THEORETICAL FOUNDATION OF NURSING
PATRICIA BENNER
FROM NOVICE TO EXPERT:
EXCELLENCE AND POWER IN CLINICAL NURSING PRACTICE
PROFESSOR C.
PATRICIA BENNER R.N., PH.D., F.A.A.N.
 Professor, University of California-San Francisco
 1964, obtained Bachelor of Arts degree from
Pasadena College
 1970, MSN from University of California, San
Francisco
 1984, published “From Novice to Expert”
 1985, Fellow in American Academy of Nursing
METAPARADIGM
PERSON
 “A self-interpreting being, that is, the person does not
come into the world predefined but gets defined in
the course of living a life.”
 The three major aspects of understanding that the
person must deal with:
o 1. The role of the situation
o 2. The role of the body
o 3. The role of personal concerns
o 4. The role of temporality
HEALTH
 Health - what can be assessed
 Well-being - human experience of health or
wholeness
 Illness - the human experience of loss or
dysfunction
 Disease - what can be assessed at the physical
level
ENVIRONMENT
 She used the word situation because it suggests a
social environment with social definition and
meaning.
 Situation – defined by the person’s engaged
interaction, interpretation and understanding of the
situation.
 Persons enter into situations with their own sets of
meaning, habits and perspectives.
NURSING
 She described nsg. as a caring relationship, an
“enabling condition of connection and concern.”
 Viewed nsg. practice as the care and study of the
lived experience of health, illness, and disease and
the relationships among these three elements.
BENNER’S STAGES OF CLINICAL COMPETENCE (1984; 2004)
NOVICE
 No experience of the situations in which they
are expected to perform
 Learn context-free rules to guide actions
(stimulus-response thinking)
 Rule-governed behavior is typical, tends to be
inflexible
 Has difficulty discriminating between relevant
and irrelevant aspects of a situation
ADVANCE BEGINNER
 Can demonstrate marginally acceptable
performance
 Have begun to identify recurring meaningful
situational aspects and apply these in new
situations
 Unable to see the entirety of a new situation
(may miss some critical details)
 They feel more responsible for managing
patient care, yet they still rely on the help of
those who have more experiences
COMPETENT
 Considers consistency, predictability and time
management as essential components and
gaining a sense of mastery
 There is an increased level of efficiency but the
focus is on time management and the nurses
organization of task are more important rather
than on timing in relation to the patient’s needs
 This stage is critical because the nurse must
know how to recognize the patterns and identify
which element of the situation needs attention
and which ones to ignore
PROFICIENT
 Perceives situations as whole rather than in
terms of aspects
 Performance is guided by maxims (cryptic
instructions that make sense only if there is
already a deep understanding of the situation)
 Perception is a key word
 Possesses a web of perspectives on a situation
 Demonstrate an increased confidence in their
knowledge and abilities
EXPERT
 No longer relies on an analytic principle (rule,
guideline, maxim) to connect understanding of a
situation to appropriate action
 Operates from a deep understanding of the total
situation
 Possessing an intuitive grasp of the problem
 There is a qualitative change as the expert
performer “knows the patient”, which means that
knowing typical patterns of responses and
knowing the patient as a person
 Key aspects of the nurse practice:
o Demonstrating a clinical grasp and
resource-based practice
o Possessing embodies knowledge
o Seeing the big picture
o Seeing the unexpected
SEVEN DOMAINS OF NURSING PRACTICE
 Helping role
 Diagnostic client-monitoring function
 Effective management of rapidly changing
situations
 Administering and monitoring therapeutic
interventions and regimens
 Monitoring and ensuring quality health care
practices
 Organizational and work-role performance
 Teaching or coaching functions