PATRICIA

BENNER
By: Samantha and Ronett
 INTRODUCTION
• Born August 1942 in Hampton, Virginia
• Worked as an admitting clerk at a local hospital
during high school
• Registered Nurse (RN) / Bachelor of Science (BS)
from Pasadena College (1964)
• Masters of Science from University of California,
San Francisco (1970)
• PhD from University of California, Berkley (1982)
• Nursing Experience on medical surgical units,
coronary units, and medical intensive coronary
care units
• Visiting Nursing Association
• University of California in san Francisco School
of nursing: Research Associate (1970-1975),
Associate Professor: Department of Physiological
Nursing (1982-1989)
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• Co wrote numerous books and published articles
BENNER: AS AUTHOR
Dr. Benner is the author of books including:
1. From Novice to Expert
2. The Primacy of Caring
3. Interpretive Phenomenology: Embodiment,
Caring and Ethics in Health and Illness
4. The Crisis of Care
5. Expertise in Nursing Practice: Caring,
Clinical Judgment, and Ethics
6. Caregiving
7. Clinical Wisdom and Interventions in
Critical Care: A Thinking-In-Action
Approach. 3
THE DREYFUSS MODEL
OF SKILL ACQUISITION
Benner’s work as applied to the nursing
profession is adapted from the Dreyfus
Model of Skill Acquisition.
“A five-stage model of the mental
activities involved in the direct skill
acquisition.”
Increased in skill experience gets in
advancement in stages

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DR. BENNER’S STAGES OF CLINICAL
COMPETENCE

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 STAGE 1: NOVICE
• This would be a nursing student in his or her first year of clinical education;
behavior in the clinical setting is very limited and inflexible.
• Novices have a very limited ability to predict what might happen in a particular
patient situation. Signs and symptoms, such as change in mental status, can only
be recognized after a novice nurse has had experience with patients with similar
symptoms.
• Beginners have had no experience of the situations in which they are expected to
perform. Novices are taught rules to help them perform. The rules are context -free
and independent of specific cases; hence the rules tend to be applied universally.
The rule-governed behavior typical of the novice is extremely limited and
inflexible. As such, novices have no "life experience" in the application of rules.
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STAGE 2: ADVANCED BEGINNER
• Those are the new grads in their first jobs; nurses have had more
experiences that enable them to recognize recurrent, meaningful
components of a situation. They have the knowledge and the know -how but
not enough in-depth experience.
• Advanced Beginners demonstrate marginally acceptable performance
because the nurse has had prior experience in actual situations. He/she is
efficient and skillful in parts of the practice area, requiring occasional
supportive cues. May/may not be within a delayed time period. Knowledge
is developing.

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 STAGE 3: COMPETENT
• These nurses lack the speed and flexibility of proficient nurses, but they have some
mastery and can rely on advance planning and organizational skills.
• Recognize patterns and nature of clinical situations more quickly and accurately than
advanced beginners.
• Competence, typified by the nurse who has been on the job in the same or similar
situations two or three years, develops when the nurse begins to see his or her actions
in terms of long-range goals or plans of which he or she is consciously aware.
• For the competent nurse, a plan establishes a perspective, and the plan is based on
considerable conscious, abstract, analytic contemplation of the problem. The
conscious, deliberate planning that is characteristic of this skill level helps achieve
efficiency and organization.
• Does not yet have enough experience to recognize a situation in terms of an overall
picture or in terms of which aspects are most salient, most important.
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 STAGE 4: PROFICIENT
• At this level, nurses are capable to see situations as “wholes” rather than
parts. Proficient nurses learn from experience what events typically occur
and are able to modify plans in response to different events.
• 3-5 years
• Perceives situations as wholes rather than in terms of chopped up parts or
aspects, and performance is guided by maxims.
• Understand a situation as a whole because they perceive its meaning in
terms of long-term goals.
• Learns from experience what typical events to expect in a given situation
and how plans need to be modified in response to these events.

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 STAGE 4: PROFICIENT (CONTINUATION)

• Can now recognize when the expected normal picture does not materialize.
This holistic understanding improves the proficient nurse's decision making;
it becomes less labored because the nurse now has a perspective on which of
the many existing attributes and aspects in the present situation are the
important ones.
• Uses maxims as guides which reflect what would appear to the competent
or novice performer as unintelligible nuances of the situation; they can
mean one thing at one time and quite another thing later. Once one has a
deep understanding of the situation overall, however, the maxim provides
direction as to what must be taken into account. Maxims ref lect nuances of the
situation.
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 STAGE 5: EXPERT
• Nurses who are able to recognize demands and resources in situations and
attain their goals.
• 5 years or greater
• These nurses know what needs to be done. They no longer rely solely on
rules to guide their actions under certain situations. They have an intuitive
grasp of the situation based on their deep knowledge and experience.
• Focus is on the most relevant problems and not irrelevant ones. Analytical
tools are used only when they have no experience with an event, or when
events don’t occur as expected.

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 STAGE 5: EXPERT (CONTINUATION)

• No longer relies on an analytic principle (rule, guideline, maxim) to connect

her or his understanding of the situation to an appropriate action.
• With an enormous background of experience, now has an intuitive grasp of
each situation and zeroes in on the accurate region of the problem without
wasteful consideration of a large range of unfruitful, alternative diagnoses
and solutions.
• Operates from a deep understanding of the total situation. The chess
master, for instance, when asked why he or she made a particularly
masterful move, will just say: "Because it felt right; it looked good."

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 STAGE 5: EXPERT (CONTINUATION)

• No longer aware of features and rules;' his/her performance becomes fluid

and flexible and highly proficient. This is not to say that the expert never
uses analytic tools. Highly skilled analytic ability is necessary for those
situations with which the nurse has had no previous experience. Analytic
tools are also necessary for those times when the expert gets a wrong grasp
of the situation and then finds that events and behaviors are not occurring
as expected When alternative perspectives are not available to the clinician,
the only way out of a wrong grasp of the problem is by using analytic
problem solving.

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METAPARADIGM

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 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 non-reflective 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 o The role of temporality

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 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

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 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

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 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

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The Primacy of Caring is a theory of what it is to be a person and what it
means to live in the world. Benner's theory is based on the lived
experience of the person providing or receiving care. The theory's
purpose is to help people cope with the stress of illness. 19
 APPLICATION OF BENNER’S THEORY
• Nursing school curriculum
• Building clinical ladders for nurses
• Preceptors for student nurses:
• Preceptors help new nurses deal with the uncertainty of the clinical setting that is inherent
to gaining proficiency. The preceptor's role of "guide at the side" is critical to moving from
novice to expert.
• Developing mentorship programs
• Mentors for newly graduated nurses: Mentors do more than teach skills; they facilitate new
learning experiences, help new nurses make career decisions, and introduce them to
networks of colleagues who can provide new professional challenges and opportunities.
Mentors are interactive sounding boards who help others make decisions. Part of mentoring
programs are preceptors

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Thank You!
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