Select a Middle range theory Identify the major concepts, model, and philosophical underpinning ????????? Evaluated the heuristic value of the theory relate

1 Running Head: AN ANALYSIS OF BENNER’S NOVICE TO EXPERT THEORY

An Analysis of Benner’s Novice to Expert theory

Karen Perez

The Evolution of Nursing Practice & Application of Theory in Nursing Practice

University of Miami

NUR 654

Dr. Cianelli

2 BENNER’S NOVICE TO EXPERT

An Evaluation of Benner’s Work

Patricia Benner a nursing theorist, lecturer, researcher and the author of nine books was

born in August, 1942 in Hampton, Virginia (Sitzman & Eichelberger, 2011). Benner received

both her associates and baccalaureate of art in nursing from Pasadena City College (Sitzman &

Eichelberger, 2011). She matriculate to the University of California San Francisco (UCSF) in

1970 for her master’s degree with a focus on medical surgical nursing, and then completed her

PhD in stress, coping, and health at University of California Berkeley in 1982 (Sitzman &

Eichelberger, 2011). Benner worked at UCSF School of nursing in the capacity of researcher

and professor in the physiological and social behavioral science department. Benner was

mentored by Virginia Henderson who greatly influenced her thinking in nursing (Brykczynski,

2010a). In 1984, Benner published her first book, From Novice to Expert, which was influenced

by a project she worked on which was funded by a federal grant titled: Achieving Methods of

Extraprofessional Consensus, Assessment and Evaluation Project (Altmann, 2007) and has

received several awards and honors for her work in nursing (Brykczynski, 2010a).

Philosophical underpinning

Stuart Dreyfus and Hubert Dreyfus are brothers who are both professors at UCSF

(Sitzman & Eichelberger, 2011). Stuart Dreyfus a system analyst and mathematician and Hubert

Dreyfus a philosopher created their model of skill acquisition grounded on the study of chess

players and airline pilots (Benner, 2001). Their theory was that students’ skill formation and

acquisition goes through five stages of proficiency: novice, advanced beginner, competent,

proficient, and expert (Benner, 2004). Benner Adapted and applied Dreyfus & Dreyfus’ model

3 BENNER’S NOVICE TO EXPERT

to nursing. Benner outlined the model of skill and learning in clinical nursing practice in her

theory Novice to Expert which stated that nurses develop skills and knowledge overtime, through

sound education and experience (Sitzman & Eichelberger, 2011). In 1989, Benner worked with

Judith Wrubel in the expansion of her model to include caring with the stages of skill acquisition

(Benner, 1995). The newer model was further influenced by the work of Mauirce Merleau-Ponty

and Martin Heidegger, two philosophers (Benner, 2001). Despite the many criticism, this was

one of the first theories that described the learning process in nursing.

Assumption

Benner has nine assumptions which were based on the individuals who influenced her

work. The first assumption is that theory is derived from practice (Benner, 2001); which means

that knowledge development (know-how and know that) is vastly dependent on practical

knowledge in applied discipline (Benner, 2001). Kuhn & Polanyi (1970 & 1958) called the

“know how” practical and the “know that” theoretical. The second assumption is that human

knowledge is more than rational calculation; which implies that intuition, which is not easily

observed or explained (Johns, 1995), occurs when an individual, especially an expert nurse no

longer relies on premeditated rational but instead uses intuition that is developed through

reflective practice (Benner, 2001). The third assumption is that theory surrounds the issues and

directs the nurse in what questions to ask and where to seek the answers (Benner, 2001). This

assumption indicates that in order for practitioner to practice effectively with positive outcome,

theory is needed to direct their action (Benner, 2001). The fourth assumption is that nursing

practice functions in a systemic way and view the client and situations in a holistic way (Benner,

2001). This infers that the nursing profession looks at the client as a whole and not in systems

while using a systemic approach (Benner, 2001). The fifth assumption is that caring is the basis

4 BENNER’S NOVICE TO EXPERT

of altruism which is to say in order for an individual to genuinely have concern and welfare for

others, caring is the foundation. The sixth assumption stated that caring is an important requisite

for all surviving, meaning that in order for both the nurse and client to cope in every situation,

caring is needed. The seventh assumption stated that caring and interdependence are the ultimate

goals of adult growth and change, which implies that both the adult client and the nurse are

mutually dependent on each other during the client-nurse relationship, while both care for self

and each other (Benner, 2001). The eighth assumption is that concern is essential for the nurse to

be situated, which means that caring is paramount for the nurse to be effective in his/ her role.

