Theory Evaluation Paper: Patricia Benner’s Novice to Expert Nurse Theory

Theory Evaluation Paper: Patricia Benner’s Novice to Expert Nurse Theory

NU 500 Theoretical Foundations of Nursing

When presented with emergency or critical situations, nurses often rely on their previous experiences to apply critical thinking, prioritize patient care, and anticipate and implement interventions (Fero, Witsberger, Wesmiller, Zullo, & Hoffman, 2009). The ability to perform effectively and independently is a skill that develops and perfects over time. Patricia Benner’s Novice to Expert nursing theory discusses the complexity of nursing and the need for long-term and ongoing career development to become a nurse expert (Benner, 1982). A critical evaluation of Benner’s theory will offer insight into its principles and application to nursing practice and development.

Theory Description

Purpose

The Novice to Expert theory is an explanatory, high middle-range theory. McEwen and Wills (2019) explain middle-range theories guide the development of nursing practice. Benner’s theory guides nursing practice by providing recognition to the enhanced skills and abilities acquired by the expert nurse and the importance of retaining such nurses. She also encourages organizations to provide ongoing education to assist with the progression of the nurse from novice to expert. The theory applies The Dreyfus Model of skill acquisition to the field of nursing and outlines it in five stages: novice, advanced beginner, competent, proficient, and expert (McEwen & Wills, 2019). The purpose of the theory is to establish and define each stage of skill acquisition based upon skill and knowledge and recognize the importance of skill development and nursing experience.

Concepts

The concepts in Benner’s theory have outlined a rationale for ongoing continuing education and career development for nurses. Concepts include skill acquisition, competence, experience, and clinical and practical knowledge (McEwen & Wills, 2019). Understanding the concepts is crucial for proper utilization of the theory.

Definitions of Concepts

The key concepts are consistently defined but vary in complexity, depending on the proficiency stage of the nurse. Benner does not provide verbiage for skill acquisition, but instead applies the Dreyfus Model of skill acquisition directly to nursing and defines each stage of competence. Benner developed the definition for each stage by considering the nurse’s experience, history of observing and practicing nursing events and utilizing that practice. Clinical knowledge applies the education and understanding of clinical practices and application, while practical knowledge is the ability to apply knowledge to a situation. According to Benner (1984), the stages of skill acquisition are:

Relationship

• Novice – no experience, lacks confidence, requires continual cueing, prolonged practice time, and lack of discretionary judgment.
• Advanced beginner – marginal performance due to experience in actual situations, efficient in parts of practice, requires occasional cues, improved delay of care, developing knowledge.
• Competent – nurse has been on the job or similar situations for two to three years, demonstrate efficiency, coordination, and confidence. The competent nurse can make a plan based upon the presenting problem, with deliberate planning with efficiency and organization. Care is delivered in a reasonable time frame, and only supportive cues are required.
• Proficient – A proficient nurse perceives a situation as a whole, understands a situation as a whole with long-term goals. Experience and holistic understanding in the proficient nurse have developed the ability to anticipate events based on a given situation and how to respond to the events. The proficient nurse has improved decision making and can prioritize efficiently.
• Expert – Expert nurses can accurately determine the source of the problem without wasteful consideration of alternative diagnoses. Their deep understanding of an entire situation has acquired them an intuitive grasp. They perform fluidly, are flexible and highly proficient in knowledge and skills.

Concepts in nursing theories are systematically formed to link with one another (McEwen & Wills, 2019). Benner’s key concepts of skill acquisition, competence, experience, and clinical and practical knowledge are all referenced in each stage of Benner’s model. Each key concept is dependent upon the other to gain overall improvement. For example, as a nurse gains experience, they also gain clinical and practical knowledge, which improves skills and competence.

Structure

The stages build upon each other to create a ladder of proficiency in skill and knowledge acquisition. Each nurse begins their career as a novice, and with increased experience and knowledge can advance to be a nurse expert. The five stages of this model create a simple structure for the theory. The complexity of the structure is understanding the differences in each stage (Altmann, 2007), and that a nurse may be an expert in one area of nursing but a novice or competent nurse in another area.

Assumptions

The Novice to Expert theory assumes real-life application and practice creates a foundation to a novice nurse that can be built upon to achieve expert status. Experience plus continual innovative methods of learning should be encouraged throughout a nurse’s career to aid in acquiring the top stage of nurse expert (Mgbekem, Ojong, Lukpata, Armon, & Kalu, 2016). Benner identifies the importance of her theory as distinguishing the differences between the varying levels of nurse proficiency. She believes that nurses from varying stages will not approach or solve a situation in the same way (Benner, 1982).

Theory Analysis

Theory’s Origin

A federally funded program project called: Achieving Methods of Interprofessional Consensus, Assessment and Evaluation Project (AMICAE), was directed by nursing theorist Patricia Benner. The project aimed to develop a deeper understanding of knowledge rooted in nursing practice through research. Her involvement led to the publication of her book and theory From Novice to Expert in 1984. The Dreyfus Model was developed by two Berkley professors, Stuart and Huebert Dreyfus, from their study of chess players and pilots (Benner, 1982). In her book/theory, she applied the Dreyfus Model of Skill Acquisition, to nursing practice (Altmann, 2007).

