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Nursing Theorist For Patricia Benner Case Study

Nursing Theorist For Patricia Benner Case Study

5-6 page paper about nursing theorist Patricia and the theory of “Novice to Expert” in 7th edition APA format.

GUIDELINES: Each Group will hand in one formal paper about a nurse theorist and the theory. The paper is to be five to six (5-6) pages total of content (double-spaced, 12 font, 1 inch margins). Papers submitted with content greater than 6 pages (*excluding reference page and cover sheet), will not be read. No Abstract page is required.
• Follow APA 7th edition guidelines for a cover sheet, headers, pagination, references, etc. Nursing Theorist For Patricia Benner Case Study
• Use APA format and label each section using the evaluation outline below.
• Use headings below to identify sections of your paper.
• The criteria guidelines below will be used to evaluate your paper.
• Each paper will be graded on a 100-point scale.
Components of the Paper and possible points
SECTION POINTS POSSIBLE POINTS EARNED
Background
• Identification of theorist including a brief background of the theorist 10
Analysis of basic components/constructs and major relationships in the theory.
• You must have a minimum of 3 citations from nursing literature (only one from a secondary source/text) to support your discussion in this section. 30
Relevance
A. Personal relevance of any of the authors described (connect the theorist to the theory)
B. Relevance to health care and the client discussed
C. Application to research and/or practice provided 30

Theory Strengths and Limitations
• Include theory strengths and limitations. 20
• Summary 5
Format
• Precise APA style and professional writing 5

Dr Patricia Benner introduced the concept that expert nurses develop skills and understanding of patient care over time through a sound educational base as well as a multitude of experiences.

She proposed that one could gain knowledge and skills (“knowing how”) without ever learning the theory (“knowing that”).

She further explains that the development of knowledge in applied disciplines such as medicine and nursing is composed of the extension of practical knowledge (know how) through research and the characterization and understanding of the “know how” of clinical experience. Nursing Theorist For Patricia Benner Case Study

She conceptualizes in her writing about nursing skills as experience is a prerequisite for becoming an expert.
ABOUT THE THEORIST

Patricia E. Benner, R.N., Ph.D., FAAN is a Professor Emerita at the University of California, San Francisco.
BA in Nursing – Pasadena College/Point Loma College
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 1979
Published 9 books and numerous articles
Published ‘Novice to Expert Theory’ in 1982
Received Book of the Year from AJN in 1984,1990,1996, 2000
Her web address is at: http://www.PatriciaBenner.com
Her profile can be obtained at http://nurseweb.ucsf.edu/www/ix-fd.shtml
LEVELS OF NURSING EXPERIENCE

She described 5 levels of nursing experience as;

Novice
Advanced beginner
Competent
Proficient
Expert
Novice

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 recurring meaningful components
Principles, based on experiences, begin to be formulated to guide actions Nursing Theorist For Patricia Benner Case Study
Competent
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
Expert
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:

Movement from relying on abstract principles to using past concrete experiences to guide actions
Change in learner’s perception of situations as whole parts rather than in separate pieces
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 clinical 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.Nursing Theorist For Patricia Benner Case Study

It recognized that nursing was poorly served by the paradigm that called for all of nursing theory 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

