THEORETICAL FOUNDATION IN NURSING

Benner’s Stages Of Nursing Expertise Nursing Philosophies

Patricia Benner (1984-1989) direction of Hubert Dreyfus and
Richard Lazarus.
 “The Primacy of Caring Model”
(From novice to expert nursing Books
model.)
 Author of nine books including
 "Nursing is an integrative science
“FROM NOVICE TO EXPERT” named
that studies the relationships
an American journal of nursing book
between mind, body, and human
of the year for nursing education and
worlds.
nursing research in 1984
 Nursing is concerned with the social
 The Primacy of Caring, co-authored
sentient body that dwells infinite
with Judith Wrubel, named book of
human worlds: that gets sick and
the year in 1990
recovers; that is altered during
illness, pain, and suffering; and that Most Recent Books:
engages with the world differently
upon recovery"  Interpretative Phenomenology:
 Caring is central to human expertise, Embodiment, Caring and Ethics in
to curing, and to healing. Health and Illness and The Crisis of
 Caring is primary for the following Care, with Susan Philips, both
reasons: published in 1994
 What matters to people sets up not  Expertise in Nursing Practice: Caring,
only what as stressful but also what Clinical Judgment and Ethics, with
options are available for coping. Christine Tanner and Catherine
 It enables a person to notice salient Chesla, also named a Book of the
aspects of a particular situation, to Year in 1996
discern problems, and to recognize  Caregiving, with Suzanne Gordon and
potential solutions. Nel Noddings, also published in 1996.
 It sets up possibilities for giving and  Clinical Wisdom and Interventions in
receiving help. Critical Care: A Thinking-In Action
Approach, with Pat Hooper-Kyriakidis
History and Background and Daphne Stannard (W.B.
Saunders), published in December
 Patricia Benner is a Professor
1998
in the Department of Physiological
 Dr. Benner is an internationally noted
Nursing in the School of Nursing at
researcher and lecturer on health,
the University of California, San
stress and coping, skill acquisition
Francisco.
and ethics. Her work has had wide
 Dr. Benner received her bachelor's
influence on nursing both in the
degree in nursing from Pasadena
United States and internationally, for
College
example in providing the basis for
 Her master's degree in medical
new legislation and design for
surgical nursing from the University
nursing practiceand education for
of California, San Francisco
three states in Australia. She was
 Ph.D. from the University of
recently elected an honorary fellow
California, Berkeley, in Stress and
of the Royal College of Nursing. Her
Coping and Health under the
work has influence beyond nursing in
THEORETICAL FOUNDATION IN NURSING
Benner’s Stages Of Nursing Expertise Nursing Philosophies
the areas of clinical practice and improves decision-making. These
clinical ethics. nurses learn from experiences what
 She has been a staff nurse in the to expect in certain situations, as
areas of medical-surgical, well as how to modify plans as
emergency room, coronary care, needed.
intensive care units and home  EXPERT nurses no longer rely on
care. Currently, her research principles, rules, or guidelines to
includes the study of nursing connect situations and determine
practice in intensive care units actions. They have a deeper
and nursing ethics. background of experience and an
intuitive grasp of clinical situations.
Dr. Benner’s Stages of Clinical Competence Their performances are fluid,
 A NOVICE is a beginner with no flexible, and highly-proficient.
experience. They are taught general Benner’s writings explain that
rules to help perform tasks, and their nursing skills through experience are
rule-governed behavior is limited a prerequisite for becoming an
Stage V, Expert
and inflexible. In other words, they expert nurse.
Stage IV, Proficient

are told what to do and simply Benner’s Stage of Nursing Expertise

Stage III, Competent
follow instruction.
Stage II, Advanced beginner
 The ADVANCED BEGINNER shows
Stage I, Novice
acceptable performance, and has
gained prior experience in actual
nursing situations. This helps the
nurse recognize recurring
meaningful components so that
principles, based on those
experiences, begin to formulate in
order to guide actions.
 A COMPETENT nurse generally has
two- or three-years’ experience on
the job in the same field. For
example, two or three years in
intensive care. The experience may
also be similar day-to-day situations. Overview of Patricia Benner’s Philosophy in
These nurses are more aware of Nursing
long-term goals, and they gain
Benner proposed seven domains of nursing
perspective from planning their own
practice which are as follows:
actions, which helps them achieve
greater efficiency and organization  The helping role.
 The teaching-coaching function.
 A PROFICIENT nurse perceives and
understands situations as whole  The diagnostic and patient-
parts. He or she has a more holistic monitoring function.
understanding of nursing, which
THEORETICAL FOUNDATION IN NURSING
Benner’s Stages Of Nursing Expertise Nursing Philosophies
 Effective management of rapidly  this refers to competencies
changing situations. in ongoing assessment and
 Administering and monitoring anticipation of outcomes.
therapeutic interventions and (Evaluate the patient)
regimens.
 Monitoring and ensuring the quality
of health care practices.
 Organizational and work-role
competencies. 4. The effective Management of
Rapidly Changing Situations Domain
Benner’s Domains of Nursing Practice
 this includes the ability to
1. The Helping Role Domain contingently match
COMFORT MEASURES demands with resources and
 Provide clean, quiet, to assess and manage care
uncluttered environment during crisis situations
 Provide warmth, coolness as (emergency).
indicated
 Provide personal hygiene: 5. The Administering and Monitoring
keep the patient dry and Therapeutic Interventions and
clean, linen change, oral care Regimens Domain
 Provide activity like TV, radio,  this includes competencies
reading materials relate to preventing
 Explain all procedures, test, complications during drug
hospital routines therapy, wound
 Facilitate family visits and management and
support hospitalization.
 Check with patient at regular
intervals about his or her Ways in Preventing Complication If the
discomfort/comfort. Patient Have Diabetes
 Keep call light within reach 1. Diet, healthy lifestyle
and encourage patient to call
you if needed. 2. Don’t smoke
2. The Teaching-Coaching Function
3. Advice to keep their blood pressure
Domain
and cholesterol under control
 this includes timing,
4. Schedule regular physical and eye
readying patients for
exam
learning, motivating,
change, assisting with 5. Keep the patients’ vaccine up to
lifestyle alterations, and date
negotiating agreement on
goals. 6. Advice the patient to take care of
their teeth
3. The Diagnostic and Patient
Monitoring Function Domain 7. Advise them to pay attention to
their feet.
THEORETICAL FOUNDATION IN NURSING
Benner’s Stages Of Nursing Expertise Nursing Philosophies
WAYS IN PREVENTING COMPLICATION IN
PREGNANCY
1. Avoid taking medications without
prescription
2. Advise them to attend
appointments and check-up
regularly
3. Avoid smoking and drinking liquors
4. Maintain healthy weight (manage
blood pressure) – to avoid
preeclampsia (condition marked by
high blood pressure that can
directly affect the baby’s ability to
receive blood and oxygen in the
womb.)
6. The Monitoring and Ensuring the
Quality of Health Care Practices
Domain
 this includes competencies
with regard to maintenance of
safety, continuous quality
improvement, collaborative
and consultation with
physicians, self- evaluation, and
management of technology.
7. The Organizational and Work-Role
Competencies Domain
 this includes competencies in
priority setting, team building,
coordinating, and providing for
continuity.
3 KEYS IN PRIORITY SETTINGS
1. Severity
2. Patient benefit
3. Cost-Effectiveness