Transcript Document

Nursing Theorist
Patricia Benner
From Novice to Expert
By: Amy Bowers, Amy Bradley, Michael Dugan,
Amanda Hubbard, & Dawn Platt
Purpose & Introduction
The purpose of this presentation is to discuss and examine
the Nursing Theorist, Patricia Brenner, and her nursing
theory: From Novice to Expert. Patricia Brenner's theory
explains how a nurse develops a sense of intuition in their
practice and develops their critical thinking skills as a
nurse (Blum, 2010).
http://www.truthaboutnursing.org/news/2010/jan/16_education.html#axzz1nRDAlWVi
Origins of the Nursing Model
What Motivated Benner’s Novice to Expert Theory?
1. Patient needs increasing
2. Lengths of stays decreasing
3. Advancement in medical technology
4. Increased learning for nurses
5. Need for more specialized nursing
6. Need for more experienced nurses

With all that is required in the nursing field, Benner (1982)
wanted to provide an understanding for nurses, as they develop
their skills, of what makes a novice nurse become an expert
nurse (Benner).
Historical Background
Theory based on Dreyfus’s
(1980) “A five stage model of the
mental activities involved in direct
skills acquisition” model (Dreyfus).
Hubert & Stuart Dreyfus
http://socrates.berkeley.edu/~hdreyfus/
http://www.ieor.berkeley.edu/People/Faculty/dreyfus.htm
Similarities
•Five developmental stages
•Increase in skills and experience gets advancement in stages
Benner’s nursing theory of novice to expert is also based on five
levels of skills; novice, advanced beginner, competent, proficient,
and expert (Benner). Associate Professor Cheryl Martin finds that
nurses move through the five levels as they “develop clinical
expertise through experience and [gain] knowledge” (Martin).
Benner's Philosophy
Benner worked in a variety of nursing areas including
Intensive Care Unit (ICU), medical-surgical, emergency,
and coronary. She became interested in not how to do
nursing but how do nurses learn to do nursing.
Using the Dreyfus model, Patricia applied the
philosophy of learning to nursing. Aspects of Benner's
philosophy include:
• practical situations are more complex than they seem
and formal methods such as textbook descriptions,
theories and models are inadequate to explain the
complexities. Experience and mastery are required to
bring a skill to a higher level.
Benner's Philosophy, cont.
• the connections between external and internal
events. Even though it may not be apparent on the
outside, nurses develop and use their own philosophies
about patients and their care using experience, ethics,
and personal knowledge. Benner believes nurses should
"interpret their own concerns, practices, and life
experiences" (Altmann, 2007, Philosophical
Underpinnings section, para 1).
• Benner describes her work as interpretive
phenomenology which means observing and interpreting
actual nursing practice to find the meaning of the
experiences (Altmann, 2007).
Content of Nursing Model
Stages of Novice to Expert Model
http://nursing-informatics.com/nrth100.html
•Novice
–Generally applies to student nurses
–Can also apply to experienced nurses in an
area or situation of unfamiliarity (Alligood &
Tomey)
–Has little background and limited practical
skills
–Relies on rules and expectations of others
for directions (Chitty & Black)
Stages of Novice to Expert Model
http://nursing-informatics.com/nrth100.html
•Advanced Beginner
–Applies to most newly graduated nurses
–Feel highly responsible for managing patient
care
–Still rely on the help of the more experienced
nurse (Alligood & Tomey)
–Has marginally competent skills
–Uses theory and principles much of the time
–Experiences difficulty establishing priorities
(Chitty & Black)
Stages of Novice to Expert Model
http://nursing-informatics.com/nrth100.html
•Competent Practitioner
–Usually applies to nurses with 2-3 years
experience
–Coordinates several tasks simultaneously (Chitty
& Black)
–Consistent, predictable, and able to manage time
–May display hyperresponsibility for the patient
–Begins to recognize patterns
–Determines which elements of the situation
warrant attention and which can be ignored
(Alligood & Tomey)
Stages of Novice to Expert Model
http://nursing-informatics.com/nrth100.html
•Proficient Practitioner
–Usually applies to nurses with 3-5 years
experience
–Views patient holistically
–Focuses on long-term goals (Chitty & Black)
–Can see changing relevance in a situation
–No longer relies on preset goals for
organization
–Demonstrates increased confidence in their
knowledge and abilities (Alligood & Tomey)
Stages of Novice to Expert Model
http://nursing-informatics.com/nrth100.html
•Expert Practitioner
–Reached only after extensive experience
–Performs intuitively without conscious thought
–Grasps patient needs automatically (Chitty &
Black)
–Demonstrates a clinical grasp and resource based
practice
–Possesses embodied know-how
–Able to see the “big picture”
–Able to recognize patterns on the basis of deep
experiential background (Alligood & Tomey)
Benner’s Description of Nursing
•A caring relationship, “an enabling condition of
connection and concern”
•“Caring is primary because caring sets up the possibility
of giving help and receiving help.”
•“Nursing is viewed as a caring practice whose science is
guided by the moral art and ethics of care and
responsibility.”
