Patricia Benner’s From Novice world predefined but gets defined

in the course of living a life.

to Expert: Excellence and  A person also has an effortless
Power in Clinical Nursing and non-reflective understanding
(Practice Skill Acquisition in of the self in the world
 participant in common meanings
Nursing Theory)  Believed that there are
August 31, 1942 - Hampton, Virginia significant aspects that make up a
person
Books
 Conceptualized the major
 From Novice to Expert: aspects of understanding that
Excellence and Power in Clinical the person must deal with as:
Nursing Practice  The role of the situation
 The Primacy of Caring  The role of the body
 Nursing Pathways for Patient safety  The role of personal concerns
 Expertise in Nursing Practice:  The role of temporality
Caring, Clinical Judgement, and  Goal - Overcome the Cartesian
Ethics dualism (the view that the mind
 Clinical Wisdom in Critical Care: and body are distinct, separate
A thinking-in action approach entities)
 Embodiment - capacity of the
From Novice to Expert - Nurses develop body to respond to meaningful
skills and an understanding of patient care situations
over time from a combination of a strong  5 Dimensions of the Body
educational foundation and personal  The unborn complex
experiences.  The habitual skilled body
Metaparadigm  The projected body
 The actual projected body
Nursing  The phenomenal body
 "enabling condition of Health
connection and concern" which
shows a high level of emotional  Focused on the lived experience of
involvement in the nurse-client being healthy and ill
relationship  What can be assessed
 care and study of the lived  well-being ↔the human experience
experience of health, illness, and of health or wholeness
disease and the relationships  Well-being and being ill are
among these three elements recognized as different ways of being
in the world
Person

 "A self-interpreting being, that is,

the person does not come into the
Described as dysfunction
not just the § Disease
absence of ↔what can
disease be assessed
and illness. at the
Also, a physical level
person may o
have a Environment
disease and § "situation"
not - it suggests a
experience social
illness environment
§ Illness with social
↔the human definition and
experience of meaning
loss or
§ used the situation
phenomenolo • Five levels
gical terms of Skill
of being Acquisition
situated and and Skill
situated development
meaning, o Novice
which are § person has
defined by the no
person's background
engaged experience of
interaction, the
interpretation situation on
and which he or
understanding she is
of the involved
§ context- § applied to
free rules nursing
and objective students
attributes § They are
must be given taught
to guide general rules
performance to help
§ there is perform
difficulty tasks, and
discerning their rule-
between governed
relevant and behavior is
irrelevant limited and
aspects of a inflexible
situation o Advanced
beginner
§ the person meaningful
can components
demonstrate of a situation
marginally § the person
acceptable has enough
performance experience to
having coped grasp
with aspects of the
enough real situation
situations to § nurses
note, or to functioning at
have this level are
pointed out guided by
by a mentor, rules and are
the recurring oriented by
task this level as a
completion stage of their
§ they have abilities
difficulty § feel highly
grasping the responsible
current for managing
patient patient
situation in care, yet they
terms of the still rely on
larger the help of
perspective those
§ clinical more
situations are experienced
viewed by § shows
nurses at acceptable
performance, based on
and has those
gained prior experiences,
experience in begin to
actual formulate in
nursing order to guide
situations actions.
§ helps the o Competent
nurse § two or
recognize three years
recurring experience
meaningful § through
components learning form
so that actual
principles, practice
situations future
and by situations
following the are important
actions of and which can
others be ignored
§ typified by §
considerable consistency,
conscious predictability
and and time
deliberate management
planning that are
determines important,
which and gaining
aspects of the a
current and sense of
mastery
  context-free rules and objective
through attributes must be given to guide
performance

planning and  there is difficulty discerning

between relevant and irrelevant
aspects of a situation

predictability 

applied to nursing students
They are taught general rules to

is the
help perform tasks, and their
rule-governed behavior is limited
and inflexible

accomplishme 2. Advanced beginner

 the person can demonstrate
nt marginally acceptable performance
having coped with enough real
 Described as not just the absence of
situations to note, or to have
disease and illness. Also, a person
pointed out by a mentor, the
may have a disease and not
recurring meaningful components
experience illness
of a situation
 Illness ↔the human experience of
 the person has enough experience
loss or dysfunction
to grasp aspects of the situation
 Disease ↔what can be assessed at
 nurses functioning at this level are
the physical level
guided by rules and are oriented by
Environment task completion
 they have difficulty grasping the
 "situation" - it suggests a social current patient situation in terms
environment with social definition and of the larger perspective
meaning
 clinical situations are viewed by
 used the phenomenological terms of nurses at this level as a stage of
being situated and situated meaning, their abilities
which are defined by the person's
 feel highly responsible for
engaged interaction, interpretation
managing patient care, yet they still
and understanding of the situation
rely on the help of those more
experienced
FIVE LEVELS OF SKILL ACQUISITION  shows acceptable performance,
AND SKILL DEVELOPMENT and has gained prior experience
in actual nursing situations
1. Novice  helps the nurse recognize recurring
 person has no background meaningful components so that
experience of the situation on principles, based on those
which he or she is involved experiences, begin to formulate in
order to guide actions.
3. Competent
 two or three years experience
 through learning form actual
organization
practice situations and by
following the actions of others
 typified by considerable conscious
of the task
and deliberate planning that
determines which aspects of the
work
§ nurse may
current and future situations are
important and which can be
ignored
 consistency, predictability and
time management are important, display
and gaining a sense of mastery
through planning and
predictability is the
hyper-
accomplishment
responsibility
increased for
level of the patient
efficiency but and may
the focus is exhibit an
on the time ever-present
management and critical
and the view of self
nurse's § most
pivotal in
clinical § nurses are
learning more aware
because the of long-term
learner must goals,
begin to and they
recognize gain
patterns and perspective
determine from
which planning
elements of their own
the situation actions, which
warrant helps them
attention and achieve
which can be greater
ignored efficiency and
organization.
o Proficient a new ability
§ performer to see
recognizes changing
the most relevance in
salient a situation
aspects and including
has an the
intuitive recognition
grasp of the and the
situation implementatio
based on n of
background skilled
understanding responses to
§ nurses the situation
demonstrate as it
evolves
§ more confidence in
holistic their
understanding knowledge
of nursing, and abilities
which § more
improves involvement
decision- with the
making patient and
§ no longer family
rely on § transition
present goals into expertise
 increased level of efficiency but the
for focus is on the time management
and the nurse's organization of the

