Application Of Benner's Theory To Nursing Practice

Outline of Benner’s Theory

Nursing is a practice of care that is maintained and promoted by the code of responsibilities and ethics. The journey of every expert nurse begins as a nursing student. The clinical setting, knowledge, and skills that student nurses gain from practical fieldwork enable them to gain expertise in their field. Dr. Benner started working in the field of nursing since the late 1960s and developed a theory that is known as the Benner’s Theory (Oshvandi et al., 2016). This essay aims to examine the Benner’s theory’s application to nursing practice. Firstly, the essay will offer an synopsis of Benner’s theory, next it will delineate five stages of clinical competency and the transition of nurses towards becoming an expert. Thirdly, the essay will explain the terms ‘advanced practice’ and recognize the functions of a ‘novice’ versus an ‘advanced nurse’. Lastly, the essay will relate the theory of Benner to two NMBA standards of practice.

Benner developed the concept that is now known as “From Novice to Expert”. According to this theory, student nurses acquire a thorough apprehension of patient care and over time also acquire the necessary skills from a combination of personal experiences and a strong educational foundation. She also proposed that skills and knowledge can be gained by nurses without ever learning the theoretical aspects of nursing care (Murray, Sundin & Cope, 2019). Benner’s theory is a situational model meaning that when a nurse educator is put in a distinct situation about which they have little to no experience, then the educator reverts to using theory and context-free rules to lead their action (Thomas & Kellgren, 2017).

Dr. Benner derived the model from Dreyfus Model of Skill so that nurses’ progress could be evaluated in a more objective manner. She used the Dreyfus model to apply the philosophy of learning to nursing (Ozdemir, 2019). According to Benner’s philosophy,

Dr. Benner derived the model from Dreyfus Model of Skill so that nurse’s progress could be evaluated in a more objective manner. She used the Dreyfus model to apply the philosophy of learning to nursing (Ozdemir, 2019). According to Benner’s philosophy, practical situation are complex in nature and formal methods such as theories, models, and textbook descriptions are not adequate to explain these complexities. To reach a higher level, the nurses must acquire necessary skills and demonstrate competence (Benner, 2021).

Benner’s theory comprises of 5 stages of clinical competence which describes the transitioning phase of nurses from students to an ‘expert’. The 5 stages include: ‘novice’, ‘advanced beginner’, ‘competent’, ‘proficient’, and ‘expert’ (Benner, 1984).

Stages of Clinical Competence

Novice is the first stage where the nurse has little to no experience and is a beginner. In this stage, they are first taught about the general rule which helps them in performing tasks by simply following the instructions (Benner, 1984).

The next stage is the advanced beginner stage where nurses have already gained some experience working in real situations and show acceptable performance. In this stage, nurses formulate their actions based on their experiences (Benner, 1984).

The third stage is the competent stage where the nurse has now acquired over 2-3 years of experience. In this stage, nurses gain understanding and knowledge of long- term goals and also gain an insight into their personal actions (Benner, 1984).

The fourth stage is proficient nurse where nurses are able to perceive and gain good understanding of the situation. At this stage nurses have gained sufficient understanding which gives them the ability to take decisions and also alter plans (Benner, 1984).

The last stage is expert nurse who do not rely on guidelines, and principles anymore to take actions. At this stage, nurses have a deep apprehension of situations and they work in clinical settings displaying flexible and proficient qualities. Therefore, to become an expert nurse, it is a pre-requisite for student nurses to gain experience through working in clinical settings (Benner, 1984).

The term ‘advanced practice’ in nursing refers to the field of nursing that expands and extends the extremities of the scope of practice of nursing and contributes to increased nursing knowledge and also promotes the advancement of the nursing profession. An advanced practice nurse is one who is actively involved in the creation of a care plan for the patient and also supervises other staff members, including the medical assistants and registered nurse professionals. Such a nurse also possesses expert knowledge on decision making, is clinically competent, and utilizes special knowledge to complete tasks (Schober, 2016).  They are also actively involved in clinical settings and play roles of a health care professional, educator, trainer, leader, and an advocate. Advanced practice nurses comprise of a specialized group that is considered to be formal clinical leaders who perform advanced clinical practice. Advanced nursing practice enables the nurses to promote patient safety at all costs and also positively influences the environment of the patient (Tappen, 2022). 

