An Evaluation of the Seminal Work of Patricia Benner: Theory or Philosophy?

By Altmann, Tanya K. | Contemporary Nurse : a Journal for the Australian Nursing Profession, May 1, 2007 | Go to article overview

An Evaluation of the Seminal Work of Patricia Benner: Theory or Philosophy?


Altmann, Tanya K., Contemporary Nurse : a Journal for the Australian Nursing Profession


Patricia Benner has provided essential understanding of how knowledge and skills are acquired and directly applied to nursing practice, education, research and administration. Specifically, her work indicates a growing concern with the development of explanatory frameworks for understanding the nature of nursing practice and the development of nursing expertise. Her research, unlike that of many of her contemporaries, progressed from practice to a useful model. It can be argued that this model is more practical when used as a philosophy. A nursing philosophy can be defined as the study of the principles underlying conduct, thought and the nature of the nursing practice. Philosophy begins when someone contemplates, or wonders, about something. Key to the discussion of whether Benner's model is a philosophy is understanding the basis of her work and her premises.

SUMMARY OF BENNER'S FROM NOVICE TO EXPERT

Patricia Benner was the author and project director of a federally funded grant titled: Achieving Methods of Intraprofessional Consensus, Assessment and Evaluation Project (the AMICAE Project). This research attempted to discover and describe knowledge embedded in nursing practice. It led to the publication of Benners' first book in 1984, From Novice to Expert and numerous articles. The AMICAE Project was 'an interpretive, descriptive study that led to the use of Dreyfus' five levels of competency to describe skill acquisition in clinical nursing practice' (Brykczynski 2002: 169).

The Dreyfus Model of Skill Acquisition (originally developed with pilots) considers 'advancement in skilled performance, based upon experience as well as education, clinical knowledge development and career progression in clinical nursing' (Myrick & Barrett 1992: 55). The model posits that individuals, while acquiring and developing skills, pass through five levels of proficiency: novice/beginner, advanced beginner, competent, proficient and expert. The five different levels reflect changes in three general aspects of skilled performance:

1. A move from a reliance on abstract principles to the use of past concrete experiences;

2. A change from viewing a situation as multiple fragments, to seeing a more holistic picture with a few relevant factors; and

3. A movement from detached observer to active performer.

A move from novice to expert is characterized by the transition from explicit rule-governed behavior to intuitive, contextually determinate behavior. Progression from novice to expert is not guaranteed; not every nurse becomes an expert.

'The Dreyfus model provides the concepts needed to differentiate between what can be taught by precept and what must be learned experientially from comparison of similar and dissimilar cases' (Benner 1984: 186). It is important to understand that Benner's and Dreyfus 's work was specifically directed at proposing a viable alternative to traditional ways of understanding practice, theory and knowledge; not to devalue science.

Benner believes that skilled pattern recognition can be taught and will lead to advancement through the stages. This teaching is done by a holistic assessment of the situation, not by breaking the situation down into individual parts. Immediate feedback about the accuracy of this type of clinical judgment is required.

Benner has continued to research nursing knowledge. Benner, Tanner and Chesla (1996) used the Dreyfus Model in an attempt to identify educational strategies that encourage the development of expertise.

PHILOSOPHICAL UNDERPINNINGS

Benner's ideas are 'based on the difference between practical and theoretical knowledge' (Cash 1995: 527). Practical situations are more complex than they initially appear. Benner asserted that formal models, theories and textbook descriptions were inadequate to explain practical situations in their complexities. Both experience and mastery are necessary for a skill to be transformed to a higher level skill. …

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