organization; 
task work
nurse may display hyper-
responsibility for the patient and

demonstrate may exhibit an ever-present and

critical view of self

increased
 most pivotal in clinical learning
because the learner must begin to
recognize patterns and determine
which elements of the situation
warrant attention and which can be
ignored
  nurses are more aware of long-
term goals, and they gain
perspective from planning their
guidelines to
own actions, which helps them
achieve greater efficiency and
organization.
connect
4. Proficient
situations
and
 performer recognizes the most
salient aspects and has an
intuitive grasp of the situation
based on background
understanding determine
 nurses demonstrate a new ability
to see changing relevance in a
situation including the recognition
actions.
and the implementation of skilled
responses to the situation as it
evolves
§ nurse
 more holistic understanding of
nursing, which improves decision- having an
intuitive
making
 no longer rely on present goals
for organization; demonstrate
increased confidence in their
knowledge and abilities grasp of the
 more involvement with the patient
and family
 transition into expertise
situation and
Expert as being able
§ nurses no to identify
longer rely on the
principles, region of the
rules, or problem
without knowing
wasting typical
consideration patterns of
on a range responses
of alternative and
diagnoses and knowing the
solutions patient as a
§ there is a person
qualitative §
change as performances
the expert are fluid,
performer flexible, and
"knows the highly-
patient", proficient
meaning § Key
aspects
• a clinical recognition
grasp and on the basis
resource- of deep
based experiential
practice background
• embodied § meeting
know-how the patient's
• seeing the actual
big picture concerns and
• seeing the needs is of
unexpected utmost
§ expert importance,
nurse has the even if it
ability of means
pattern planning and
 importance, even if it means
negotiating planning and negotiating for a
change in the plan of care

for a  transparent view of self

change in the Concepts and

plan of care definitions
§ transparent o Aspects
view of self of situation
5. Expert
 nurses no longer rely on principles, ↔recurring
meaningful
rules, or guidelines to connect
situations and determine actions.
 nurse having an intuitive grasp
of the situation and as being
able to identify the region of the
problem without wasting
situational
consideration on a range of
alternative diagnoses and solutions
components
 there is a qualitative change as
the expert performer "knows the
patient", meaning knowing typical
recognized
patterns of responses and
knowing the patient as a person and
 performances are fluid, flexible,
and highly-proficient
 Key aspects
understood
 a clinical grasp and resource-
based practice
 embodied know-how
in context
 seeing the big picture
 seeing the unexpected
because the
 expert nurse has the ability of
pattern recognition on the basis of
deep experiential background
nurse has
 meeting the patient's actual
concerns and needs is of utmost previous
experience defined area
o Attribute of
of a situation skilled
↔measurable performance
properties of identified and
a situation described by
that can be its
explained intent,
without functions, and
previous meanings
experience in o Domain
the situation ↔area of
o practice
Competency having a
↔an number of
interpretively
competencies or outcomes
with similar easily
intents, translated to
functions, other clinical
and situation
meanings o
o Exemplar Experience
↔example of ↔active
a clinical process of
situation that refining and
conveys one changing
or more preconceived
intents, theories,
meanings, notions, and
functions, ideas
when skilled
confronted performance
with actual that requires
situations; a certain
implies level of
there is a experience to
dialogue recognize the
between what implications
is found in of the
practice and instructions
what is o Paradigm
expected case
o Maxim § clinical
↔cryptic experience
description of that stands
out and alters
 context because the nurse has
the way the o
previous experience
Attribute of a situation -measurable

nurse properties of a situation that can be

explained without previous
experience in the situation

perceives and o Competency - an interpretively

defined area of skilled performance

understands
identified and described by its intent,
functions, and meanings
o Domain - area of practice having a

future clinical number of competencies with

similar intents, functions, and
meanings
situations o Exemplar - example of a clinical
situation that conveys one or more

§ create a intents, meanings, functions, or

outcomes easily translated to other
clinical situation

new clinical o Experience - active process of

refining and changing preconceived

understanding
theories, notions, and ideas when
confronted with actual situations;
implies there is a dialogue between

and what is found in practice and what is

expected
o Maxim - cryptic description of skilled
open new performance that requires a certain
level of experience to recognize the

clinical o
implications of the instructions
Paradigm case
 clinical experience that stands

perspectives out and alters the way the

nurse perceives and

and
understands future clinical
situations
 create a new clinical

alternatives understanding and open new

clinical perspectives and
Concepts and definitions alternatives

o Aspects of situation -recurring

meaningful situational components
recognized and understood in