Major Concepts

and Important Principles

• Dr Patricia Benner introduced the concept that
expert nurses develop skills and understanding
of patient care over time through a sound
educational base as well as a multitude of
experiences.
• She proposed that one could gain knowledge
and skills ("knowing how") without ever
learning the theory ("knowing that").
Nursing
Benner described nursing as an
“enabling condition of connection and
concern” (Marriner-Tomey, 1989, p.192)
which shows a high level of emotional
involvement in the nurse-client
relationship. She viewed nursing practice
as the care and study of the lived
experience of health, illness, and disease
and the relationships among these three
elements.
 Person
Benner stated that “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. A person also has.an
effortless and non-reflective
understanding of the self in the
world. The person is viewed as
a participant in common
meanings.” (Tomey, 2002,
pp.173).
 Benner focused “on the lived

Health experience of being healthy and ill.” She

defined health as what can be
assessed, while well-being is the human
experience of health or wholeness.
Well-being and being ill are recognized
as different ways of being in the world.
Health is described as not just
the absence of disease and illness.
Also, a person may have a disease
and not experience illness because
illness is the human experience of
loss or dysfunction, whereas
disease is what can be assessed
at the physical level.
Environment
Instead of using the term
“environment”, Benner used the
term “situation”, because it
suggests a social environment
with social definition and meaning.
She used the
phenomenological terms of being
situated and situated meaning,
which are defined by the person’s
engaged interaction, interpretation
and understanding of the situation.
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 I’ll
do it.”
 Advance
Beginner
• 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 day-to-day
situations
• More aware of long-term goals
• Gains perspective from planning
own actions based on conscious,
abstract, and analytical thinking and
helps to achieve greater efficiency
and organization
Proficient
• Perceives and understands
 situations as whole parts
• 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
• Much more background of experience
• Has intuitive grasp of clinical situations
• Performance is now fluid, flexible, and highly-proficient
DIFFERENT LEVELS
OF SKILLS REFLECT
CHANGES IN 3 ASPECTS OF
SKILLED PERFORMANCE:
• Movement from relying on abstract
principles to using past concrete
experiences to guide actions
• Change in learner’s perception of
situations as whole parts rather than in
separate pieces
• Passage from a detached observer to an
involved performer, no longer outside the
situation but now actively engaged in
participation
SEVEN DOMAINS
OF NURSING
PRACTICE
• Helping role
• Teaching or coaching function
• Diagnostic client-monitoring function
• Effective management of rapidly changing
situations
• Administering and monitoring therapeutic
interventions and regimes
• Monitoring and ensuring quality of health
care practices
• Organizational and work-role competencies
 Practice
In her book, From Novice to Expert, Benner described
clinical nursing practice using an interpretative approach. The
model has been used to aid in the development of clinical
ladders of promotion, new graduate orientation programs and
clinical knowledge development seminars. This has greatly
contributed in the competency ladders and promotions in the
nursing service organization.

Education
Benner’s seven domains of nursing practice have the
greatest influence and impact on nursing education with
regard to her works. Nursing educators have realized that
learning needs at the early stages of clinical knowledge
development are different from those required at late
researches.
Research
Her researches have been used in studying the impact of
nursing and its seven domains in every aspect of the
profession. Several researches tested these models and
validated them. In application of the theory presented by
Benner, nurses have a clear vision of the competencies
required in order for them to climb up into the leadership
ladder.
Simplicity
Benner’s model is comparatively simple about five
stages of skill acquisition. It gives a relative guide for
classifying levels of nursing practice, from individual
nurse descriptions and observations to actual nursing
practice. The interpretations are validated by agreement
or by general acceptance.
Generality
Benner’s model has universal characteristic for the
reason that it is not restricted by age, illness, health, or
location of nursing practice. However, the characteristic of
theoretical universality involve properties of functionality
for prediction that is not a part of this perspective.
The descriptive model of nursing practice has
the potential for universal application as a
framework; however the descriptions are limited
by dependence on the actual clinical nursing
situations from which they must be used. It
depends on the understanding of the five levels
of competency and the ability to identify the
characteristic intentions and meaning intrinsic at
each level of practice.
Empirical
PrecisionIn terms of empirical precision,
Benner’s model was tested using
qualitative methodologies.
Succeeding researches suggest that
the framework is applicable and
useful in providing knowledge of the
description of nursing practice. The
strength of Benner’s model is that
data-based research contributes to
the science of nursing.
Derivable
Consequences
The usefulness of Benner’s model gives a
general framework for identifying, defining and
describing clinical nursing practice. She uses a
phenomenological approach to express and
obtain meaning and abilities from interactions in
life situations. The implication of Benner’s
research finding lies on her conclusion that “a
nurse’s clinical knowledge is relevant to the
extent to which its manifestation in nursing skill
makes a difference in patient care and patient
outcome.”
REFERENCES
Octaviano,E.F. and Balita,C.A.,(2008),Theoretical
Foundations of Nursing:The Philippine
Perspective, Ultimate Learning Series

Benner, P.E. (2011). From Novice to Expert.

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