Patricia Benner R.N., Ph.D., F.A.A.N., F.R.C.N.

1. Patricia Benner R.N., Ph.D., F.A.A.N., F.R.C.N. Nursing theorist From Novice to Expert Kelly Lockhart Sara Young NURS 324 Spring 2013 Patricia Benner (photo by Robert Foothorap)

2. Patricia BennerR.N., Ph.D., F.A.A.N, F.R.C.N. • Current Professor Emerita at the University of California, San Francisco • Has taught and been involved in research since 1979. • Well published in journals and books. • 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. Patricia Benner http://www.bing.com/images/search?q=Nursing+Symbols&FORM=RESTAB#

3. Purpose • Basic overview of nursing theory • Explanation of Patricia Benner’s work “From Novice to Expert” model • Relation of Benner’s work to current practices Photo courtesy http://www.123rf.com/search.php?word=abstract_nursing&start=0&searchopts=&itemsperpage=60

4. What is nursing theory? • “A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and/or prescribing.” • Many nursing theories incorporate the four paradigms: nursing, person, health and environment (Nursing Theories, 2012)

5. Why is theory important? • When nursing practice is built on sound theories, the profession is strengthened • Using theory in nursing helps us to: • Think critically • Analyze information and make clinical judgments • Assist in decision making • Support excellence in practice • Assist novices in becoming experts therefore improving patient care (Black, 2011) Photo courtesy http://blogs.hpedsb.on.ca/hjc/1213nevan/

6. From Novice to Expert Nursing Model “Patricia Benner developed a concept known as “From Novice to Expert”. This concept explains that nurses develop skills and an understanding of patient care over time from a combination of a strong educational foundation and personal experiences.” Benner’s theory identifies five levels of nursing experience: novice, advanced beginner, competent, proficient, and expert. (Nursing Theory, 2011)

7. 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 accrued over time; it is embedded in expertise. Thoughts are based on the Dreyfus model. • Knowledge has gone uncharted and unstudied because differences between practical and theoretical knowledge have been misunderstood • Well charted nursing practice and observation are essential for theory development (Benner, 2001, p. 1)

8. Benner’s Philosophy • Benner “proposed that a nurse could gain knowledge and skills without actually learning a theory” Described as “knowing how” without “knowing that” • Development of knowledge in nursing is “a combination of knowledge through research and understanding through clinical experience” (Nursing Theory, 2011) Photo: http://www.canstockphoto.com/nurse-word-cloud-concept-11506014.html

9. 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 • 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. (Tomey & Alligood, 2006)

10. Dreyfus Model of Skill Acquisition Table 1: The model in 1980 shows how skill acquisition changes for the given mental functions throughout advancement in the given skill levels. (Dreyfus & Dreyfus, 1980)

11. Dreyfus vs. Benner Dreyfus model including the 5 levels as of 1986 (moleseyhill.com) Benner’s Stages of Nursing Proficiency (nursinginformatics.ca)

12. Novice to Expert • Novice • Advanced Beginner • Competent • Proficient • Expert Benner’s stages of Nursing Proficiency Photo courtesy http://nursetopia.net/2011/06/29/star-wars-flavor-to-dr-patricia-benners-novice-to-expert/

13. The Novice • Begins with no prior experience • Taught rules to perform tasks • Rule governed behavior is limited and inflexible • Being a novice is not exclusive to students- any nurse entering a setting without prior experience with that particular patient population may be limited to the novice level Photo: http://shop.atozteacherstuff.com/downloads/daily-5-self-evaluation-novice-apprentice-practitioner-expert.html (Benner, 2001, pp. 20-21)

14. The Advanced Beginner • 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 (Benner, 2001, pp. 22-23) Photo courtesy http://youthvoices.net/discussion/nursing

15. The Competent Nurse • Has been on the job in similar situations for 2-3 years • Aware of long term goals-- gain perspective from planning their own actions • Become more efficient and organized (Nursing Theory, 2011) Photo courtesy http://libguides.gvltec.edu/nursing

16. The Proficient Nurse • Perceives and understands situations as whole parts • Views patients holistically • Has learned what to expect in certain situations and how to modify plans as needed (Nursing Theory, 2011)

17. 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 (Black 2011, p. 137) (Nursing Theory, 2011) http://www.abstractbrokers.com/Buyers/IndustryLinks/tabid/62/Default.aspx

18. Benner’s Explanation of the Four Paradigms • Nursing • Person • Health • Environment Photo courtesy http://www.emporia.edu/nursing/nursing-mission.html

19. Nursing Benner viewed nursing as the care and study of the lived experience and the relationship of these three elements: • Health • Illness • Disease Photo courtesy http://cnx.org/content/m13589/latest/ (Nursing Theories, 2013)

