Acquisition of Skills (Patricia Benner)

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 Theorist Background
• Born on August,1942 at
Hampton Virginia.
• BSN from Pasadena college in
1964.
• MSN in Medical Surgical
Nursing, University of
California , 1970.
• PhD from University of
California in 1982.
Patricia Benner
http://www.bing.com/images/search?
q=Nursing+Symbols&FORM=RESTAB#

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Theorist Background Cont…

• Taught and been involved in research since 1979.

• She was Professor Emerita at the University of
California, San Francisco.
• She published nineteen books in which one on “Novice
to expert” and published in 1984 and many articles and
nursing journals.

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 Cont…
• Named one of the American Academy of Nursing’s
“Living Legends” in August, 2011.

• Introduced her “Novice to Expert” theory in 1982.

• Many publications refer to her nursing practice model.

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 Novice to Expert

Benner’s stages of Nursing Proficiency

• Novice

• Advanced Beginner

• Competent

• Proficient

• Expert

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 The Novice

• In the novice stage, nurses have no background practical

experience while they have theoretical knowledge only.

• Novice is not limited to students- any nurse entering a setting

without prior experience with that particular patient

population may be limited to the novice level .

• Begins with no prior experience

• Taught rules to perform tasks.

(Benner, 2001, pp. 20-21)
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 The Advanced Beginner

• Activities is limited and inflexible.

• Can demonstrate marginally acceptable performance.

• Has gained prior experience in actual nursing situations.

• Formulation of guidelines or principles from prior

experiences provide guidance in future experiences.

• Through trial and error, they may learn new ways to affect
situations

Photo courtesy http://youthvoices.net/discussion/nursin (Benner, 2001, pp. 22-23)

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 The Competent Nurse
• A nurse who is working in similar situations for 2-3 years.

• Aware of long term goals-- gain perspective from planning

their own actions.

• Become more efficient and organized.

• Competent nurses better plan individualized nursing care for
patients

(Nursing Theory, 2011)

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 The Proficient Nurse

• Perceives and understands situations as whole parts.

• Views patients holistically.

• Learned what to expect in certain situations and how to

modify plans as needed.

• They are analytical and to cope with different clinical

situation such as patient and system crises.

(Nursing Theory, 2011)

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 The Expert Nurse
• No longer relies on principles, rules or guidelines to
connect situations and determine actions.
• Performances are fluid, flexible, and highly proficient.

• Expertise comes naturally.

• On the other hand, they are able to develop

comprehensive curriculum systems or training programs
(Black 2011, p. 137)
(Nursing Theory, 2011)

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 Benner’s Motivation 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 added over time; it is embedded in

expertise. Thoughts are based on the Dreyfus model.

(Benner, 2001, p. 1)

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 Benner’s influences

• Virginia Henderson
• 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.

(Tomey & Alligood, 2006)

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 Dreyfus model development

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 Cont…
• 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

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 Benner’s Explanation of the Four Paradigms

• Nursing

• Person

• Health

• Environment

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

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 Nursing
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)

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 Person
“The person does not come into the world predefined but gets
defined in the course of living a life”.

(Nursing Theories, 2013)

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 Contd..
Benner believed that there are significant aspects that make
the being. She conceptualized these as the roles of:

• The situation

• The body

• Personal concerns

• Temporality

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 Health
Benner focused “on the lived experience of being healthy and
being ill”

• Health can be assessed.

• Well-being is the human experience of health or wholeness.

• Illness is the human experience of loss or dysfunction.

(Tomey & Alligood, 2006, p. 151)

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 Environment
Benner uses the term situation rather than environment.

“Personal interpretation of the situation is bounded by the way

the individual is in it.”

A person’s past, present, and future influences their current

situation
(Tomey & Alligood, 2006, p. 151)

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 Major Assumptions:

• Theory is derived from practice.

• Human wisdom is more than rational calculation. 

• Theory frames issues and guides the practitioner in where to

look and what to ask.

• Practice is a systematic whole with a concept of excellence.

• Caring is basis of altruism.

 
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 Seven Domains of Nursing role:
• Helping role.

• Teaching or coaching functions.

• Diagnostic client-monitoring function.

• Effective management of rapidly changing situations.

• Administering and monitoring therapeutic interventions and

regimens.

• Monitoring and ensuring quality of health care practices.

• Organizational and work role competencies.

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