The 4 Metaparadigms in Nursing as experience of loss or dysfunction, whereas
defined by Patricia Benner: disease is what can be assessed at the physical
Nursing level.
Patricia Benner described nursing as Environment
an “enabling condition of connection and Instead of using the term “environment”, Benner
concern” (Marriner-Tomey, 1989, p192) used the term “situation”, because it suggests
which shows a high level of emotional a social environmentwith
involvement in the nurse-client relationship. She social definition and meaning. She used the
viewed nursing practice as the care and study of phenomenological terms of being
the lived experience of health, illness, and situated and situated meaning, which are
disease and the relationships among these three defined by the person’s engaged interaction,
elements. interpretation an understanding of the situation.
Person
Benner stated that a “self-interpreting being, that
is, the person does not come into the world Patricia Benner Nursing Theory:
predefined but gets defined in the course of From Novice to Expert
living a life. A person also has… an effortless
LEVELS OF NURSING EXPERIENCE
and non-reflective understanding of the self in
She described 5 levels of nursing experience as;
the world. The person is viewed as
a participant in common meanings.” (Tomey,
Novice
2002 p173)
Advanced beginner
Benner believed that there are significant
Competent
aspects that make up a person. She had
Proficient
conceptualized the major aspects of
Expert
understanding that the person must deal as:
Stage 1: Novice
1. The role of the situation
Beginners have had no experience of
2. The role of the body.
the situations in which they are expected to
3. The role of personal concerns.
perform. Novices are taught rules to help them
4. The role of temporarility.
perform. The rules are context-free and
Health
independent of specific cases, hence the rules
Patricia Benner focused “on the lived experience
tend to be applied universally. The rule-
of being healthy and ill.” She defined health as
governed behavior typical of the novice is
what can be assessed, while well-being is the
extremely limited and inflexible. As such,
human experience of health or wholeness. Well-
novices have no “life experience” in the
being and being ill are recognized as different
application of rules.
ways of being in the world. Health is described
“Just tell me what I need to do and I’ll do it”
as not just the absence of disease and illness.
Also, a person may have a disease and not
experience illness because illness is the human
Stage 2: Advanced Beginner learns from experience what typical events to
Advanced Beginner are those who can expect in a given situation and how plans need
demonstrate marginally acceptable to be modified in response to these events. The
performance, those who have coped with proficient nurse can now recognize when the
enough real situations to note, or to have expected normal picture does not materialize.
pointed out to them by a mentor, the recurring The holistic understanding improves the
meaningful situational components. These proficient nurse’s decision making; it becomes
components require prior experience in less labored because the nurse now has a
actual situations for recognition. Principles to perspective on which of the many existing
guide actions begin to be formulated. The attributes and aspects in the present situation
principles are based on experience. are the important ones.
Stage 3: Competent Stage 5: The Expert
Competence, typified by the nurse who has The expert performer no longer relies on an
been on the job in the same or analytic principle (rule, guideline, maxim)
similar situations two or three years, develops to connect her or his understanding of the
when the nurse begins to see his or her actions situation to an appropriate action. The expert
in terms of long-range goals or plans of which he nurse, with an enormous background of
or she is consciously aware. For the competent experience, now has an intuitive grasp of each
nurse, a plan establishes a perspective, and the situation and zeroes in the accurate region of
plan is based on considerable conscious, the problem without wasteful consideration of a
abstract, analytic, contemplation of the problem, large range of unfruitful, alternative diagnosis
The Conscious, deliberate planning that is and solutions. The expert operates from a deep
characteristic of this skill levels help achieve understanding of the total situation.