•Is the care and study of the lived experience of health,
illness,
and disease and the relationships among these three
elements
(Alligood & Tomey, 2011, p.148)
http://www.himolde.no/db/57/3973.jpg
Benner’s Description of Person
•“A person is 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 nonreflective understanding of the self in
the world.”
"The person is viewed as a participant in common meaning."
The four major aspects of understanding that the person
must deal with:
o The role of the situation
o The role of the body
o The role of personal concerns
o The role of temporality
(Alligood & Tomey, 2011, p. 148)
http://www.himolde.no/db/57/3973.jpg
Benner’s Description of Health
•Health is defined as what can be assessed
•Well-being is the human experience of health or
wholeness
•A person may have a disease and not experience
illness
–Illness is the human experience of loss or
dysfunction
–Disease is what can be assessed at the physical
level
(Alligood & Tomey, 2011, p. 149)
http://www.himolde.no/db/57/3973.jpg
Benner’s Description of Situation
(Environment)
•She uses the term situation instead of environment
because situation conveys a social environment with social
definition and meaningfulness
•“Personal interpretation of the situation is bounded by
the way the individual is in it.”
–Each person’s past, present, and future, which include
their own personal meanings, habits, and perspectives,
influence the current situation
(Alligood & Tomey, 2011, p. 149)
http://www.himolde.no/db/57/3973.jpg
Interpretation
By applying the Dreyfus model to nursing, Benner was
able to explain how nurses can have different stages of
experience and knowledge and how these different
stages affect how the nurse sees and interprets the
nursing process, the patient, the patient’s health, and the
environment (situation) the patient is in. This model
demonstrates that the majority of nursing knowledge
and expertise comes from actual on-the-job clinical
experience.
Patricia Benner visits a
patient along with Jenna
Buffington, a first-year
student in the master's entry
program in nursing at UCSF.
http://www.ucsf.edu/news/2005/07/6290/ucsf-faculty-member-leads-first-major-study-nursing-education-more-th
Implications and Consequences
• Schools of nursing have adopted Benner's model to use
as a base for the education of nurses.
• Hospitals and other nurse work places use the model
as a foundation for perceptor based guidance of
nursing students and new graduate nurses.
• Social agencies and nursing continuing education
program developers also use Benner's model.
• Nursing administrators utilize the model to help
"develop career ladders, staff development, and
recognition and rewards programs" (Altmann, 2007,
"Critique Of The Model," para 7).
http://nursetopia.net/2011/06/29/star-wars-flavor-to-dr-patricia-benners-novice-to-expert/
Implications and Consequences, cont.
Benner's model is used to determine expert nurses
and as a method in developing more expertise in
nurses. This can help optimize nursing by having the
most knowledgeable expert nurses providing care and
teaching the less experienced.
Benner's model was tested and confirmed to be
valid. The stages that Benner developed can be
applied to any adult learning scenerio and not just
nursing (Chitty & Black, 2011).
http://nursetopia.net/2011/06/29/star-wars-flavor-to-dr-patricia-benners-novice-to-expert/
Evaluation of the Nursing Model
Origin
This philosophy can be used in any professional
setting. The novice to expert is all about how
knowledge, intuition, and experience are
achieved. The philosophy was based on a
skill acquisition model developed by Dreyfus and
Dreyfus that was based on a study of chess
players and airline pilots (Benner, 1980).
http://nursetopia.net/2011/06/29/star-wars-flavor-to-dr-patricia-benners-novice-to-expert/
Evaluation of the Nursing Model
Content
This model adds to the global concept of human being,
environment, health and nursing. This model leads the nurse
from novice to expert by using education and mentoring to
allow nurses to grow to be experts. During the nurses
growth the global concepts are in everything you learn and
do. According to Hardt, “The expert nurse profile includes
extraordinary clinical knowledge, supreme connection with
the patient, and the ability to differentiate between
changes that matter and those that are inconsequential.”
http://nursetopia.net/2011/06/29/star-wars-flavor-to-dr-patricia-benners-novice-to-expert/
View
Evaluation of the Nursing Model
In the aspects of nursing this model can be used in
any type of nursing. Benner herself practiced in
Med/Surg, ER, Coronary Care, ICU’s and Home Health
Care. According to Chitty and Black (2011), this model
can be applied to any adult learning situation giving it
a broad view. The concepts of Benner’s theory are
pretty specific. You have to master the skills in one
level before you can move to the next one. You cannot
jump from novice to expert without going through the
other three phases first .
http://nursetopia.net/2011/06/29/star-wars-flavor-to-dr-patricia-benners-novice-to-expert/
Evaluation of the Nursing Model
Practice Situations
Novice/advanced beginner:
I took care of this neuro patient the other night. I am not as
familiar with this type of patient as some of the others that I
have cared for in the year that I have been a nurse. The patient
was alert and oriented and then within the span of a few hours
was getting more and more obtunded. The MD ordered a stat CT
scan and I had to transport the patient for the scan. I was very
nervous about this process because I had only taken a few trips
to CT scan before as an ICU nurse and was unsure as to what
may occur while I was off the unit. Fortunately, I was able to
complete the transport and the patient's status did not change
much while I was gone. I considered this very successful because
I was able to complete this process without any ill effects to the
patient.