Benner’s used qualitative methodology observing and interviewing nurses with various levels of experience in several different settings, to empirically test the practicality of the Dreyfus model in nursing (Benner, 1982). Critics of Benner’s theory disparaged her sample size and accused participants of the study as being biased (Altmann, 2007).

Unique Focus

The unique focus of a nursing theory refers to its distinctive views of the metaparadigm concepts of nursing: nursing, environment, health, and person (McEwen & Wills, 2019). Benner’s application of the nursing metaparadigms built a foundation for her theory. Each proficiency stage a nurse goes through affects the metaparadigm concepts. The outcomes that are achieved by moving beyond a novice nurse and toward an expert nurse, improve the experience of the person, skill/knowledge of the nurse, impact the patient’s health and are enhanced by the environment (situation).

Content

Benner’s philosophy defines the metaparadigm concepts as:

Person: Embodied person living in the world who is a self-interpreting being who gets defined by the course of living

Environment (situation): A social environment with social definition of meaningfulness

Health: The human experience of health or wholeness

Nursing: A caring relationship that includes the care and study of the lived experience of health, illness, and disease (Masters, 2015, p. 55)

Theory Evaluation

Significance

Benner’s theory utilized a tool to promotes the continual education and practice of nursing, determining experts in practice, and promoting the development of expertise in others. This concept creates an immense social significance, as it promotes having the most skillful and knowledgeable practitioners providing care (Altmann, 2007). The theory can also be utilized by organizations as a career ladder, encouraging retention. Using the theory in this manner correlates nurse retainment and nursing expertise with improved quality of practice and patient outcomes (Mgbekem et al., 2016).

Comprehensiveness

Education provided to nurses at any stage of Benner’s model is invaluable as it provides a transitional process from novice to expert. Benner’s theory provides a comprehensive understanding of the process while also discussing barriers (Murray, Sundin, & Cope, 2019). The application of the theory is broad. It can be applied to any field of nursing or level of experience, making it beneficial to the entire nursing population.

Logical Congruence

The simplicity of Benner’s theory created an easy to understand the logic. When evaluating each component of Benner’s theory, she remained consistent with her concepts and how they were utilized (Altmann, 2007). Benner also remained consistent with the definition of her concepts, principles, and methods (Mgbekem et al., 2016).

Credibility

There are differing opinions on the credibility of Benner’s research. One perspective finds Benner’s research findings as subjective, qualitative, and should meet the requirements as a philosophy rather than a theory (Altmann, 2007). The more accepted opinion is that despite the methodology being qualitative, she used empirical data-based research, and greatly contributed to nursing science (Tomey, 1994).

Contribution to Nursing

The theory is utilized in many aspects of nursing, including, management, career enhancement and development, the orientation of new graduate and novice nurses, and in the overall staffing of a facility (McEwen & Wills, 2019). It has been used to develop preceptor guidelines, clinical ladders, and promotes ongoing education and training for nurses. With increasing demands and accountability placed on nurses, researchers have utilized Benner’s concept as a theoretical framework to further study the clinical decision-making processes of experienced nurses (Stinson, 2016).

Conclusion

The description, analysis, and evaluation of Benner’s theory conclude it is a fundamental principle of nursing development. The application of her theory to nursing practice gives value and understanding to nursing expertise and promotes ongoing nurse education. The Novice to Expert theory increases the number of nurse experts, improving the quality of care and patient outcomes.

References

Altmann, Tanya. (2007). An evaluation of the seminal work of Patricia Benner: Theory or philosophy?. Contemporary nurse, 25. 114-23. doi:10.5172/conu.2007.25.1-2.114

Benner, P. (1982). From Novice to Expert. The American Journal of Nursing,82(3), 402-407. Retrieved May 26, 2019, from https://journals.lww.com/ajnonline/Citation/1982/82030/From_Novice_To_Expert.4.aspx

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley, pp. 13-34

Fero, L. J., Witsberger, C. M., Wesmiller, S. W., Zullo, T. G., & Hoffman, L. A. (2009). Critical thinking ability of new graduate and experienced nurses. Journal of Advanced Nursing,65(1), 139-148. doi:10.1111/j.1365-2648.2008.04834.x

Masters, K. (2015). Nursing theories: A framework for professional practice (2nd ed.). Burlington, MA: Jones & Bartlett Learning

McEwen, M. & Wills, E. (2019). Theoretical basis for nursing (5th). Philadelphia, PA: Lippincott Williams & Wilkins.

Mgbekem, M., Ojong, I., Lukpata, F., Armon, M., & Kalu, V. (2016). Middle range theory evaluation: Bridging the theory-practice gap. Global Journal of Pure and Applied Sciences,22(2), 249. doi:10.4314/gjpas.v22i2.13

Murray, M., Sundin, D., & Cope, V. (2019). Benner’s model and Duchschers theory: Providing the framework for understanding new graduate nurses transition to practice. Nurse Education in Practice,34, 199-203. doi:10.1016/j.nepr.2018.12.003

Stinson, K. J. (2016). Benner’s Framework and Clinical Decision-Making in the Critical Care Environment. Nursing Science Quarterly,30(1), 52-57. doi:10.1177/0894318416680536

Tomey, A. M. (1994). Nursing theorist and their works (3rd ed.). (N. D. Como & B. M. Cowell, Eds.). St. Louis, MO: Mosby.