Benner in her theory has described how nurses transition from novice to an expert. Through the different stages, Benner has highlighted the difference between novice nurses and advanced nurses. A novice nurse is one who has been working in the profession for less than a year. They are beginners in the nursing field and have zero confidence. They do not rely on supporting clues, but on verbal clues which makes them incompetent to perform in real situations. Novice nurses are expected to be aware of the formal education that they received and are expected to act accordingly while gradually gaining experience (Hendricks-Ferguson et al., 2015). Novice nurses face a lot of emotional, intellectual, and physical changes during their transitioning phase when they evolve from a student to a professional nurse. They are also at an increased risk of making errors. Their primary functions include observing and assessing patient’s conditions and symptoms, recording medical histories of patient, administering medications, and monitoring medical equipments. Being aware of the updated scientific information also requires novice nurses to also instruct their colleagues in a hospital (Manoochehri, Imani, Atashzadeh-Shoorideh & Alavi-Majd, 2015).

Advanced Nursing Practice

An advanced practice nurse is one who has more experience and skills in comparison to a novice nurse. They hold expertise in the nursing field and act accordingly in real situations. Advanced practice nurse have expertise of the knowledge, possess efficient management skills, and also follow the code of ethics in professionalism. They also possess healthy advocacy skills and effectively advocate for their patients.  Functions of an advanced nurse differ from that of a novice nurse in many aspects. An advanced nurse is responsible for creating plans for patient care and treatment, and providing emotional care and support to clients and their families. They also play an effective role in educating patients regarding in- home treatments and offer instructions to patients for effectively managing their illnesses and injuries (Walker & Polancich, 2015).

The Registered nurses need to follow the standards that have been laid down by the NMBA. The Registered nurse standards comprise of 7 standards. Two NMBA Standards of Practice that relate to Benner’s Theory include the following: ‘thinking critically and analyzing nursing practice’ (standard 1), and ‘engaging in professional and therapeutic relationship’ (standard 2) (Nursing and Midwifery Board of Australia, 2017). 

Standard 1- According to this standard, nurses must utilize the best evidence based practice available to analyze the problem and implement safe practices to ensure that safe and quality nursing care is offered to the patients (Nursing and Midwifery Board of Australia, 2017).  Benner’s theory states that expert nurses, with much expertise are able to think critically during an emergency situation and act accordingly. They are able to achieve their goal by thinking analytically. Expert nurses also have the ability to solve problems by examining the cues, whereas novice nurses do not possess the ability to analyze cues and solve problems on their own. In comparison to novice nurses, advanced beginners are able to analyze the problems by learning from their own past experiences (Hughes, Johnston & Mitchell, 2021).

Standard 2- According to this standard, registered nurses must establish professional relationships by communicating effectively, advocating, delegating, supervising, and offering support to the patient to foster a trustworthy relationship (Nursing and Midwifery Board of Australia, 2017).  The nurses must establish relevant relationships to make a difference in professional and individual personal living. According to Benner’s theory, expert nurses are strong leaders and also advocate for their patients. They give necessary feedbacks and also offer instructions to patients whereas novice nurses have limited responsibilities and are not capable of establishing professional relationships. Novice nurses after transitioning to an expert nurse are capable of developing professional and therapeutic relationships.

Novice Nurses vs Advanced Nurses

Conclusion

In conclusion, this essay gave an insight finto the Benner’s Theory and its application to nursing practice. Dr. Benner is a nursing theorist, author, and educator who is most notably known for “From Novice to Expert: Excellence and Power in Clinical Nursing Practice”. According to Benner’s Theory there are 5 levels of nursing experience which include the following, ‘novice’, ‘advanced beginner’, ‘competent’, ‘proficient’, and ‘expert’. The essay has discussed in details each of the above mentioned stages. Next the terms ‘advanced practice’ was explained which refers to nursing practice which is knowledge-based, and that is used by advanced practice nurses to promote patient safety. The essay then identified and differentiated between the functions of a ‘novice nurse’ and an ‘advanced practice nurse’ A novice nurse is one who is a beginner in the nursing field and does not possess much advanced knowledge and skills related to nursing practice whereas and advanced nurse is a an expert in the nursing field and is capable of making own decisions. Lastly, the essay related Benner’s theory to standard 1 and 2 of NMBA standards of practice and highlighted how roles of novice nurse changes as they transition to being an expert in the field (Murray, Sundin & Cope, 2019).

References

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