Major Key Concepts

Nursing

Benner described nursing as "caring relationship" (Alligood & Marriner-Tomey, 2010)
 “Nursing is viewed as a caring practice whose science is guided by the moral art and ethics of care and responsibility” (Benner & Wrubel, 1989).
She believes the most important way a nurse can enhance their practice is through experience (Swingshift Nurses, 2009)
The Dreyfus Model of Skill Acquisition, applied to nursing and combined with an interpretive approach to describing nursing practices, offers guidelines for career and for knowledge development in clinical nursing practice. (American Journal of Nursing/March 1982)

Person

The Person is a self-interpretative 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 self in the world” (Tomey & Alligood, 2006, p.151).
Benner and Wrubel (1989) described the four aspects of a person's understanding
1. The role of the situation
2. The role of the body
3. The role of personal concerns
4. The role of temporality.
Furthermore, Benner and Wrubel (1989) outline the five dimensions of the body which nurses attend.
1. The unborn complex - this includes the body of the fetus and the newborn baby
2. The habitual skilled body - this includes the body that has gained socially learned postures, gestures, customs, and skills
3. The projective body - this include the body that is predisposed to act in specific situations
4. The actual projected body indicating an individual’s current bodily orientation or projection in a situation that is flexible and varied to fit the situation.
5. The phenomenal body, the body aware of itself with the ability to imagine and describe kinesthetic sensations


Health

Benner defined Health as the state that can be assessed and uses the idea of health being not just the absence of disease and illness. Health pertains more on the physical, physiological and observable, in contrast with well-being that is more on the experiential and psychological (Alligood & Marriner-Tomey, 2010).
She further adds that a person may acquire a disease and yet not experience illness, because illness is the human experience of loss or dysfunction, whereas disease is what can be assessed at the physical level (Benner & Wrubel, 1989).

Environment

Benner and Wrubel (1989) use the term "situation" in their work instead of using environment.
“She uses the terms being situated and situated meaning, which are defined by a person’s engaged interaction, interpretation, and understanding of the situation” (Tomey & Alligood, 2006, p.151). This implies that a person’s experiences and perspectives influence their environment (Tomey & Alligood, 2006)

SHARING GROUP MEMBERS PERSONAL EXPERIENCE ON HOW WE RELATE WITH THE THEORY

Benner proposed that a nurse could gain knowledge and skills without actually learning a theory. She describes this as a nurse "knowing how" without "knowing that." She further explains that the development of knowledge in fields such as nursing is made up of the extension of knowledge through research and understanding through clinical experience.In my experience, when it was my first years of being a staff nurse in pediatric department, I greatly relied on my senior’s instructions and teachings. My senior nurses were assigned to be my buddies during my shift. They will do the patient’s care to the patients assigned to us, while I keenly observe them do the nursing care, and then teach me how to do it, such as bed bathing the patients, suctioning the intubated patients, and establishing intravenous access. (almost all of my “workplace” knowledge were provided by my seniors.)

As the years passed, I now gained deeper background of experience and intuitive grasp of the clinical situation, I can perceive that when there are relevant signs and symptoms happening to my patients as being highly febrile, tachycardic, cold clammy extremities and drop in blood pressure, even drop in blood sugar in severely ill infants, the patient is significantly having a septic shock and needed an immediate referral to he doctor.

Our institution also provides regular seminars and talks to refresh me and give me up to date knowledge about the field of nursing. Thus, I can say that I can now rely on my experience and learned skills and can independently do assessment to  patients and creating care plan for them. As well as providing education to the patients as needed.

Truly, that a nurse could gain knowledge and skills without actually learning a theory. And that the development of knowledge in fields such as nursing is made up of the extension of knowledge through research and understanding through clinical experience.  -MARIA LOURDES TROCINO
                            


