Novice to

Expert 1

Dr. Patricia Benner

R.N., Ph.D., F.A.A.N., F.R.C.N.

\
 Contents
 Purpose & Introduction 2
 Biography of Prof. Patricia Benner
 From Novice to Expert Nursing Model
 Dr. Benner’s Motivation for Novice to Expert
 Dr. Benner’s influences for Novice to Expert
 Stages of Novice to Expert Model
 Dr. Benner’s Explanation of the Four Paradigms
 Using Dr. Benner’s Model in Practice
 Strength and Weakness
 Critique
 Conclusion
 Case Study
 Purpose & Introduction
3
The purpose of this presentation is to discuss and examine
the Nursing Theorist, Patricia Brenner, and her nursing theory;
From Novice to Expert.

 Basic overview of nursing theory.

Explanation of Dr. Patricia Benner’s work “From Novice to

Expert” model.

Relation of Prof. Benner’s work to current practices.

 Introduction cont….
4
What is nursing theory?
“A nursing theory is a set of concepts, definitions, relationships, and
assumptions or 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”(Nursing Theories, 2012).

When nursing practice is built on sound theories, the profession is

strengthened (Black, 2011).
will be propagated, your proffesion will be strengthen
 Introduction cont….
5
Using theory in nursing helps Nurses 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.
(Black, 2011)
 Prof. Patricia Benner
R.N., Ph.D., F.A.A.N,F.R.C.N.

oBorn August 1942

Hampton, Virginia
oNationality American
oFields Nursing theory, Nursing Education University
oInstitution of California, San Francisco (USCF) Pasadena
oAlma mater City Collage
Pasadena College
University of California, San Francisco (USCF)
University of California, Berkeley
oKnown for From Novice to Expert
Excellence and Power in Clinical Nursing practice
 Professor Emerita at the
University of California, San Francisco
Ex 6
 Prof. Patricia Benner cont..
7
o Influences Hubert Dreyfus, Stuart Dreyfus, Maurice Merieau- Ponty
Martin Heidegger.

o Notable awards Living Legend of the American Academy of Nursing (2011)

Staff nurse in the areas of Medical, Surgical, Emergency room. Coronary Care,
Intensive Care and Home care
 An Internationally noted researcher and lecture on health, stress and coping, skills
acquisition and ethics
 Elected as an honorary fellow of the Royal Collage of Nursing
 Currently her research includes the study of nursing practice in intensive care and
nursing ethics
 Prof. Patricia Benner: AsAuthor-
8
Dr. Benner is the author of books including:
 From Novice to Export
 The primacy of Caring
 Interpretive Phenomenology: Embodiment Caring and Ethics in
Health and Illness
 The Crisis of Care
 Expertise in Nursing Practice: Caring, Clinical Judgment and
Ethics
 Caregiving
 Clinical Wisdom and Interventions in Critical Care: A Thinking In
Action Approach
 From Novice to Expert Nursing
Model 9

“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)
 Dr. Benner’s Motivation
10
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).
 Dr. Benner’s Motivation for Novice to Expert
cont….
11

 Patient needs increasing

 Lengths of stays decreasing
 Advancement in Medical technology
 Increased Learning for nurses
 Need for more experienced nurses
With all that is required in the nursing field,
Wanted to provide an understanding for nurses, as they develop their skills of
what makes a novice nurse become an expert nurse (Benner,1982).
 Dr. Benner’s Philosophy
12

Dr. Benner “proposed that a nurse could gain knowledge and skills without
actually learning a theory” Described as “knowing how” without “knowing
that” upgrading yourself

about caring... kay watson.... watson, as the nurse goes,

Development of knowledge in nursing is “a combination of knowledge

through research and understanding through clinical experience”
(Nursing Theory, 2011). improve confidence

Dr. Benner describes her works interpretive phenomenology which means

observing and interpreting actual nursing practice to find the meaning of the
experiences (Altmann, 2007).
 Dr. Benner’s influences
13
 Virginia Henderson
Dr. 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 SkillAcquisition
14

starting point

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)
The Dreyfus Model Of SkillAcquisition
15
 Dreyfus vs. Dr. Benner
16

Dreyfus model including the 5 levels as of Dr. Benner’s Stages of Nursing

1986 (moleseyhill.com) Proficiency (nursinginformatics.ca)
 Stages of Novice to ExpertModel
17

Dr. Benner’s stages of Nursing Proficiency

u just graduated

1. Novice
passing board exam

2. Advanced Beginner
gaining experience knowledge 2-3 years, about the practice

3. Competent
so you know all around your profession, you know how to deal different challenges

4. Proficient
become expert in all, ICU, dealing with lives, if you commited mistake

5. Expert
 The Novice
18

 Generally applies to student nurse

Can also apply to experienced nurse in a area or
situation of unfamiliarity (Alligood & Tomey 2007).
 Has little background and limited practical skills
Relies on rules and expectations of others for
directions (Chitty & Black, 2007).
 The AdvancedBeginner
19

 Applies to most newly pass out or graduated nurses

 Fell highly responsible for managing patients care
 Still rely on the help of the more experienced nurse
 Has marginally competent skills
 Uses theory and principles much of the time
 Experiences difficulty establishing priorities
awaiting for board exam, still relying of others, in order for you to be competent

(Chitty & Black, 2007).

