Benner's Theory as Applied to Research

Benner's Novice to Expert model of skill acquisition received substantial interest from the moment it was first published on 1984. It has received significant amount of recognition especially from nurse educationalists who highly considered incorporating it in formulating and improving the nursing curricula. It is evident, then, that in the past few years after its initial publication, the said model was being employed as a significant underpinning concept of several research articles aimed at gaining deeper knowledge and understanding as well as improving the nursing practice in general. 

Explicating Benner’s concept of expert practice: intuition in emergency nursing

Benner’s practice development theory is widely accepted for all stages except for the existence or efficacy of intuitive practice, a characteristic of the expert practitioner. The study explored, through an interview, the experiences of emergency nurses in relation to intuition.

The analysis resulted in the reconstruction of Benner’s expert stage into three distinct phases:

1.       Cognitive intuition, where assessment is processed subconsciously and can be rationalized in hindsight;

2.       Transitional intuition, where a physical sensation and other behaviors enter the nurse’s awareness; and

3.       Embodied intuition, when the nurse trusts the intuitive thoughts.

The findings validate the use of intuitive decision-making as a construct in explaining expert clinical decision-making practices. The validity of intuitive practice should be recognized. It is essential to recognize the conditions that support practice development, and in the prenovice stage (during their university course) factors such as reflection, research (in its broadest sense) and clinical curiosity should be fostered.

Reference:

LYNEHAM J . , PARKINSON C. & DENHOLM C. (2008) Explicating Benner’s concept of expert practice: intuition in emergency nursing. Journal of Advanced Nursing 64(4), 380–387.

A Model to Describe the Relationship between Knowledge, Skill, and Judgment in Nursing Practice

In 2006, Evans and Donnelly strived to further investigate on the interrelationship and the evolution of knowledge, skill, and judgment in a nurse’s practice. In their paper entitled “A Model to Describe the Relationship between Knowledge, Skill, and Judgment in Nursing Practice”, they tried to focus on other aspects that define the nursing practice rather than on the accomplishment of tasks and psychomotor skills alone. Drawing on Benner’s theory of Novice to Expert, where she stated that the decision making skills of the nurses changes as they go through the different levels, the model also proposes that skills, knowledge and judgment do not remain static, as well.

The emphasis in the said article is that the practice of nursing is not solely reliant on the performance of skills and nursing actions. It is, in fact, a more complex phenomena revolving around the interrelatedness of several factors including knowledge and judgment which are also continuously improving as a nurse advances in the ladder of nursing practice moving from novice to expert.

Reference:

Evans, R. & Donnelly, G. (2006). A Model to Describe the Relationship Between

Knowledge, Skill, and Judgment in Nursing Practice. Nursing Forum Volume 41, No. 4

Nurse Competence Scale: development and psychometric testing

Benner’s Novice to Expert Theory has also been widely used as a significant basis in formulating tools in assessing a nurse’s level of competence. In a study entitled: Nurse Competence Scale: development and psychometric testing (2004), researchers aimed to design and test an evidence-based model that could assess a nurse’s level of competence in different hospital work environments. Through the utilization of Benner’s theory, the researchers were able to formulate and validate the Nurse Competency Scale (NCS) tool which consists of a 73-item scale distributed into seven categories as follows:

1.       helping role (seven items)

2.       teaching–coaching (16 items)

3.       diagnostic functions (seven items)

4.       managing situations (eight items)

5.       therapeutic interventions (10 items)

6.       ensuring quality (six items)

7.       work role (19 items)     

The result of the study clearly suggests the validity of the said tool. This study also emphasized the importance of integrating competence assessment models into quality assurance systems and human resources management as a way to develop workforce planning and career opportunities of practicing nurses. 

Reference:

Meretoja, R., Isoaho, H. & Leino-Kilpi, H. (2004). Nurse Competence Scale: development and psychometric testing. Journal of Advanced Nursing, 47(2), 124–133

Embodied dispositions or experience?

Identifying new patterns of professional competence

It is known that Benner has proposed nursing competence to be achieved in a five-stage process which is from novice to expert. This is commonly viewed as a developmental linear progression. The study has tested the theory by exploring nurses’ competence in terms of admission assessment. This was achieved  by comparing experienced (expert) nurses and inexperienced (novice) nurses through a stuctured observation.

The finding is that each nurse had unique patterns of practice that did not correspond to the level of competence expected in relation to their length of experience as a nurse. Nurses’ competence seems to be situational rather than related to levels in the developmental model: in some observed variables, inexperience nurses acted as experts, while experienced nurses acted as advanced beginners, contrary to the expectations of Benner.

Further empirical research is needed to clarify the apparent links between situation and competence.

Reference:

RISCHEL V., LARSEN K. & JACKSON K. (2008) Embodied dispositions or experience? Identifying new patterns of professional competence. Journal of Advanced Nursing 61(5), 512–521.