PATRICIA BENNERs THEORY

NOVICE TO EXPERT THEORY

Patricia Benner, R.N., P.h.D., FAAN,F.R.C.N.
Dr. Benner received her bachelor's degree in
nursing from Pasadena College (1964); her
master's degree in medical surgical nursing from
the University of California, San Francisco
(1970), and the Ph.D. from the University of
California, Berkeley, in Stress and Coping and
Health(1982) under the direction of Hubert
Dreyfus and Richard Lazarus.
Has taught and done research at UCSF since
1979
Published Novice to Expert Theory in 1982
Patricia Benner, R.N., P.h.D., FAAN,F.R.C.N.
Published 9 books including From Novice to Expert,
named an American Journal of Nursing Book of the Year
for nursing education and nursing research in 1984, and
The Primacy of Caring, co-authored with Judith Wrubel,
named Book of the Year in 1990, also in two categories.
Was awarded the 15th Helen Nahm Research Lecture
Award from the University of California at San Francisco
School of Nursing in 1995.
Patricia Benner is currently a Professor Emerita in the
Department of Physiological Nursing in the School of
Nursing at the University of California, San Francisco.
 PATRICIA BENNER
INTRODUCTION
Dr Patricia Benner introduced the concept that expert nurses
develop skills and understanding of patient care over time
through a sound educational base as well as a multitude of
experiences.
She proposed that one could gain knowledge and skills
(knowing how) without ever learning the theory (knowing
that).
She further explains that the development of knowledge in
applied disciplines such as medicine and nursing is composed
of the extension of practical knowledge (know how) through
research and the characterization and understanding of the
know how of clinical experience.
 Dr. Benners Theory
Nursing is categorized into 5 levels of capabilities:
Novice, Advanced beginner, Competent, Proficient, and
Expert.
She believed experience in the clinical setting is key to
nursing because it allows a nurse to continuously
expand their knowledge base and to provide holistic,
competent care to the patient.
Her research was aimed at discovering if there were
distinguishable, characteristic differences in the
novices and experts descriptions of the same clinical
incident.
Four Domains of Nursing Paradigm
 Client/ Person
The 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.- Dr. Benner
 Health
Dr. Benner focuses on the lived
experience of being healthy and
being ill.
Health is defined as what can be
assessed, whereas well being is
the human experience of health
or wholeness.
Well being and being ill are
understood as distinct ways of
being in the world.
Environment/Situation
Benner uses situation rather
than environment because
situation conveys a social
environment with social
definition and
meaningfulness.
To be situated implies that
one has a past, present, and
future and that all of these
aspects.influence the
current situation.- Dr.
Benner
 Nursing
Nursing is described as a caring
relationship, an enabling condition
of connection and concern. -Dr.
Benner
Caring is primary because caring
sets up the possibility of giving and
receiving help.
Nursing is viewed as a caring practice
whose science is guided by the moral
art and ethics of care and
responsibility.
Dr. Benner understands that nursing
practice as the care and study of the
lived experience of health, illness,
and disease and the relationships
among the three elements.
Nursing theory as a framework for
practice
Dr. Benner developed a concept known
as From Novice to Expert. This
concept explains that the nurse
develop skills and an understanding of
patient care over time from
combination of a strong educational
foundation and personal experiences.
Dr. Benner proposed that the nurse
could gain knowledge and skills
without actually learning a theory. She
describes this as knowing how
without knowing that.
Nursing theory as a framework for
practice
Dr. Benner explains that the
development of knowledge in
fields such as nursing is made
up of extension of knowledge
through research and
understanding through clinical
experience.
Stages of Nursing Expertise
 Stage I: Novice
The person has no
background experience of
the situation in which he/
or she is involved.
They are taught general
rules to help perform tasks,
and their rule-governed
behavior is limited and
inflexible.
Generally this level applies
to nursing students.
 Stage II: Advanced Beginner
Demonstrates marginally
acceptable performance having
coped with enough real
situations to note, or to have
pointed out by mentor, the
recurring meaningful
components of the situation.
Nurses functioning at this level
are guided by rules and
oriented by task completion.
 Stage III: Competent
It is the most pivotal in clinical
learning because the learner must
begin to recognize patterns and
determine which elements of the
situation warrant attention and
which can be ignored.
A competent nurse generally has two
or three years experience on the job
in the same field.
These nurses are more aware of long
term goals, and they gain perspective
from planning their own actions,
which helps them achieve greater
efficiency and organization.
 Stage IV: Proficient
Proficient nurse perceives and
understands situations as a whole
parts.
Proficient level is a qualitative
leap beyond the competent.
Nurses at this level demonstrate a
new ability to see changing
relevance in a situation including
the recognition and the
implementation of skilled
responses to the situation as is it
evolves.
 Stage V: Expert
It is achieved when the expert
performer no longer relies on
analytical principals to connect her
or his understanding of the
situation to an appropriate action.
Their performance are fluid,
flexible, and highly proficient.
According to Dr. Benner that the
nursing skills through experience
are a prerequisite for becoming an
expert nurse.
Significance of
the Theory
 These levels reflect movement from
reliance on past abstract principles to the
use of past concrete experience as
paradigms and change in perception of
situation as a complete whole in which
certain parts are relevant
Each step builds on the previous one as
abstract principles are refined and
expanded by experience and the learner
gains clinical expertise.
 This theory changed the profession's
understanding of what it means to be an expert,
placing this designation not on the nurse with
the most highly paid or most prestigious
position, but on the nurse who provided "the
most exquisite nursing care.
It recognized that nursing was poorly served by
the paradigm that called for all of nursing theory
to be developed by researchers and scholars, but
rather introduced the revolutionary notion that
the practice itself could and should inform
theory.
Knowledge development
in a practice discipline
consists of extending
practical knowledge
(know-how) through
theory based scientific
investigations and through
the clinical experience in
the practice of that
discipline (Benner, 1984)
Changes in three general aspects
of skilled performance:
A movement from reliance on
abstract principles to the use of
past concrete experience as
paradigms.
A change in the learner's
perception of the demand
situation, in which the situation
is seen less and less as a
compilation of equally relevant
bits, and more and more as a
complete whole in which only
certain parts are relevant.
A passage
from detached observation to
involved performer.
 References
Taylor, C.,et al, Fundamentals of Nursing
Kozier, Erb, et. Al, Fundamentals of Nursing
http://nursingtheories.info/patricia-
benner-metaparadigm-in-nursing
http://nursingtheories.info/tag/patrcia-
benner
 References
http://www.scribd.com/doc/27103958/Benner-
Theory-Novice-to-Expert
http://at.phcc.edu/NUR2820/PDFs/MOD4/Novice_to
_Expert.pdf
http://ajcc.aacnjournals.org/content/13/6/448.full
http://nursingtheories.info/patricia-benner-nursing-
theory-from-novice-to-expert/