Patricia Benner

1
Nursing Theorist Patricia Benner

• From Novice to Expert

By Brooke Wilson, Ann Chamberless, Jennifer
Burns,  Vicki
2
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.htmlaxzz1nRDAlWVi
3




4
Origins of the Nursing ModelWhat Motivated
Benners 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).

5
Historical Background
Theory based on Dreyfuss (1980)  A five stage
model of the mental activities involved in 
direct skills acquisition model (Dreyfus).

• Similarities
• Five developmental stages
• Increase in skills and experience gets
  advancement in stages
• Benners 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).

Hubert Stuart Dreyfus http//socrates.berkeley.e
du/hdreyfus/  http//www.ieor.berkeley.edu/Peopl
e/Faculty/dreyfus.htm   
6
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.

7
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).

8
Content of Nursing ModelStages 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)
•  

9
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)

10
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)

11
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)

12
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)

13
Benners 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
14
Benners 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 
• The role of the situation 
• The role of the body 
• The role of personal concerns
• The role of temporality 
• (Alligood Tomey, 2011, p. 148)

http//www.himolde.no/db/57/3973.jpg
15
Benners 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
16
Benners 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 persons 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
17
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
  patients 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         
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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/
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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/
20
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/
21
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/
22
Evaluation of the Nursing Model

• View
• In the aspects of nursing this model can be used
  in any type of nursing. Benner herself practiced
  in Med/Surg, ER, Coronary Care, ICUs 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 Benners 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/
23
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.

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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 its 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.

25
 Question to Case Study

• Given the previous scenario, in what stage is the
  nurse in Patricia Benners Novice to Expert
  theory? 

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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).
27
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/stab
  le/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

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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. 201
  0.01.009
• Emerita. (n.d). Patricia Benner-01-Career and
  influence in educating professionals video
  file. Retrieved from http//www.youtube.com/watc
  h?vFUIT1_pYBBcfeature
• relat
• http//www.youtube.com/watch?vFUIT1_pYBBcfeature
  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/346292
  8
•  
• 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

29
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//0-go.galegroup.com.libcat.ferris.edu/ps/i.d
  o?idGale7CA166565269v2.1ulom_ferrissuitrp
  AONEsww
•  
• 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/resourc
  es/Pages/ProfilesInLeadershipPatriciaBenner.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/Patric
  ia-Benner.php