efficiency and organization. The competent
nurse lacks the speed and flexibility of the
Patricia Benner Nursing Theory:
proficient nurse but does have a feeling of
mastery and the ability to cope with and manage
From Novice to Expert
the many contingencies of clinical nursing. The Seven Domains of Nursing Practice
competent person does not yet have enough Helping role
experience to recognize a situation in terms of Teaching or coaching function
an overall picture or in terms of which aspects Diagnostic client-monitoring function
are most salient, most important. Effective management of rapidly
changing situations
Stage 4: Proficient Administering and monitoring therapeutic
The proficient performer perceives situations as interventions and regiments
whole rather than in terms of chopped up parts Monitoring and ensuring quality of health
or aspects, and performance is guided by care practices
maxims. Proficient nurses understand a situation Organizational and work-role competencies
as a whole because they perceive its meaning in
terms of long term goals. The proficient nurse
3. Competent
4. Proficient
5. Expert
From Novice to Expert
Patricia E. Benner
Novice
Beginner with no experience
Introduction
Taught general rules to help perform tasks
Rules are: context-free, independent of specific cases, and applied
Dr Patricia Benner introduced the concept that expert nurses
universally
develop skills and understanding of patient care over time through a
Rule-governed behavior is limited and inflexible
sound educational base as well as a multitude of experiences.
Ex. “Tell me what I need to do and I’ll do it.”
She proposed that one could gain knowledge and skills ("knowing
how") without ever learning the theory ("knowing that").
Advanced Beginner
She further explains that the development of knowledge in applied
disciplines such as medicine and nursing is composed of the
Demonstrates acceptable performance
extension of practical knowledge (know how) through research and
Has gained prior experience in actual situations to recognize
the characterization and understanding of the "know how" of clinical
recurring meaningful components
experience.
Principles, based on experiences, begin to be formulated to guide
She coneptualizes in her writing about nursing skills as experience
actions
is a prerequisite for becoming an expert.
Competent
ABOUT THE THEORIST
Typically a nurse with 2-3 years experience on the job in the same
Patricia E. Benner, R.N., Ph.D., FAAN is a Professor Emerita at the
area or in similar day-to-day situations
University of California, San Francisco.
More aware of long-term goals
BA in Nursing - Pasadena College/Point Loma College
Gains perspective from planning own actions based on conscious,
MS in Med/Surg nursing from UCSF
abstract, and analytical thinking and helps to achieve greater
PhD -1982 from UC Berkeley
efficiency and organization
1970s - Research at UCSF and UC Berkeley
Has taught and done research at UCSF since 1979
Proficient
Published 9 books and numerous articles
Published ‘Novice to Expert Theory’ in 1982 Perceives and understands situations as whole parts
Received Book of the Year from AJN in 1984,1990,1996, 2000 More holistic understanding improves decision-making
Her web address is at: http://www.PatriciaBenner.com Learns from experiences what to expect in certain situations and
Her profile can be obtained at http://nurseweb.ucsf.edu/www/ix- how to modify plans
fd.shtml
Expert
LEVELS OF NURSING EXPERIENCE
No longer relies on principles, rules, or guidelines to connect
She described 5 levels of nursing experience as;
situations and determine actions
Much more background of experience
1. Novice
Has intuitive grasp of clinical situations
2. Advanced beginner
Performance is now fluid, flexible, and highly-proficient
Different levels of skills reflect changes in 3 aspects of skilled performance:
1. Movement from relying on abstract principles to using past concrete
experiences to guide actions
2. Change in learner’s perception of situations as whole parts rather
than in separate pieces
3. Passage from a detached observer to an involved performer, no
longer outside the situation but now actively engaged in participation
SIGNIFICANCE OF THE THEORY
These levels reflect movement from reliance on past abstract
principles to the use of past concrete experience as paradigms and
change in perception of situation as a complete whole in which
certain parts are relevant
Each step builds on the previous one as abstract principles are
refined and expanded by experience and the learner gains clinical
expertise.
This theory changed the profession's understanding of what it
means to be an expert, placing this designation not on the nurse
with the most highly paid or most prestigious position, but on the
nurse who provided "the most exquisite nursing care.
It recognized that nursing was poorly served by the paradigm that
called for all of nursing theory to be developed by researchers and
scholars, but rather introduced the revolutionary notion that the
practice itself could and should inform theory.
CONCLUSION
Nursing practice guided by the human becoming theory live the
processes of the Parse practice methodology illuminating meaning,
synchronizing rhythms, and mobilizing transcendence
Research guided by the human becoming theory sheds light on the
meaning of universal humanly lived experiences such as hope,
taking life day-by-day, grieving, suffering, and time passing
