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). 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). Hubert & Stuart Dreyfus http://socrates.berkeley.edu/~hdreyfus/  http://www.ieor.berkeley.edu/People/Faculty/dreyfus.htm   

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:  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

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/

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, 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://0-go.galegroup.com.libcat.ferris.edu/ps/i.do?id=Gale%7CA166565269&v=2.1&u=lom_ferrissu&it=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/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/Patricia-Benner.php