INTRODUCTION OF NURSING THEORIES AND

INTRODUCTION OF NURSING THEORIES ANDINTRODUCTION OF NURSING THEORIES ANDMODELSMODELS

Presented ByPresented By:: SajidaSajida ParveenParveenGroup members:Group members: Rahman U DinRahman U Din

Sana MushtaqSana MushtaqSyed Zahid AliSyed Zahid Ali

(post RN BScN 1(post RN BScN 1stst year 2year 2ndnd semester)semester)

(New Life College Of Nursing)(New Life College Of Nursing)

FacultyFaculty:: RameshRamesh KumarKumarDate: 30Date: 30thth June 2016June 2016






INTRODUCTION OF NURSING THEORIES ANDINTRODUCTION OF NURSING THEORIES ANDMODELSMODELS











PATRICIA BENNERPATRICIA BENNERFrom Novice toFrom Novice to Expert THEORYExpert THEORYFrom Novice toFrom Novice to Expert THEORYExpert THEORY

PATRICIA BENNERPATRICIA BENNERFrom Novice toFrom Novice to Expert THEORYExpert THEORYFrom Novice toFrom Novice to Expert THEORYExpert THEORY

OBJECTIVESOBJECTIVES•• Introduction ofIntroduction of Patr ic iaPatr ic ia Benner .Benner .

•• DefineDefine Benner'sBenner's Philosophy.Philosophy.

•• Discuss StagesDiscuss Stages of Novice to Expertof Novice to Expert Model.Model.• Define Novice• Define Advanced beginner• Define Competent• Define Proficient• Define Expert

•• Introduction ofIntroduction of Patr ic iaPatr ic ia Benner .Benner .









OBJECTIVESOBJECTIVES•• DiscussDiscuss Application of benner‘s theory inApplication of benner‘s theory in nursing.nursing.

•• Benner’s Description ofBenner’s Description of Nursing, person, health, environment.Nursing, person, health, environment.

•• Case studyCase study

•• DiscussDiscuss Application of benner‘s theory inApplication of benner‘s theory in nursing.nursing.

•• Benner’s Description ofBenner’s Description of Nursing, person, health, environment.Nursing, person, health, environment.

•• Case studyCase study

PATRICIA BENNERPATRICIA BENNER

• Patricia E. Benner, R.N., Ph.D., FAAN is a Professor at theUniversity of California, San Francisco.

• BA in Nursing - Pasadena College/Point Loma College

• MS in Med/Surg nursing from University of California,San Francisco (UCSF)

• PhD -1982 from UC Berkeley

• 1970s - Research at UCSF and University of California(UC) Berkeley


















• Has taught and done research at UCSF since1979

• Published 9 books and numerous articles

• Published ‘Novice to Expert Theory’ in 1982

• Received Book of the Year from AJN in1984,1990,1996, 2000














INTRODUCTIONINTRODUCTION•• Theory based on Dreyfus’s (1980)Theory based on Dreyfus’s (1980) “A five“A five

stage model of the mental activities involvedstage model of the mental activities involvedinin direct skills acquisition” model (Dreyfusdirect skills acquisition” model (Dreyfus).).

SimilaritiesSimilarities•• FiveFive developmentaldevelopmental stagesstages•• IncreaseIncrease in skills and experience getsin skills and experience gets

advancement in stagesadvancement in stages

•• Theory based on Dreyfus’s (1980)Theory based on Dreyfus’s (1980) “A five“A fivestage model of the mental activities involvedstage model of the mental activities involvedinin direct skills acquisition” model (Dreyfusdirect skills acquisition” model (Dreyfus).).



INTRODUCTIONINTRODUCTION•• Theory based on Dreyfus’s (1980)Theory based on Dreyfus’s (1980) “A five“A five

stage model of the mental activities involvedstage model of the mental activities involvedinin direct skills acquisition” model (Dreyfusdirect skills acquisition” model (Dreyfus).).



