The 4 Metaparadigms in Nursing as defined by Patricia Benner:
experience of loss or dysfunction, whereas
Nursing
level.
Patricia
Benner
an “enabling
described
condition
nursing
as
of connection connection and
concern” (Marriner-Tomey, concern” (Marriner-Tomey,
1989,
p192)
disease is what can be assessed at the physical Environment Instead of using the term “environment” , Benner used the term “situation” , because it suggests a social
environmentwith
involvement in the nurse-client relationship. She
social definition and meaning.
She
viewed nursing practice as the care and study of
phenomenological
the lived experience of health, illness, and
situated and and situated meaning ,
disease and the relationships among these three
defined by the person‟s engaged interaction,
elements.
interpretation an understanding of the situation.
which shows a
high
level
of
emotional
used
the
of being
terms
which
are
Person Benner stated that a “self -interpreting -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 non-reflective understanding of the self in the
world.
The
a participant in
person
is
viewed
as
common meanings.” (Tomey, (Tomey,
2002 p173) Benner
believed
that
there
are
significant
aspects that make up a person. She had conceptualized
the
major
aspects
of
understanding that the person must deal as: 1.
The role of the situation
2.
The role of the body.
3.
The role of personal concerns.
4.
The role of temporarility.
Health Patricia Benner focused “on the lived experience of being healthy and ill.” She defined health health as as what can be assessed, while well-being is the well-being is human experience of health or wholeness. Wellbeing and being and being ill are recognized as different ways of being in the world. Health world. Health is described 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
Patricia Benner Nursing Theory: From Novice to Expert LEVELS OF NURSING EXPERIENCE She described 5 levels of nursing experience as;
Novice
Advanced beginner
Competent
Proficient
Expert
Stage 1: Novice Beginners
have
had
no
experience
of
the situations in which they are expected to perform. Novices are taught rules to help them perform.
The
rules
are
context-free
and
independent of specific cases, hence the rules tend
to
be
applied
universally.
The
rule-
governed behavior typical of the novice is extremely novices
limited have
no
and “life
inflexible.
As
experience”
such, in
application of rules. “Just tell me what I need to do and I‟ll do it”
the
Stage 2: Advanced Beginner Advanced
Beginner
demonstrate performance, enough
are
learns from experience what typical events to
those
who
marginally those
who
real situations to
have note,
can
expect in a given situation and how plans need
acceptable
to be modified in response to these events. The
coped or
to
with
proficient nurse can now recognize when the
have
expected normal picture does not materialize.
pointed out to them by a mentor, the recurring
The
meaningful
situational
proficient nurse‟s decision making; it becomes
components
require
components.
improves
the
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
analytic
the
job
in
experience
understanding
in
on
prior
These
holistic
the
same
or
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,
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
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.
is
based
on
considerable
with
an
enormous
background
of
efficiency and organization. The competent nurse lacks the speed and flexibility of the proficient nurse but does have a feeling of mastery and the ability to cope with and manage the many contingencies of clinical nursing. The
Patricia Benner Nursing Theory: From Novice to Expert 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
as a whole because they perceive its meaning in terms of long term goals. The proficient nurse
therapeutic
Monitoring and ensuring quality of health care practices
or aspects, and performance is guided by maxims. Proficient nurses understand a situation
and monitoring
interventions and regiments
The proficient performer perceives situations as whole rather than in terms of chopped up parts
Administering
Organizational and work-role competencies
From Novice to Expert Patricia E. Benner
Dr Patricia Benner introduced the concept that e
She proposed that one could gain knowledge an how") without ever learning the theory ("knowing
She furt her explai ns that the development of kn disciplines such as medicine and nursing is com extension of practical knowledge (know how) thr
Proficient
5.
Expert
Beginner with no experience
Taught general rules to help perform tasks
Rules are: context-free, independent of specific cases, and applied universally
Rule-governed behavior is limited and inflexible
Ex. “Tell me what I need to do and I‟ll do it.”
Advanced Beginner
Demonstrates acceptable performance
Has gained prior experience in actual situations to recognize
the characterization and understanding of the "k experience.
4.
develop skills and understanding of patient care sound educational base as well as a multitude o
Competent
Novice
Introduction
3.
recurring meaningful components
She coneptualizes in her writing about nursing s
Principles, based on experiences, begin to be formulated to guide actions
is a prerequisite for becoming an expert. Competent ABOUT THE THEORIST
Patricia E. Benner, R.N., Ph.D., FAAN is a Prof University of California, San Francisco.
BA in Nursing - Pasadena College/Point Loma
MS in Med/Surg nursing from UCSF
PhD -1982 from UC Berkeley
1970s - Research at UCSF and UC Berkeley
Has taught and done research at UCSF since 1
Published 9 books and numerous articles
Published „Novice to Expert Theory‟ in 1982
Rec eived Book of t he Year f rom AJN in 1984, 19
Her web address is at: http://www.PatriciaBenn
Her profile can be obtained at http://nurseweb.u
Typically a nurse with 2-3 years experience on the job in the same area or in similar day-to-day situations
More aware of long-term goals
Gains perspective from planning own actions based on conscious, abstract, and analytical thinking and helps to achieve greater efficiency and organization
Proficient
Perceives and understands situations as whole parts
More holistic understanding improves decision-making
Learns from experiences what to expect in certain situations and how to modify plans
fd.shtml Expert LEVELS OF NURSING EXPERIENCE
She described 5 levels of nursing experience as;
1.
Novice
2.
Advanced beginner
No longer relies on principles, rules, or guidelines to connect situations and determine actions
Much more background of experience
Has intuitive grasp of clinical situations
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 c linical 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 t heory 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
