From Novice to Expert, Patricia Benner

1. From Novice to Expert, Patricia Benner By Lisa Nutt Jackie Savage Amy Scanlon Title PageTitle Page

2. From Novice to Expert- Theory Development Source of Theory Early 1980�s University of California, Berkley, Benner�s qualitative research related to the Dreyfus & Dreyfus Five Stage Model of Mental Activities Skill Acquisition 1984 Benner publishes From Novice to Expert: Excellence and Power in Clinical Nursing Practice Theory defines skill levels in nursing and establishes best practices for nursing education (Frisch, 2009) Patricia Benner attended the University of California, Berkley division, in the 1970's and early 1980's to attain her Ph.D. There she met Hubert Dreyfus. Dreyfus worked with his brother and was contracted by the U.S. Air Force to study skill acquisition to assist with developing training programs for the Air Force. Benner conducted qualitative data collection and research applying the skill acquisition model from Dreyfus & Dreyfus to nursing skill acquisition. The book introduced the concept of nursing intuition. Nursing intuition develops over time, it is difficult to define and measure (Frisch, 2009).Patricia Benner attended the University of California, Berkley division, in the 1970's and early 1980's to attain her Ph.D. There she met Hubert Dreyfus. Dreyfus worked with his brother and was contracted by the U.S. Air Force to study skill acquisition to assist with developing training programs for the Air Force. Benner conducted qualitative data collection and research applying the skill acquisition model from Dreyfus & Dreyfus to nursing skill acquisition. The book introduced the concept of nursing intuition. Nursing intuition develops over time, it is difficult to define and measure (Frisch, 2009).

3. From Novice to Expert- Theory Development Description of Theory- Five Stages of Skill Acquisition in Nursing Stage I- Novice Beginner to profession or nurse changing area of practice (Frisch, 2009) Explicit rule based knowledge and behavior (Altmann, 2007) Stage II- Advanced Beginner Nurse begins to incorporate real-life experiences in practice into knowledge base (Frisch, 2009) Still requires mentor or experienced nurse to assist with defining situations, to set priorities, and to integrate practical knowledge (English, 1993) Patricia Benner's Theory of From Novice to Expert includes five stages of skill acquisition in nursing. Stage I is the Novice Stage. Nurses in the Novice Stage are beginners in the profession or nurses that are changing to a different area of nursing (Frisch, 2009). The nurse has no practical experience in the area of the profession. The nurse's decision making at this stage is based upon explicit, rule based knowledge (Altmann, 2007). Stage II is Advanced Beginner. The Advanced Beginner starts to integrate real-life experiences in their practice (Frisch, 2009). According to Benner's theory, the preferred learning method is to provide the newer nurse with a role model/mentor to guide the inexperienced learner to develop their nursing skills (English, 1993). Patricia Benner's Theory of From Novice to Expert includes five stages of skill acquisition in nursing. Stage I is the Novice Stage. Nurses in the Novice Stage are beginners in the profession or nurses that are changing to a different area of nursing (Frisch, 2009). The nurse has no practical experience in the area of the profession. The nurse's decision making at this stage is based upon explicit, rule based knowledge (Altmann, 2007). Stage II is Advanced Beginner. The Advanced Beginner starts to integrate real-life experiences in their practice (Frisch, 2009). According to Benner's theory, the preferred learning method is to provide the newer nurse with a role model/mentor to guide the inexperienced learner to develop their nursing skills (English, 1993).

4. From Novice to Expert-Description of Theory Stage III-Competent After two to three years in the same area of nursing the nurse moves into the Competent Stage of skill acquisition The nurse still relies on conscious planning, efficiency, and organization skills Stage IV- Proficient After three to five years in the same area of nursing the nurse moves into the Proficient Stage The nurse possesses a deep understanding of situations as they occur, less conscious planning is necessary, critical thinking and decision-making skills have developed (Frisch, 2009) Stage III of Benner's theory is the Competent Stage (Frisch, 2009). The nurse in this stage through experience begins to refine rule based behavior by learning of nuances or shades of differences in situations. The nurse learns of rule exceptions through practical knowledge gained by experience over time (Altmann, 2007). As quoted in Altmann (2007), Benner states that "Experience is a requisite for expertise." During the Proficient Stage of Benner's model, the nurse is no longer aware of rules or textbook knowledge, the nurse's performance becomes "fluid and flexible" as the nurse becomes more proficient in their practice (English, 2003).Stage III of Benner's theory is the Competent Stage (Frisch, 2009). The nurse in this stage through experience begins to refine rule based behavior by learning of nuances or shades of differences in situations. The nurse learns of rule exceptions through practical knowledge gained by experience over time (Altmann, 2007). As quoted in Altmann (2007), Benner states that "Experience is a requisite for expertise." During the Proficient Stage of Benner's model, the nurse is no longer aware of rules or textbook knowledge, the nurse's performance becomes "fluid and flexible" as the nurse becomes more proficient in their practice (English, 2003).

