Theory Evaluation: Patricia Benner



Theory Evaluation: Patricia BennerNatasha LomaxCoppin State UniversityTheoretical Foundations for the Practice of Nursing NURS 620Dr. Patricia SetlowJanuary 19, 2015Theory Evaluation: Patricia BennerTheory DescriptionPatricia Benner is a theorist that studied the clinical nursing practice in order to discover and describe how the practice’s knowledge is gained. Benner declared that knowledge development is a “extending practical knowledge through theory-based scientific investigations and through the charting of the existent ‘know-how’ developed through clinical experience in the practice of that discipline” (Brykczynski, 2010, p. 139). Benner’s theory is known as From Novice to Expert, which derived from the Dreyfus Model of Skill Acquisition (Brykczynski, 2010). The five levels of skill acquisition and development found in Dereyfus Model of Skill Acquisition are the following: novice, advanced beginner, competent, proficient and expert. Benner explains that the model is based on situations and therefore it is use to evaluate the function of a nurse’s expertise with a particular situation. Benner’s explanation of nursing practice is “reasonable behavior responds to the demands of a given situation” (Brykczynski, 2010, p. 141). She continues to explain that expert nurses develop skills acquired through their clinical experience and perceptual awareness (Brykczynski, 2010).ConceptsOne major concept that Benner’s theory is based on is the concept of experience. Benner defines experience as “the outcome when preconceived notions are challenged, refined, or refuted in actual situations” (Brykczynski, 2010, p. 141). Expertise is sought as being able to overcome tests and modify principle-based expectations in actual situation through the practical and theoretical knowledge-experience gained (Brykczynski, 2010). Other major concepts incorporated into Benner’s theory include: novice, advance beginner, competent, proficient, and expert. Novice is defined as an individual with limited to no background experience to a situation that they are involved in. Benner states that this refers to student nurses and an experienced nurse whom possesses high quality skills in one clinical area, but is a novice in another unfamiliar area of practice (Brykczynski, 2010). The advanced beginner is a person, who is able to demonstrate satisfactory skills and have enough experience to handle aspects of a situation. “Nurses functioning at this level are guided by rules and are oriented by task completion; they have difficulty grasping the current patient situation in terms of the larger perspective” (Brykczynski, 2010, p. 142.). These nurses tend to rely on the help from other nurses whom are more experienced; an example given is a new graduate nurse. The next concept discussed in Benner’s theory is the concept of competent. A nurse is viewed as competent when they are able to demonstrate “consistency, predictability, and time management” (Brykczynski, 2010, p. 143) in their performance. The advance beginner transitions into this stage through learning from their practice environment and following others. In this particular stage, the nurse’s “efficiency improve, but focus is place on time management and organization of the task rather than on timing in relation to the patient’s needs” (Brykczynski, 2010, p. 143).According to Benner the last two concepts in the theory is the proficient and expert stages. In the proficient stage the nurse is able to recognize the most important aspects of their care and has an intuitive awareness of the present situation. Benner states that nurses at this level have the ability to observe significant changes in a patient’s situation and are able to apply implementations to improve the patient’s situation before it progress (Brykczynski, 2010). “Proficient nurses have “confidence in their knowledge and abilities” (Brykczynski, 2010, p. 143); these nurses tend to be more involved with their patients and their families. Nurses at the proficient stage are beginning their transition into expertise. The level of expertise is described by Benner as being an expert nurse. These nurse “have an intuitive grasp of the situation and as being able to identify the region of the problem without losing time considering a range of alternative diagnoses and solutions” (Brykczynski, 2010, p. 143). Benner list key attributes that an expert nurse follows in practice are: demonstrating a resource based practice, embodied know-how, see the big picture, and see the unexpected (Brykczynski, 2010). It’s important to expert nurses to be able to meet their patient’s actual concerns and needs even if they have to advocate for change in the patient’s plan of care. AssumptionsThere are six major assumptions that Benner incorporated into her theory. The first assumption is that “there are no interpretation-free data; this abandons the assumption that an independent reality whose meaning can be represented by abstract terms or concepts” (Brykczynski, 2010, p. 147). The second assumption is “there are no nonreactive data; which abandons the false belief from natural science that one can neutrally observe brute data” (Brykczynski, 2010, p. 147). Benner’s next assumption is the meanings are embedded in skills, practices, intentions, expectations, and outcomes. Benner goes further to say that the meanings embedded in skills and other traits listed above are not completely clear, but they interpreted by someone else with similar background. Another assumption is that individual with similar culture background or who share the same language has a common background meaning that will allow understanding (Brykczynski, 2010). The last assumption mentioned is that humans are integrated, holistic beings; “embodied knowledge enables skilled activity that is transformed through experience and mastery” (Brykczynski, 2010).Theory AnalysisThe concepts used in Benner’s theory are theoretically defined. The concepts are based on theory rather than practical application. The concepts are not operational defined because they are not measured and are determined on a situational basis. The linkage of the different concepts is clear and précised. Benner gives examples of each of her concepts and explains how they are related to the nursing practice. Benner does not have a model/diagram for her theory. Theory EvaluationBenner’s theory is congruent with current nursing standards because it can be applied to today’s nursing society. Every nurse practicing today will either fall into one of the following categories regardless of their level of educational background or can remember being in one of these categories. Benner’s theory is also congruent with the advanced nursing practice because the advanced practice nurse is seen as a novice in their new role and will progress through the stages as their clinical experience grows. The theory is socially and cross-culturally relevant to nursing practices as well as to other professions. Everyone at some point of their life will begin as a novice in a situation and progress to the stage of expertise with gaining life experience and knowledge. The theory contributes to the discipline of nursing by providing a theoretical framework for how knowledge is gained in the nursing practice. Benner’s theory places awareness and expanding knowledge in the practice discipline. “Nursing has been delinquent in documenting their clinical learning; deprives nursing theory of the uniqueness and richness of the knowledge embedded in expert clinical practice” (Brykczynski, 2010, p. 139).Usage of the TheoryNumerous of studies Gentile, 2012; Hill, 2010; McHugh & Lake, 2010 use Benner’s Novice-to-Expert theory in their research study. In Hill (2010) article the author incorporates Benner’s theory and then gives the reader “five vehicles to maintain expertise in practice” (Hill, 2010). This article concluded that “the data available have already demonstrated that years of experience in nursing support expertise and have a positive impact on the quality of care provided”(Hill, 2010, para. 26). McHugh & Lake (2010) study used Benner’s theory to guide their research study. The study suggested that both individual level and hospital contextual factors have influences on expertise (McHugh & Lake, 2010). In Gentile (2012) study the novice-to-expert theory was implemented at a Midwestern hospital in order to promote reflective practice, recognize nursing expertise, and creates a peer review system (Gentile, 2012). The hospital used Benner’s theory in order to create their own model called the Aurora Development and Advancement Model-RN (ADAM-RN), which levels consists of graduate nurse, competent, accomplished, proficient, and expert (Gentile, 2012). This particular article concluded that “reflective practice and transformative learning experiences is the core of the novice-to-expert model” (Gentile, 2012, p. 107). In summary Benner’s Novice- to- Expert theory is guide to access how knowledge is gained within the nursing practice. Nurses will transitions back and forth through the various phases of the theory at different periods of their careers. Benner’s theory has been used in different purpose forms in the nursing practice such as: education, research, and practice. The theory will continue to be congruent to current and future nursing standards. ReferencesBrykczynski, K. A. (2010). Chapter 9 Patricia Benner: Caring, clinical wisdom, and ethics in nursing practice. In M. R. Alligood, & A. M. Tomey (Eds.), Nursing Theorists and Their Work (7 ed., pp. 137-164). Maryland Height, MO: Mosby Elsevier.Gentile, D. L. (2012). Applying the novice-to-expert model to infusion nursing. Infusion Nurses Society, 35(2), 101-107. , K. S. (2010, August 2). Improving Quality and patient safety by retaining nursing expertise. OJIN: The Online Journal of Issues in Nursing, 15(3). , M. D., & Lake, E. T. (2010, August). Understanding clinical expertise: Nurse Education, experience, and the hospital context. Research Nursing Health, 33(4), 276-287. ................
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