•• Theory based on Dreyfus’s (1980)Theory based on Dreyfus’s (1980) “A five“A fivestage model of the mental activities involvedstage model of the mental activities involvedinin direct skills acquisition” model (Dreyfusdirect skills acquisition” model (Dreyfus).).


advancement in stagesadvancement in stages Hubert & Stuart Dreyfus

INTRODUCTIONINTRODUCTION•• Benner’s nursing theory of novice to expert is also based on five levels ofBenner’s nursing theory of novice to expert is also based on five levels of

skills; novice, advanced beginner, competent, proficient, and expertskills; novice, advanced beginner, competent, proficient, and expert•• The purpose of this presentation is to discuss and examine the NursingThe purpose of this presentation is to discuss and examine the Nursing

Theorist, Patricia Brenner, and her nursing theory: From Novice toTheorist, Patricia Brenner, and her nursing theory: From Novice toExpert.Expert. Patricia Brenner's theory explains how a nurse develops a sensePatricia Brenner's theory explains how a nurse develops a senseof intuition in their practice and develops their critical thinking skills as aof intuition in their practice and develops their critical thinking skills as anurse.nurse.

•• Benner wanted to provide an understanding for nurses, as they developBenner wanted to provide an understanding for nurses, as they developtheir skills, of what makes a novice nurse become an expert nurse.their skills, of what makes a novice nurse become an expert nurse.

•• Benner’s nursing theory of novice to expert is also based on five levels ofBenner’s nursing theory of novice to expert is also based on five levels ofskills; novice, advanced beginner, competent, proficient, and expertskills; novice, advanced beginner, competent, proficient, and expert

•• The purpose of this presentation is to discuss and examine the NursingThe purpose of this presentation is to discuss and examine the NursingTheorist, Patricia Brenner, and her nursing theory: From Novice toTheorist, Patricia Brenner, and her nursing theory: From Novice toExpert.Expert. Patricia Brenner's theory explains how a nurse develops a sensePatricia Brenner's theory explains how a nurse develops a senseof intuition in their practice and develops their critical thinking skills as aof intuition in their practice and develops their critical thinking skills as anurse.nurse.


INTRODUCTIONINTRODUCTION•• Benner’s nursing theory of novice to expert is also based on five levels ofBenner’s nursing theory of novice to expert is also based on five levels of

skills; novice, advanced beginner, competent, proficient, and expertskills; novice, advanced beginner, competent, proficient, and expert•• The purpose of this presentation is to discuss and examine the NursingThe purpose of this presentation is to discuss and examine the Nursing

Theorist, Patricia Brenner, and her nursing theory: From Novice toTheorist, Patricia Brenner, and her nursing theory: From Novice toExpert.Expert. Patricia Brenner's theory explains how a nurse develops a sensePatricia Brenner's theory explains how a nurse develops a senseof intuition in their practice and develops their critical thinking skills as aof intuition in their practice and develops their critical thinking skills as anurse.nurse.


•• Benner’s nursing theory of novice to expert is also based on five levels ofBenner’s nursing theory of novice to expert is also based on five levels ofskills; novice, advanced beginner, competent, proficient, and expertskills; novice, advanced beginner, competent, proficient, and expert

•• The purpose of this presentation is to discuss and examine the NursingThe purpose of this presentation is to discuss and examine the NursingTheorist, Patricia Brenner, and her nursing theory: From Novice toTheorist, Patricia Brenner, and her nursing theory: From Novice toExpert.Expert. Patricia Brenner's theory explains how a nurse develops a sensePatricia Brenner's theory explains how a nurse develops a senseof intuition in their practice and develops their critical thinking skills as aof intuition in their practice and develops their critical thinking skills as anurse.nurse.


BENNER'S PHILOSOPHYBENNER'S PHILOSOPHY

•• BennerBenner workedworked inin aa varietyvariety ofof nursingnursing areasareas includingincluding IntensiveIntensiveCareCare UnitUnit (ICU),(ICU), medicalmedical--surgical,surgical, emergency,emergency, andandcoronarycoronary.. SheShe becamebecame interestedinterested inin notnot howhow toto dodo nursingnursing butbuthowhow dodo nursesnurses learnlearn toto dodo nursingnursing..

