RELATIONSHIP BETWEEN THEORY AND PRACTICE IN BENNERS THEORY.

Nursing theory helps in the organization of knowledge, guidance of practice, enhancement of patients care and guidance of inquiry to advance science. It is primarily aimed at furthering the development and understanding of the practice of nursing. Theory forms the framework of nursing practice and both (theory and practice) are therefore intertwined as a nurse transitions from a novice to an expert (Parker & Smith, 2010). Benners novice to expert model is based on Dreyfus and Dreyfus Model of Skill Acquisition. Benner categorized nursing experience into five levels: novice, advanced learner, competent, proficient, and expert. She believed that the key to nursing is clinical experience because of the allowance it gives the nurse to continue expanding his/her knowledge, and keep providing patient care in a holistic and competent manner (George, 2011). Guidance and direction from a good preceptor is very important in making a successful transition from the initial to the final stage. Novice: This person has no experience although he/she has received teaching on general rules that will help in performing tasks. These rules are context-free, unspecific and have universal application. There is limitation and inflexibility of behavior guided by rules (Current Nursing, 2011). Discerning between relevant and irrelevant components of a particular situation is difficult as practice is based on theoretical knowledge acquired in formal training (George, 2011). In general terms, this level is applicable to nursing students. In the context of this discussion, it applies to a family nurse practitioner who is still in training. Advanced beginner: At this level, performance that is acceptable is demonstrated (Current Nursing, 2011).There is some level of anxiety and exhaustion in identifying all the significant elements in complex situations. Clinical practice is seen as a test of ones ability as a person and is focused on goals that are personal and not centered on the patient. There is recognition of

changes in clinical situations but experience in the identification of methods of managing the changes is lacking (George, 2011). Rules guide the actions of nurses at this level. Competent: This is a pivotal stage in the learning process because recognition of patterns and determination of the significance of elements in a clinical situation must begin at this level. The nurse has about one and a half to two years of experience in a specific unit (George, 2011). The experience may be 2 3 years on a specified job or daily situations that are similar (Current Nursing, 2011). There is improvement in ability to organize, anticipate likely course of events as well as improvement in clinical understanding and technical skills. The nurse starts seeing the big picture with the integration of clinical knowledge and theoretical knowledge (George, 2011). Proficient: At this level, there is holistic perception and understanding of situations, which improves clinical decision making. The big picture guides care and there is a shift of focus to patient outcome from being focused on self. Also, there is the ability to discriminate between situations based on experience, though the experience still falls short that of an expert (George, 2011). Expert: At this stage, the nurse does not rely on principles, rules and guidelines to connect situations and determine what actions to take. There is more experience and intuitive grasp of clinical situations with fluidity, flexibility and high proficiency in performance (Current Nursing, 2011). The big picture is oriented in the future and is specific as well as contextually based (George, 2011). As can be seen from this discussion, each stage builds on the previous one as reliance on abstract principles gradually gives way to utilization of experience as progression is made towards gaining clinical expertise. The designation of an expertise nurse is based on the

provision of the most outstanding nursing care rather than on influential position or financial remuneration. Again, Benners notion that nursing practice could and should inform theory is revolutionary. In other words, she states that theory arises from practice and practice subsequently uses theory to change practice (George, 2011). She points out that emphasis on the development of theory by researchers and scholars has not served nursing very well (Current Nursing, 2011). Finally, it can be seen that theory and practice are intertwined as a nurse moves from a novice to an expert. Theoretical knowledge forms the framework of nursing practice and practice informs theory. The novice starts by utilizing theoretical knowledge acquired in training in practice. As transition is made towards becoming an expert, experience is acquired. This experience gives the nurse the allowance to increase his/her knowledge and also to provide nursing care that is competent and holistic. A preceptor does play a very significant role in this transition from a novice to an expert. Reference Benner, P. E. (2011). From novice to expert. Retrieved from http://currentnursing.com/nursing_theory/Patricia_Benner_From_Novice_to_Expert.html. George, J. B. (2011) Nursing theories: The base for professional nursing practice (6th ed.). Upper Saddle River, NJ: Pearson. Parker, M. E. & Smith, M. C. (2010). Nursing theories & nursing practice (3rd ed.). Philadelphia, PA: F. A. Davis Company.