Patricia Benner has a rich history in research. Part of her career began as a postgraduate
nurse researcher in 1970 in California. She has been a staff nurse in the areas of medicalsurgical, emergency room, coronary care, intensive care units, and home care. Currently, her
research includes the study of nursing practice in intensive care units, and nursing ethics.
She acknowledges that she has been influenced by Virginia Henderson (Tomey, 1994).Nursing Theorist For Patricia Benner Case Study
Benner became in involved in a research project called Achieving Methods of Intraprofessional Consensus, Assessment, and Evaluation (AMICAE) which became the foundation
for her famous book From Novice to Expert: Excellence and Power in Clinical Nursing Practice.
During this research it was discovered that knowledge could be gained in clinical practice and
that practice could be a way of knowing in and of itself. There were two outcomes of the
research project: “(1) validation and interpretation of the Dreyfus model of skill acquisition for
nurses; and (2) description for the domains and competencies of nursing practice” (Alligood &
Tomey, 2006 p. 131).
The Dreyfus skill acquisition and skill development model was developed by professors
Stuart and Hubert Dreyfus. The model was adapted by Benner to clinical nursing practice. She
further used the model to identify and distinguish levels of nursing practice from advanced
beginner to expert (Tomey, 1994).
Through her research project, observation of actual practice, and clinical situation
interviews, seven domains of nursing practice emerged. These domains included: the helping
role, the teaching-coaching function, the diagnostic and patient-monitoring function, effective
management of rapidly changing situations, administering and monitoring therapeutic
Theory in Practice: 3
interventions and regimens, monitoring and ensuring the quality of health care practices, and
organizational work-role competencies. Thirty-one competencies emerged and were described as
well (Alligood & Tomey, 2006).Nursing Theorist For Patricia Benner Case Study
Synthetic Analysis of the theory
Benner‟s (1984) model describes five stages of nursing development: novice, advanced
beginner, competent, proficient, and expert. There are distinct differences in the practice abilities
and experience levels within the five stages.
Novices must be given rules to guide them because they have no experience in the
situations they have in front of them. Advanced beginners have had enough experience to be
guided by a mentor and have an understanding of the situation or the „aspects‟ of the situation.
The competent practitioner has 2-3 years of experience in the same or similar setting, engages in
conscious and deliberate planning, and consistently uses an analytical framework. The proficient
practitioner views situations as a whole rather than an „aspect‟ and are able to perceive the
meaning in the situation and anticipate expectations. The expert practitioner has practiced for six
or more years in the same or similar setting and does not rely on maxims, rules, or analytic
frameworks (Benner, 1984). Other major concepts of Benner include: aspects of a situation,
attributes of a situation, competency, domains, exemplars, experience, maxims, paradigm cases,
and salience (Tomey, 1994).
The major assumptions are nursing, person, situation and health. “This model assumes
that all practical situations are far more complex than can be described by formal models,
theories and textbook descriptions” (Tomey, 1994, p. 169).
Nursing is described as a caring relationship that sets up the possibility of giving and
receiving help, a science guided by morals, ethics, and responsibilities. “Benner understands
Theory in Practice: 4
nursing practice as the care and study of the lived experience of health, illness, and disease and
the relationships between these three” (Tomey, 1994, p. 169).
“A person is a self interpreting being, that is, the person does not come into the world
predefined but gets defined in the course of living a life” (Tomey, 1994, p. 169). Understanding
the person, one must consider the role of the situation, the body, the personal concerns, and the
temporality. These aspects make up the person in the world. Benner defined embodiment as the
capacity of the body to respond to meaningful situations (Tomey, 1994).
Benner prefers to use the term situation instead of environment. Persons enter into
situations with their own opinions and understandings; how they may be involved in the situation
is their personal interpretation. She believes that being situated means that one has a past,
present, and future and that these effect the current situation. According to Benner and Wrubel
(1989), “situation implies a social definition and meaningfulness” (p. 80).
According to Benner, her published work The Primacy of Caring “focuses on the lived
experience of being healthy and being ill” (Benner & Wrubel, 1989, p. 7). Health and disease are
defined as what can be assessed at a physical level. Well-being and illness are the human
experience. A person may have a disease yet not consider themselves ill (Benner & Wrubel).Nursing Theorist For Patricia Benner Case Study
Focused theory evaluation
Christian worldview
Patricia Benner has helped to create an atmosphere within the nursing profession which
values the wholeness of human beings including their psychosocial and spiritual needs. Many of
her beliefs can be accepted and affirmed by Christian nurses. She calls to all nurses to be
“compassionate strangers”.
Theory in Practice: 5
The care ethic given to us in the Christian tradition has been marginalized in the current
market model of health care systems. . . The story of the Good Samaritan suggests that
the starting point in health care ethics should be in recognition and in relationship to the
universal human reality of vulnerability and suffering. . . Therefore, we are to be
compassionate strangers to those who fall outside our own communities and kinships
(Benner, 1998, p. 1).
How was the theory developed?
Patricia Benner has the educational and experiential background to develop a nursing
theory. The theory is inductive, based on evidence drawn from observations, personal
experiences, interviews, and exemplars provided by nurses. Benner applied her work to the
Dreyfus Model of Skill Acquisition developed by Herbert and Stuart Dreyfus both professors at
the University of California (Tomey, 1994).
How the theory is internally structured?
The theory is relatively simple with regard to the five stages of skill development and
understanding of the different levels of nursing practice. The complexity comes with the
differentiation between the levels of competencies. The key terms are well defined without the
overuse of unnecessary words.
How the theory is used
The theory has the potential to be used universally as a framework and is not restricted by
age, illness, health, or location of nursing practice. The model was empirically tested using
qualitative methodologies. The testing derived 31 competencies and seven domains of nursing
practice. “The strength of the Benner model is that it is data-based research that contributes to
the science of nursing” (Tomey, 1994, p. 173). The model is also used in educational curricula. Nursing Theorist For Patricia Benner Case Study
Theory in Practice: 6
The theory has social significance and is socially accepted. Benner has considered
ethically the greater good of society and that society expects nurses to be competent. Society has
put it‟s faith in nurses to be experts in their areas and provide competent care.