5. From Novice to Expert-Description of Theory Stage V- Expert This stage occurs after five years or greater in the same area of nursing (experienced nurses changing areas of nursing practice may progress more quickly through the five stages) The nurse develops an intuitive grasp of situations and experiences The expert nurse operates from a deep, holistic understanding of the situation or experience (Frisch, 2009) According to Altmann (as cited in Carper, 1978) the expert incorporates the ways of knowing, empiric knowledge, moral/ethical knowledge, personal knowledge, and aesthetics into their practice of nursing Stage V of Benner's theory is the Expert Stage. According to Altmann (as cited in Carpenter, 1978), the expert nurse incorporates ways of knowing into their daily practice. The expert nurse utilizes empiric knowledge, moral and ethical knowledge, personal knowing, and aesthetics to treat patients. The nurse uses all the ways of knowing to contribute to a holistic approach to care (Altmann, 2007). English (1993) describes Benner's belief that not all nurses will become experts. Not all nurses will develop intuition or a sixth sense in nursing. Nursing intuition is described as an expert's feeling of a sense of uneasiness or that things are not quite right. It is a perceptive ability to sense vague or subtle changes in the patient's condition before the patient's clinical picture begins to deteriorate. The expert nurse is able to intervene to treat the patient during a critical time to prevent or mitigate a bad outcome.Stage V of Benner's theory is the Expert Stage. According to Altmann (as cited in Carpenter, 1978), the expert nurse incorporates ways of knowing into their daily practice. The expert nurse utilizes empiric knowledge, moral and ethical knowledge, personal knowing, and aesthetics to treat patients. The nurse uses all the ways of knowing to contribute to a holistic approach to care (Altmann, 2007). English (1993) describes Benner's belief that not all nurses will become experts. Not all nurses will develop intuition or a sixth sense in nursing. Nursing intuition is described as an expert's feeling of a sense of uneasiness or that things are not quite right. It is a perceptive ability to sense vague or subtle changes in the patient's condition before the patient's clinical picture begins to deteriorate. The expert nurse is able to intervene to treat the patient during a critical time to prevent or mitigate a bad outcome.

6. Benner�s Original Research Goal: Compare Novice & Expert Nurse�s descriptions and responses to the same clinical situations Participants: 21 nurse preceptors & 21 new graduate nurses 51 experienced nurses 11 newly graduated nurses 5 senior nursing students Collection of Research: Interviews with narrative accounts of situations Observation of behaviors in clinical settings (Benner, 1984) Benner performed her research by studying nurses and nursing students at different skill levels in their careers. The conclusion of Benner's research in 1984 was that formal models, theories and textbook descriptions were not adequate to explain skill acquisition. Experience and mastery of the art of nursing transforms skill to higher levels (Benner, 1984).Benner performed her research by studying nurses and nursing students at different skill levels in their careers. The conclusion of Benner's research in 1984 was that formal models, theories and textbook descriptions were not adequate to explain skill acquisition. Experience and mastery of the art of nursing transforms skill to higher levels (Benner, 1984).

7. Nursing Education Incorporates Benner�s Theory Goal: Identify if simulating unstable patient scenarios by providing interactive teaching will transition nursing students to higher levels of expertise Participants: 190 Adult Health Nursing Students Collection of Research: Observation of students in simulated patient rooms with manikins providing clues to clinical scenarios Conclusion: Development of nursing competency requires practice and clinical simulation provides a safe, structured learning experience (Larew, Lessans, Spunt, Foster, and Covington, 2006) Benner's theory of Novice to Expert has been applied to nursing research. Larew et al. (2006) described a research study utilizing manikins in clinical scenarios to train Adult Health Nursing students. The use of manikins allowed the instructors to provide learning experiences for nursing students in a safe environment allowing them to gain knowledge that they can apply in their career in a more controlled environment than the hospital setting.Benner's theory of Novice to Expert has been applied to nursing research. Larew et al. (2006) described a research study utilizing manikins in clinical scenarios to train Adult Health Nursing students. The use of manikins allowed the instructors to provide learning experiences for nursing students in a safe environment allowing them to gain knowledge that they can apply in their career in a more controlled environment than the hospital setting.

8. Nursing Application of Benner�s Theory Nursing applies Benner�s Theory through: Nursing school curriculum Building clinical ladders for nurses (Frisch, 2009) Developing mentorship programs Preceptors for student nurses Mentors for newly graduated nurses (Dracup and Bryan- Brown, 2004) Development of the Clinical Simulation Protocol (Larew et al., 2006) Benner's work from Novice to Expert is considered to be the gold standard, and is incorporated into most nursing core curriculums and clinical ladders in place in nursing practice today (Frisch, 2009). Nursing applies Benner's theory in mentorship programs. Mentors do more than teach skills; they facilitate new learning experiences, help new nurses make career decisions, and introduce them to networks of colleagues who can provide new professional challenges and opportunities. Mentors are interactive sounding boards who help others make decisions. Part of mentoring programs are preceptors. Preceptors help new nurses deal with the uncertainty of the clinical setting that is inherent to gaining proficiency. The preceptor's role of "guide at the side" is critical to moving from novice to expert (Dracup and Bryan- Brown, 2004).Benner's work from Novice to Expert is considered to be the gold standard, and is incorporated into most nursing core curriculums and clinical ladders in place in nursing practice today (Frisch, 2009). Nursing applies Benner's theory in mentorship programs. Mentors do more than teach skills; they facilitate new learning experiences, help new nurses make career decisions, and introduce them to networks of colleagues who can provide new professional challenges and opportunities. Mentors are interactive sounding boards who help others make decisions. Part of mentoring programs are preceptors. Preceptors help new nurses deal with the uncertainty of the clinical setting that is inherent to gaining proficiency. The preceptor's role of "guide at the side" is critical to moving from novice to expert (Dracup and Bryan- Brown, 2004).