•• practicalpractical situationssituations areare moremore complexcomplex thanthan theythey seemseem andandformalformal methodsmethods suchsuch asas textbooktextbook descriptions,descriptions, theoriestheories andandmodelsmodels areare inadequateinadequate toto explainexplain thethecomplexitiescomplexities.. ExperienceExperience andand masterymastery areare requiredrequired toto bringbringaa skillskill toto aa higherhigher levellevel..



BENNER'S PHILOSOPHYBENNER'S PHILOSOPHY





STAGES OF NOVICE TO EXPERT MODELSTAGES OF NOVICE TO EXPERT MODELSTAGES OF NOVICE TO EXPERT MODELSTAGES OF NOVICE TO EXPERT MODEL

STAGES OF NOVICE TO EXPERT MODELSTAGES OF NOVICE TO EXPERT MODEL

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.”

•• Can also apply to experienced nurses in an area or situation ofCan also apply to experienced nurses in an area or situation of unfamiliarity.unfamiliarity.





















Advanced Beginner

• Demonstrates acceptable performance

• Has gained prior experience in actual situations to recognizerecurring meaningful components

• Principles, based on experiences, begin to be formulated to guideactions

•• AppliesApplies to most newly graduatedto most newly graduated nursesnurses

•• FeelFeel highly responsible for managing patienthighly responsible for managing patient carecare

Advanced Beginner







Advanced Beginner






Advanced Beginner







•• StillStill rely on the help of the more experienced nurserely on the help of the more experienced nurse

•• Has marginally competent skillsHas marginally competent skills

•• Uses theory and principles much of the timeUses theory and principles much of the time

•• Experiences difficulty establishing prioritiesExperiences difficulty establishing priorities















Competent PractitionerCompetent Practitioner

•• Usually applies to nurses with 2Usually applies to nurses with 2--3 years experience3 years experience•• CoordinatesCoordinates several tasksseveral tasks simultaneouslysimultaneously•• ConsistentConsistent, predictable, and able to manage time, predictable, and able to manage time•• MayMay displaydisplay hyper responsibilityhyper responsibility for the patientfor the patient•• BeginsBegins to recognize patternsto recognize patterns•• DeterminesDetermines which elements of the situation warrant attention andwhich elements of the situation warrant attention and

which can bewhich can be ignoredignored












ProficientProficient PractitionerPractitioner

•• UsuallyUsually applies to nurses with 3applies to nurses with 3--5 years experience5 years experience•• ViewsViews patient holisticallypatient holistically•• FocusesFocuses on longon long--termterm goalsgoals•• CanCan see changing relevance in a situationsee changing relevance in a situation•• NoNo longer relies on preset goals for organizationlonger relies on preset goals for organization•• DemonstratesDemonstrates increased confidence in their knowledge andincreased confidence in their knowledge and abilitiesabilities• More holistic understanding improves decision-making• Learns from experiences what to expect in certain situations and how to modify

plans



plans




plans



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

•• GraspsGrasps patient needspatient needs automaticallyautomatically

•• DemonstratesDemonstrates a clinical grasp and resource baseda clinical grasp and resource based practicepractice

•• PossessesPossesses embodiedembodied knowknow--howhow

•• AbleAble to see the “bigto see the “big picture”picture”

•• AbleAble to recognize patterns on the basis of deep experiential backgroundto recognize patterns on the basis of deep experiential background


determine actions










determine actions









determine actions








APPLICATION OF BENNER‘S THEORYAPPLICATION OF BENNER‘S THEORY

Nursing applies Benner’s Theory throughNursing applies Benner’s Theory through::•• Nursing school curriculumNursing school curriculum

•• Building clinical ladders forBuilding clinical ladders for nursesnurses

•• Developing mentorship programsDeveloping mentorship programs•• MentorsMentors for newly graduatedfor newly graduated nurses:nurses: Mentors do more than teach skills;Mentors do more than teach skills;

they facilitate new learning experiences, help new nurses make careerthey facilitate new learning experiences, help new nurses make careerdecisions, and introduce them to networks of colleagues who can providedecisions, and introduce them to networks of colleagues who can providenew professional challenges and opportunities. Mentors are interactivenew professional challenges and opportunities. Mentors are interactivesounding boards who help others make decisions. Part of mentoringsounding boards who help others make decisions. Part of mentoringprograms areprograms are preceptorspreceptors















