ANP PPT BY cindrella john on Patircia benner thoery.ppt

theory utilization patricia benner

1. PATRICIA BENNER THEORY FROM NOVICE TO EXPERT Presenter Cindrella John 1 st Year Msc Psychiatric Nursing College Of N ursing, IHBAS

2. Introduction Patricia Benner developed a concept known as “ From Novice to Expert”. This concept explains that nurses develop skills and an understanding of patient care over time from a combination of a strong educational foundation and personal experiences. Benner’s theory identifies five levels of nursing experience: Novice, Advanced Beginner, Competent, Proficient, and Expert.

3. Background of the Theorist Born August 1942, Hampton, Virginia Nationality American Fields Nursing Theory, Nursing Education Alma Mater City College, Pasadena College, University of California, San Francisco University of California, Berkeley Known for From Novice to Expert Excellence and Power in Clinical Nursing Practice Professor Emerita at the University of California, San Francisco Influences Hubert Dreyfus, Stuart Dreyfus, Virginia Henderson Noble Awards Living Legend of the American Academy of Nursing (2011)

4. She was a staff nurse in the areas of Medical, Surgical, Emergency , Coronary Care, Intensive Care and Home Care. An Internationally noted researcher and lecture on health, stress and coping, skills acquisition and ethics. Elected as an honorary fellow of the Royal College of Nursing. Currently her research includes the study of nursing practice in intensive care and nursing ethics. Continued Background of the Theorist

5. Benner’s Theoretical Sources Theoretical Knowledge = Knowing that Practical Knowledge =Knowing how

6. Virginia Henderson Dr. Benner has acknowledged that her “thinking has been influenced greatly by Virginia Henderson. Benner studies clinical nursing practice in an attempt to discover and describe the knowledge embedded in nursing practice. Drefyus Model of Skill Acquisition Developed in 1980. Describes five levels of skill acquisition and development Model showed advancement through the stages by changes in performance Developed by studying chess players and pilots Benner adapted the Drefyus model for clinical nursing practice, basis for her work: Novice to Expert

7. DREYFUS MODEL

8. Major Concepts and Definitions From Novice to Expert theory explains five levels / stages of role of acquisition and professional development including: Novice Advanced Beginner Competent Proficient Expert

9. Novice The person has no background experience of the situation in which he or she is involved. Context-free rules and objective attributes must be given to guide performance . Benner has suggested that nurses at higher levels of skill in one area of practice could be classified at the novice level if placed in an area or situation completely foreign to them such as moving from general medical-surgical adult care to neonatal intensive care units. Example : Nursing students in their first year of clinical education. Continued

10. Advanced B eginner Applies to most newly pass out or graduated nurses. Highly responsible for managing patients care Still rely on the help of the more experienced nurse Has marginally competent skills Uses theory and principles. Experiences difficulty in establishing priorities. Example : New graduate nurses who have completed their initial training and are starting to work independently. Continued

11. Competent Through learning from actual practice situations and by following the actions of others, the advanced beginner moves to the competent level. Consistency, predictability, and time management are important in competent performance. The competent stage is most pivotal in clinical learning . T he learner must begin to recognize patterns and determine which elements of the situation warrant attention and which can be ignored. Example : Nurses who have been working in a specific department for a few years and can manage patient care effectively. Continued

12. Proficient T he performer perceives the situation as a whole rather than in terms of aspects, and the performance is guided by maxims. Nurses at this level demonstrate a new ability to see changing relevance in a situation, including recognition and implementation of skilled responses to the situation as it evolves. The proficient stage is a transition into expertise. Example : Experienced nurses who can anticipate patient needs and adapt their care plans accordingly. Continued

13. Expert The fifth stage of the Dreyfus model is achieved when “the expert performer no longer relies on analytical principle to connect an understanding of the situation to an appropriate action. There is a qualitative change as the expert performer “knows the patient,” meaning knowing typical patterns of responses and knowing the patient as a person. The key aspects of an expert nurse are: Shows clinical guidelines and practical resources Realizing the know-how process See the broad picture Seeing the unexpected Example : Highly experienced nurses who are often consulted for their expertise and can handle complex patient care scenarios with ease. Continued

