Theory, practice and research

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Theory, Practice, and Research

Analyze Benner's novice to expert theory. Your analysis should include the following:

  • Description of the theory's background and influencing factors, including worldview
  • Explanation of the underlying assumptions
  • Evaluation of major strengths and weaknesses
  • Application strategies for clinical practice
  • Citation of case example from personal or professional life that describe the application in practice

Cite a minimum of three sources in-text and include a page or slide with APA-formatted references, depending on how you format your assignment.

Format your assignment as one of the following:

  • 15- to 20-slide presentation with detailed speaker notes, provide a Word document with the speaker's notes for submission to the plagiarism tool.
  • 1,050- to 1225-word paper

Remember: Title slide/page and reference list/slide do not count toward slide or word count requirement.

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From Novice to Expert Author(s): Patricia Benner Source: The American Journal of Nursing, Vol. 82, No. 3 (Mar., 1982), pp. 402-407 Published by: Lippincott Williams & Wilkins Stable URL: Accessed: 11-11-2018 07:55 UTC JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at Lippincott Williams & Wilkins is collaborating with JSTOR to digitize, preserve and extend access to The American Journal of Nursing This content downloaded from on Sun, 11 Nov 2018 07:55:58 UTC All use subject to .i i; ~f~-r~s ,? -f r ;. 1. i41-5~-i~~jiS' ,-.. us r "' ,Ti-.~??, ?Z-? ?ri???? --,, *. ???r ;:i Y1?h" :i- I. .:i~t. y, ~Zt~T:,. 'i- ...?h--~ ~? -h i' ~? t *? ~: * ?~ : ?. '. . - -i i..?r? d~' ~?) r;- ?; -I?;? ."(.. 7~ ~~ .I?. "";~4~4 ~i~s~~l~ r-u .:YJ ~ ;Ji~ria-I r :~? -i~?F .-,*c?~i? i~l~?. e ;r. :.? dr; long-term and ongoing career de- opment of a skill, one passes through velopment. This, in turn, requires five levels of proficiency: * novice an understanding Nursing in acute-care settings hasof the differences * advanced beginner experienced nurse and grown so complex that itbetween is no the longthe routinize, novice. * competent er possible to standardize, By Patricia Benner The Dreyfus and delegate much of what theModel of Skill Ac- nurse does. quisition offers a useful tool for doing this. of This model was inducIn the past, formalization tively derived by two University of nursing care and interchangeability of nursing personnel were considCalifornia, Berkeley, professors-- * proficient * expert The levels reflect changes in two general aspects of skilled per- formance. One is a movement from Stuart Dreyfus, a mathematician ered easy answers to nurse turnover. and systemsof analyst, and Hubert The discretionary responsibility Dreyfus, a philosopher-from their nursing care for patient welfare was reliance on abstract principles to the lots(1,2).and repaid to providing incentives myclinistudies, I have found wards for long-term careersInin thatThis the model be generalized to cal nursing in hospitals. iscan no nursing. It takes into account increlonger tenable. ments of in skilled performance based Increased acuity levels patients, decreased length of upon hospitaliexperience as well as education. It also provides zation, and the proliferation ofa basis for clinical knowledge development and health care technology and specialization have increased the need for career progression in clinical nurs- of a demand situation so that the sit- study of was chess players and piignored, and little attention highly experienced nurses. The complexity and responsibility of use of past, concrete experience as paradigms. The other is a change in the perception and understanding uation is seen less as a compilation of equally relevant bits and more as a complete whole in which only certain parts are relevant(2). To evaluate the practicality of applying the Dreyfus model to nursing and to clarify the characteristics of nurse performance at different stages of skill acquisition, interviews ing. Briefly, the Dreyfus model pos- nursing practice today requires its that, in the acquisition and devel- and participant observations were conducted with 51 experienced 402 American Journal of Nursing/March 1982 This content downloaded from on Sun, 11 Nov 2018 07:55:58 UTC All use subject to aA-l~ a Jr,-: ~:~t~9 ;.j -- ldi;;4"-'~"~?; ii.- ~%?Pr' ?-:i ~~'"-?:?: i; -?i :~;~?- .p ? b~?;-:~~~ af~~Y~S~c~ ~?S: ~p~`i ~,li *Y*xlx' ~tr~i p":r;- . :.. ? ~3i t~~P`~ -;? ~ -;; ;?--- )-~42 ~,. ; "" ;c, 3-~?',~at; -jc+T~a~ ?' IV1-4;:6-5i-."~-~E*?~;~b ~?.*?C-P'~"~t~Aj~,~;= ; r-?t;:'f~?~-~;? h~~g; ?frr2j? ~S~T, ~ ".P a, t= .- :~ .;. L; J ~:'~: _ a r~? -I i: ": I.. -;-~"^";? rr~ ?-x;e ; ir2~~ ~~~~~f~LI~: 1? -- .I:._: ~ ~~~5" .-_-:.~ BFZ~JT~ ';i~::? :~L;. 17X L;~ 7* .. -j~?::i~?- ~~J;-a ~?. iv : .,- ~ , cts-: 9",~~ ~?` .? ":' .~i ~13~e ?i?~i?~-I " ;I ~t~;~*ai~ . i~-P -i.:. -* "o' e --=-;r:i- 4-)3C~ a~ frX ?',P~?'g~`l ~j~ :P ICI~ a~_ ?? '?"ill;jtAl;"~Xf~:`-^ ; -.? ~t)d~I ~,~fY--~~~p),tr;;c~~ a-7~~ ';;t~u~E pi3bL"P~a~,~ -. i i ;.yl....