How the theory influences knowledge development
I do not believe the theory has great potential to generate other theory but the theory can
be further studied. It is forward-looking and is a valuable resource that is currently used and will
continue to be used to improve the nursing practice as other nursing skills and situations are
evaluated. It will also be a valuable resource to use as nursing practice continues to evolve;
nurses are expected to grow with technology and as new procedures are developed. “Subsequent
research suggests that the framework is applicable and useful in providing knowledge of the
description of nursing practice” (Tomey, 1994, p. 173).
How the theory stands up to testing
The theory testing has minimal use and can be used only as a framework. According to
Tomey (1994), the model has potential universal application as a framework but it is dependent
on actual clinical nursing situations. The properties do not allow for predictions as it is based on
phenomenological perspectives.
Review of related research and literature
Theory’s contribution to a moral commitment to the public
According to Benner (1998), “Moral worth and respect is to be accorded to all fellow
human beings” (p. 1). Benner‟s theory leads practitioners to understand that an everyday ethical
comportment is meeting and recognizing the healthcare concerns of patients and their families.
Nurses are expected to be advocates and act in the best interests of patients and families.
Becoming a „good‟ practitioner is more than a moral obligation and more than just following the
Theory in Practice: 7
patients‟ rights. It is being involved in the patient‟s vulnerability and responding to the patient as
a fellow human being. The „good‟ practitioner also requires learning from experience and that
experiential learning needs to be shared with other practitioners (Benner & Shobe, 2003).
Advocacy for good everyday ethical comportments, social ethics and public policy that
address social inequities are also essential to ensuring that healthcare is a right and fulfills
notions of good essential to a healthy society . . .As moral agents, clinicians are required
to learn from their experience in order to develop better judgment and character over time
. . . Our fiduciary relationship to patients extends to social justice and preventive public
health measures to reduce human suffering and vulnerability (Benner & Shobe, 2003, p. Nursing Theorist For Patricia Benner Case Study
374).
Theory’s contribution to education
Benner has described a variety of approaches to education and clinical expertise
development including: clinical knowledge development seminars, dialogue around clinical
narratives, exchanges, research participation and the writing of paradigm cases (Benner, 1984).
The National Organization of Nurse Practitioner Faculties (NONPF) is the organization that
provides leadership in promoting nurse practitioner (NP) education. In 2004, NONPF released
four curriculum models. The models they suggest follow the theoretical basis of Benner‟s novice
to expert concepts. Each model has the same level of competencies starting with a preprofessional level moving into basic nursing, clinical leader, nurse specialist and finally to the
doctoral competencies (National Organization of Nurse Practitioner Faculties [NONPF], 2004).
Balancing teaching and maintaining clinical practice competence are among the greatest
challenges of nurse educators. It is an expectation that nurse educators are experts in clinical
Theory in Practice: 8
practice and education concurrently. Benner‟s (1984) description of the development of nursing
practice can give nurse educators guidance in their dual roles.
Little and Milliken (2007) state, it would be difficult for nurses to gain experience,
knowledge and skills in the educational and clinical areas at the same time to achieve the dual
expert levels that are expected. Therefore, they have proposed “that the term „competence‟ is
more accurate and achievable than „expert‟ when describing the clinical practice requirements
for a full-time faculty member” (p.2).
Theory’s contribution to practice
Benner‟s work, for the most part through the use of narratives, has been able to show
other ways of uncovering and seeing much of the value, depth, and complexity of skilled nursing
practice (Darbyshire, 1994).
Benner‟s entire project, her research, writing, speaking, promotion of narratives and
clinical-ladders development in hospitals . . . has been to understand better and re-vision
skilled nursing practice as shared and common understandings. It has been to learn more
about how nurses develop expertise and practice expertly and it has been to encourage
and enable nurses to describe, uncover and share their expertise (Darbyshire, 1994, p.Nursing Theorist For Patricia Benner Case Study
758).
In 1990, NONPF published a set of domains and core competencies for primary care
NP‟s. There are seven domains and within each domain are 75 specific competencies. The
competencies were based on Benner‟s (1984) domains of expert care nursing. She “described
domains and competencies for advanced nursing practice” (National Organization of Nurse
Practitioner Faculties [NONPF], 2002, p. 2).
Theory’s contribution to knowledge development
Theory in Practice: 9
Benner studied clinical nursing practice as she was trying to find and describe the
knowledge that nurses hold and gain over time in practice. She describes the difference between
practical and theoretical knowledge that “knowing how” is practical knowledge and “knowing
that” is theoretical knowledge. She has given nursing a unique way to understand that theory is
derived from practice and practice is then altered or extended by theory. “Knowledge
development in a practice discipline consists of extending practical knowledge (know-how)
through theory-based scientific investigations and through the charting of the existent „knowhow‟ developed through clinical experience in the practice of that discipline” (Tomey, 1994, p.
164). Benner believes that nurses have failed to document their clinical experiences and
observations and in turn this has deprived nursing theory from the unique knowledge embedded
in expert practice (Tomey, 1994).
Recommendations for theory integration in Advanced Practice
In your practice
I will be able to integrate Benner‟s model in my practice. I have developed a better
understanding of the different stages of expertise and I believe I will be able to determine, for
myself, what skill level I am at depending on the situation in front of me. With that
understanding of the five different levels of skill development, I will be able to identify how to
better approach situations. Nursing Theorist For Patricia Benner Case Study
I am frequently asked to orient and precept new employees in the department I am
currently working. I feel in the current position I am working I would be considered an expert in
my field. I have been working in surgical services for the last 12 years and do not rely on rules
and frameworks. I have a deep knowledge and high skill level in the specialty I work in. I trust
and act on my intuitions as they relate to surgical patients. I struggle with preceptor situations
Theory in Practice: 10
and find that it is difficult to explain and difficult to show intuition or „knowing how‟. I believe
another nurse who is at a competent skill level may be a better fit for being a preceptor than
someone at the expert level. Suggesting this and using Benner‟s model as my research base may
be a way to incorporate better preceptor situations in the future.