 Patricia Benner’s Novice to Expert theory is one of the theories we will never forget due to the fact that we have experienced it and some are in the process of achieving the role of an expert Nurse.
7 years ago, I was just a newly graduate nurse that is very enthusiastic of the new world I will be stepping in.  I often imagined myself participating in hospital procedures so easy and swiftly doing it without mistakes.  Most of the time, I thought that the knowledge and skills I acquired from school is enough to make me a good nurse.  I then realized I was wrong.
My first hospital experience was at Baguio General Hospital and Medical Center, where in 2011 they were accepting Nurses as Nurse fellow or trainee.  It was a 4 month stay in the Neonatal Intensive Care Unit and you are assigned in rotation to 4 subunits: Delivery and Newborn Care, Sick babies, Well babies and Mother and Child room.   I was overwhelmed at the current situation at that time and was expecting a very ideal setup, but of course, you can’t have an ideal setup in a government hospital in the Philippines.  I just do what my older staff nurses tell me to do and often I try to observe them. I always thought “This is not what the book says.” And honestly, I was rigid and inflexible.
In few months’ time, I worked as RN HEALS for 1 year at the same institution but now I was rotated in major areas –medical ward and private rooms.  Again my excitement heightened. Why not? New experiences and new learning awaits me.  I experienced difficulty at first, I was caring for adults now and with different cases but now I knew more and I have to know more.  I could not accept that I’d be finishing this year without being confident with the nursing skills I acquired through my hospital duties and being unable to explain cases of my patients.  Soon, I.  I gained self-esteem and I knew I was better than before.
Today marks my 6 years of experience as a Nurse. Currently working for 3 years in the Neurology Department and Stroke Unit.  Now, I know how to make decision making based on the situation set upon me and I am guiding my fellow colleagues.  I have gained self-reliance and was flexible enough to meet the needs of my patients.
 I believe that there is always room for growth and learning as long you never underestimate yourself and you are open to new things.  I always keep in mind that an expert nurse was once a newbie nurse.-CATHERINE TAFALENG


Continuous learning is inherent to nursing practice.  We can use the novice to expert theory of Benner as a guage in measuring nurses level of experience and competence  in their course of nursing career. Through this, nurses will be able to assess their competency in performing nurses task and find strategies to hasten their skills.   
For example my own experience in the hospital  I am working with right now, nurses were being assess yearly base on our skills such as   performing bedside procedures, assisting physicians, communication , social interactions,  bedside medical equipment manipulations and patient care. Furthermore, competencies were conducted yearly to assess how familiar we are with our hospital wide policy. We were encouraged also to share our learning to the new staff in the area. It is overwhelming how it feels to precept for I can compare myself to them during my orientation phase. Thanks to my colleagues who enriched me with constructive criticisms and patiently taught me how to cope for they became my guide in assessing my performace in the area. 
Knowing ones limitations in applied nursing is a big help being used to step up from being novice to expert. -LEZLIE AN UGALE

 

HOW THEORY INFLUENCES NURSES TODAY

                                                       How Benner's theory 
                                                     affect modern practice




Patricia Benner’s Theory of Skill Acquisition: From Novice to Expert had greatly contributed to our knowledge and nursing practice today. In this theory, Benner explained that theories and formal models of nursing should only be utilized by the novice nurses in order to give compensation for being inexperienced (Gardner, 2012). However, once these nurses have acquired appropriate clinical experience to develop their clinical eye and judgment, intuition is then better utilized in providing nursing care to patients in certain instances.   Benner has given emphasis on the irrational aspect of providing quality nursing practice once a nurse reached the expert level and is guided more of what we call as “intuition”.
Darbyshire (1994) has discussed how the works of Benner has shown the public the significance of having a skilled nursing practice. In Benner’s theory, much of the spotlight is on developing the nurse’s skill which will then impact the way the patients will be taken care of and how safe and efficient practice will be utilized. Similarly, Karen S.  Hill (2010) in her article mentioned that despite the sufficient theoretical nursing knowledge that an entry level nurse possesses, knowledge acquired from experience is necessary for this new nurse to improve and provide safer levels of practice. Nursing practice become safer as each nurse progresses from novice level. This was further proven by a study performed by Dunton together with his colleagues in 2007, where data revealed that for every one year increase of the total RN experience, the rate of fall incidences in a unit decreased by 1% lower.  Safe and quality nursing practice improves with the higher years of experience of nurses (Hill, 2010).  Benner wanted to stay away and to emphasize the importance of passionate and quality care.
Benner’s theory has contributed greatly in recognizing the great value of apprenticeship in providing education in training nurses.  This can be seen in today’s way of educating nurses by having their clinical rotations as part of their curriculum. Also, in the hospital set up, entry level nurses are initially paired with a senior nurse for a few weeks to do their clinical rotations together as a part of training the novice nurse in the clinical set-up and in helping the novice nurse develop his or her clinical eye.  According to Gardner’s article in 2012, Dreyfus indicated that the best way in educating students would be by preferring to utilize an apprenticeship model instead of theoretical ones.