~---j~lli?~fl~ 4 , ;I*~Lp ~::::: ~gi?:?c~rk~ i Gr: s:~ ., ~_ ?:Z, ::I8~:6t~~~fr-l;% I8:C~R~T~-iX~SBPII S ;: :.L~*~:L I' ~XP~ x94 .."t~t~f ~1-~fF~.~ ? C .?9,-~ . r? ct~~ ~-~s-~-~~ii~i %~-?~i7~~t~ in ? ? -~---lt "., ~~ L~C~~ ?~I~? -?-9f: r; :'a~~~ ~o~ :~e r ~i~(~?J?-~~~S~J?~I~FI1 ..r :*~ ~;t :r-e? ~j~ . *c? ~- ?1?~ t?-~t-:? I -?:?:::?:~, -,c-~~ _:sr ::" ,~~~d~:t S `~.?? P ~"~4~?~":'~ krc~s: -o".-'~ r'.,rss;r i~,q=??t--~ r. ,ic`i~?~c-; ? ~- r -?id ?` ?-, ..e ~-r=J~~~~,?-? ~~??,g ~: ?" m: '' .?:c-~-i --i ?_::"f__L-~?;~ iSz'~: : ? ~~ ~~?-" t.. .::1? ? -" ~J~t~t-" ii- i-, B ;$r f5: PiY~i? : i?ir: r' )? >~-_^;" i;+,driuii;?Spl~e~~~ d~ .' .~Yd~` -~?-~ ;?i~t ,7~h?""~;~~~+"~P~ZR~rgrsm;c~,~;~ r-7~.~-,PU-.~bd:.'?. ,._ L -~kil~----~ . = i; i_ 3~t"i`~~ I-: ;::??I,.e a;`-Lb~k~c~ ~t~53~;Y6;L~4t?3~z~i3~~s~~i- 2~;~?5~~ ?i~it~m~ '" Lh-'j~L~I i ?iV) _1 nurse ?:. i iS~T- f?;.R L: :c:~ c:-:T "'--.~-- ? ?"-~:I ? :fi ?-lsT-:_l 2- , ?:_.ill.i: ~7~:] i ---;; and output, temperature, blooding graduate clinicians, 11 new rules legislates against successful pulse, and other such ob- task performance and 5pressure, senior nursing students because no rule tasks are different hospitals-two prijectifiable, measurable parameterscan tell a novice which nurses, in six mosttwo relevant in a comreal situation or vate community of the patient's hospitals, condition. when an exception to the rule is in Novice practitioners are also munity teaching hospitals, one university medical taught rules center, to guide actionand in order. one inrespect to different attributes. The ner-city general teaching hospital. Much confirming following is an example and of suchno aLevel II: disconAdvanced Beginner context-free rule: firming evidence was found for use of the Dreyfus Skill AcquiThe advanced beginner is one To Model determine fluidof balance, sition tice(3,4). Level I: Novice in check the patient'snursing morning clinical pracwho can demonstrate marginally weights and daily intake and out- put for the past three days. Weight gain in addition to an intake that is consistently greater than 500 cc Beginners have no experiencecould indicate water retention; in with the situations in which they are that case, fluid restriction should be started until the cause of the expected to perform tasks. In order imbalance can be determined. to give them entry to these situa- acceptable performance. This person is one who has coped with enough real situations to note (or to have them pointed out by a mentor) the recurrent meaningful situational components, called aspects. In the Dreyfus model, the term "aspects" has a very specific mean- The heart of the difficulty that ing. Unlike the measurable, contexttions, they are taught about them in terms of objective attributes. Thesethe novice faces is the inability to free attributes of features that the attributes are features of the task use discretionary judgment. Since inexperienced novice uses, aspects that can be recognized without situ- novices have no experience with the are overall, global characteristics ational experience. situation they face, they must usethat require prior experience in acCommon attributes accessible these context-free rules to guide tual situations for recognition. to the novice include weight, intake their task performance. But followFor example, assessing a pa- American Journal of Nursing/March 1982 403 This content downloaded from on Sun, 11 Nov 2018 07:55:58 UTC All use subject to The advanced beginner, or inindicative of pulmonary edema and structor of the advanced beginner,those indicative of pneumonia. But similar situations and similar teachcan formulate guidelines for actions in practice areas, where the cliniing-learning needs. An expert clini- in terms of attributes and aspects. cian has already attained competencian describes her assessment of a These action guidelines integrate ascy, aspect recognition will probably patient's readiness to learn about his many attributes and aspects as possibe redundant; the competent clinician will focus on the more adcontinent ileostomy this way: ble, but they tend to ignore the difEarlier, I thought he was feel- ferential importance. In other vanced clinical skill of judging the relative importance of different aspects of the situation. The major implication for both tient's readiness to learn depends on experience with previous patients in "Novices and advanced beginners can take in little of the situation-it is too new, too strange." preservice and inservice education is that the advanced beginner needs support in the clinical setting. Ad- vanced beginners need help in setting priorities since they operate on general guidelines and are only being helpless about the operation he had just had. He looked as though he felt crummy-physically, sort of stressed-looking, nervous-looking. Furthermore, he was treating the wound physically very gingerly. He didn't need to be that gentle with it. But, on this morning, it was different, he