Benner's Theory

Advanced beginner stage

Marginally acceptable level of performance after having experience coping with real situations Still guided by rules and are guided toward task completion and will continue to rely on the assistance of more experienced nurses to manage patient care Clinical situations are viewed in terms of the nurse's abilities and the demands the situation places on the nurses rather than on the needs of the patient.

Theorist

Pat Benner BSN, Masters, PhD

Person

embodied person living in the world who is self-interpreting being, that is, the person does not come into the world pre-defined but gets defined in the course of living a life

Nine Domains of Critical Care Nursing

1. Diagnosing and managing life-sustaining physiological functions in unstable patients 2. Using skilled know-how to manage a crisis 3. Providing comfort measures for the critically ill 4. Caring for patients' families 5. Preventing hazards in a technological environment 6. Facing death: end-of-life care and decision making 7. Communicating and negotiating multiple perspectives 8. Monitoring quality and managing breakdown 9. Using the skilled know-how of clinical leadership and the coaching and mentoring of others

Five Stages of Skill Acquisition

1. Novice Stage 2. Advanced beginner stage 3. Competent stage 4. Proficient stage 5. Expert stage

Seven Domains

1. The helping role 2. The teaching-coaching function 3. The diagnostic and patient monitoring function 4. Effective management of rapidly changing situations 5. Administering and monitoring therapeutic interventions and regimens 6. Monitoring and ensuring the quality of healthcare practices 7. Organizational work role competencies

Benner's Philosophy of Clinical Wisdom in Nursing

Benner identified five stages of skill acquisition based on the Dreyfus model of skill acquisition as applied to nursing along with characteristics of each stage Dreyfus' model of skill acquisition studied pilots and how they learned the skilled of flying

Benner

Benner's work focuses on perceptual acuity, clinical judgment, skilled know-how, ethical comportment and ongoing experiential learning

6 aspects of clinical judgement and skilled comportment

In 1999, Benner and her colleagues Hooper-Kyriakidis and Stannard provide readers with not only exemplars for each of the domains of critical care nursing practice but also descriptions for 6 aspects of clinical judgment and skilled comportment

Novice stage

Person has no background experience Requires rules to govern performance Through instruction, the novice learns rules for drawing conclusions and determining actions Applies to nursing students as well as experienced nurses when they are placed in an unfamiliar situation.

Competent stage

The nurse now begins to recognize patterns The competent nurse feels a great sense of responsibility for his or her actions as compared to the novice and advanced beginner who need to follow the rule Displays a focus on time management and organization because planning and predictability are required to achieve a sense of mastery

Proficient stage

The nurse perceives the situation as a whole, plans can be formulated intuitively The nurse demonstrates increased confidence in his or her abilities and has the ability to turn the focus away from self and toward the patient The nurse at this stage can start the transition into expertise

Nursing

a caring relationship that includes the care and study of the lived experience of health, illness, and disease

Environment

a social environment with social definition and meaningfulness

Benner's Theory

based on clinical situation interviews and observations of nurses in actual practice. Theory based on research skill acquisition of helicopter pilots by Stuart Dreyfus...looked at theory and applied this to nursing to learn "how do nurses learn to do nursing?" Benner and her colleagues identified nine domains of critical care nursing.

Expert stage

care is intuitive and has grasp of the situation and does not need the rules The expert nurse has the ability to recognize patterns owing to his or her deep experiential background The nurses expert practice is characterized by demonstration of a clinical grasp and resource-based practice, possessing embodied know-how, seeing the big picture and seeing the unexpected

Health

the human experience of health or wholeness