Patricia Benner

(1942)

Presented by:
Christal Jade Cristales
Lean Rose Gallardo
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 • BIOGRAPHY
• Born in Hampton, Virginia, United States on August 31,1942
• Spent her childhood in California
• Her parents are Shirley and Clint Sawyer.
• She first became interested in nursing when she had the
opportunity to work as an admitting clerk at a hospital in
Pasadena, California
• She married Richard Benner in August 1967 and had 2
children

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 • BIOGRAPHY
• 1970 - graduated from UCSF with a master's degree in
nursing
• 1982 - received her PhD from the University of California,
Berkeley.
• 1989 - She became an associate professor in the Dept. of
Physiological Nursing at UCSF.
• She is a well-known nursing instructor and author of "From
Novice to Expert: Excellence and Power in Clinical Nursing
Practice". (1984)

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 • BIOGRAPHY
• 2002- she became the first holder of the Thelma Shobe
Cook endowed Chair in Ethics and Spirituality at UCSF's
Department of Social and Behavioral Sciences.
• Benner retired from full-time teaching in 2008. She was a
nursing theorist, academic and author.

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 Major Works and Awards

o She received the American Journal of Nursing Book of the Year

award for "From Novice to Expert: Excellence and Power in
Clinical Nursing Practice" in 1984, 1989, 1996, 1999, and 2011.
o In 1995, she was selected for CHOICE list of Outstanding
Academic Books together with Susan S. Phillips.
o She was elected to the American Academy of Nursing in
1985.
o In 1990, California Organization of Nurse Executives honored
her with the Excellence in Nursing Research and Excellence in
Nursing Education Awards.
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 Major Works and Awards

o She was awarded the Helen Nahm Research Lecture Award by

the UCSF faculty for her contributions to nursing science and
research.(1995)
o In 2002, The Institute for Nursing Healthcare Leadership
recognized the book From Novice to Expert (1984)
o UCSF School of Nursing’s Centennial Wall of Fame
o American Organization of Nurse Executives excellence in
research award.
o Ranked as the 4th most influential nurse in the past 60 years

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 “From Novice to Expert Model”
(Stages of Nursing Expertise Nursing
T Philosophies)
H
E
O
R
Y

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 Overview of the Theory

 Benner’s theory was published in 1982

 Benner simply describes how a human begins
in the novice stage and goes through a
number of stages to wind up in the expert
domain as new skills and knowledge are
gained.

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 Overview of the Theory

 Theory Basis: The Dreyfus Model of Skill Acquisition

 Theory Goal: Nurses could gain knowledge and skills
without learning a theory
 Nursing focus: A novice nurse's learning and acquiring
clinical knowledge and building on clinical
competence in becoming an expert when
experiencing ongoing different clinical situations

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 Major Concepts and Definitions

FIVE LEVELS OF NURSING EXPERIENCE:

1. Novice
2. Beginner
3. Competent
4. Proficient
5. Expert

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 NOVICE

∙ Nursing student in his or her first year of clinical

education; behavior in the clinical setting is very limited
and inflexible.
∙ Limited ability to predict what might happen in a
particular situation.
∙ Signs and symptoms, such as a change in mental state,
may only be identified after a novice encounter with the
patient who shows same symptoms.
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 BEGINNER

∙ New graduate in their first jobs

∙ Nurses have had more experiences that enables them to
recognize recurrent, meaningful components of a situation.
∙ They have the knowledge and the know-how but not enough
in-depth experience.

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 COMPETENT

∙ Nurses lack the quickness and flexibility of skilled nurses,

but they do have some mastery and may rely on
advance planning and organization skills.
∙ They can recognize patterns and the nature of clinical
problems faster and more precisely than advanced
beginners.

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 PROFICIENT

∙ Nurses can recognize situations as "wholes" rather

than pieces.
∙ Proficient nurses learn form experience what
typically occur and are able to modify plans in
response on different events.

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 EXPERT

∙ Nurses who are able to recognize demands and

resources in situations and attain their goals.
∙ They no longer rely solely on rules to guide their actions
under certain situations.
∙ They have an intuitive grasp of situation based on
their deep knowledge and experience.

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 EXPERT

∙ Key aspects of expert practice include the following:

1. Demonstrating a clinical grasp and resource-based
practice
2. Possessing embodied know-how
3. Seeing the unexpected

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 Major Concepts and Definitions

Aspects of a Situation
-the recurring meaningful situational components recognized
and understood in context because the nurse has previous
experience. (Benner, 1984)
Attributes of a Situation
-measurable properties of a situation that can be explained
without previous experience in the situation. (Benner, 1984)

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 Major Concepts and Definitions

Competency
-“an interpretively defined area of skilled performance identified
and described by its intent, functions, and meanings”
Domain
-area of practice having a number of competencies with similar
intents, functions, and meanings

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 Major Concepts and Definitions

Exemplar
-example of a clinical situation that conveys one or more
intents, meanings, functions, or outcomes easily translated to
other clinical situations.