began to ask questions. An instructor or mentor can words, they treat all attributes and aspects as equally important. The ginning to perceive recurrent meaningful patterns in their clinical prac- following comment about advanced beginners in an intensive care nursery illustrates this. nurses to ensure that important pa- tice. Their patient care must be backed up by competent level I give very detailed and expli- tient needs do not go unattended cit instructions to the new grad- because the advanced beginner canuate: When you come in and first not yet sort out what is most imporsee the baby, take the vital signs tant. and make the physical examina- provide guidelines for recognizingtion. Then, check the IV sites, such aspects as readiness to learn; check the standby ventilator and Level III: Competent for example, "Notice whether or not make sure that it works, and check the patient asks questions about the the monitors and alarms. When I Competency, typified by the nurse who has been on the job two surgery or the dressing change."say this to new graduates, they do to three years, develops when the "Observe whether or not the patient exactly what I tell them to do, no nurse begins to see his or her actions looks at or handles the wound." But matter what else is going on.... in terms of long-range goals or the guidelines are dependent onThey can't choose one to leave out. plans. The nurse is consciously knowing what these aspects soundThey can't choose which is more aware of these plans, and the goal or like and look like in a patient careimportant.... They can't do for plan dictates which attributes and situation. one baby the things that are most aspects of the current and contem- While aspects may be made important, then go to the next baby explicit, they cannot be made com- and do the things that are most pletely objective. It makes a differ- important and leave out the things ence in the way that the patient asks that can be left until later. plated future situation are to be con- about the surgery or the dressing tive, and the plan is based on consid- Novices and advanced begin- change. You have to have some ners can take in little of the situa- experience with prior situations be- tion-it is too new, too strange. Aspect recognition is dependent on prior experience. remembering the rules they have fore you can use the guidelines. Besides, they have to concentrate on PATRIC(:IA BENNER, RN. MS, has been involved in studies to identify the competencies of new graduates for over 10 years. When this was prepared, Ms. Benner was director of the Achieving Methods of Intraprofessional Con- sensus, Assessment, and Evaluation (AMI- CAE) Project at the University of San Francisco. This article is based on material to be published by the National Commission on Nursing of the American Hospital Associa- tion in a monograph, From' Novice to Expert: Promoting Excellence and Career Develop- ment in Clinical Nursing Practice. The study reported in the monograph was sup- ported by a Department of Health and Human Services Division of Nursing grant. sidered most important and which can be ignored. For the competent nurse, a plan establishes a perspecerable conscious, abstract, analytic contemplation of the problem. A preceptor describes her own evolu- tion to the stage of competent, been taught. As the expert clinician planned nursing from her earlier quoted above adds, If I say, you have to do these stimulus-response level of nursing: eight things, they do those things. They don't stop if another baby is I had four patients. One needed colostomy teaching, the others needed a lot of other things. Instead of thinking before I went into the room, I got caught up.... Someone's IV would stop, and I'd needs attention, they're like mules work on that. Then I'd forget to between two piles of hay. Much time is spent by precep- give someone their meds, and so would have to rush around and do tors and new graduates on aspect that. And then someone would feel recognition. For example, in mak- screaming its head off. When they do realize that the other child ing physical assessments, aspect rec-nauseated and I'd try to make them feel better while they were ognition is an appropriate learning goal. The nurse will practice dis-sick. And then the colostomy bag criminating between breath soundswould fall off when I wanted to 404 American Journal of Nursing/March 1982 This content downloaded from on Sun, 11 Nov 2018 07:55:58 UTC All use subject to start teaching. And, all of a sudden the morning was gone, and no one had a bed bath. Now I come out of report and I know I have a couple of things that I have to do. Before I go in the room, I write down the meds I'm supposed to give for that day, and then walk in there and make sure terms of aspects, and performance situation. is They can mean one thing at one time and quite another at guided by maxims. another time. But once one has a Experience teaches the profi- cient nurse what typical events deep to understanding of the situation, the maxim