Background

Journal

Our Novice to Expert Endeavors


NAME:  Patricia Benner
DATE OF BIRTH: May 10, 1955
PLACE OF BIRTH: Hampton Virginia USA 

EDUCATIONAL ATTAINMENT:

Ø  Bachelor’s Degree in Nursing (BSN)- PASADENA COLLEGE 1964.
Ø  Master’s Degree in Medical Surgical Nursing- UNIVERSITY OF CALIFORNIA, San Francisco 1970.
Ø  Ph.D – UNIVERSITY OF CALIFORNIA, BERKELY 1982.

PROFESSIONAL BACKGROUND:


* 1989- became Associate Professor in Department of Physiological Nursing, in the School of Nursing at the University of California, San Francisco (became tenured Professor 1989.)
* 2002 - Professor at the Department of Social and Behavioral Sciences at UCSF. and the first occupant of the Thelma Shobe Cook Endowed Chair in Ethics and Spirituality.
* Recently elected an honorary fellow of the Royal College of Nursing.
* Internationally noted Researcher and Lecturer on health, stress and coping, skill acquisition and ethics.
* Dr. Patricia Benner acknowledged that her thinking in Nursing had been influenced greatly by Virginia Henderson, who commented that because of the nature and scope of her work, “From Novice to Expert”, it had potential to materially affect practice and at the same time, the nurses’ preparation.


According to P. Benner: “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.”

Her Theory:
  • Dr. Benner categorized nursing 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 novice’s and expert’s descriptions of the same clinical incident.
NOVICE:
  • Beginner with no experience
  • Taught general rules to help perform tasks
  • Rules are: context-free, independent of specific cases, and applied universally
  • Rule-governed behavior is limited and inflexible
ADVANCED BEGINNER:
  • Demonstrates acceptable performance
  • Has gained prior experience in actual situations to recognize recurring meaningful components
  • Principles, based on experiences, begin to be formulated to guide actions
 COMPETENT:
  • Typically a nurse with 2-3 years experience on the job in the same area or in similar day-to-day situations
  • More aware of long-term goals
  • Gains perspective from planning own actions based on conscious, abstract, and analytical thinking and helps to achieve greater efficiency and organization
PROFICIENT:
  • Perceives and understands  situations as whole parts
  • More holistic understanding  improves decision-making
  • Learns from experiences what to expect in certain situations  and how to modify plans
EXPERT:
  • No longer relies on principles, rules, or guidelines to connect situations and determine actions
  • Much more background of experience
  • Has intuitive grasp of clinical situations
  • Performance is now fluid, flexible, and highly-proficient


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.

Benner’s theory established the belief that patients has the potential to grow personally in a healthy and creative way while relying on our practice in our field of work from being a novice who is a beginner with no experience to being expert who doesn’t have to rely any longer on principles, rules and guidelines.

It expresses more the role function of a nurse in a patient-nurse interaction. Her theory acknowledges the individuality while defining nurses’ role based on art and science. Nursing, as an art makes use of our resources available which depends on passion of a nurse. With this, we nurses could express one and acquire knowledge without having to force ourselves to do what we don’t feel like to especially in providing services to patients. It has leaded us to openness which would eventually result to a comfortable and meaningful nursing experience to everyone.

She has truly showed us how the nurses progress through time and emphasized the true meaning of caring as a key component of Nursing.

Most importantly, Benner provided us a structure from using the past experiences as the basis and rely to this as our guidance to present that could help us to decide in dealing with problematic day-to-day experience in our practice.

Benner incorporated assumptions from the Dreyfus model, “that with experience and mastery the skill is transformed.” She furthered , “This model assumes that all practical situations are far more complex than can be described by formal models, theories and textbook descriptions.”

PERSON:

Benner and Wrubel use Heidiegger’s phenomenological description of a 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. In addition, a person also has . . . an effortless and non-reflective understanding of the self in the world. He is seen as a participant in common meanings. Finally, the person is embodied. Benner and Wrubel have conceptualized the major aspects of understanding that the person must deal with as:

  • the role of the situation
  • the role of the body, 
  • the role of personal concerns
  • the role of temporality. 
This view of the person is based on the works of Heidegger, Merleau, Ponty, and Dreyfus. 


HEALTH:

Is defined as what can be assessed, while well being is the human experience of health or wholeness. Health is described as not just the absence of disease and illness. A person may have a disease but not experience illness because illness is the human experience of loss or dysfunction, whereas disease is what can be assessed at the physical level.





SITUATION:
           
Benner and Wrubel used the term rather than environment because situation conveys a social environment with social definition and meaningfulness. They use the phenomenological terms of being situated and situated meaning, that are defined by the person’s engaged interaction, interpretation, and understanding of the situation. They stated, “To be situated implies that one has a past, present, and future and that all of these aspects . . . influence the current situation.” Persons “enter into situations with their own sets of meanings, habits, and perspectives.” “Personal interpretation of the situation is bounded by the way the individual is in it.”


HEALTH:

Is defined as what can be assessed, while well being is the human experience of health or wholeness. Health is described as not just the absence of disease and illness. A person may have a disease but not experience illness because illness is the human experience of loss or dysfunction, whereas disease is what can be assessed at the physical level.