Patricia Benner: The Theory of Nursing Laniece C. Leon Chamberlain College of Nursing CCN 100: Success Seminar Patricia Benner: The Theory of Nursing Dr. Patricia Benner is a very accomplished nursing theorist. She was born on May 10, 1955 to parents Ethel and Donald Brushett (www. yahoo. com). She went to Pasadena College and received her BSN. She then received her Master’s Degree in Medical Surgical Nursing from the University of California, San Francisco and went to get her Ph. D. in Stress, Coping and Health from the University of California, Berkeley. Dr. Benner is currently a professor of nursing in the Department of Social and Behavioral Nursing at the University of California, San Francisco. She has written nine books, and received many awards for her accomplishments. She is an internationally known researcher and lecturer on health, stress and coping, skill acquisition and ethics and has had great influence on the world of nursing. Theory Dr. Benner introduced the theory that expert nurses develop skills and understanding of patient care over time through a sound educational base and a multitude of experiences. The premise of this theory is that the development of knowledge on applied disciplines such as medicine and nursing is composed of the extension of practical knowledge through research and understanding the “know-how” of clinical experience. It states that nursing requires procedural or scientific knowledge, techne, and the advancement of knowledge through practice and experience, phronesis. Before the publication of her most widely known book From Novice to Expert: Excellence and Power in Clinical Nursing Practice, there was no real characterization of the learning process of nurses. Using a model called The Dreyfus Model of Skill and Acquisition developed by Stuart and Hubert Dreyfus and applying it to nursing, Dr. Benner developed a five-stage process that a nurse goes through on the journey to developing expertise in the field: The Novice Stage, The Advanced Beginner Stage, The Competent Stage, The Proficient Stage, and The Expert Stage. Each stage builds on the other as the nurse gains experience and learns. The Novice Stage According to Dr. Benner, a nurse in this stage is completely dependent on the rules or plans set forth by their instructor. They have very little situational perception and no discretionary judgment. Their instructors break down the task environment into “context-free” features that a beginning nurse can recognize without the having had any experience in the field of nursing. The instructor provides rules that the “novice” nurse needs to use in order to draw a conclusion or determine the action necessary based on the facts of the situation that can be recognized without prior experience. A “novice” nurse exhibits “rule-governed behavior” which leads the nurse to be limited and inflexible. Due to their lack of experience, the nurse tends to have a “Just tell me what to do and I’ll do it” attitude. The Advanced Beginner Stage As the nurse progresses from the novice stage to the advanced beginner stage they acquire experience from their work. At this stage they are able to use the rules and plans illustrated by their instructors in conjunction with their practical or situational experience to help them increase their skill level. More features of a situation become recognizable for nurse based upon their experiences which allows them to be able to anticipate certain elements of a situation. The down side is that the “advanced beginner” nurse can feel overwhelmed. Their situational perception is still a bit limited so they treat all aspects of the situation separately and with equal importance. As more things become recognizable, more rules are introduced that apply to each situation making things more difficult. The Competent Stage At this stage, the nurse learns that in order to feel less overwhelmed with the potential relevant elements of a situation, they need to devise a plan or a perspective that will help them determine what elements of a situation are important. A plan will help them determine what elements of a situation needs to be taken care of immediately and what elements can be ignored. “The competent performer must devise new rules and reasoning procedures for the chosen plan or perspective determination so that the learned rules for actions based on relevant facts can then be applied. ()Because there are so many different situation that directly named or defined, the “competent” nurse has to decide for themselves what plan to use for each situation even if they’re not absolutely sure. “Prior to this stage, if the learned rules did not work out, the performer could rationalize that they he or she had not been given good enough rules rather than feel remorse because of a mistake. ”() This can create a sense of responsibility that can be frightening for the nurse. However it can also give the nurse a sense of accomplishment when the outcome is in their favor. By the time the nurse is ready to move to the next stage of development, he or she “can now better predict immediately likely events and needs of patients and plan for them. ”() The Proficient Stage In this stage, the nurse becomes less overwhelmed as they are able to more readily see a situation as a whole rather than in separate aspects. Their decision process is less perplexing because their plan for the situation has become a part of their intuition. Actions become easier and less stressful as the learner simply sees what needs to be achieved rather than deciding”() The Expert Stage At this stage, the nurse no longer uses rules or guidelines to gear their actions. They now have an intuitive grasp of the situation which allows them to be more fluid and flexible in their responses. They let their now long grown experience guide them. In times where an “expert” nurse has diagnosed a situation in the wrong way they can revert back breaking down the situation into aspects to get a better handle on the situation. For they most part, though, they are able to see the situation and do what needs to be done based on what has previously worked for them in past experiences. References Benner, P. , Chelsa, C. , & Tanner C. (2009). Expertise in Clinical Practice: Caring, Clinical Judgment, and Ethics. Jones, Moniaree Parker. (2007). Nursing Expertise: A Look at Theory and the LNCC Certification Exam. Journal of Legal Nurse Consulting, 18(2), 12-15. PATRICIA BENNER: THE THEORY OF NURSING
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