Patricia Sawyer Benner’s from Novice to Expert Theory 1984 (USA)

Patricia Sawyer Benner’s from Novice to Expert Theory 1984 (USA)

 
Patricia Benner was born in Virginia, received her bachelor’s degree in nursing from Pasadena College, master’s degree in medical surgical nursing and PhD from University of California in 1970 and 1982 respectively. She has nursing practice experience as staff nurse and in management, in medical surgical, emergency care unit, coronary care unit, intensive care and home care nursing. Benner is currently director of the National Nursing Education study for the Carnegie foundation for the advancement of teaching. In addition, she is a professor in the department of social and behavioral sciences at university of California.
The Dreyfus model of skill acquisition serves as the theoretical basis of Benner’s work in identifying the professional development of nurses. This model identifies ‘five stages of qualitatively different perceptions of their task as skill improves. These stages have been labeled as novice, advanced beginner, competent, proficient and expert. Benner states that the five levels reflect changes occurring in three aspects of skilled performance. They are;

• A movement from reliance on rules and abstract principles to the use of concrete past experiences as the basis of decision making
• Increasing ability to see the situation as a whole or the big picture
• Increasing involvement within the situation

Novice

• A complete beginner with no experience in the specialty area
• Practices using theoretical knowledge acquire through formal learning
• Relies on use of context free rules for drawing conclusions based on objective features of the situation

Advanced beginner

• The newly graduated nurse who has transferred to another specialty
• Begins to notice situational elements and structure in the clinical setting
• Begins constructing more and more complex rules developed from actual practice to help guide actions
• Begins to recognize changes in clinical state but lacks the experience to identify how to manage those changes

Competent

• The nurse who has about one to two years of experience on a specific unit and improves in clinical understanding, routines, technical skills, organized ability and ability to anticipate the likely course of events.
• Exemplifies standard of care
• Establish new rules and facilitates the choice of plan

Proficient
It is a transition stage that leads to expertise and experience results in development of synaptic pathways in the brain that alter the rules and principles based responses to a more situationally associated response set of behaviors referred to as intuition. The actions of a proficient nurse demonstrate a smooth based approach and are situationally appropriate. The communication and negotiation skill of proficient nurse increases in order to meet the situational needs of the patient and family.
Expert
They are vigilant monitors. Expert nurses situate themselves with in an observational distance of the patient in order to stay attained to the changing needs and condition of the patient. She attunes to changes and awareness of salient aspects of the situation is accomplished without conscious deliberation. She uses the ‘deliberative rationality’ to reflect on goals and actions to achieve those goals rather than former rules. They can take high positions based on their experience and are confident.
Domains of nursing practice and related competencies;

• The helping role

The healing relationship;
Creates a climate and establishes a commitment to healing
Provides comfort measures
Being with the patient
Provide and communicates through therapeutic touch
Guides the patient through physical and psychological change

• The teaching and coaching role

Timing captures a patient’s readiness to learn to;
Elicit and understand the patient’s interpretation of illness
Provides an interpretation of the patient’s condition and giving a rationale for procedure

• The diagnostic and patient monitoring function

Detection and documentation of significant changes in patient’s condition
Providing an early warning signal through diagnostic signs
Anticipates patient care needs
Assess the patient’s potential for wellness and for responding to various treatment strategies

• Effective management of rapidly changing situations

Skilled performance in extreme life threatening situation
Rapid matching of demands and resources in emerging situations
Identify and mange the patient crisis until physician is available

• Administering and monitoring therapeutic interventions

Starts and maintains intravenous therapy
Administer medications accurately and safely

• Monitoring and ensuring the quality of health care practices

Provide a back up system to ensure safe medical and nursing care
Supervise the patient care

• Organizational and work role competencies

Coordinates, orders and meets multiple patient needs
Sets priorities
Builds and maintains a therapeutic team
Copes with staff shortage and high turn over

Benner’s work can be understood in a simple form such as skill levels of novice to expert or can be applied in more expanded forms in terms of understanding critical thinking and caring practices. Her work has been influential in nursing to practice, especially in caring.