 The Competent Nurse
20

 Usually Applies to nurses with 2-3 years experience

 Coordinates several tasks simultaneously
 Consistent, predictable and able to manage time
 May display hyper responsibility for the patient
 Begins to recognize patterns
 Determines which elements of the situation warrant attention and
which
can be ignored (Alligood & Tomey, 2007).
working, gain experience 2-3 years, manage time in handling different situation
 The Proficient Nurse
21

 Perceives and understands situations as whole parts

 Views patients holistically (Nursing Theory, 2011)
 Focuses on long – term goals
 Can see changing relevance in a situation
Demonstrates increased confidence in their knowledge
and abilities
 No longer relies on present goals for organization
as u go along, there will be adding of your objective or goals in life. after 5 yrs, or,
(Alligood & Tomey, 2007)
 The Expert Nurse
22

No longer relies on principles, rules or guidelines to connect

situations and determine actions
 Performances are fluid, flexible, and highly proficient
 Expertise comes naturally (Nursing Theory, 2011).
 Become more efficient and organized
 Reached only after extensive experience
 Grasps patients need automatically
 Demonstrates a clinical grasp and resource based practice
(Chitty & Black, 2007)
 Dr. Benner’s Explanation of the Four
Paradigms
23

 Nursing
 Person
 Health
 Environment

Photo courtesy http://www.emporia.edu/nursing/nursing-mission.html

 Dr. Benner’s Description of Nursing
24

Benner viewed nursing as the care and study of the lived

experience and the relationship of these three
elements:

 Health
 Illness
 Disease
(Nursing Theories, 2013)
 Dr. Benner’s Description of Person
25

“…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 role of the situation
 The role of the body
 The role of the personal concerns
 The role of the temporality
(Nursing Theories, 2013)
 Dr. Benner’s Description
26
of Health

Benner focused “on the lived experience of being healthy and

being ill”
 Health is defined as what can be assessed
Well- being is the human experience of health or
wholeness
 A person may have a disease and not experience illness
 Illness is the human experience of loss or dysfunction
 Disease is what can be assessed at physical level
(Alligood & Tomey 2011)
 Dr. Benner’s Description of Environment
27

Dr. Benner uses the term situation rather than environment.

“Personal interpretation of the situation is bounded by the
way the individual is in it”(Tomey & Alligood, 2006).

Each person’s past, present and future which include their

own personal meaning , habits and perspectives influence the
current situation (Alligood & Tomy, 2011).
 Relationship of Paradigms to Benner’s
The conclusion of the four Model
paradigms of nursing create
28 to advance through the
experiences that nurses utilize
stages of Benner’s model From Novice to Expert
 Using Dr. Benner’s Model
29
in Practice

Examples of use in practice:

 Nursing School curriculum
 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) (Larew et al., 2006)
 Using Dr. Benner’s Model in Practice cont…
30

 Developing mentorship programs

 Preceptors for student nurses
 Mentors for newly graduated / pass out nurses (Larew et al., 2006)

 Development of Clinical Simulation Protocol

 Application of theory in nursing research

(Meretoja et al., 2004).)
 Implications and Consequences
31

School of nursing have adopted Benner’s model to use as a base for

the education of nurses.
Hospitals and other nurse work places use the model as a
foundation for preceptor based guidance of nursing students and new
graduate nurses
Social agencies and nursing continuing education program
developers also use Benner’ s model.
Nursing administrators utilize the model to help “develop career
ladders, staff development and recognition and rewards programs”
(Altmann, 2007).
 Benner inAction
32
Clinical Ladder Programs
Most are based on stages of
clinical competence of Benner’s
Intention of the ladder is to
retain experienced nurses
Greater rewards at the expert
levels than the novice level
(Murphy, 2012)
 Benner in Actioncont….
33
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.
(AACN, 2005)
 Interpretation
34

By applying the Dreyfus model to nursing, Dr. Benner was able to

explain how nurses can have deferent stages of experience and
knowledge and how these deferent stages affect how the nurse
sees and interprets the nursing process, the patient, the
patient’s health and the environment (situation) the patient is
in.
This model demonstrates that the majority of nursing knowledge
and expertise comes from actual on-the-job clinical experience.
(Tomey & Alligood, 2006).
 Strength and
Weakness
35

