Nursing is a caring practice maintained by the art & code of ethics and responsibilities. Nursing is an open relationship between the nurse and the patient. Every expert nurse begins as a nursing student. Clinical practice is a very important term for nursing education. The clinical setting is important for the learning process which covers the most part of their curriculum. The student nurses gain knowledge and practice skill from fieldwork which helps then to become the expert. Dr. Benner introduced the concept that expert nurses develop sound knowledge of skill and understanding of patients through time periods of educational learning and many experiences. The Benner mentions the nurse gain learning and skill with experiences on patients or industrial field without ever learning the theory.
Nursing skills as experiences in the situation are necessary for becoming an expert. Benner theorizes how a nurse should progress through their career. The knowledge and expertise of nurse practice mainly identified in the clinical settings or situations rather than having the expedition generated capabilities in models. The purpose of the paper is mainly to explore the Benner’s Theory “Novice to Expert”. This paper also depicts the clinical competence of theory, their relationship with the NMBA and the concept of advanced nursing practice with stages of transition through which the nurse becomes the expert. Benner’s theory The “Novice to expert” model is introduced by Dr. Benner in 1892. This model is generated from the Dreyfus Model of Skill and Acquisition. Benner discuss in model how individuals gain new knowledge from becoming novice to expert. Benner shows how the nurse attains the nursing knowledge, skill, scientific competence of patient care through theoretical training and experimental learning.
This theory first instance on clinical skills such as giving the injection, monitoring the blood pressure, the skill of effective hand washing and so on. As the novice nurses has to follow the essential skills and progress their learning to become expert from novice. According to Benner (1984), the practice knowledge is only developed when nurses passes through the clinical situations. The Novice to expert also describes the expertise of patient care which is results from practicing the various nursing experiences in clinical settings. The model depends upon the three important aspects: Moving from past concrete experiences to abstract principals. Changing the perception in a demanding situation. Journey from detached observer to become the involved performer.
STAGES OF CLINICAL COMPETENCE
Benner’s five stages of clinical competence as following the Dreyfus model, through which it becomes possible to describe the performance characteristics at each level of development. Novice: The novice are student graduates and having no experience of any situations and work under the clear guidance of the instructor to demonstrate acceptable or safe performance. Novice has as following lack of confidence.Advanced Beginner: Advanced beginner are new graduates, perform the acceptable performance because of having the little experience of previous situation which them efficient and skilled in some parts of field but have to follow the guidelines to perform in real situationsCompetent: Competent nurse is having experience of two or three years in some clinical settings. Competent begin to see the action in terms of plans and goals. Competent are efficient in skill and confident to provide the patient care in suitable time with supportive clues.Proficient: The experience of three to five year in clinical practice make them proficient. Proficient nurses perceive the situation as a whole rather than chopped up it in parts and know-how to modify the plan in response to a specific situation by making good decisions.Expert: Expertise in their field and have the enormous previous experiences and grasp each situation easily. Exert nurses work in the field with deep understanding and high skill. Expert make decision in any present situation by analyze the problem. APPLICATION OF
BENNER’S THEORY
Advanced practice nurse: The advanced practice nurse is a person who is an expert in knowledge-based on complex, decision making, skills, and clinical competence. Advanced practice nursing is specialized knowledge used by the expert nurse to complete the complex task and capable to play a role in clinical settings as health care, teaching job, researcher, leadership quality, advocacy. The advanced nurses are certified and are able to play job roles as Certified nurse anesthetists, Certified obstetric nurse, Clinical nurse specialist, Certified practice nurse. The advanced nurses are a specialized group of health care nurses. For example, the expert nurse act as a good leader. Advanced practice nurses in administrative and management roles are considered as formal leaders while those who perform the clinical advanced practice are defined as clinical leaders. The advanced nurse is prepared to influence the patient’s environment and promote patient safety. Due to advanced nursing practice, the positive effect on the patient is shown as there is a decrease in the risk of patient falls, decrease the risk of infections during the insertion of catheters, intervenous infusions. The standards of anesthetic practice are improved.