14. Benner’s Theory Model

15. There are no interpretation-free data. This abandons the assumption from natural science that there is an independent reality whose meaning can be represented by abstract terms or concept. There are no nonreactive data. This abandons the false belief from natural science that one can neutrally observe brute data. Meanings are embedded in skills, practices, intentions, expectations, and outcomes. They are taken for granted and often are not recognized as knowledge. People sharing a common cultural and language history have a background of common meanings, that allow for understanding and interpretation. Humans are integrated, holistic beings. The mind-body split is abandoned

16. Metaparadigm Of Benner’s Theory Person Health Environment Nursing

17. 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. The person is viewed as a participant in common meanings. Finally, the person is embodied. Benner conceptualized the following 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 The role of temporality Continued

18. Health Benner and Wrubel focus on the lived experience of being healthy and being ill. Health is defined as what can be assessed, whereas well-being is the human experience of health or wholeness. Health is described as not just the absence of disease and illness. A person may have a disease and not experience illness, because illness is the human experience of loss or dysfunction, whereas disease is what can be assessed at the physical level. Continued

19. Environment Benner use the term situation rather than 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 meaning, habits and perspectives influences the current situation. Continued

20. Nursing Nursing is described as 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. Benner viewed nursing as the care and study of the lived experience and the relationship of these three elements: Health Illness Disease Continued

21. THEORTICAL ASSERTIONS Benner stated that there is always more to any situation than theory predicts. Some relationships statements included in Benner’s work follow: Clinical knowledge is embedded in perceptions rather than precepts. Perceptual awareness is central to good nursing judgment. Formal rules are limited, and discretionary judgment is needed in actual clinical situations. Clinical knowledge develops over time, and each clinician develops a personal repertoire of practice knowledge that can be shared in dialog with other clinician. Expertise develops when the clinician tests and refines propositions, hypotheses, and principle-based expectations in actual practice situations.

22. Logical Framework Through qualitative descriptive research, Benner used the Dreyfus Model of Skill Acquisition to better understand skill acquisition in clinical nursing practice. By following the model’s logical sequence, Benner was able to identify the performance characteristics and teaching-learning needs inherent at each skill level. The goal of Benner’s research is to bring meanings and knowledge embedded in skilled practice into public discourse. Benner claims that new knowledge and understanding are constituted by articulating meanings, skills, and knowledge that previously were taken for granted and embedded in clinical practice

23. Application of Benner’s Theory Examples of use in Practice: Nursing School Curriculum Orientation Processes Nursing Educational Programs Professional Advancement Ladders Inter- departmental Job Changes Developing Mentorship Programs Development of Clinical Simulation Protocol Application of Theory in Nursing Reseach

24. Strength of the Theory The theory has the potential to be used universally as a framework and is not restricted by age, illness, health, or location of nursing practice. The model was empirically tested using qualitative methodologies. The strength of the Benner model is that it is data- based research that contributes to the science of nursing. It focuses on the behaviour of nurses depending on their level of understanding with nursing practice. Her theory highlights the importance of clinical experience in developing expertise. As observed today, her theory is widely used as it provides a foundation to use for assigning clinical competencies.

25. Weakness of the Theory Benner’s perspective is phenomenological and not cognitive. Benner’s theory is too simple to account for the complex pattern of phenomena linked to expert intuition in nursing. Benner and her colleagues, based on previous work by the Dreyfus brothers strongly argue that intuition and holistic perception are necessary for performing at expert level. However, by doing so, they underestimate the role played by analytic and conscious problem solving at the expert level

26. Critique of the Theory Clarity Simplicity Generality Empirical Precision

27. Clarity The clarity of Benner’s Novice to Expert model has led to its utilization among nurses around the world. An identification with the idea of clinical wisdom and varying levels of clinical expertise development progresses very quickly. Benner’s work not only contributed to appreciative understanding of clinical practice but also revealed nursing knowledge embedded in practice. Continued

28. Simplicity The model is relatively simple in regard to the five stages of skill acquisition, and it provides a comparative guide for identifying levels of nursing practice. Description of novice level of performance would be possible but expert description would be difficult if not impossible and limited to its usefulness. Degree of complexity is encountered in sub concepts for differentiation among the levels of competency and the need to identify meanings and intentions. Continued

