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Patricia Benner introduced the 4 metaparadigms of nursing - nursing, person, health, and environment. She described 5 levels of nursing experience from novice to expert based on skills and understanding gained over time through education and experience. The levels are novice, advanced beginner, competent, proficient, and expert. As nurses progress from one level to the next, they move from relying on rules to using past experiences to guide care and see situations more holistically.
Descrizione originale:
Metaparadigms of Nursing,
Foundations of Nursing,
Nursing Theories,
Patricia Benner
Titolo originale
The 4 Metaparadigms in Nursing as Defined by Patricia Benner
Patricia Benner introduced the 4 metaparadigms of nursing - nursing, person, health, and environment. She described 5 levels of nursing experience from novice to expert based on skills and understanding gained over time through education and experience. The levels are novice, advanced beginner, competent, proficient, and expert. As nurses progress from one level to the next, they move from relying on rules to using past experiences to guide care and see situations more holistically.
Patricia Benner introduced the 4 metaparadigms of nursing - nursing, person, health, and environment. She described 5 levels of nursing experience from novice to expert based on skills and understanding gained over time through education and experience. The levels are novice, advanced beginner, competent, proficient, and expert. As nurses progress from one level to the next, they move from relying on rules to using past experiences to guide care and see situations more holistically.
Nursing Patricia Benner described nursing as an enabling condition of connection and concern (Marriner-Tomey, 1989, p192) which shows a high level of emotional involvement in the nurse-client relationship. She viewed nursing practice as the care and study of the lived experience of health, illness, and disease and the relationships among these three elements.
Person Benner stated that 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. A person also has an effortless and non-reflective understanding of the self in the world. The person is viewed as a participant in common meanings. (Tomey, 2002 p173) Benner believed that there are significant aspects that make up a person. She had conceptualized the major aspects of understanding that the person must deal as: 1. The role of the situation 2. The role of the body. 3. The role of personal concerns. 4. The role of temporarility. Health Patricia Benner focused on the lived experience of being healthy and ill. She defined health as what can be assessed, while well-being is the human experience of health or wholeness. Well- being and being ill are recognized as different ways of being in the world. Health is described as not just the absence of disease and illness. Also, a person may have a disease and not experience illness because illness is the human experience of loss or dysfunction, whereas disease is what can be assessed at the physical level. Environment Instead of using the term environment, Benner used the term situation, because it suggests a social environmentwith social definition and meaning. She used the phenomenological terms of being situated and situated meaning, which are defined by the persons engaged interaction, interpretation an understanding of the situation.
Patricia Benner Nursing Theory: From Novice to Expert LEVELS OF NURSING EXPERIENCE She described 5 levels of nursing experience as;
Novice Advanced beginner Competent Proficient Expert Stage 1: Novice Beginners have had no experience of the situations in which they are expected to perform. Novices are taught rules to help them perform. The rules are context-free and independent of specific cases, hence the rules tend to be applied universally. The rule- governed behavior typical of the novice is extremely limited and inflexible. As such, novices have no life experience in the application of rules. Just tell me what I need to do and Ill do it
Stage 2: Advanced Beginner Advanced Beginner are those who can demonstrate marginally acceptable performance, those who have coped with enough real situations to note, or to have pointed out to them by a mentor, the recurring meaningful situational components. These components require prior experience in actual situations for recognition. Principles to guide actions begin to be formulated. The principles are based on experience.
Stage 3: Competent Competence, typified by the nurse who has been on the job in the same or similar situations two or three years, develops when the nurse begins to see his or her actions in terms of long-range goals or plans of which he or she is consciously aware. For the competent nurse, a plan establishes a perspective, and the plan is based on considerable conscious, abstract, analytic, contemplation of the problem, The Conscious, deliberate planning that is characteristic of this skill levels help achieve efficiency and organization. The competent nurse lacks the speed and flexibility of the proficient nurse but does have a feeling of mastery and the ability to cope with and manage the many contingencies of clinical nursing. The competent person does not yet have enough experience to recognize a situation in terms of an overall picture or in terms of which aspects are most salient, most important.
Stage 4: Proficient The proficient performer perceives situations as whole rather than in terms of chopped up parts or aspects, and performance is guided by maxims. Proficient nurses understand a situation as a whole because they perceive its meaning in terms of long term goals. The proficient nurse learns from experience what typical events to expect in a given situation and how plans need to be modified in response to these events. The proficient nurse can now recognize when the expected normal picture does not materialize. The holistic understanding improves the proficient nurses decision making; it becomes less labored because the nurse now has a perspective on which of the many existing attributes and aspects in the present situation are the important ones.
Stage 5: The Expert The expert performer no longer relies on an analytic principle (rule, guideline, maxim) to connect her or his understanding of the situation to an appropriate action. The expert nurse, with an enormous background of experience, now has an intuitive grasp of each situation and zeroes in the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnosis and solutions. The expert operates from a deep understanding of the total situation.
Patricia Benner Nursing Theory: From Novice to Expert Seven Domains of Nursing Practice Helping role Teaching or coaching function Diagnostic client-monitoring function Effective management of rapidly changing situations Administering and monitoring therapeutic interventions and regiments Monitoring and ensuring quality of health care practices Organizational and work-role competencies
From Novice to Expert P a t r i c i a E . B e n n e r
Introduction 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. She coneptualizes 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; 1. Novice 2. Advanced beginner 3. Competent 4. Proficient 5. 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 Ill 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 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: 1. Movement from relying on abstract principles to using past concrete experiences to guide actions 2. Change in learners perception of situations as whole parts rather than in separate pieces 3. 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. 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
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