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Transcript of Benner Presentation
Dr. Benner's Background
From Novice To Expert
Metaparadigm for Nursing
RN and BA in Nursing, Pasadena College 1964
MS in Med. Surg. Nursing, UC Berkely
Received PhD in Stress, Coping and Health 1982
Completed her research and teaching at UCSF
Associate Professor in Psychological Nursing at UCSF
Currently Professor in Department of Social and Behavioral Sciences at UCSF
1st occupant of Thelma Shobe Cook Endowed Chair in Ethics and Spirituality
Published 9 books
"Novice to Expert Theory” 1982
Book of the Year from AJN in 1984, 1989, 1996, 1999
Her books have been translated into over 10 languages
Countless published scholarly articles
National League for Nursing’s Award for Leadership in Education
Selected for UCSF’s School of Nursing Centennial Wall of Fame
Honorary fellow of the Royal College of Nursing
Beginner with no experience
Difficulty distinguishing relevant from irrelevant information
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,
Ex. “Tell me what I need to know and I’ll do it”
(most nursing students)
Demonstrates acceptable performance
Has gained some prior experience in actual situations to recognize recurring meaningful components
Principles, based on experiences, begin to be formulated to guide actions
Still guided by rules and task completion
Difficulty seeing “whole picture,”
Rely on help of more experienced nurses
(most newly graduated nurses)
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;
Able to recognize patterns and determine what can be ignored and what needs attention.
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
Increased confidence in knowledge and skills
More patient and family involvement
No longer relies on principles, rules, or guidelines to connect situations and determine actions
Much more background experience
Has intuitive grasp of clinical situations
Performance is now fluid, flexible, and highly proficient
Knows patterns of responses
Sees whole picture and the unexpected
Meeting patients needs is utmost importance
"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 nonreflective understanding of the self in the world."
Major aspects of understanding:
The role of the situation
The role of the body
The role of personal concerns
The role of temporality
Person is "embodied"; body and mind are one
Nursing "is a caring relationship and an enabling condition of connection and concern."
"Nursing is viewed as a caring practice whose science is guided by the moral art and ethics of care and responsibility."
"Caring is primary because caring sets up the possibility of giving help and receiving help."
Health is what can be assessed, well-being is the human experience of health or wholeness
Well-being and being ill are different
Health is not simply the absence of disease and illness.
Used the term "situation" as opposed to "environment" because it conveys a social environment with social definition and meaning
“Each persons past, present, and future, including his or her personal meanings, habits, and perspectives, influence the current situation.
Alligood, M. R., & Tomey, A. (2010). Caring, Clinical Wisdom, and Ethic in Nursing Practice. Nursing theorists and their work (7th ed., pp. 137-156). Maryland Heights, Mo.: Mosby/Elsevier.
Benner, P. (2001). From novice to expert : excellence and power in clinical nursing practice. Upper Saddle River, N.J: Prentice Hall.
Benner, P., Tanner, C. & Chesla, C. (2009). Expertise in nursing practice : caring, clinical judgment & ethics. New York: Springer Pub.
Benner, P. (2011). Formation in Professional Education: An Examination of the Relationship between Theories of Meaning and Theories of the Self. Journal Of Medicine & Philosophy, 36(4), 342-353.
Benner, P. (2004). Relational Ethics of Comfort, Touch, and Solace - Endangered Arts?. American Journal Of Critical Care, 13(4), 346-349.
NoviceToExpert-YouTube. (n.d.). YOUTUBE. Retrieved August 8, 2013, from hhtp://m.youtube.com/watch?v=efuodnirhog
Tomey, A., & Alligood, M. R. (2002). From novice to expert: excellence and power in clinical nursing practice. Nursing theorists and their work (5th ed., pp. 165-178). St. Louis, Mo.: Mosby.
Significance of Benner's Theories
Changed the profession's understanding of what it means to be an expert
It is not based on the nurse who is most highly paid or holds the most prestigious position; Rather it is the nurse who provides the most exceptional care
Benner's novice to expert theory predicts that nurses with higher competencies will identify problems more quickly with subtle cues
(Benner and Wrubel, 1989. p.4)
(Nursing Theorists and Their Work, 2010, p. 149)
(Tomey and Alligood, 2002, p. 173)
(Tomey and Alligood, 2002, p. 174)
Initial goal: understand gap between nursing theory and practice
Gathered data through observation and interviews
Clinical nursing practice more complex than current nursing theories could explain
Created a shift in nursing that knowledge was developed in practice
Her work was research-based and derived from actual practice situations, not just conceptual models
of Nursing Defined:
Person, Environment, Health, Nursing first concepts
The most abstract level of knowledge in nursing
Specifies the main concepts that encompass the subject and scope of nursing
Staff Nurse in a Multitude of Areas:
intensive care units
Consistency with Team Values
Nursing competency can only be completed through a combination of nursing clinical practice AND theory, not simply from one or the other
As human beings, we are not born in a certain way, but are molded through our own emotional, personal and sociological experiences
Nursing should be a caring and holistic relationship between both patient and nurse.
You cannot separate the body from the mind...they are cooperative and interdependent upon each other.
More Novice to Expert Examples:
Although Susan, a nurse that has worked in a hospital ICU ward for over 5 years would be considered an "expert level" nurse in her field, if she moved to the pediatric unit she may only be performing on a competent level as practice is needed for learning
Real nursing practice is a "caring art" based on ethics
The body of the patient is more than a set of anatomical variables but is also a part of a broader social and mental world. This part of the person means as much to health as the physiology
Ex. Peace of mind can be just as valuable as actual clinical and bodily health
This approach separates nursing as its own profession.
Ex. While a physician is more comfortable with the formal rules of clinical practice,nursing is based on caring based perceptions of both mental and physical health
Caring in Nursing