•• Preceptors for studentPreceptors for student nurses:nurses:•• PreceptorsPreceptors help new nurses deal with the uncertainty of the clinical settinghelp new nurses deal with the uncertainty of the clinical setting

that is inherent to gaining proficiency. The preceptor's role of "guide at thethat is inherent to gaining proficiency. The preceptor's role of "guide at theside" isside" is criticalcritical to moving from novice toto moving from novice to expert.expert.








BENNER’S DESCRIPTION OF NURSINGBENNER’S DESCRIPTION OF NURSING

•• A caring relationship, “an enabling condition of connection andA caring relationship, “an enabling condition of connection andconcernconcern””

•• ““Caring is primary because caring sets up the possibility of giving helpCaring is primary because caring sets up the possibility of giving helpand receiving helpand receiving help.”.”

•• ““Nursing is viewed as a caring practice whose science is guided by theNursing is viewed as a caring practice whose science is guided by themoral art and ethics of care and responsibilitymoral art and ethics of care and responsibility.”.”

•• IsIs the care and study of the lived experience of health, illness,the care and study of the lived experience of health, illness,andand disease and the relationships among these three elementsdisease and the relationships among these three elements





BENNER’S DESCRIPTION OF NURSINGBENNER’S DESCRIPTION OF NURSING









BENNER’S DESCRIPTION OF PERSONBENNER’S DESCRIPTION OF PERSON

•“A person is a self•“A person is a self--interpreting being, that is, the personinterpreting being, that is, the persondoes not come into the world predefined but gets defined indoes not come into the world predefined but gets defined inthe course of living a life. A person also hasthe course of living a life. A person also has anan effortlesseffortlessandand nonnon--reflectivereflective understanding of the self in the world.”understanding of the self in the world.”"The person is viewed as a participant in common meaning.""The person is viewed as a participant in common meaning."The four major aspects of understanding that the personThe four major aspects of understanding that the personmust deal with:must deal with:

oo The role of the situationThe role of the situationoo The role of the bodyThe role of the bodyoo The role of personal concernsThe role of personal concernsoo The role of temporalityThe role of temporality



BENNER’S DESCRIPTION OF PERSONBENNER’S DESCRIPTION OF PERSON





BENNER’S DESCRIPTION OFBENNER’S DESCRIPTION OF HEALTHHEALTH

•Health is defined as what can be assessed•Health is defined as what can be assessed•Well•Well--being is the human experience of health or wholenessbeing is the human experience of health or wholeness•A person may have a disease and not experience illness•A person may have a disease and not experience illness––Illness is the human experience of loss or dysfunctionIllness is the human experience of loss or dysfunction––Disease is what can be assessed at the physicalDisease is what can be assessed at the physical levellevel


BENNER’S DESCRIPTION OFBENNER’S DESCRIPTION OF HEALTHHEALTH



BENNER’S DESCRIPTION OF SITUATIONBENNER’S DESCRIPTION OF SITUATION(ENVIRONMENT)(ENVIRONMENT)

•She uses the term situation instead of environment because•She uses the term situation instead of environment becausesituation conveys a social environment with social definitionsituation conveys a social environment with social definitionand meaningfulnessand meaningfulness•“Personal interpretation of the situation is bounded by the•“Personal interpretation of the situation is bounded by theway the individual is in it.”way the individual is in it.”––Each person’s past, present, and future, which include theirEach person’s past, present, and future, which include theirown personal meanings, habits, and perspectives, influenceown personal meanings, habits, and perspectives, influencethe currentthe current situationsituation


BENNER’S DESCRIPTION OF SITUATIONBENNER’S DESCRIPTION OF SITUATION(ENVIRONMENT)(ENVIRONMENT)