The final assumption proposed that irrespective of the stage, practitioners cannot practice beyond

his/her experience (Benner, 2001).

Metaparadigm / Major Concepts

Benner’s theory, like most theories, identify four metaparadigm: nursing, person, health

which she called well-being, and environment which that called situation. Nursing, she defined

as a supporting network which includes the emotions between the client and the nurse (Benner,

2001). She viewed nursing practice as the caring and studying of the lived experience of illness,

disease, and health with nurses possessing the power to influence the lived experience (Benner,

2001). She defined person as a self-evolving being; this is to say, that the person did not enter

the world with all the characteristic, neither tangible nor intangible, that they will need for the

rest of their lives, but is shaped by their experiences in life. She used the concept well-being

instead of health because the term is more phenomenological (Benner, 2001). She defined well-

being as the congruence between an individual’s potential and the individual’s actual practice as

it is based on caring and feeling cared for (Benner, 2001). She also used the concept situation

rather than environment because it is more applicable to nursing, and the term environment is too

5 BENNER’S NOVICE TO EXPERT

broad (Benner, 2001). She defined situation as a phenomena that is experienced by everyone

and places a vital role in how an individual views the world (Benner, 2001).

The Model

Benner adapted Dreyfus & Dreyfus’ five levels of skill acquisition, novice, advanced

beginner, competent, proficient, and expert, and apply to nursing with progression from novice

to expert not guaranteed (Benner, 1984). Benner (2001) described novice as a nurse who has no

experience of the situation and learn features of task that can be recognized without situational

experience. New clinical situation is needed for the novice nurse to develop skills and requires

objectives and measurable parameters to care for client (Benner, 2004). The novice nurse is

described as a newly graduated nurse, or a nurse who is taking care of clients in an unfamiliar

situation and is inflexible and rely on strict rules to guide his/her practice; for this reason

objectives and measurable parameters are needed (Dale, Drew, Dimmitt, Hildebrandt, Hittle,

Tielsch-Goddard, 2013). Their approach to the task at hand is “tell me what I need to do and I

will do it” (Benner 2001). It is evident that in order for the novice to move to the next level, an

opportunity must exist for the nurse to gain experience.

In contrast to the novice, the advanced beginner has gained some experience which enables

him/her to identify the meaning of events that are reoccurring (Dreyfus & Dreyfus, 1980). Even

though they have gained some experience they are unable to prioritize task (Benner, 2001). For

example, if an advanced beginner nurse has a list of tasks to be done, he/she will not change the

order of task even if something else is a priority (Benner, 2001).

The competent nurse has approximately two to three years of experience in which he/she

starts to view plan of action in terms of long-range goals with plans made consciously enabling

6 BENNER’S NOVICE TO EXPERT

nurse to prioritize (Benner, 2001). While planning helps the competent nurse to be organized

and effective, he/she still lacks speed and flexibility (Benner, 2001).

The proficient nurse anticipates situations as a whole instead of fragments, and gained

experience from past situations (Benner, 2001). They can recognize when a plan needs to be

revamped due to unexpected or expected reasons and uses maxims as a guide (Benner, 2001).

On the other hand, an expert nurse is a nurse with many years of experience and has an

intuitive handle on situations which come from experience and knowledge gained over a period

of time (Benner, 2001). This nurse has a deep connection and understanding of the situation;

he/she no longer relies on analytic principle and flexible (Benner, 2001).