Strengths of the theory

The theory has the potential to be used universally as a
framework and is not restricted by age, illness, health, or
location of nursing practice.
The model was empirically tested using qualitative
methodologies.
“The strength of the Benner model is that it is data-based
research that contributes to the science of nursing”
(Tomey, 1994).
 Strengths of the theory cont….
36
One of the greatest strengths of Benner’s theory is that it focuses
on the behaviour of nurses depending on their level of
understanding with nursing practice – novice, advanced beginner,
competent, proficient, expert. Her theory highlights the importance
of clinical experience in developing expertise. As observed today,
her theory is widely used as it provides a foundation to use for
assigning clinical competence. (Patricia Benner's Novice to Expert, 2015).
 Weaknesses of the theory
37
Dr.Benner’s theory is too simple to account for the complex pattern of
phenomena linked to expert intuition in nursing (Gobet & Chassy,2006).

Benner and her colleagues, based on previous work by the Dreyfus

brothers (Dreyfus & Dreyfus, 1986), strongly argue that, intuition and holistic
perception are necessary for performing at expert level. However, by
doing so, they under,estimate the role played by analytic and conscious
problem solving at the expert level. (Gobet & Chassy., 2008).
 Critique of the theary
38
Clarity
The clarity of Benner’s Novice to Expert model has led to its
utilization among nurses around the world.
An identification with the idea of clinical wisdom and varying levels
of clinical expertise development progressed very quickly.
Benner’s work not only contributed to appreciative understanding of
clinical practice but also revealed nursing knowledge embedded in
practice (Alligood, 2010).
 Critique cont…
39
Simplicity
The modal is relatively simple with regard to the five stages of skill
acquisition, and it provides a comparative guide for identifying levels
of nursing practice from individual nurse descriptions, observation
and interpretations validated by consensus.
(Alligood, 2010).
 Critique cont…
40
Generality
The Novice to expert skill acquisition modal has universal
characteristics, It is not restricted by age illness, health or location of
nursing practice.

Although clinical knowledge is relational, contextual and involves

local, specific, historical issues, it generalizable in terms of the
translation of meanings to similar situations (Guba & Lincoln, 1982).
 Critique cont…
41
Accessibility
The modal was tested empirically using qualitative methods, 31
competencies, 7 domains of nursing practice and 9 domains of critical
care nursing practice were derived inductively.

Subsequent research suggests that the framework is applicable and

useful for continued development of knowledge embedded in
nursing practice (Benner, 1999).
 Conclusion
42

Benner’s model provides a philosophy for nursing. It is

seminal qualitative research which lays the foundation for
understanding nursing expertise and skill acquisition.
From Novice to Expert is ‘coherent, well written, most
importantly, strongly theoretically grounded’ (Cash, 1995). It
provides a framework that supports lifelong learning for
nurses, therefore it is applicable to nursing practice, research
and education.
 Case Study
A nurse, with over 15 years ‘experience with an Obstetrics unit, is attempting to teach a new
43 she makes sure that the new mother has privacy,
mother how to breast feed her infant. First thing
that the room is worm and the lighting is dimmed. The mother is now relaxed and comforted by
her surroundings. The nurse proceeds to explain to the mother about how to hold her infant and
get him to latch on to her breast.
She shows the mother a booklet with pictures explaining how this is done. The mother is still a bit
nervous, so the nurse reassures her, that she can do this, with explanations of, how it benefits the
baby. With this done, the mother is ready to try breast feeding for the first time. The nurse is
careful to continue reassuring the new mother and to assist her only when it’s necessary. The nurse
notice that the baby still will not latch on the breast, and immediately intervenes before the
mother gets discouraged. An explanation is giving that different techniques can be used to hold the
infant, so they are more comfortable and can latch on better. When the mother places the infant,
with instruction from the nurse, into the new position the latch on is successful. Of course, the new
mother is over joyed, but asked the nurse what she will do if she is at home, at cannot get the baby
to eat. The nurse is fully prepared and is able to get new mother, phone numbers for local support
groups in her area.
 Question to Case Study

44
Given the previous scenario, in what stage is the nurse In
Prof. Patricia Beneer’s Novice to Expert theory?
 Answr
45

The nurse is in the expert practitioner.

She performs her education with ease even when the situation
changes. She performs instinctively and knows her patients needs
automatically. She was able to diffuse a potential negative situation
with her patient before the patient got discouraged. The nurse was
fully prepared to answer all questions and provide outside resources
(Nursing Theories).
 References
46
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.

Nursing Theory. (2011). Patricia Benner: Biography of Patricia Benner. Retrieved from http://nursing- theory.org/nursing-theorists/Patricia-

Benner.php

Nursing Theories. (2013). Patricia Benner: Metaparadigm in nursing. Retrieved fromhttp://nursingtheories.info/patricia-benner-metaparadigm-in-

nursing/
Questions
47

?
THANK YOU
48