CASE STUDYCASE STUDY

•• A nurse, with over 15 years’ experience on the obstetrics floor, isA nurse, with over 15 years’ experience on the obstetrics floor, isattempting to teach a new mother how to breast feed her infant.attempting to teach a new mother how to breast feed her infant. FirstFirstthing she does is makes sure the new mother has privacy, that the room isthing she does is makes sure the new mother has privacy, that the room iswarm and the lighting is dimmed.warm and the lighting is dimmed. The mother is now relaxed and comfortedThe mother is now relaxed and comfortedby her surroundings.by her surroundings. The nurse proceeds to explain to the mother aboutThe nurse proceeds to explain to the mother abouthow to hold her infant and get him to latch on to her breast.how to hold her infant and get him to latch on to her breast. She showsShe showsthe mother a pamphlet with pictures explaining how this is done.the mother a pamphlet with pictures explaining how this is done. TheThemother is still a bit nervous, so the nurse reassures her that she can domother is still a bit nervous, so the nurse reassures her that she can dothis, with explanations of how it benefits the baby.this, with explanations of how it benefits the baby. With this done, theWith this done, themother is ready to try breast feeding for the first time.mother is ready to try breast feeding for the first time.






The nurse is careful to continue reassuring the new mother and to assist her onlyThe nurse is careful to continue reassuring the new mother and to assist her onlywhen it’s necessary.when it’s necessary.

The nurse notices that the baby still will not latch on to the breast and immediatelyThe nurse notices that the baby still will not latch on to the breast and immediatelyintervenes before the mother gets discouraged.intervenes before the mother gets discouraged. An explanation is given thatAn explanation is given thatdifferent techniques can be used to hold the infant, so they are more comfortabledifferent techniques can be used to hold the infant, so they are more comfortableand can latch on better.and can latch on better. When the mother places the infant, with instruction fromWhen the mother places the infant, with instruction fromthe nurse, into the football position the latch on is successful.the nurse, into the football position the latch on is successful. Of course, the newOf course, the newmother is over joyed but asked the nurse what she will do if she is at home at cannotmother is over joyed but asked the nurse what she will do if she is at home at cannotget the baby to eat.get the baby to eat. The nurse is fully prepared and is able to get the new motherThe nurse is fully prepared and is able to get the new motherphone numbers for local support groups in her area.phone numbers for local support groups in her area.








QUESTION TO CASE STUDYQUESTION TO CASE STUDY

Given the previous scenario,what stage is the nurse inPatricia Benner’s Novice toExpert theory?


QUESTION TO CASE STUDYQUESTION TO CASE STUDY



ANSWERANSWER

•• The answer is the nurse is in the expert practitioner. SheThe answer is the nurse is in the expert practitioner. Sheperforms her education with ease even when the situationperforms her education with ease even when the situationchanges. She performs instinctively and knows her patientschanges. She performs instinctively and knows her patientsneeds automatically. She was able to diffuse a potentialneeds automatically. She was able to diffuse a potentialnegative situation with her patient before the patient gotnegative situation with her patient before the patient gotdiscouraged.discouraged. The nurse was fully prepared to answer allThe nurse was fully prepared to answer allquestions and provide outside resources (Nursingquestions and provide outside resources (NursingTheoriesTheories).).


ANSWERANSWER



REFERENCESREFERENCES

•• AlligoodAlligood, M. R. &, M. R. & TomeyTomey, A. M. (2010)., A. M. (2010). Nursing theorists and their workNursing theorists and their work (7th ed.).(7th ed.).

Maryland HeightsMaryland Heights,, MOMO: Saunders,: Saunders, Elsevier.Elsevier.

•• BennerBenner, Patricia. (2001)., Patricia. (2001). From Novice to Expert: Excellence and Power in ClinicalFrom Novice to Expert: Excellence and Power in Clinical

Nursing PracticeNursing Practice.. UpperUpper Saddle River, New Jersey: Prentice Hall Health.Saddle River, New Jersey: Prentice Hall Health.

•• Benner, P. (1982). From novice to expert.Benner, P. (1982). From novice to expert. The American Journal ofThe American Journal of NursingNursing

•• Pubmed.comPubmed.com

•• Google scholarly.Google scholarly.








REFERENCESREFERENCES















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