provides directions as to expect in a given situation and how what is important to take into conto modify plans in response to these sideration. This is revealed in the events. There is a web of perspectives, and as Dreyfus notes, experienced nurse clinicians's ac- Except in unusual circum-count of how she weans a patient that everybody's IV is fine.... I stances, the performer will be expefrom a respirator: know what I have to do, and I am much more organized. Competence is evidenced by the fact that the nurse begins to see his or her actions in terms of longrange goals or plans. The competent nurse lacks the speed and flexibility riencing his current situation as Well, you look at vital signs to similar to some brain-stored, expesee if there is anything significant there. But even here you need to do rience-created, typical situation little guessing. You have to decide (complete with its saliences) due ato recent past history of events.... if the patient is just anxious be- cause he's so used to the machine Hence the person will experience breathing for him. And if he does of the nurse who has reached the through a perspective, but ratherget anxious, you don't really want proficient level, but the competencythan consciously calculating this to medicate him, because you're stage is characterized by a feeling ofperspective or plan, it will simply afraid he will quit breathing. But mastery and the ability to cope withpresent itself to him or her(5). on the other hand, he may really and manage the many contingenBecause of the experience- need to calm down a bit. It just his or her situation at all times cies of clinical nursing. The compe- based ability to recognize whole sit-depends on the situation.... You tent nurse's conscious, deliberateuations, the proficient nurse canhave your groundwork from what planning helps achieve a level of now recognize when the expectedyou have done in the past, and you efficiency and organization. Nurses normal picture does not present know when you are going to get at this stage can benefit from deci-itself-that is, when the normal is sion-making games and simulations absent. The holistic understanding that give them practice in planningof the proficient nurse improves his and coordinating multiple, com- or her decision making. Decision plex, patient care demands. making is now less labored since the The competent level is sup-nurse has a perspective about which ported and reinforced institutional-of the many attributes and aspects ly, and many nurses may stay at thispresent are the important ones. level because it is perceived as the Whereas the competent person ideal by their supervisors. The stan-does not yet have enough experidardization and routinization of ence to recognize a situation in into trouble. Proficient performers are best taught by use of case studies where their ability to grasp the situation is solicited and taxed. Providing proficient performers with context-free principles and rules will leave them somewhat frustrated and will usually stimulate them to give examples of situations where, clearly, the principle or rule would be contra- procedures, geared to manage the terms of an overall picture or in dicted, high turnover in nursing, most often terms of which aspects are most salireflect the competent level of perent and most important, the profi- Level V: Expert "Experience teaches the proficient nurse what typical events to expect in a given situation and how to modify plans in response to these events." formance. Most inservice education cient performer now considers few- is aimed at the competent level of er options and hones in on an accuachievement; few inservice offer- rate region of the problem. Aspects ings are aimed at the proficient or stand out to the proficient nurse as expert level of performance. Level IV: Proficient With continued practice, the competent performer moves to the proficient stage. Characteristically, the proficient performer perceives situations as wholes, rather than in being more or less important to the situation at hand. Maxims are used to guide the proficient performer, but a deep understanding of the situation is required before a maxim can be used. At the expert level, the performer no longer relies on an analy- tical principle (rule, guideline, maxim) to connect her/his under- standing of the situation to an appropriate action. The expert nurse, with her/his enormous background of experience, has an intuitive grasp of the situation and zeros in on the accurate region of the problem without wasteful consideration of a large range of unfruitful possible problem situations. It is very frustrating to try to capture verbal descriptions of expert performance because the expert operates from a deep under- standing of the situation, much like the chess master who, when asked Maxims reflect what would appear why he made a particularly masterto the competent or novice perform- ful move, will jus ...
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School: Cornell University