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 Major Concepts and Definitions

Experience
- not a mere passage of time, but an active process of refining
and changing preconceived theories, it implies there is a
dialogue between what is found in practice and what is
expected.
Situated Coaching
- identified as the signature pedagogy in nursing from the
Educating Nurses study.
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 Major Concepts and Definitions

Maxim
-a cryptic description of skilled performance that requires a
certain level of experience to recognize the implications of the
instructions.
Paradigm Case
-a clinical experience that stands out and alters the way the
nurse will perceive and understand future clinical situations.

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 Major Concepts and Definitions

Salience
-describes a perpetual stance or embodied knowledge whereby aspects of a
situation stand out as more or less important.
Ethical Comportment
-good conduct born out of an individualized relationship with the patient.

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 Major Concepts and Definitions

Hermeneutics
-means “interpretive”. The term derives from biblical and judicial
exegesis. “Meaningful human phenomena in a careful and detailed manner as
free as possible from prior theoretical assumptions, based instead on practical
understanding”

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 Major Concepts and Definitions

Formation
-”Transformation and formation address the development ofsenses,
esthetics, perceptual activities, relational skills, knowledge, and dispositions
that take place as student nurses form professional identity.”

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1. The Helping Role Domain
2. The Teaching-Coaching Function Domain
3. The Diagnostic and Patient-Monitoring Function Domain.
4. The Effective management of Rapidly Changing
Situations Domain

BENNER’S DOMAIN OF NURSING PRACTICE

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5. The Administering and Monitoring Therapeutic
Interventions and Regimens Domain
6. The Monitoring and Ensuring the Quality of Health care
Practices Domain
7. The Organizational and Work-Role Competencies
Domain

BENNER’S DOMAIN OF NURSING PRACTICE

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1. The Helping Role Domain
-Includes competencies related to establishing a healing
relationship, providing comfort measures, and inviting active
patient participation and control in care.
2. The Teaching-Coaching Function Domain
- Includes timing, readying patients for learning,
motivating, change, assisting with lifestyle alterations and
negotiating agreement.

BENNER’S DOMAIN OF NURSING PRACTICE

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3. The Diagnostic and Patient-Monitoring Function
Domain.
-Refers to competencies in ongoing assessment and
anticipation of outcomes.
4. The Effective management of Rapidly Changing
Situations Domain
-Includes the ability to contingently match demands with resources
to assess and manage care during crisis situations.

BENNER’S DOMAIN OF NURSING PRACTICE

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5.The Administering and Monitoring Therapeutic
Interventions and Regimens Domain
-Includes competencies related to preventing compilations
during drug therapy , wound management, and
hospitalization

BENNER’S DOMAIN OF NURSING PRACTICE

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6.The Monitoring and Ensuring the Quality of Health
Care Practices Domain
-Includes competencies about maintenance of safety,
continuous quality improvement, collaboration and consultation
with physicians, self-evaluation, and management of technology.

BENNER’S DOMAIN OF NURSING PRACTICE

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7. The Organizational and Work-Role Competencies
Domain
- Includes competencies in priority setting, team building,
coordinating, and providing for continuity.

BENNER’S DOMAIN OF NURSING PRACTICE

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• There are no free interpretation of
The
data way to get started
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• There are no nonreactive data
is to quit
• People who share a common
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talking
cultural andand begin
language doing.
history
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have a background of O
common meanings that allow R
for understanding and
interpretation
ASSUMPTIONS
• Humans are integrated,
holistic beings
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• The meanings embedded in skills,
The way to get started
practices, intentions, expectations, and
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outcomes cannot be made completely
is to quit
explicit; however, they can be A
talking and begin doing.
interpreted by someone who shares a J
similar language and cultural O
background and can be validated R
consensually by participants and
relevant practitioners ASSUMPTIONS

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 Metaparadigm of the Theory

Nurse Enviroment Person Health

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NURSING

 Described as a caring  She also viewed nursing as

relationship, an the care and study of the
“enabling condition of lived experience of health,
connection and illness, and disease and the
concern” (Benner & relationships among these
Wrubel, 1989, p.4). three elements.

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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. A
person also has an effortless and nonreflective understanding of the self in
the world” (p.41)

 “Theperson is viewed as a participant in common meanings”

(Benner & Wrubel 1989, p.23)

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PERSON
The person is viewed as a
Four major aspects of participant in common meanings”
understanding that the (Benner & Wrubel 1989, p.23)
The goal of this is to overcome
person must deal with: the Cartesian Dualism, the view
1.The role of the situation that the mind and body are
2.The role of the body distinct, separate entities.
3.The role of personal Embodiment- capacity of the
concerns body to respond to meaningful
4.The role of temporality situations.