Heuristic Value of the Theory

Benner’s model From Novice to Expert is widely used in nursing practice, research,

education and administration (Altmann, 2007). The Institute of Medicine report in 2004,

indicated the important role nurses play in patient safety. This report was instrumental to the

American Nursing Association to conduct a study to see the attributes in nurses that affected

patient safety. Using Benner’s models they were able to identify nurses with different levels of

experience and assess their patient outcome. The findings indicated that nurses’ years of

experience influence the quality of care delivered (Aiken, Havens, & Slone, 2009). Benner’s

model is widely used in hospitals, especially hospitals with residence programs, to track the

progress of the new graduate nurse and to assign mentors/preceptors (Benner, 2001). Benner’s

model is beneficial to mentoring programs because it shows how novice nurses can benefit

greatly from proficient and expert nurses (Benner, 2001). The model is not only used to identify

and correct issues related to the nursing practice, but it is also used to identify employees in most

professions for growth, and as a guideline for career knowledge development in many settings

7 BENNER’S NOVICE TO EXPERT

(Benner, 2001). Due to the applicability of the model, it has been used in academic settings

other than nursing such as kindergarten through college. According to Pesata (1994) the

dynamics of school nursing has evolved since the enactment of the Education for all Handicap

Children’s Act. This change required advanced nurse practitioners to be skilled and

knowledgeable in this setting. To be effective, Benner’s model of Expert practice was used to

promote optimal function in children with multiple handicaps (Pesata, 1994).

Critic of Model

Even though Benner’s theory is being widely used, her theory has been critiqued by

many. Nursing practice has been formed and studied from a sociological view (Benner, 2001),

despite Benner’ acknowledgement of the vital role sociology plays in the nursing practice, she

failed to recognize the dependence of this in her model (Thompson 1990; Purkis 1994; & Rudge

1992). Altmann (2007) highlighted the need for an operational definition of expertise and

intuition which will allow the concepts to be tested and measured. Benner views expertise and

intuition as phenomenological; this view makes the concept difficult to measure and test (Effken,

2001). English (2003) pointed out the difficulty of measuring the continuum of the stages,

because no explanation is given of what phenomena takes place for the transition from one stage

to the next which makes creating a guide to assist nurses to become experts challenging.

In Benner’s original research she had 21 nurse preceptors and 21 new graduate nurses, 51

experienced nurses, 11 newly graduated nurses, and 5 senior nursing students (Benner, 1984.

She collected her data by interviews with narrative accounts of situation and by observation of

behaviors in clinical settings (Benner, 1984) and according to Allen & Cloyes (2005), these

interviews were conducted with critical care nurses in small groups or individuals who were

chosen based on experience and / or managers’ evaluations. This left critics to question the

8 BENNER’S NOVICE TO EXPERT

methodological process claiming that problems existed with sampling which indicated a bias

toward the positive, and the model was built on qualitative research instead of quantitative,

further opening the model to criticism. (Altmann, 2007). The question of credibility and validity

arise because the narrative data given by the participants and the interpretation of the data by the

researchers were subjective (Nelson & McGillion, 2004). Another issue was that no background

information was given about one of her researchers in one interpretation of the data which could

possible affect the interpretation of the data collected (Atlmann, 2007).

Analysis

The Novice to Expert theory provides a useful frame work which has been adapted by

schools of nursing, hospitals, social agencies, and continuing education programs. It is also used

for the foundation of preceptor programs. Even though the frame work is used in many different

settings, it is not beneficial as a curriculum model for pre-registration nurse education (Atlmann,

2007). While Benner provided theoretical definitions for all major concepts, there were no

operational definition necessary for empirical measurement (Atlmann, 2007). Even though

Benner’s model is simple, brief, and general, it is situational specific (Atlmann, 2007). The five

stages of skill acquisition is easy and simply to follow and apply except for the challenges that

are encountered in identifying what prompt the transitions through the stages (Cash, 1995).