Practicing and documenting observations and situations, as Benner recommends, is the
best way to allow practice to alter and extend theory. In turn, theory is incorporated into practice.
Understanding how to become empathetic and caring to patients and families, advocating for
vulnerable people and nurturing those in need are also ways to integrate theory into practice.
For the profession
Integration of Benner‟s model into the nursing profession is already underway with the
NONPF competencies being used for advance practice and advanced practice curriculum. The
NONPF domains and competencies are the recommended basic competencies for advance
practice nurses and will continue to be the recommendation as nine new domains and
competencies for the practice doctorate have been further developed, building on the existing
core competencies for all nurse practitioners. (National Organization of Nurse Practitioner
Faculties [NONPF], 2006).Nursing Theorist For Patricia Benner Case Study

The purpose of this article is to review the seminal work of Patricia Benner, From Novice to Expert, in order to assert it as a philosophy and not a theory. In the literature there is no clear consensus on where this model stands – theory or philosophy. There is no intent to devalue Patricia Benner’s work as it is valuable and has become widely used in nursing practice, research, education and administration. However, as a philosophy, Benner’s interpretive work is more constructive. Appropriate use of this model requires an understanding of whether it is a theory or a philosophy, its underpinnings and an assessment of its development and testing. This can be accomplished by knowing the differences between a theory and a philosophy and by reviewing the ways of knowing and processes of reasoning which are necessary for skill acquisition. Much of the critique of Benner’s work falls into two categories: it is not quantitative research and there are issues with the use of narratives. These will be reviewed. Judgment and understanding of the nature of Benner’s model allows for its appropriate use in journal articles, research, or other projects and/or modification as necessary. Nursing Theorist For Patricia Benner Case Study