Case Study
A nurse, with over 15 years’ experience on the obstetrics floor, is attempting
to teach a new mother how to breast feed her infant. First thing she does is
makes sure the new mother has privacy, that the room is warm and the
lighting is dimmed. The mother is now relaxed and comforted by her
surroundings. The nurse proceeds to explain to the mother about how to
hold her infant and get him to latch on to her breast. She shows the mother
a pamphlet with pictures explaining how this is done. The mother is still a bit
nervous, so the nurse reassures her that she can do this, with explanations
of how it benefits the baby. With this done, the mother is ready to try
breast feeding for the first time. The nurse is careful to continue
reassuring the new mother and to assist her only when it’s necessary. The
nurse notices that the baby still will not latch on to the breast and
immediately intervenes before the mother gets discouraged. An explanation
is given that different techniques can be used to hold the infant, so they are
more comfortable and can latch on better. When the mother places the
infant, with instruction from the nurse, into the football position the latch on
is successful. Of course, the new mother is over joyed but asked the nurse
what she will do if she is at home at cannot get the baby to eat. The nurse is
fully prepared and is able to get the new mother phone numbers for local
support groups in her area.
Question to Case Study
Given the previous scenario, in what stage is
the nurse in Patricia Benner’s Novice to
Expert theory?
Answer
The answer is the nurse is in the expert practitioner. She
performs her education with ease even when the situation
changes. She performs instinctively and knows her patients
needs automatically. She was able to diffuse a potential
negative situation with her patient before the patient got
discouraged. The nurse was fully prepared to answer all
questions and provide outside resources (Nursing Theories).
References
Alligood, M. R. & Tomey, A. M. (2010). Nursing theorists and their work (7th ed.). Maryland Heights, MO: Saunders, Elsevier.
Benner, Patricia. (2001). From Novice to Expert: Excellence and Power in Clinical Nursing Practice.
Upper Saddle River, New Jersey: Prentice Hall Health.
Benner, P. (1982). From novice to expert. The American Journal of Nursing, 82(3), 402-407. Retrieved from
http://www.jstor.org/stable/3462928
Chitty, K. K. & Black, B. P. (2011). Professional nursing: Concepts & challenges (6th ed.). Maryland Heights, MO: Saunders, Elsevier.
Dreyfus, S.E., & Dreyfus, H.L. (1980, February). A five stage model of the mental activities involved in direct skills acquisition. United
Stated Air Force Operations Research Center Report 80-2.
Martin, M. (2002). The theory of critical thinking of nursing. Nursing Education Perspectives. 23(5), 243-247.
Nursing Theories. (n.d.). Retrieved February 18, 2012 From Current
Nursing: http://currentnursing.com/nursing_theory/Patricia_Benner_From_Novice_to_expert.html
Resources and Web-Links
Amy Bradley
Blum, C. (2010). Using the Benner intuitive-humanistic decision-making model in action: A case
study. Nursing Education in Practice, 10(5), 303-307. doi: 10.1016/j.nepr. 2010.01.009
Emerita. (n.d). Patricia Benner-01-Career and influence in educating professionals [video file].
Retrieved from http://www.youtube.com/watch?v=FUIT1_pYBBc&feature=
relat
http://www.youtube.com/watch?v=FUIT1_pYBBc&feature=related
Amy Bowers
Dreyfus, S. E., & Dreyfus, H. L. (1980, February). A five stage model of the mental activities
Involved in direct skills acquisition. United States Air Force Operations Research
Center Report 80-2.
Benner, P. (1982). From novice to expert. The American Journal of Nursing, 82(3), 402-407.
Retrieved from http://www.jstor.org/stable/3462928
Martin, M. (2002). The theory of critical thinking of nursing. Nursing Education Perspectives,
23(5), 243-247.
Nursing Theories. (n.d.). Retrieved February 18, 2012 From Current Nursing:
http://currentnursing.com/nursing_theory/Patricia_Benner_From_Novice_to_Expert.
html
Resources and Web-Links
Mike Dugan
Altmann, T. (2007, May-June). An evaluation of the seminal work of Patricia
Benner: Theory or philosophy? Contemporary Nurse, 25.1-2. Retrieved November
21, 2012, from http://0go.galegroup.com.libcat.ferris.edu/ps/i.do?id=Gale%7CA166565269&v=2.1&u=lom_ferrissu&i
t=r&p=AONE&sw=w
http://www.educatingnurses.com/
Amanda Hubbard
Hardt, Marge. (2001). Core Then Care: The Nurse Leader's Role in "Caring". Nursing
Administration Quarterly,25(3), 37-45.
http://www.ihi.org/offerings/IHIOpenSchool/resources/Pages/ProfilesInLeadershipPatrici
aBenner.aspx
Dawn Platt
Gardner, L. (2011). From novice to expert: Benner's legacy for nurse education. Nurse
Education Today, doi: 10.1016/j.nedt.2011.11.011
http://nursing-theory.org/nursing-theorists/Patricia-Benner.php