While the theory is useful in the different professions, it is not based on empirical methodology

and is often critized for not being developed from quantitative research (Cash, 1995)

Conclusion

To conclude, Benner’s novice to expert theory gave tremendous insight in how

individuals acquire skills and how it can be nurtured. Even though the critics stated that the

9 BENNER’S NOVICE TO EXPERT

theory is not beneficial to pre-registering nursing curriculum, it gives nursing educators the

understanding of the transition of nursing students. This understanding will better equip nursing

educators to design more effective teaching and learning strategies. The theory adds knowledge

and raised questions in the nursing practice which will better help the profession not only to

guide our nursing students, but to help nurses in terms of impacting direct care or to aid in

personal development and growth.

10 BENNER’S NOVICE TO EXPERT

References

Aiken, L., Haven, D. & Sloane, D. (2009). The magnet nursing services recognition program: a

comparison of two group of magnet hospital. Journal of Advanced Nursing, 39(7/8), s5-

s14

Altmann. T. K., (2007). An evaluation of the seminal work of Patricia Benner: Theory or

Philosophy? Contemporary Nurse, 25(1), 114-123

Allen, D. & Cloyes, K. (2005). The language of experience in nursing research. Nursing Inquiry

(12), 98-105

Benner, P. A. (1984). From Novice to Expert: Excellence and power in clinical nursing practice.

Menlo Park, CA: Addison-Wesley

Benner, P. A. (1995). A response by P. Benner to K. Cash, “Benner and expertise in Nursing: a

critique”. International Journal of Nursing Studies, 32(6), 527-527

Benner, P.A. (2004). Using the Dreyfus model of skill acquisition to describe interpret skill

acquisition and clinical judgment in nursing practice and education. Bulletin of Science,

Technology & Society, 24(3), 188-199.

Benner, P. A. (2001). From Novice to Expert: Excellence and power in clinical nursing practice.

Upper Saddle River, New Jersey: Prentice Hall Health

Brykczynsk. K. A. (2010a). Nursing theorist and their work. (7thth ed.). Maryland Heights, Mo:

Mosby Elsevier.

Brykczynsk. K. A. (2010b). Benner’s philosophy in nursing practice, In M. R. Alligood (4th ed.),

11 BENNER’S NOVICE TO EXPERT

Nursing Theory: Utilization and application (pp. 137-159). Heights, Mo: Mosby Elsevier

Cash, K. (1995). Benner and expertise in nursing: a critique. International Journal Nursing

Study, 32 (6), 527-534

Dale, J. C., Drews, B., Dimmitt, P., Hildebrandt, E., Hittle, K., & Tielsch-Goddard, A.

(2013). Novice to Expert: the evolution of an advanced practice evaluation Tool. Journal

of Pediatric Health Care, 27(3), 195-201

Dreyfus, S. E. & Dreyfus, H. L. (1980). A five-stage model of mental activities involved in

direct skill acquisition. (Rep. No. ORC-80-2). University of California, Berkeley,

Operations Research Center.

Effken, J. A. (2011). Informational basis for expert intuition. Journal of Advance Nursing,

(34) 246-255

English I. (1993), Intuition a function of the expert nurse: A critique of Benner’s novice to expert

model. Journal of Advanced Nursing 18, 387-393

John, C. (1995). The value of reflective practice for nursing. Journal of Clinical Nursing, 4,

23-30.

Kuhn T. S. (1970). The structure of scientific revolutions. Chicago: University of Chicago Press

Nelson, S. & McGillion (2004). Expertise or performance? Questioning the rhetoric of

contemporary narrative use in nursing. Journal of Advanced Nursing, (47), pp. 631-638

Pesata V. L. (1994). Applying Benner’s model to school of multiple handicapped children.

Clinical nurse special, 8 (5),

Polanyi M. (1958). Personal knowledge: Towards a post critical philosophy. Chicago:

University of Chicago press.

