From Novice to Expert by Patricia Benner - Assignment Example

Analyzing Benner’s From Novice to Expert of Patricia Benner is widely known for her book From Novice to Expert, among others. Her work demonstrates the distinction between novice nurses and expert nurses in terms of experience and knowledge. The five phases of development described by Benner are novice, advanced beginner, competent, proficient, and expert. This model has been the guide of many practicing nurses in the clinical setting. Through experience and knowledge, a nurse can attain a deep understanding and appreciation of themselves and clinical nursing practice and eventually enhance nursing care. Such is the fundamental message of Benner’s From Novice to Expert. This paper analyzes and discusses Patricia Benner’s From Novice to Expert. The first section introduces the life and theory of Benner, and the key components of the theory. The second section discusses how the theory can connect theory, research, and practice. Then the last section explains how this theory is relevant to my practice goals and how can I apply the theory now and in the future. Analyzing Benner’s From Novice to Expert Patricia Benner of the University of California was a forerunner in clinical practice research; specifically, she examined the traits of experts and the development of expertise. Employing a qualitative design, as well as interview and observation, she studied several nurses involved in clinical activities—from novice nurses to expert nurses. From this research she wrote her book From Novice to Expert: Excellence and power in clinical nursing (2001) wherein she identified a hierarchy or pyramid of practice in medical nursing. The five phases of development described by Benner are ‘novice, advanced beginner, competent, proficient, and expert’ (Alber et al., 2009, 126). Benner’s work covers clear, perceptive explanations of every stage and the framework has been applied by others in examining their profession and creating academic programs. This paper analyzes and discusses Patricia Benner’s From Novice to Expert. The first section introduces the life and theory of Benner, and the key components of the theory. The second section discusses how the theory can connect theory, research, and practice. Then the last section explains how this theory is relevant to my practice goals and how can I apply the theory now and in the future. The Life and Work of Patricia Benner Patricia Benner is a nursing graduate from Pasadena College. She later on obtained a Master’s Degree in nursing from University of California in 1970, with her primary focus on medical-surgical nursing. Benner has a broad array of clinical knowledge and experience in home health care, critical care, acute medical-surgical care, and others (Haag-Heitman, 2008). She has worked as a staff and, later on, as head nurse. Benner has published widely and has received many awards, especially for her book From Novice to Expert. She said that nursing is a cultural irony in a largely technological world and that people are hesitant to give importance to and express caring practices. She thinks that the significance of too much individualism hinders people to see the true genius of caring in the field of expert nursing (Benner, 2001). Benner’s From Novice to Expert was developed from the pioneering research of Dreyfus and Dreyfus on skill acquisition by Air Force pilots and chess players. As greater education and experience are acquired, a person can advance through observable developmental stages, with noticeable changes and dissimilarities in attitudes toward work productivity, organization, problem solving, and decision making (Benner, 2004). Nevertheless, as stressed by Benner, “Some persons will tend to settle in a competent or proficient level because of personal learning styles, personal concerns, or organizational constraints that cause them to plateau at a level of practice” (Benner & Benner, 1991, 70). Those who have been confined into the same profession for so long and are responding unfavorably to organizational changes may not have been progressing to the final stage—expertise. Benner’s model explains five stages of skill attainment: first stage is novice, second is advanced beginner, third is competent, fourth is proficient, and fifth is expert. The first level—the novice nurse—refers to the student nurse or a capable nurse working in an unfamiliar domain; the second level—the advanced beginner—denotes the new graduate nurse who exhibits slightly satisfactory performance and depends on more knowledgeable and practiced nurses (Benner et al., 1992). At the third level—competent—the nurse can formulate and establish goals, multitask, and is able to reason systematically and theoretically. At level four—proficient—the nurse is capable of seeing the entirety of a scenario or problem, identifying even the slightest changes, and focusing on long-term objectives. The final stage—the expert nurse—is characterized by the capacity to identify feedback, responses, and patterns that are spontaneous and cohesive (Larrabee, 