Individualized nursing care is considered as
indicator for the quality of care due to enhance
positive patient outcomes (Acaroglu & Sendir,
2012; Papastavrou et al., 2015). Therefore, the
importance of individuality in nursing education
and patient careare emphasized by governments
and health care policies nowadays (Cronenwett et
al., 2007; Delaney, 2018; OECD, 2010; Suhonen,
Gustafsson, Katajisto, Välimäki, & Leino‐Kilpi,
2010a).
Individualized care constituting the basis of the
holistic philosophy, values and ethical codes of
nursing includes planning and practicing nursing
care in accordance with the individual
characteristics, requirements, preferences,
experiences, feelings, perceptions and opinions of
the individual and incorpating the individual to
this process (Acaroglu & Sendir, 2012;
Papastavrou et al., 2015; Suhonen et al., 2011;
Suhonen, Stolt, Gustafsson, Katajisto, &
Charalambous, 2014).On the other hand, in order
to achieve the purpose of individualized care, the
patients should comprehend nurses’ these
approaches, and express their own perceptions
about these approaches by experiencing and
feeling them in his/her own care (Acaroglu &
Sendir, 2012). In this regard, it is important that
nurses take into consideration factors such as
their clinical condition, their personal life
situation, and their preferences in order to
promote patient participation in decision making
(Idvall et al., 2012).
Nurses have an important role in evaluation and
development of individualized care (Suhonen,
Gustafsson, Katajisto, Välimäki, & Leino‐Kilpi,
2010b). Nurses need experiences in order to
develop individualized nursing care perceptions
and practices that are effective in the use of
nursing process and classification systems to
provide quality nursing care (Baraki et al., 2017;
Suhonen et al., 2010b). Novice nurses need to be
supported to implement individualized patient
care affected by the length of clinical experience
(Suhonen et al., 2010b).Nursing Theorist For Patricia Benner Case Study
Nursing theories and models contribute to the
development of nursing profession by supporting
the independent roles of nurses during care
delivery in accordance with nursing process
(Alligood, 2017; McCrae, 2012).Nurses can be in
a powerful position to improve the quality of care
and patient outcomes when they use the nursing
models guiding them about what questions they
can ask, how they can process the information
International Journal of Caring Sciences May – August 2019 Volume 12 | Issue 2| Page 1280
www.internationaljournalofcaringsciences.org
that is learned, and what nursing activities can be
included in their care practices (Alligood, 2013).
In nursing profession, these models provide a
mechanism for a systematic approach to teaching
theoretical and clinical knowledge (Dobrina,
Tenze, & Palese, 2014). Benner’s Novice to
Expert Model is one of the most useful
conceptual frameworks that guides the
professional development of nurses (Oshvandi et
al., 2016).This article describes how the Benner’s
Model guides nurses’ practice for the
development of individualized care perceptions
and practices throughout their clinical
experience.
Conceptual Framework: Benner’s Novice to
Expert Model
The Novice to Expert Model introduced by Dr
Patricia Benner in 1982 is generated from the
Dreyfus Model of Skill Acquisition and
essentially discusses how an individual gains new
skills and knowledge from novice stage to expert
stage (Davis & Maisano, 2016; Gentile, 2012).
Patricia Benner’s model stands on how a nurse
develop nursing knowledge, skill, clinical
competence and comprehension of patient care
through complete theoretical training and
experiential learning from novice stage to expert
stage (Davis & Maisano, 2016; Homard, 2013;
Walker-Reed, 2016). Development through these
phases is affected from clinical experience,
length of working time in profession (Blum,
2010).Nursing Theorist For Patricia Benner Case Study
In the novice stage, nurses have no background
practical experience while they have theoretical
knowledge only. They have no information on
how to transfer new knowledge and skills to their
applications when they face with unique
situations. Novice nurses can be considered
honeymoon practitioners, they reached the
advanced beginner level over by the time
(Brykczynski, 2017; Thomas & Kellgren, 2017).
Advanced beginner nurses still need to assistance
of experienced nurses for patient care. They
focus on completing all ordered treatments and
procedures more than individualized nursing
care. In the competent stage, nurses devise new
procedures and develop new clinical knowledge
along with learned procedures for managing the
patient care while they are learning ethical
behaviors. At the proficient stage, nurses
demonstrate new abilities for changing situations.
Expert nurses have critical critical thinking skills
to plan the patient care again in line with the
patient’s actual conditions, concerns and needs
(Benner, Tanner, & Chesla, 2009; Brykczynski,