Purkis, M. E. (1994). Entering the field: Intrusions of the social and its exclusion from

12 BENNER’S NOVICE TO EXPERT

studies of nursing practice. International Journal of Nursing Studies. (31), pp. 315-336

Rudge, T. (1992). Reflections of Benner: A critical Perspective. Contemporary Nursing (1),

84-88

Sitzman, K. L., & Eichelberger, L. W. (2011). Understanding the work of nurse theorists: A

creative beginning. (2nd Ed.). Subbury, MA: Jones and Bartlett.

Thompson, J. L. (1990). Hermeneutic inquiry in Moody E. (Ed.) Advancing Nursing Science

through Research (2), 223-280

Doctor of Nursing Practice Program

DNP 7000 Middle Range Theory Scholarly Paper

Evolution of Nursing Practice Application of Theory in Nursing

February 28, 2020

Middle Range Theory Scholarly Paper

Purpose

This is an individual assignment. The purpose of this paper is to analysis and evaluates a middle range theory. The paper should include the major concepts, the model, and the philosophical underpinnings. Evaluate the heuristic value of the theory along with its use in practice/research. You can use the guideline that is below to write your paper. This assignment should be maximum 15 pages (excluding references, tables, pictures and graphics), double spaced, Times Roman, 12 font. Submit your assignment with a title page, abstract and reference page using APA 6th Edition. References must include at least 15 journals. Select a different Middle Range Theory that the one that you presented in class.

Guideline

Topic Point Value

Introduction 10%

Philosophical Underpinnings 10%

Main Concepts of the Theory 15%

The Model 15%

Heuristic Value of the Theory 10%

Analysis 20%

Conclusion 10%

References 10%

Doctor of Nursing Practice Program

DNP 7000 Middle Range Theory Scholarly Paper

Evolution of Nursing Practice Application of Theory in Nursing

February 28, 2020

DIRECTIONS AND GRADING CRITERIA

Category Points % Description

Introduction

10 points

10 10 Introduces the purpose of the assignment. Rationale is well presented

and purpose fully developed.

Philosophical

Underpinnings

10 points

10 10 Include a description of the philosophical underpinning of the Middle

Range Theory selected.

Main Concepts

of the Theory

15 points

15 15 Provide a complete description of the main concepts of the theory.

The Model

15 points

15 15 Provide a description of the theoretical model and its application.

Heuristic Value

of the Theory

10 points

10 10 Describe the Heuristic value of the selected theory.

Analysis

20 points

20 20 Provide an analysis of the theory application.

Conclusion

10 points

10 10 Provide a fully developed conclusion summarizing the content of the

paper.

Reference /

APA

10 10 Provide at least six articles within the last 5 years. Paper follows APA format

Total: 100 100 A quality essay will meet or exceed all of the above

requirements.

Doctor of Nursing Practice Program

DNP 7000 Middle Range Theory Scholarly Paper

Evolution of Nursing Practice Application of Theory in Nursing

February 28, 2020

GRADING RUBRIC

Assignment

Criteria

Meets Criteria Partially Meets Criteria Does Not Meet Criteria

Introduction

10 points

Excellent introduction

with information on the

theorist and theory (DOB,

education, and creation of

theory).

10 points

Introduction about the

theory and theorist is

sufficient (DOB,

education, and creation of

theory).

.

6 points

Introduction about the theory

and theorist is minimal.

4 points

Introduction is general with

no information about the

theorist and theory

0 point

Philosophical

Underpinnings

10 points

Excellent information on

the history and making of

the theory.

10 points

Good information on the

history and making of the

theory.

6 points

Minimal information on the

history and making of the

theory.

4 points

Unacceptable / general

information on the history

and making of the theory.

0 point

Doctor of Nursing Practice Program

DNP 7000 Middle Range Theory Scholarly Paper

Evolution of Nursing Practice Application of Theory in Nursing

February 28, 2020

Main Concepts of

the Theory

15 points

Clear and excellent

information on the main

Concepts of the Theory

15 points

Good information on the

main Concepts of the

Theory

10 points

Minimal information on the

main Concepts of the Theory

5 points

General or little information

on the main Concepts of the

Theor

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