THEORIST APPLICATION IN NURSING RESEARCH

                                 THEORY TO NURSING RESEARCH


Nurse Competence Scale: development and psychometric testing

Benner’s Novice to Expert Theory has also been widely used as a significant basis in formulating tools in assessing a nurse’s level of competence. In a study entitled: Nurse Competence Scale: development and psychometric testing (2004), researchers aimed to design and test an evidence-based model that could assess a nurse’s level of competence in different hospital work environments. Through the utilization of Benner’s theory, the researchers were able to formulate and validate the Nurse Competency Scale (NCS) tool which consists of a 73-item scale distributed into seven categories as follows:

1.       helping role (seven items)
2.       teaching–coaching (16 items)
3.       diagnostic functions (seven items)
4.       managing situations (eight items)
5.       therapeutic interventions (10 items)
6.       ensuring quality (six items)
7.       work role (19 items)    
The result of the study clearly suggests the validity of the said tool. This study also emphasized the importance of integrating competence assessment models into quality assurance systems and human resources management as a way to develop workforce planning and career opportunities of practicing nurses





Explicating Benner’s concept of expert practice: intuition in emergency nursing
   
Benner’s practice development theory is widely accepted for all stages except for the existence or efficacy of the intuitive practice, a characteristic of the expert practitioner. The study explored, through an interview, the experience of emergency nurses in relation to intuition.
    The analysis resulted in the reconstruction of Benner’s expert stage into three distinct phases:
1. Cognitive intuition, where assessment is processed subconsciously and can be rationalized in hindsight
2. Transitional intuition, where a physical sensation and other behaviours enter the nurse’s awareness
3. Embodied intuition, when the nurse trust the intuitive thoughts.
    Te finding validates the use of intuitive decision making as a construct in explaining expert clinical  decision making practices. The validity of intuitive practice should be recognized. It is essential to recognize the conditions that support practice development, and in the prenovice stage(during their university course)factors such as reflection, research(in its broadest sense) and clinical curiosity should be fostered.


 REFERENCE:http://psbennersnsgtheory.blogspot.com/2015/09/benners-theory-as-applied-to-research_29.html
REFERENCE:
http://psbennersnsgtheory.blogspot.com/2015/09/benners-theory-as-applied-to-research_29.html

THEORIST APPLICATION TO NURSING EDUCATION

                        THEORY APPLICATION TO NURSING EDUCATION


Benner's concepts regarding the performance characteristics and learning needs of nurses with varying levels of clinical competency can be incorporated into nursing education. Valid and reliable methods of identifying the developmental stage of nurses are important when developing and implementing teaching NOVICE TO EXPERT THEORY AND REFLECTIVE PRACTICE 19 and learning strategies (Haag-Heitman, 2008).However, she critiqued the concept of competency based testing by contrasting it with the complexity of proficiency and expert stages described in the Dreyfus Model of Skill Acquisition” and stated that “ Competency based testing seems limited to the less situational, less interactional areas of patient care where the behavior can be well defined and patient and nurse variations do not alter the performance criteria.

As a result of Benner’s application of the Dreyfus model, nursing educators have realized that learning needs at the early stages of clinical knowledge development are different from those required at later stages.

In Expertise of Nursing Practice, Benner Tanner and Chelsea (1996) emphasized the importance of learning the skills of involvement and caring through practical experiences, the articulation of knowledge and practice, and the use of narratives in undergraduate education. This work provides support to the thesis that it may be better to place a new graduate with a competent nurse preceptor who can explain nursing practice in ways that the beginner comprehends, rather than with the expert, whose intuitive knowledge may elude beginners who do not have experienced know how to grasp the situation. This work, led to the development of internship and orientation programs for newly graduated nurses and to clinical development for more experienced nurse.
In Clinical Wisdom in Critical Care, Benner Hopper-Kyriakidis, and Stannard (1999) urged greater attention to experiential learning and presented the work as a guide to teaching. They designed a highly interactive CD-ROM to accompany the book. Two major types of integrative strategies presented in 2011 edition are multiple examples of coaching situated learning and a thinking-in-action approach to integrating classroom with clinical teaching.

