Benner & Wrubel, 1989 in Sitzman & Eichelberger 2011).
c. Health
Benner and Wrubel use the definition of health from Kleinman, Elsenberg, and Good
which states that health is the absence of a disease which is described as an experience of loss
or impairment of function but disease is a manifestation of abnormalities in cells, tissues, or
organs. All treatment of illness during illness must make sense in the context of human life
experience. (Benner & Wrubel, 1989 in Sitzman & Eichelberger 2011).
d. Situation
 Benner refers to situations or prioritizes situations rather than the concept of the
environment at work. Benner chooses situations because according to Benner, situations have
a social context in their meaning and interpretation that impacts humans. Humans are more
accustomed to their world than living in an environment. Someone's interpretation has an
impact. on every situation. Benner's phenomenological view is based on the situation. This is
evidenced in his writing when he uses the term "being situated and situated in meaning"
indicating the involvement and interpretation of every event or event in life (Benner &
Wrubel, 1989 in Sitzman & Eichelberger 2011).
e. Stress
According to Benner, stress is the meaning of distraction, understanding, and smooth
functioning so that the dangers, losses, or challenges experienced are able to make humans
acquire new skills. Stress is a manifestation of physical, emotional, and / or intellectual
dysfunction. Stress occurs when a person realizes that something is wrong or is not
imbalanced. Stress is a consequence in life that cannot be avoided in life in the world so it
requires concern for this (Benner & Wrubel, 1989 in Sitzman & Eichelberger 2011).
f. Coping
Coping does not include a solution to stress but rather what a person does to deal with
distractions caused by stress. Benner and Wrubel are based on the work of Lasarus (1986)
which explains stress and coping. Coping is doing something directly and also not doing
something directly on the basis of existing goals. Another coping behavior is looking for
information. The way a person views a situation and makes choices for have a positive
character in dealing with disturbances. Benner and Wrubel provide many examples of how
someone copes with situations such as: self-development during life / in life, caring for
oneself from various diseases including cancer and neurological diseases (Benner & Wrubel,
1989 in Sitzman & Eichelberger 2011).

ACCEPTANCE IN THE NURSING COMMUNITY

a. Nursing Practice
Benner describes clinical practice of nursing using a phenomenological interpretation
approach. From Novice to Expert (1984) includes several examples of applications in the
application of the method in practical situations. Initially, Benner used a promotion approach,
the clinical nursing level, a graduate nurse program recently and seminars to develop clinical
knowledge. The symposium focuses on excellence in nursing practice which is carried out for
staff development, recognition, and awards as a way to demonstrate the development of
clinical knowledge in practice (Alligood & Tomey, 2014).
After that, the Benner method was widely adopted by nursing practitioners for
example Fenton (1984) used the Benner approach in an ethnographic study of the appearance
of specialist clinical nurses. The findings consist of the identification and description of
nurses' competencies to prepare proficient nurses. Balasco and Black (1988) and Silver
(1986) used the Benner method to guide differentiating clinical development and career paths
in nursing. Farrel and Bramadat (1990) used the Banner case analysis paradigm in a
collaborative project between nursing education universities and teaching hospitals to explore
clinical development according to real-life skills (Alligood & Tomey, 2014).
b. Education
 In the world of education, the Benner model is widely used as a reference by
educators to study every level of nurses from novice to expert and learn the differences of
each level so as to provide a learning experience for nursing students (Alligood & Tomey,
2014).
Benner (1982) criticized the concept of competency-based testing as opposed to the
complexity of skills and skill levels described in the Dreyfus Model and 31 competencies
described by AMICAE (Benner, 1984). In the Expertise in Nursing Practice, Benner and
colleagues (1996) emphasize the importance of learning skills and care through practical
experience, the use of science in practice, and with formal education. In Clinical Wisdom in
Critical Care, Benner and colleagues (1999) pay great attention to experiential learning and
present how to teach. They designed an interactive CD ROM to complement the book
(Alligood & Tomey, 2014).
c. Research
The Benner method is widely used as a reference in the nursing field. For example,
Fenton (1984,1985) uses Benner's model in educational research. Lock and Gordon (1989)
supported the AMICAE project, which developed inquiry learning in a formal model used in
nursing and medical practice. They conclude that the formal model provides clues about
direct services, knowledge, and desired outcomes (Alligood & Tomey, 2014).

THE WEAKNESS OF PATRICIA BENNER THEORY

● Patricia Benner's theory was adapted from the "Dreyfus Model" proposed by Hubert
Dreyfus and Stuart Dreyfus. From Novice to Expert theory explains 5 levels / stages
of role acquisition and professional development including: Novice, Advance
Beginner, competent, proficient, and expert. This model is relatively simple by simply
dividing nurse proficiency level is in 5 stages and it requires level identification of
nursing practice from the description of the individual nurse and from practical
observations actual clinic.
● From Novice to Expert theory has universal characteristics that are not limited by age,
disease, health or location of nursing practice. For interpretation 9 this model in
nursing practice OF tice is used as a temporary framework only its application is
limited by nursing practice situations, so understanding is needed the nurse's 5 level
competencies and the ability to identify characteristics and objectives in each level.
● Benner's model is only proven using a qualitative methodology consisting of 31
competencies, 7 domains of nursing practice and 9 domains of care critical. With a
qualitative approach, Benner considers it a generating hypothesis (cause) rather than
hypothesis testing, therefore it needs to be proven by approach other alternatives to
qualitative.
● Benner's perspective is phenomenological and not cognitive. The Benner model is
based on data based research that supports the development of nursing practice
 CHAPTER III
CONCLUSION

The theory put forward by Patricia Benner about caring, clinical wisdom and ethics in
nursing practice is used to confirm and restore nursing care practices carried out by nurses
with an orientation towards efficiency, technical skills, and measurable results. A nurse in
nursing care must have knowledge and skills about daily needs, so that in the application of
nurses can be in harmony with the patient and the situation at that time.

Philosophy, practice, research and theory are interdependent, interrelated, and

heumanitic according to Benner. This proves that nursing knowledge is firmly embedded in
practice, where nurses provide nursing care based on the knowledge they get from theory and
research. In addition, caring and ethics are closely related in nursing practice, where nurses
must be able to overcome the boundaries between nurses and patients in a reflection of their
communication skills and wisdom in compassion, so that nurses can expand, change,
maintain differences in ethics and interests and be able to validate nursing as a ethical
practice.
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