Introduction
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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.
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She proposed that one could gain knowledge and skills ("knowing how") without ever learning the theory ("knowing that").
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She further explains that the development of knowledge in applied disciplines such as medicine and nursing is composed of the extension of practical knowledge (know how) through research and the characterization and understanding of the "know how" of clinical experience.
- She coneptualizes in her writing about nursing skills as experience is a prerequisite for becoming an expert.
ABOUT THE THEORIST
- Patricia E. Benner, R.N., Ph.D., FAAN is a Professor Emerita at the University of California, San Francisco.
- BA in Nursing - Pasadena College/Point Loma College
- MS in Med/Surg nursing from UCSF
- PhD -1982 from UC Berkeley
- 1970s - Research at UCSF and UC Berkeley
- Has taught and done research at UCSF since 1979
- Published 9 books and numerous articles
- Published ‘Novice to Expert Theory’ in 1982
- Received Book of the Year from AJN in 1984,1990,1996, 2000
- Her web address is at: http://www.PatriciaBenner.com
- Her profile can be obtained at http://nurseweb.ucsf.edu/www/ix-fd.shtml
LEVELS OF NURSING EXPERIENCE
She described 5 levels of nursing experience as;
- Novice
- Advanced beginner
- Competent
- Proficient
- Expert
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.”
Advanced 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
SIGNIFICANCE OF THE THEORY
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These levels reflect movement from reliance on past abstract principles to the use of past concrete experience as paradigms and change in perception of situation as a complete whole in which certain parts are relevant
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Each step builds on the previous one as abstract principles are refined and expanded by experience and the learner gains clinical expertise.
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This theory changed the profession's understanding of what it means to be an expert, placing this designation not on the nurse with the most highly paid or most prestigious position, but on the nurse who provided "the most exquisite nursing care.
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It recognized that nursing was poorly served by the paradigm that called for all of nursing theory to be developed by researchers and scholars, but rather introduced the revolutionary notion that the practice itself could and should inform theory.
CONCLUSION
- Nursing practice guided by the human becoming theory live the processes of the Parse practice methodology illuminating meaning, synchronizing rhythms, and mobilizing transcendence
- Research guided by the human becoming theory sheds light on the meaning of universal humanly lived experiences such as hope, taking life day-by-day, grieving, suffering, and time passing
RESEARCH ON BENNER'S THEORY
- Towards an alternative to Benner's theory of expert intuition in nursing: a discussion paper
- An evaluation of the seminal work of Patricia Benner: theory or philosophy?
- A response by P. Benner to K. Cash, "Benner and expertise in nursing: a critique"
- Benner and expertise in nursing: a critique
- Intuition as a function of the expert nurse: a critique of Benner's novice to expert model
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BIBILIOGRAPHY
- Benner, P. (1982). From novice to expert.American Journal of Nursing, 82(3), 402-407
- Benner, P., & Wrubel, J. (1982a). Skilled clinical knowledge: The value of perceptual awareness. Part 1.Journal of Nursing Administration, 12(5), 11-14.
- Benner, P., & Wrubel, J. (1982b). Skilled clinical knowledge: The value of perceptualawareness. Part 2.Journal of Nursing Administration, 12(6), 28-33.
- Benner, P. (1984). From novice to expert: Excellence and power in clinical nursingpractice. Menlo Park, CA: Addison-Wesley.
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