2017)
Application of Benner’s Novice to Expert
Model to Improve Individualized Care
Perceptions and Practices
Novice
Novices called theoretical knowledge as students
learn domain-specific facts, features, and actions
relevant to a particular skill and their actions
(Benner et al., 2009; Gobet & Chassy, 2008;
Lyneham, Parkinson, & Denholm, 2008). They
have limited performance as they perform their
practice under the guidance of context-free and
inflexible rule (Benner et al., 2009; Brykczynski,
2017). Although they learn definition of
individualized nursing care through the nursing
education, the development of individualized
nursing care perceptions and practices takes a
period of time (Suhonen et al., 2010b).
Novices generally have limited experience to
practices and discussion about their caring for
patient at hospital settings before graduation.
Novices have difficulties to perform the skills on
patients having clinically different symptoms as
these skills learned and performed easily on a
simulation mannequin are inflexible. Students
typically rely on nursing care plans in the
textbooks without planning nursing care for
individual applications. They tend to relate
theoretical knowledge to clinical practices in a
non critical thinking manner, thus having
perception how this theoretical knowledge needs
to be applied in individualized nursing care
practices is very important for their professional
development (Benner, 2004; Benner et al., 2009;
Ortiz, 2016).Nursing Theorist For Patricia Benner Case Study
Guidance and education provided by educators
coach to students to advance from one stage of
development to the next. They can access to the
culture and expectations of the clinical units
thanks to clinical educators where they are
gaining clinical experience to implement
individualized patient care. Novice nursing
students must be assisted to learn about
individualized nursing care and integrate this
knowledge to actual patient care practices. The
instructors must give students responsibility to
plan and implement nursing care of patients who
may have possible changes in their conditions
(Benner, 2004).
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www.internationaljournalofcaringsciences.org
Advanced Beginner
Advanced beginners worked as a professional for
6 months or less are able to identify global
characteristics of a situation (Benner et al., 2009;
Lyneham et al., 2008). Grasping the aspects of
patient current situation in terms of the holistic
view is complex for advanced beginners as they
have not enough experience to expand their
vision to patients’ past experiences and future
expectations. They are unable to decide the order
of nursing diagnoses and practices according to
the importance for the individual. Generally, they
implement the care practices as a routine and
task-oriented maintenance in their first working
experiences. They can only focus on one aspect
of individual during care such as their
requirements, values, beliefs, behaviours,
emotions, perceptions etc. Although they
generally view the nursing process as a task that
need to be accomplished, they begin to perceive
meaningful occurrences of this process (Benner
et al., 2009; Brykczynski, 2017). King and Clark
(2002) found that advanced beginner nurses
focused upon processing routine tasks, and
monitoring of clinical observations required for
patient care without endeavoring to assess the
patient’s emotional state. Nursing Theorist For Patricia Benner Case Study
They begin to work at a clinical environment
without developing individualized caring
practices. The first year of practice helps to
further internalize nursing philosophy, nursing
values and the code of ethics for nurses required
for individualized care practices developed
through their working experience. They cannot
see the “big picture” involving the nursing cares’
all dimensions. The management of patients
with complex conditions, heavy workloads,
and sudden increases in responsibility could be
stressor for advanced beginners. They may have
difficulty to take independent decisions and
implement individualized nursing care.
Replanning the individualized nursing care make
the advanced beginner nurses quite anxious and
stressful when individuals’ needs were changed
during the care process (Benner et al., 2009;
Karahan, Toruner, Abbasoglu, & Ceylan, 2012).
Through trial and error, they may learn new ways
to affect situations, which will aid them in their
future care practices (Benner et al., 2009). They
need for special advices and guidances from their
more experienced colleagues to percept and
implement the individualized patient care. They
can improve cognitive, psychomotor and
emotional skills in a coordinated way required to
implement individualized nursing care through
planned interactions with other experience
professionals. On the other hand, hospital
management also has great responsibility in this
regard. Many hospital managements have
developed orientation education for advanced