Benner’s Novice to Expert Theory
Author’s Name
Institutional Affiliation




Patricia Benner Came up with a theory identified as Novice to Expert theory. The theory
depicts that nurses improve on their skills and their understanding and knowledge of healthcare
of patients as time goes by. This is through personal experiences and effective academic
foundation. According to Benner, a nurse can obtain skills and knowledge without necessarily
learning a theory. There are five stages of the nursing profession and experience in Benner's
theory and they include novice or a beginner, advanced beginner, competent, proficient and
expert. The paper will discuss the background of Benner's theory and its influencing factors
including the world view, the assumptions of the theory, its major strengths and weaknesses and
application approach in clinical practice. The paper will also comprise of a conclusion to give a
general overview of what has been discussed (Williams & Wilkins, 2018).
Description of the theory's background and influencing factors, including worldview
Experience and competency are the most important aspects of the nursing field. Quality
of the health care provided by nurses depends on the experience and knowhow of the nurse. In
the past, the prudence responsibilities and roles of nurses to provide effective care to patients was
ignored. The factors that were out into consideration were the turnover rates of nurses and the
nursing positions and personnel. There was no attention paid to individuals that had sacrificed to
provide their services as nurses in a long period of time (Williams & Wilkins, 2018). Rewarding
nurses was not in the minds of any of the...

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