1999). Wide-ranging experience determines whether a nurse is already at the expert level. Level of Theory In her theory, Benner argues that acquiring and enhancing nursing abilities by means of situational experience or practice is a requirement for expertise. Benner carried out a phenomenological research assessing experts in clinical nursing practice “to ascertain and understand the differences in clinical performance and situation appraisal of beginning and expert nurses” (Benner, 2001, 14). She wanted to assess the distinctions between theoretical and practical knowledge and explains the latter by identifying competency cases in clinical nursing. Benner carried out a research of clinical nursing practice in order to identify and understand the knowledge that is entrenched in nursing practice. Newly practicing nurses and those recognized as experts were interviewed, in an effort to identify and learn about typical distinctions in clinical settings: “Not knowing who and what we are about now will seriously impede what we want to become” (Benner, 2001, xxv). Benner tried to introduce new perspectives of nursing practice so as to understand the challenges and importance of the nursing profession. She argued that the study and documentation of the traits, significance, recognition skills, and perceptions of expert nurses would empower nurses to boost skills and knowledge and push practice forward (Teekman, 2000). Yet, nurses have a tendency to be negligent in keeping a record of clinical learning. Failure to document clinical learning and nursing practice deprives nursing theory of the distinctiveness and individuality of knowledge that is observed among expert nurses. Moreover, from her work, Benner discussed theoretical differences from theory itself. According to her, there are two distinct forms of knowledge, namely, ‘knowing how’ and ‘knowing that’. The broadening of ‘know-how’-- or practical knowledge-- by means of ‘know that’-- or theory centered knowledge-- is essential for the discipline’s knowledge expansion (Benner, 2001). This results in the expert’s skill advancement, which, by means of experience, has become skilled at facilitating their perceptions toward evidence confirmation (Orsolini-Hain & Malone, 2007). Benner (2001) claimed that theory is vital in order to create the correct questions to examine in a clinical setting; theory guides the professional in identifying problems and getting ahead of care requirements. The experienced practice of nursing goes beyond the limits of traditional theory. Actual experience produces the knowledge about the anomalies and nuances of meaning in a scenario or setting. The knowledge rooted in practice identifies and analyzes theory, heralds or expands theory, and consolidates and applies theory in the practice of nursing (Benner & Tanner, 1987). Several of the relationship declarations contained in the work of Benner are the following (Benner, 2001, 8): The clinician’s knowledge is embedded in perceptions rather than precepts… Perceptual awareness is central to good nursing judgment and… begins with vague hunches and global assessments that initially bypass critical analysis; conceptual clarity follows more often than it precedes… Expertise develops when the clinician tests and refines propositions, hypotheses, and principle-based expectations in actual practice situations. Benner fulfills the objective of her work which she proclaimed to be “to uncover meanings and knowledge embedded in skilled practice… by bringing these meaning, skills, and knowledge into public discourse, new knowledge and understanding are constituted” (Benner, 2001, 218). From Novice to Expert: Connecting Theory, Research, and Practice The journey from novice to expert can affect the capability of a nurse to understand the patient in entirety. A novice or advanced beginner may realize that his/her experience level to be a short-term hindrance in recognizing patient outcomes, choosing the appropriate care plan for a patient, and disseminating information about the general plan when managing others (Tanner, 2006). Novice nurses, since they do not have the necessary experience with the settings wherein they are obliged to carry out, should rely on guidelines to inform their decisions and actions. Yet, obeying rules has limitations. At times nurses have to be discerning and come up with responses that are most appropriate in actual settings. Novice nurses depend on rules, become confused or unsystematic easily, and may fail to recognize patient outcomes and impart these promptly with the help of other staff and patients (Zerwekh, 1993). Managers should not suppose that novice nurses will be capable of leading a group satisfactorily. Advanced beginners have handled enough actual scenarios to identify several of the persistent important aspects. They require assistance in establishing goals because they work on overall rules and are merely starting to identify persistent important patterns. At this level, the nurse cannot dependably identify or carry out what is most essential in complicated settings (Benner, 2001). A decision-making instrument is valuable at this point because nurses can employ it to facilitate problem solving skills by performing situations in task creation and talking about other clinical events, like mistakes that have taken place in their division. Advanced beginners, in steady conditions, obey rules and procedures; they become confused or unsystematic in unsteady conditions and have an immature confidence in standard procedures (Alber et al., 2009). Generally, a competent nurse has been practicing at least 2 years or more. Competent nurses can depend on long-term objectives and plans to decide which parts of a setting are vital and which can be disregarded (Benner, 2001). The competent person does not have the flexibility and promptness of the individual who has attained proficiency, yet competence is distinguished by a sense of proficiency and the capacity to handle and tackle numerous emergencies and possibilities of clinical care. Competent nurses are more skilled at identifying patient outcomes, yet they may still need some level of guidance in analyzing critical scenarios they have not yet encountered or have experience with (Haag-Heitman, 2008). Competent nurses apply fixed rules and objectives that are individually recognized, are less inexperienced about colleagues and procedures, and create their own way of performing or accomplishing certain things. Proficient nurses recognize scenarios as entireties, not parts. With rounded and complete knowledge, decision making is easier since the person has an idea on which of the numerous existing features and elements are vital. The proficient nurse takes into consideration a smaller number of choices and focuses on a correct part of the issue (Orsolini-Hain & Malone, 2007). They consider patient outcomes identification to be a secondary priority and may be capable of planning care and organizing a group to handle difficult patients without difficulty or stress. Proficient nurses analyze scenarios more appropriately and establish goals based on the circumstances as they develop (Teekman, 2000). The expert nurse does not depend on guidelines or rules anymore to link knowledge of a specific scenario to a suitable response or decision. The expert nurse with a massive pool of experience has remarkable intuition of the condition and focuses on the relevant aspect of the issue without careless thought on a wide array of unimportant likelihoods (Benner, 2001). Expert nurses are capable of leading a group successfully and productively and will be capable of structuring and organizing their task and the task of others while managing them competently. They are flexible and practiced in supervising and addressing both the most relevant elements as well as those that are missed by less skilled nurses (Alber et al., 2009). Experts at times have difficulties itemizing their instinctive, fast thinking mechanisms into stages so that they can efficiently communicate them to others (Tanner, 2006). Benner has defined clinical nursing practice through the application of an interpretive model. Contained in From Novice to Expert are a number of illustrations of the application of her theory and research in actual practice. The framework has been employed to guide the creation of clinical hierarchy of promotion, clinical knowledge development discussions, and new graduate orientation activities (Haag-Heitman, 2008). Seminars on expertise in nursing practice have been carried out for employee reward, recognition, and development and as a means to prove the development of clinical knowledge in the practice setting. According to Fenton, an ethnographic research on the performance and behavior of clinical nurse professionals used Benner’s model. She reported that the nurses were performing at an advanced level, yet “we have not yet developed accurate written and verbal descriptions of that advanced practice” (Benner, 2001, 8). The study of Balasco and colleagues employed Benner’s framework as starting point for distinguishing career advancement and clinical knowledge growth in nursing (Basavanthappa, 2007). Crissman and Jelsma used Benner’s model when creating cross-training activities to help resolve staffing disparities. They stated that “cross-training delineates specific performance objectives for the nurse in her novice role and provides a preceptor in the setting for the clinical area unfamiliar to her” (Basavanthappa, 2007, 322). Within this setting, as a novice, she intends to reach the level of an advanced beginner capable of working self-reliantly with an expert nurses accessible as a guide. Likewise, Neverveld made use of Benner’s reasoning and pattern in her creation of beginner and advanced preceptor seminars (Basavanthappa, 2007). Benner has been mentioned and used widely in nursing literature concerning nursing practice issues and the function of caring in practice. Benner keeps on publishing uses of the model in clinical settings. At present, Benner writes regularly for the American Journal of Nursing wherein she gives explanatory note on presented narrative