beginners to adapt to clinical environment and
workplace conditions (Karahan et al., 2012).
Internationally, On the other hand, many
approaches such as internship programs,
residency, mentorship, and perceptorship assisted
them to consolidate theoretical learning, critical
skills and judgement in their new professional
role are designed to facilitate and support the
development of skills to meet individualized care
needs (Hezaveh, Rafii, & Seyedfatemi, 2014;
Hussein, Everett, Ramjan, Hu, & Salamonson,
2017; Phillips, Esterman, & Kenny, 2015).
Competent
In the competent stage, nurses worked as a
professional for 1 to 2 years focus on managing
the individualized nursing care unlike advance
beginners because they cope with a wide range of
nursing situations. Although they have the
confidence and ability to foresee patient’s
recovery, they have not enough speed and
flexibility for reflection and feedback of practice.
Competent nurses gain the knowledge and skills
over time about patients’ priority and urgency
develop (Benner et al., 2009; Brykczynski, 2017;
Lyneham et al., 2008).Nursing Theorist For Patricia Benner Case Study
Competent nurses better plan individualized
nursing care for patients according to novices and
advanced beginners as they can predict
immediate likely events and changing needs of
them (Benner, 2004). They have now little
anxiety when they learn and perform well
without making mistakes during care. Common
programs including nurse internships,
residencies, and mentoring programs help nurses
to maintain their competencies. Evaluating nurse
competence about the individualized nursing care
may be important for development of nursing
care. In this regard, nurses may also take national
certification exams to develop and validate their
specialized knowledge about the individualized
nursing care in an effort to demonstrate
competence (Smith, 2012). On the other hand,
nurse’s annual competency can be checked
by clinical education and hands-on demonstration
programmes (Woody & Davis, 2013).
International Journal of Caring Sciences May – August 2019 Volume 12 | Issue 2| Page 1282
www.internationaljournalofcaringsciences.org
Compotent nurses begin to develop a sense of
agency and take responsibility alone effectively
in clinical area. These sense of agencies and
responsibilities enables to provide instructive
feedback for their individualized nursing care
knowledge and practices based on novice
students’ and advanced beginners’ learning needs
(Benner et al., 2009). Although they can design
and implement a programs for less experienced
nurses about individualized nursing care based on
knowledge, skills and attitudes, they should
continue read evidence-based literature about
care practices. When competents conduct
evidence-based researches and present their
results in a conference or publish them in peerreviewed journals, these experiences contribute
to nursing care literature. Theory and principles
enable competent nurses to ask the right
questions to hone in on patient problems to
provide individualized nursing care and make
good clinical decisions (Benner et al., 2009;
McHugh & Lake, 2010)Nursing Theorist For Patricia Benner Case Study
Proficient
At the proficient stage, nurses worked as a
professional for 3 or more years have respond-based skills which can be used to give
information in accordance with patients’ demand
(Benner et al., 2009; Brykczynski, 2017).They
are analytical and fluid to cope with different
clinical situation such as patient and system
crises (Lyneham et al., 2008; Uhrenfeldt & Hall,
2007). Benner stated that they take clinical
leadership when needed and they have a
emotional responsiveness to patients’ discomfort
situations (Benner et al., 2009; Uhrenfeldt &
Hall, 2007).
They build on seeing aspects of a whole situation
rather than understanding the situation in terms of
rules and context-free attributes. They implement
individualized nursing care based on
responsibility, thinking, ethical discernment, and
a drive for action (Uhrenfeldt & Hall, 2009).
Emotional responses and moods what proficients
exhibit toward the patients’ situation enable the
patient to experience and feel the nurses’
individualized care perceptions and to express to
them with feedback, and so individualized
nursing care achieves its purpose (Benner et al.,
2009). Although proficient-level nurses have
experiences about individualized nursing care,
they must refresh their knowledge and develop
their practices to provide a better quality of care
by attending scientific meetings, reading nursing
journals, attending the national and international
project and researching (Benner, Kyriakidis, &
Stannard, 2011).
On the other hand, they can mentor and coach
the novices, advanced beginners and competents
by demonstrating appropriate behaviors as an
affective leader for development of
individualized nursing care. Given education by
proficients in nursing faculties or health centers
generated from their clinical experiences and
