Patricia Benner RN, Ph.D, F.A.A.

• Professor, University of California- San • viewed nursing practice as the care and
Francisco
study of the lived experience of health,
• obtained a Bachelor of Arts degree from illness, and disease and the relationships
Pasadena College in 1964
among these three elements.

• Earned a master’s degree in nursing from

the University of California, San Francisco BENNER’S STAGES OF CLINICAL
School of Nursing in 1970
COMPETENCE (1984; 2004)
• She published From Novice to Expert in
1984 and became a Fellow in the American NOVICE
Academy of Nursing in 1985
‣ no experience of the situations in which
• Living legend of the American Academy of they are expected to perform
Nursing- 2011
‣ learn context-free rules to guide action
(stimulus-response thinking)
Rule-governed behavior is typical, tends to
METAPARADIGM be inflexible
‣ has difficulty discriminating between
PERSON relevant & irrelevant aspects of a situations
• “a self-interpreting being, that is the person
does not come into the world predefined ADVANCE BEGINNER
but gets in the course of living a life.”
‣ can demonstrate marginally acceptable
• The three major aspects of understanding performance
that the person must deal with:
‣ have begun to identify recurring meaningful
1. the role of the situation
situational aspects and apple these in new
2. the role of the body
situations
3. the role of personal concerns
‣ unable to see the entirely of a new situation
4. the role of temporality
(may miss some critical details)
‣ they feel more responsible for managing
HEALTH patient care, yet they still rely on the help of
• Health- what can be assessed
those who have more experienced
• Well-being— human experience of health
or wholeness
COMPETENT
• Illness- the human experience of loss or ‣ considers consistency, predictability & time
dysfunction
management as essential components &
• Disease- is what can be assessed at the gaining a sense of mastery
physical level
‣ there is an increased level of efficiency but
the focus is on time management & the
ENVIRONMENT nurses organization of the tack are more
important rather than on timing in relation to
• she used the word situation because it
suggests a social environment with social the patient’s needs
definition and meaning
‣ this stage is critical because the nurse
must know how to recognize the patterns &
• Situation- defined by the person’s engaged
interaction, interpretation and identify which element of the situation
understanding of the situation
needs attention & which ones to ignore
• persons enter into situations with their own
sets of meaning, habits, & perspectives

NURSING
• she described nursing as a caring
relationship, an “enabling condition of
connection and concern”

PROFICIENT
‣ perceives situations as whole rather than in
terms of aspects
‣ performance is guide by maxims (cryptic
instructions that make sense only if there is
already a deep understanding of the
situation)
‣ perception is a key word
‣ possesses a web of perspectives on a
situation
‣ demonstrate an increased confidence in
their knowledge & abilities

EXPERT
‣ no longer relies on an analytic principle
(rule, guideline, maxim) to connect
understanding of a situation to appropriate
action
‣ operates from a deep understanding of the
total situation
‣ possessing an intuitive grasp of the
problem
‣ there is a qualitative change as the expert
performer “knows the patient”, which
means that knowing typical patterns of
responses & knowing the patient as a
person
‣ key aspects of the expert nurse practice:
- demonstrating a clinical grasp and
resource-based practice
- possessing embodied knowledge
- seeing the big picture
- seeing the unexpected

seven domains of nursing

practice

• helping role
• diagnostic client-monitoring function
• effective management of rapidly changing
situations
• administering & monitoring therapeutic
interventions & regimens
• monitoring & ensuring quality health care
practices
• organizational & work-role performance
• teaching or coaching function