A national study of nursing education was designed to identify “signature pedagogies” that maximize the nurse’s ability to cope with the challenges of nursing that have developed during the 30 years since the last national study of nursing education. The authors recommend that nursed educators make four major shifts in their focus (1) from covering abstract knowledge to emphasizing teaching from particular situations; (2) from separations between clinical and classroom teaching to integration of these components: (3) from critical thinking to clinical reasoning; and (4) from emphasizing socialization and role-taking to professional identity formation. In addition, several nursing schools have used Benner’s philosophy of novice to expert skill acquisition to develop a structure for nursing curricula (Brykcznski, 2010b).

References:
Nursing Theorist and their Work, 8th Edition by Marth Raile Alligood, PhD, RN, ANEF, Copyright 2014 by Mosby, Page 132-33

THEORIST BACKGROUND STUDY

THEORIST BACKGROUND STUDY OF NOVICE-EXPERT THEORY

More than 30 years ago, Benner began what she describes as an articulation project of the knowledge embedded in nursing practice. Her initial thrust toward further understanding of the theory/practice gap in nursing became transformed while conducting the Achieving Methods of Intra-Professional Consensus, Assessment and Evaluation (AMICAE) project, which provided the data for the widely acclaimed book From Novice to Expert: Excellence and Power in Clinical Nursing Practice, abbreviated FNE. Profound exemplars of nursing practices were uncovered from observations and interviews with clinical nurses during this project that demonstrated that clinical nursing practice was more complex than theories of nursing could describe, explain, or predict. This constituted a paradigm shift in nursing by demonstrating that knowledge can be developed in practice, not just applied, and signifying that practice is a way of knowing in its own right.

Two direct outcomes of the AMICAE research project were (1) validation and interpretation of the Dreyfus model of skill acquisition for nurses and (2) description of the domains and competencies of nursing practice. Benner’s ongoing research studies have continued the development of these two components that have been applied extensively in clinical practice development models (CPDMs) for nursing staff in hospitals around the world.

These findings have also been used for preceptorship programs, symposia on nursing excellence and competency validation in maternal and child community health nursing.

The books FNE, Expertise in Clinical Nursing Practice, and Clinical Wisdom and Interventions in Critical Care report studies of skill development in nursing and research-based interpretations of the nature of clinical nursing knowledge. The ongoing development of interpretive phenomenology as a narrative qualitative research method is described and illustrated in each of Benner’s knowledge development publications. The growing body of research that this work has generated is highlighted in the books Interpretive Phenomenology: Embodiment, Caring, and Ethics in Health and Illness and Interpretive Phenomenology in Health Care Research. Interpretive phenomenology is both a philosophy and a qualitative research methodology. Benner and colleagues delineate the historical background, philosophical foundations, and methodological processes of interpretive phenomenological research and examine caring practices and aspects of the moral dimensions of caring for and living with both health and illness

THEORY REFERENCE

Patricia Benner believed that the best nurses develop their skills over time. Education and experience help to contribute to this development, allowing a nurse to fully understand what it means to provide high quality patient care. This process of development would become the foundation for the Novice 

to Expert Nursing Theory.

Benner believed that nurses gained knowledge and skills, lending to their personal expertise, even if they didn’t realize that this process was happening. This idea would become the “Knowing How, Knowing That” component of this theory.

She also believed that this process of development could occur in any applied discipline with the medical field. Every person, Benner theorized, would follow through specific steps of development, allowing them to progress from novice to expert if they were given enough time to do so.
What Are the 5 Stages of Clinical Competence?

Patricia Benner believed that how an individual understands nursing would proceed through 5 specific steps. Each nurse would need to proceed through these steps in order to achieve “expert” status, even if they were not aware of their progression through the steps. Benner suggested in the Novice to Expert Nursing Theory that these would be the steps that every individual would need to follow.