evidence-based practices help the nursing
students and less experienced nurses to recognize
the needs of patients and implement the care
practices with holistic philosophy (Benner et al.,
2009). They are able to assume the leadership
roles in hospital managements or professional
organizations to define and implement strategies
or procedures that guide that less experienced
nurses and novice students learn and implement
individualized care practices. Nurses can make
alterations to health policies and organizations
processes which are effective in providing quality
care (Benner et al., 2011; Benner et al., 2009).Nursing Theorist For Patricia Benner Case Study
Expert
Expert nurses responds in a fluid automatic
manner to come to a judgement unlike proficient
nurses (Lyneham et al., 2008). They make critical
clinical decisions while grasping the whole by
means of having intuitive ability or combining
technical and existential skills for innovative
solutions (Benner et al., 2009; Brykczynski,
2017; Fero, Witsberger, Wesmiller, Zullo, &
Hoffman, 2009; McHugh & Lake, 2010) . Expert
nurses have a broad vision, sensing the needs and
capability of patients (Benner et al., 2009).
Nurses who are both well-educated and
experienced have no problem to give
individualized nursing care as they better observe
subtle relevant changes problems and use a
developed keen intuition of future events that
may occur (Amaral & Ferreira, 2014; Fraley,
2016). Expertise influences nurses’ clinical
judgment and quality of care and develops the
individualized care implementations when a
nurse tests and refines both theoretical and
practical knowledge about it (McHugh & Lake,
2010). Nurses should develop their experience
further by testing and refining both their scientific
knowledge about individualized care since
expertise influences nurses’ clinical judgment and
quality of care . Counselling of expert nurses are
critical that less experienced nurses are able to
manage the nursing care by providing them to
International Journal of Caring Sciences May – August 2019 Volume 12 | Issue 2| Page 1283
www.internationaljournalofcaringsciences.org
think critically and ethically during their
practices (Benner et al., 2009).Nursing Theorist For Patricia Benner Case Study
On the other hand, they are able to develop
comprehensive curriculum systems or training
programs for novice students or less experienced
nurses and they can evaluate outcomes of these
educations (Thomas & Kellgren, 2017). Since
expert nurses have a high level of insight to
analyze in-depth nursing interventions, they can
develop new nursing theories, models and
researches based on holistic and humanistic
philosophies intended for individualized nursing
care perceptions and practices (Benner et al.,
2009). Insights and accomplishments of expert
nurses are one of the most important factors
determine the national and international health
policies related to individualized care practices
(Benner et al., 2009; Charalambous, Katajisto,
Välimäki, Leino‐Kilpi, & Suhonen, 2010;
Douglas, 2018). Expert nurses have experience
and knowledge to be able to integrate new
technological development to individualized care
practices. All these scientific and technological
knowledge of expert nurses guide less
experienced nurses to plan and implement the
individualized care.
Conclusion
Nursing education, professional development
programs, nursing theories and models and health
policies help ensure that nurses develop the
perception and experience about individualized
care since nurses’ experiences play key roles in
positively affecting the results of patient care. In
this regard, the one of the professional goals for
nurses should be to become an expert in
individualized nursing care for quality care and
they must develop their perceptions and
implementations about individualized nursing
care.
Nurses’ individualized care perceptions and
implementations have to develop beginning from
nursing faculties during to the years worked as a
professional, even though according to Benner’s
Novice to Expert Model nurses provide direct
care beginning from advanced beginner level
(Benner, 2004; Benner et al., 2009). Novice to
Expert Model is relatively simple with regard to
the five stages of skill acquisition, and it provides
a comparative guide for identifying levels of
nursing practice from individual nurse
descriptions and observations and interpretations
validated by consensus. Benner maintains that
caring practices must be attuned to individual
being cared for and to the particular situation as it
unfolds (Brykczynski, 2017). In this regard, this
article guides all novice students, nurse educators
and nurses at different levels according to
Benner’s Novice to Expert Model to develop the
individualized nursing care perceptions and
implementions. The framework of this study also
provides a foundation for ongoing research about
individualized nursing care.  Nursing Theorist For Patricia Benner Case Study

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