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ENVIROMENT
 Environment - Benner referred to the circumstances
rather than the surroundings because it hints at a
social setting with a defined and meaningful social
context.

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HEALTH
 Defined as what can be assessed, whereas well-being is
the human experience of health or wholeness.
 Well-being and being ill are recognized in different ways
of being in the world.

 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
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 PRACTICE

Acceptance by
the EDUCATION
Nursing
Community

RESEARCH
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 A. PRACTICE

✔ Benner’s approach continues to be used in the

development of clinical promotion ladders, new
graduate orientation programs, and clinical
knowledge development seminars.

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 B. EDUCATION

✔ The greatest impact on nursing education was

Benner’s “Appreciation of the utility of the
Dreyfus model in describing learning and thinking
in nursing discipline. (Barnum, 1990)
✔ “Expertise in Nursing Practice”

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 C. RESEARCH

✔ Benner maintains that there is excellence and

power in clinical nursing practice made visible
through articulation research.

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 H E TH E ORY
I ON O F T
APPLICAT

“From Novice to Expert

Model”
(Stages of Nursing Expertise
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Nursing Philosophies)
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Mrs. Gina T. is a 24-year-old young woman from Bacolod
who speaks Ilonggo and little Tagalog. She had moved to
Cebu City, the hometown of her husband Lucas. She was
admitted in the Labor and Delivery Department of a
Medical Center in Cebu for birth of her first baby. She was
full-term primipara. Mrs. T. was transferred in the ICU
because she become comatose secondary to acute fatty
liver of pregnancy following the delivery of her healthy
baby girl. She was intubated, placed on a ventilator, and
required hemodialysis. Her electroencephalogram (EEG)
showed minimal brain wave activity. She was eventually
designated a “do not resuscitate” (DNR) case after
consultation with her husband and her family. L 46
Nursing Care of Mrs. T. with Benner’s Philosophy in Nursing Practice

Domain: The Helping Role

-The holistic view of the nurses enabled them to perceive
Mrs.T's situation very differently from the objective clinical
gaze of the physicians

Domain:The Teaching-Coaching Function

-The nurses reported that they described what they were
doing while they cared for Mrs.T and consistently provided
ongoing feedback about her condition and her family to
promote her participation in care as much as possible
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Nursing Care of Mrs. T. with Benner’s Philosophy in Nursing Practice

Domain: The Diagnostic and Monitoring Function

•The nurses reported reading everything they could find
about Mrs. T.’s rare condition (acute fatty liver of
pregnancy) to increase their understanding of her illness
and enhance their ability to assess her potential for
wellness and for responding to various treatment
strategies.

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Nursing Care of Mrs. T. with Benner’s Philosophy in Nursing Practice

Domain: Monitoring and Ensuring the Quality

The group of ICU nurses had ready access to the OB
nurses with whom they had recently worked during their
training, thereby providing a readily accessible backup
system for safe care. This combination of ICU and OB
care knowledge and skills enabled them to ensure that
optimal supportive care was provided. The nurses made
adjustments in the care plan over and above that
recommended by the physicians.

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✔ Analysis of the data:
-Major concern for Mrs. T. is that she has
secondary acute fatty liver and her
electroencephalogram (EEG) showed minimal brain
wave activity.
✔ Nursing Diagnosis:
-The nurses reported reading everything they
could find about Mrs. T.’s rare condition (acute fatty
liver of pregnancy) to increase their understanding of
her illness and enhance their ability to assess her
potential for wellness and for responding to various
treatment strategies. C5 0
✔ Planning and Implementation:
- Providing stimulation in the environment
-Encourage the family to talk to her and whisper
loving and encouraging words.
-Providing supportive care in cooperation with
supportive care provided by the nurses.

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✔ Evaluation:
- After many days of caring for Mrs. T., the nurses
noticed that she was starting to improve in her
neurologic responses- pupil reactions, and level of
consciousness. Gradually, she became more and
more alert and finally she was extubated.
Remarkably, Mrs. T.’s liver healed; she recovered
with no residual brain damage.

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References
Udan, J. (2020). Theoretical Foundation in Nursing
(Second Edition)
Alligood, MT. Nursing Theorists and Their Work (Ninth
Edition)
https://nursing-theory.org/nursing-theorists/Patricia-
Benner.php
https://www.slideshare.net/xenna_85/pat ricia-benner-
38508791

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 PATRICIA BENNER
“Nursing is an integrative science that studies
the relationships between mind, body, and
human worlds. It is concerned with far more
than the cognitive structure of formal mental
properties, such as attitudes and belief
systems of the mind-brain, and the physiology
and pathophysiology of the body as a system
of cells, tissues, and organs. Nursing is
concerned with the social sentient body that
dwells infinite human worlds; that gets sick
and recovers; that is altered during illness,
pain, and suffering; and that engages with the
world differently upon recovery.” (Benner,
1999, p.315) L 54