Stage #1 – Novice: Individuals at this stage of competence would be first starting their nursing career. It could be an individual in their first year of a clinical trial, working their way through college classes, or perhaps their first days on the job as a nurse or nursing assistant. People in this stage would have a very limited ability to predict what could happen to their patients. To recognize certain signs and symptoms being experienced, a novice would need to be introduced to those same signs and symptoms in other patients.

Stage #2 – Beginner: In this stage, you’d find recent graduates working in their first jobs. It could also be a nurse without a formal education, but has 1-2 years of experience in the field. Beginners have the ability to recognize recurrent situations, have knowledge that they can act upon, and can often work independently because they have enough personalized in-depth experience they can draw upon.

Stage #3 – Competence: This is the stage where nurses formalize their knowledge and education into practical daily applications. They have organizational skills, recognize patterns quickly, and can implement care strategies with consistent accuracy. Because of this, most nurses who reach this stage will focus on enhancing their speed and flexibility while performing their duties because they can recognize immediately how they must react to most situations.

Stage #4 – Proficiency: In this stage, nurses begin to realize that there is a bigger picture that can be embraced. Instead of managing specific events and being reactionary to patient care, nurses begin to realize that they can become proactive with certain aspects of care as well. This causes the nurse to modify their response plans to different events, even if there isn’t the ability to have advance planning or scheduling involved in the thought process.

Stage #5 – Expert: In this stage, a nurse can recognize resources and demands. They can then use this recognition in order to attain specific goals. Nurses know what needs to be done, so they implement a care plan to properly care for a patient. Instead of relying on rules or procedures, they rely on their knowledge and experience to act on intuition when necessary. They stay focused on relevant problems, use tools when necessary, and ignore events that don’t need to be addressed.

How Patricia Benner Developed the Novice to Expert Nursing Theory

Benner’s theory focuses on how nurses acquire nursing knowledge. It does not focus on the actual process of what it takes to become a nurse in the first place. This is why it is possible to follow the stages of Benner’s theory without actually wanting to be a nurse in the first place.
This is an idea that is based on the Dreyfus Model of Skill Acquisition. The Dreyfus brothers believed that learning was an experiential process, supplemented by a situation-based process. People could learn to be a pilot, for example, by watching how an experience pilot is able to steer an aircraft. In order to apply practical knowledge to flying, however, the person learning to become a pilot would also need to be able to take the controls of the airplane so they could gain relevant experiences.
The one setback to the Novice to Expert Nursing Theory is that it does not allow for critical thinking. It relies on intuition and observation of that intuition rather than the logical thought processes that individuals have when completing a task. Because of this, it may become possible for some individuals to “skip” certain stages within the progression of this theory because they act upon their own observations without being trained to do so.
What Is Notable About the Novice to Expert Nursing Theory?
Benner proposes that nurses should always be moving forward in their progression through these five stages. In the beginning of a nursing career, there tends to be a reliance on to-do lists, checklists, and specific policies or procedures because the nurse is attempting to apply abstract principles to real events. Over time, experience expands the perspective of the nurse, allowing them to change their perception of what needs to be done for every patient.

There are four key reasons why this model can be used effectively for all people, not just those who are engaged in the nursing profession.

1. It allows for an assessment of progress within the development of a personal skill set.
2. It helps to define what an organization or individual may consider to be a desired level of competence for a specific skill.
3. It supports development progression for specific skills because it understands that there are different needs and/or styles required at each stage of progression.
4. It helps to determine when an individual has progressed far enough to be able to teach others the same skills they learned in previous stages.

This creates changes in how the medical field should treat nurses. Instead of the nurse with the most experience or the most extensive degrees receiving the top jobs, Brenner’s theory would propose that the nurses who provide the best nursing care in a consistent manner should be rewarded. It is the process of care that experience is developed, not the process of working with administrative components.
By recognizing who the most experienced nurses happen to be, the quality care all patients can receive will increase. Promoting forward progress will help to achieve better care as well, which is why the Patricia Benner Novice to Expert Learning Theory will always have merit in modern medicine.
Reference:  Patricia Benner Novice to Expert Nursing Theory Explained. (    2017, February 03).  Retrieved from http://healthresearchfunding.org/patricia-benner-novice-to-expert-nursing-theory-explained/