20. Person “…the person does not come into the world predefined but gets defined in the course of living a life” 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 Photo courtesy http://www.bing.com/images/search?q=nurse+images&qs=HS&form=QBIR&pq=&sc=8-0&sp=2&sk=HS1#view=detail&id=8B0FC4FBC4E9A78296B556430D55638F7399DF6D&selectedIndex=832 (Nursing Theories, 2013)

21. 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) Photo courtesy http://learningfundamentals.com.au/resources/

22. 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 http://bizchicks.org/2011/02/the-emotion-health-connection/ Photo courtesy http://www.howtolearn.com/2012/01/what-did-we-learn-about-health-and-happiness-in-2011 (Tomey& Alligood, 2006, p. 151)

23. Relationship of Paradigms to Benner’s Model The culmination of the four paradigms of nursing create experiences that nurses utilize to advance through the stages of Benner’s model From Novice to Expert Photo courtesy http://www.clker.com/clipart-nurse-icon.html Photo courtesy http://www.pearsoned.co.uk/Bookshop/detail.asp?item=229360

24. Using Benner’s Model in Practice Examples of use in practice: • Preceptorship • Orientation processes • Nursing educational programs • Professional advancement ladders • Interdepartmental job changes (e.g. medical-surgical nurse transitioning to an intensive care unit) http://www.galaxyhealth.net/

25. Benner in Action American Association of Critical-Care Nurses (AACN) Synergy Model • Developed as a basis for nursing practice • Development utilized use of Benner’s Novice to Expert stages of development • Combines nursing competencies with characteristics of patients to “enhance optimal patient outcomes” (Kaplow, 2002) • Patient outcomes will be different at the different levels of the nurse’s expertise. (photo courtesy AACN.org)

26. Benner in Action Clinical Ladder Programs • Most are based on stages of clinical competence of Benner’s (Murphy, 2012) • Intention of the ladder is to retain experienced nurses • Greater rewards at the expert levels than the novice level

27. Conclusion This model can be applied to all areas of nursing. It looks at the education and development of a nurse and how they become an expert. Patricia Benner examined how nurses learn to nurse (Nursingtimes.net, 2010) Photo courtesy http://nursesaidetraining.blog.com/ Photo courtesy http://depositphotos.com/9744222/stock-illustration-Nursing-home-logo.html

28. References American Association of Critical-Care Nurses (2013). Retrieved from www.aacn.org Benner, P., (2001). From novice to expert: Excellence and power in clinical nursing practice (Commemorative edition). New Jersey: Prentice Hall Health. Black, B.P. (2011). Becoming a nurse: Defining nursing and socialization into professional practice. In K.K. Chitty & B.P. Black (Eds.), Professional nursing: Concepts and challenges (6th ed. pp. 126-145). Maryland Heights, MO: Saunders Elsevier. Dreyfus, S. E., & Dreyfus, H. L. (1980). A five-stage model of the mental activities involved in directed skill acquisition (Operations Research Center Rep. No. ORC-80-2). Kaplow, R. (2002). The synergy model in practice applying the synergy model to nursing education. Critical Care Nurse, 22(3), 77-81.

29. References Murphy, D. (2012, September/October). Novice to expert: clinical ladder programs as a recruitment and retention tool. Ohio Nurses Review., 16-17. Retrieved from www.ohnurses.org Nursingtimes.net [website]. (2010, March). Nursing Times. Retrieved from http://www.nursingtimes.net/whats-new-in-nursing/hall-of-fame/patricia-benner-us-nurse-theorist-and-author-of-from-novice-to-expert/5012095.article Nursing Theory. (2011). Patricia Benner: Biography of Patricia Benner. Retrieved from http://nursing- theory.org/nursing-theorists/Patricia-Benner.php Nursing Theories. (2013). Patricia Benner: Metaparadigm in nursing. Retrieved from http://nursingtheories.info/patricia-benner-metaparadigm-in-nursing/ Nursing Theories: a companion to nursing theories and models website. (2012). Retrieved from www.currentnursing.com/nursing_theory Tomey, A., & Alligood, M. (2006). Nursing theorists and their work (6th ed.). St. Louis, MO: Mosby Elsevier.

30. Case Study #1 Sally had the opportunity to be a nurse extern at a hospital on a busy medical-surgical unit while she finished her undergraduate studies. With this opportunity, Sally stated that she had the chance to become comfortable in a nursing role, and was able to relate nursing practice to the theory that she was learning in class. After graduation, Sally became an RN in the Neonatal ICU. Given her recent nursing experience, which of Benner’s stages is Sally practicing at as a Neonatal RN?

31. Case Study #2 You and Ginger have been nurses together for the last five years. You have both worked on the Orthopedic unit since graduating nursing school. You both easily perform the required nursing duties, seem to have “that nursing sense” about when something is going downhill, and act as charge nurses on the unit. Ginger is reluctant to act as a preceptor to newer nurses stating that “I still need to work on my organization before trying to help others learn the way.” You have acted and excelled as a preceptor with excellent feedback. What stages of Benner’s model would you place yourself and Ginger?