29. Generality The model has universal characteristics; it is not restricted by age, illness, health, or location of nursing practice. Has the potential for universal application as a framework, but the descriptions are limited by dependence on the actual clinical nursing situations from which they must be derived. Finally, clinical knowledge is relational and contextual and involves local, specific, historical issues. It generalizable in terms of the translation of meaning to similar situation. Continued

30. Empirical Precision Benner theory is researchable, and qualitative research has been the primary paradigms to discover embedded knowledge of clinical practice. Quantitative attempt has been made to design and validate nurse competence scale. Her work can be considered as hypothesis generating rather than hypothesis testing. So, it is an inductive theory. Continued

31. Research Input Readiness levels of intern nursing students during the transition to professional practice within the Al Jouf Region in Saudi Arabia Author- Alruwaili , A. N., Alruwaili , M. M., & Colby, N. Published on- 2024 Background:  The transition of newly graduated nurses into the workforce is recognized as a complex undertaking and has been examined extensively in the literature. Results- Findings revealed that most intern nursing students (63.7%) exhibited a moderate level of readiness. Furthermore, 70.4% and 55.6% of the students showed moderate readiness in terms of their professional attitudes and patient-centeredness, respectively. More than one-third of the students demonstrated a high level of readiness in the self-regulation domain (36.3%), while a similar proportion indicated a high level of readiness in the domain of collaborative interpersonal relationships (33.3%). The students underscored their reliance on the education system as pivotal in enhancing their preparedness for clinical practice.

32. Conclusion In conclusion, Patricia Benner's Novice to Expert Theory provides a valuable framework for understanding the progression of nursing skills and expertise. The theory highlights that expertise is gained through experience, not just formal education, and that the journey from novice to expert involves a deepening of both practical knowledge and intuition. This progression allows nurses to deliver care that is not only based on rules but also on a holistic understanding of patient needs. By recognizing the different stages of skill acquisition, Benner’s theory helps guide nurse educators and mentors in providing appropriate support and opportunities for growth at each level. Ultimately, the theory underscores the importance of experiential learning in the development of clinical competence and professional mastery in nursing.

33. Case Scenario Maria is a new graduate nurse who just started working in a busy medical-surgical unit. During her first week, she is assigned a patient with multiple comorbidities, including diabetes and hypertension, who requires frequent blood glucose monitoring, medication administration, and wound care. Maria feels overwhelmed by the complexity of managing all the tasks and isn’t sure if she’s prioritizing care appropriately. She follows her preceptor’s instructions closely, relying on step-by-step guidance and is unsure how to handle unexpected situations without support. Six months later, Maria is more comfortable with her daily tasks but still hesitates when faced with complex patient care situations. She follows protocols but doesn’t feel fully confident in her decision-making. A year into her job, Maria can manage multiple patients more efficiently. She begins to recognize patterns and predict patient needs, relying less on guidelines and more on her growing clinical judgment. Question: Using Benner's Novice to Expert Theory, explain Maria's progression in her nursing practice and identify her stage at each point in the scenario. What steps can Maria take to continue her professional growth?

34. References Alligood MR. Nursing Theorists and Their Work-E-Book: Nursing Theorists and Their Work-E-Book. Elsevier Health Sciences; 2017 Jul 20. Benner P. Novice to mastery. Teaching and Learning for Adult Skill Acquisition: Applying the Dreyfus and Dreyfus Model in Different Fields. 2021 May 1;215. Benner P, Tanner CA, Chesla CA, editors. Expertise in nursing practice: Caring, clinical judgment, and ethics. Springer Publishing Company; 2009 Mar 16. McHugh MD, Lake ET. Understanding clinical expertise: nurse education, experience, and the hospital context. Research in nursing & health. 2010 Aug;33(4):276-87. Bazrafkan L, Yousefy A, Amini M, Yamani N. The journey of thesis supervisors from novice to expert: a grounded theory study. BMC medical education. 2019 Dec;19:1-2. Alruwaili AN, Alruwaili MM, Colby N. Readiness levels of intern nursing students during the transition to professional practice within the Al Jouf Region in Saudi Arabia. BMC Nursing. 2024 Jun 21;23(1):421.

35. Thank you