Benner’s theory relation with NMBA standards :
The nurse and midwifery board of Australia set some standards for nurses. The nurse has to fulfill the criteria to become a registered nurse. The registered nurse practice consists of seven standards. Benner consist of five stages of clinical competence which are related to NMBA standards as;
Thinks critically and analyses nursing practice: The nurse uses the best available evidence to analyses the problem to make the safe practical practice to patients. The expert nurses are much expertise in this field. The expert nurse thinks during the action in the situation presently. The proficient nurses required maxims to achieve certain goals but have analytic thinking. The competent nurse also has the ability to analyze the problem with supporting clues. The novice nurse depends on verbal clues for performance, do not their own analyzing ability. As compared to novice the advanced beginner can analyses by learning from their previous field experiences.
Develop a plan for nurse practices: The advanced practice nurse used the knowledge, experiences, patient assessments as shreds of evidence for making the priorities based plan, goals, and actions to improve the quality of practice. The expert nurse modified the goals which are time-specific and person specialized. The novice nurse is only capable of performing the objective tasks. The competent nurse can establish the goal and can not modify it accordingly to facilitate the relevant outcome. The proficient nurse has a holistic understanding of the field and can use the direction guides for modifying the goals.Engages the therapeutic and professional relationship: The nurse has to established relevant relationship in clinical settings in such a way that make difference in individual personal and professional living. The expert nurses are strong clinical leaders and act as advocates that coach the supportive exchange of instructions and feedbacks necessary for effective clinical skills. The novice is limited in rules, don’t establish certain relationships.
Novice versus advanced nurse: Benner describes the stages of clinical competence in theory. Benner mentions in stages the ways the beginner passes to become the expert. Benner shows the difference between novice and advanced nurses. The novice is a beginner in the field with zero confidence, relay on the verbal clues and not allow to perform in actual situations. On the other side advanced nurse having expertise knowledge of field, management skills, show code of ethics in professionalism, health advocacy social actions Stages of transition: According to Benner the nurse should have to pass the five stages and moves toward the level of progress. Novice: Benner defines the novice as the beginner with no experience of the situation in which they have to perform. The first stage of nursing career with a lack of experience and having no judgment of situations. The Benner states that for novice nurses to develop the skill, the nurse must be put in clinical situations. In terms of developing skilled nursing knowledge they are trained in terms of objective parameters like TPR, weight, intake output like that are recognized without situational experiences. They are inflexible and always limited to governed rules and have limited performance.Advanced beginners: The next level of skill acquisition is advanced beginners. The Benner describes the advanced nurse, “ the one who demonstrates acceptable performance by recognizing previous experiences.
The nurse develops the principals based upon the previous experiences and use them as a guide to make their activities in the field. They have to complete the task with the rules. The nurse by following the concrete experiences as novice moves to the advanced beginner stage. Competent: A competent nurse has gained two to three-year experience in the same field. Benner states that a competent stage develops when “ the nurse starts establishes his or her plans for action in real situations”. Competent nurses plan the goals based on conscious, abstract and well analytic reviewing of problems. Deliberate planning shows the skill level that makes her efficient and organized. Proficient: The proficient nurse perceives the situation as a whole rather than chop it into parts. Benner explains that proficient nurses having holistic understanding which improves the decision-making skills of nurses. Proficient recognize the situation and find the most salient and important features to detect the problem. The proficient nurse learned from the experimental events and use those maxims to provide direction for patient care. The nurse with experience of five years in the same field established all these qualities and said to be proficient nurses.
Expert: The next level of skill acquisition model is an expert nurse who is flexible and highly proficient. The expert nurse has a deep understanding of the field and highly skilled. Benner theorizes that expert nurse no longer relies on guidelines, have analytic grasp of situation and enormous past experiences, that are utilized to attain the actions. The nurse becomes expert when passing through the various stages and develops the advanced features in her skill such as using the knowledge in practice, critical thinker, well judgment of the situation, act as a strong clinical leader and develop coaching and mentoring skill. Being an expert the nurse play the role in advanced practice.Conclusion: Every clinical situation provides the experience to nurse for learning. Clinical practice is such a tool that helps the nurse to find a deep knowledge of experiences.
This paper discuss about Benner theory “ novice to expert” that explain the levels of clinical competencies through which the nurse transition to become the expert and provide the advanced practice patient care. This study states the application of advanced nursing in various fields and their relation with standards to NMBA. This paper discusses the function of novice nurses versus advanced nurse. Thus understanding of the skill level of the student help them to learn experimentally. Benner’s theory has motivational forces both the student nurse novice and the expert which facilitates the development in their career leading to excellence and power in their clinical experiences.
References
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