statements of clinical settings by practicing nurses (Haag-Heitman, 2008). According to Benner, “this column has the potential to become a data source for a systematic study of the practical moral reasoning of nurses as well as extend the work on expert clinical nursing knowledge… serves to raise consciousness about the level and nature of the caring practices of nurses, which are currently threatened by lack of societal recognition and valuing” (Basavanthappa, 2007, 322). Application of the Theory I have learned from Benner’s From Novice to Expert that the process of becoming an expert starts with having knowledge of and becoming skilled at basic skills of nursing practice while at the same time knowing how to use appropriate nursing principles, backed up by empirical findings and demonstrated through skillful nursing care. I believe that Benner’s theory is relevant to my practice goals because it teaches me the proven effective steps to excel in my selected field, which are, openness to new information, willingness to learn, inviting and accepting helpful criticism, and adjusting to new settings. For newly practicing nurses like me, having the skill to shift from theory to practice by acquiring practical experience in patient care is an essential measure. Nursing theories provide the resources for critical thinking and problem solving steps in clinical nursing practice. However, until I have the chance to use the ideas or knowledge from the basic theories in actual settings regularly, I, being a novice, am not yet completely ready to practice effectively. However, as I have learned from Benner’s model, as the novice nurse acquires direct, practical nursing experience, knowledge and experience rises over time. In other words, a new nurse must consistently prepare for the future. As soon as the novice has acquired relevant knowledge and experience, s/he can recognize strengths and weaknesses. Hence I will try to write in a journal the aspects wherein I want to become better, communicate the details with my mentor, and afterward chart information and resources I will require in order to boost my learning. I will read academic, peer-reviewed journals, carry out educational dialogues with nurses acknowledged for their expertise, and update when they get a positive assessment of their performance in the clinical environment. Nursing is a vigorous, involved, and continuously changing profession. Nurses, at all levels, are constantly seeking to enhance patient care and look for ingenious solutions to complicated issues. It is essential that nurses operate as a group, bearing in mind that all nurses, regardless of the level where they are at, are vital components of the group. Conclusions Practical, hands-on knowledge is vital to nursing development. All clinical situations are a chance to learn. Through experience and knowledge, a nurse can attain a deep understanding and appreciation of themselves and clinical nursing practice and eventually enhance nursing care. Such is the fundamental message of Benner’s From Novice to Expert. Benner’s model is relevant and valuable in that it has viewed or interpreted clinical nursing practice from the point of view of the real nature and objective of nursing, rather than from unrealistic theoretical explanations that are value-free and objective. References Alber, L. et al. (2009). Applying Benner’s Model to Psychiatric Mental Health Nurse Practitioner Self-Ratings of Role Competence. Journal of the American Psychiatric Nurses Association, 15(2), 126-137. Basavanthappa (2007). Nursing Theories. New York: Jaypee Brothers Publishers. Benner, P. (2001). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. New York: Prentice Hall. Benner, P.A. (2004). Using the Dreyfus model of skill acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice and education. Bulletin of Science, Technology, & Society, 24(3), 188-199. Benner, P. & Benner, R. (1991). Stories from the front lines. Healthcare Forum Journal, 69-74. Benner, P. & Tanner, C. (1987). Clinical judgment: how expert nurses use intuition. American Journal of Nursing, 23-31. Benner, P., Tanner, C., & Chesla, C. (1992). From beginner to expert: Gaining a differentiated clinical world in critical care nursing. Advances in Nursing Science, 14, 13-28. Haag-Heitman, B. (2008). The development of expert performance in nursing. Journal for Nurses in Staff Development, 24(5), 203-211. Larrabee, S. (1999). Benner’s Novice to Expert Nursing Theory Applied to the Implementation of Laptops in the Home Care Setting. Home Health Care Management & Practice, 11(5), 41-47. Orsolini-Hain, L. & Malone, R. (2007). Examining the Impending Gap in Clinical Nursing Expertise. Policy, Politics & Nursing Practice, 8(3), 158-169. Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211. Teekman, B. (2000). Exploring reflective thinking in nursing practice. Journal of Advanced Nursing, 31(5), 1125-1135. Zerwekh, J. (1993). Transcending life: The practice wisdom of nursing hospice experts. American Journal of Hospice and Palliative Medicine, 10(5), 26-31. Read More