1 BENNER’S THEORY Introduction and outline: Dr. Benner had categorised nursing expertise development into five important levels of capabilities. During the period of acquisition and development of a skill, every nursing professional are seen to pass through five important stages of proficiency. Studies are of the opinion that she believed experiences in the clinical setting is the main key for developing nursingknowledgeandskills(Alligood,2017).Thisismainlybecausethenursing professionals can only develop knowledge base and can expand their knowledge and skills through experiences only. This would help them to provide holistic as well as competent care for the patients. The research that she conducted was mainly aimed at discovering if there had been any characteristics as well as distinguishable differences in the description of the same clinical incident between the novice and expert. This assignment would help in depicting the featured of each of the stages and would show how this theory can be successfully applied in nursing practise. Stage: The theory include stages namely novice, advanced beginner, competent, proficient as well as expert. The first stage is mainly described as“novice”. In this stage the nursing professionals usuallydo nothaveanyexperiencesof situationswheretheyneedtoperform.The professionals are seen to lack confidence for effective demonstration of safe practices. They are also seen to require continual physical as well as verbal cues (Elhami et al., 2018). The professionals need to be in practice in this stage for prolonged period of time and they are unable to utilise any discretionary treatment.
2 BENNER’S THEORY Thesecondstageiscalledtheadvancedbeginnerstagewherethenursing professionals are seen to demonstrate marginally acceptable performances. This is mainly because the nurse had been successful in developing prior experiences in real life situations. Such nursing professional is found to be skilful and efficient in certain parts of the practices and requires occasional supportive cues. However, the knowledge development is yet in the preliminary stages and continues to develop through further experiences (Flott & Lindel, 2016). The third stage is called thecompetent stage. The skill of competence is demonstrated by the nursing professionals who had been in the profession in the similar or same situations for about two or three years. These professionals are able to demonstrate efficiency and are coordinated and confident in the actions. For nurses in this stage, any plans developed by them can seen to establish a perspective and these plans are entirely based on considerable conscious, analytic contemplation as well as abstract of the problem (Sajadi et al., 2018). The characteristics of these skill levels are conscious, deliberate planning. This helps in achieving efficiency as well as organisation. However, the researchers are of the opinion that acre is completed within a suitable time frame without any form of supporting cues from mentors. The fourth stage is called the proficient stage. When the nursing professionals reach the stage, they are seen to perceive situations as wholes rather than in terms of chopped up aspects or parts. Proficient nurses are seen to develop the ability of understanding the situation as a whole. This is said so because they are seen to perceive its meanings in the form of long term goals. The proficient nurses are seen to learn from different experiences about the typical events that can be expected in the situations and how different plans need to be modifying for effectively responding to the stated events (Padilha et al., 2018). They also develop the ability to understand when the expected picture of the events might not materialise. Researchers are of the opinion that holistic understanding mainly helps in
3 BENNER’S THEORY improvement of the decision making ability of nursing professionals. Studies are also of the opinion that professional nurses also have to undertake less labour when they reach this stage. This is because within this time, they develop the capability to develop perspectives about which of the many existing attributes as well as aspects are significant in the immediate situations. The last stage of the model is called theExpert stage. The nursing professionals in this stage is seen to develop an ability by which they can have intuitive grasp of every situation and can thereby zero on the accurate aspects of the problem without wastefully considering of the large range of unfruitful alternative diagnoses as well as solutions. Such nursing professionals are seen to develop a deep understanding of the total situation (Gomez et al., 2015). Studies suggest that their performances become flexible and fluid along with high proficiency. They are successfully able to apply highly skilled analytical ability which is extremely significant for situations with which the nurse had no previous experiences. Use in nursing practice: Thomasetal.(2015)hadputforwardaninterestingideaabouthownursing stimulation facilitators can develop an important tool for competency development following Benner’sframework.Researchershaveopinedinthisstudythatanursestimulation facilitator, in order to progress from one level of performance to another along the five stage continuum, need to move from resilience on abstract principles to the utilisation of past and concrete forms of experiences as paradigms. It has been seen that as they progress, perception and understanding of the situations are seen to shift from a group of equally relevant components to that of the holistic paradigms where certain parts become more relevant. This study has also outlined another important point. A nurse educator can be expert in one method of teaching while a novice at another (Attard et al., 2014). Therefore, following the
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4 BENNER’S THEORY model in each of the identified incompetence level, the researchers had put forward nine content areas which nursing educators need to develop to move through the five stages from novicetoexpertsuccessfully.Theseare“technology,scenariodesign,debriefing, teaching/learning strategies, curriculum integration, evaluation, realism, standardized patients, and simulation management”.The researchers stated that when the nine content areas can be successfully applied to the stimulation educator application of novice to expert at appropriate levels of knowledge, skills and attitudes of nurses, professionals can become expert in each of the skills successfully. Oshvandi et al. (2016) has provided much important information about how the model of Benner had become successful in ensuring effective nursing practice and development of expertise among the professionals. The study had found that the effective integration of the Benner’s model as well as nursing education programs can help in the improvement of the intuitive knowledge as well as the knowledge gained from the practices of the nursing professionals. They have also found that when student nurses are educated by effective integration of the Benner’s model as well as with different simulation techniques, it results in providing students with positive experiences. This help in making them enable to manage patients in a more effective and proper manner and also helps in cooperating with their colleagues for effectively solving issues related to patients (West et al., 2016). The study also states about the possibility of using this model in assessing the competency of practitioners in performing special tasks and finding strategies in improvement of the performances. This study also reveals that with the help of this theory, the employees can evaluate their own performance and skill level and thereby compare them with that of the others. This theory helpsinprovidingametrictotheprofessionalsforevaluatingtheirperformanceof themselves and their subordinates.
5 BENNER’S THEORY In another paper by Thomas et al. (2017), step by step application procedures for analysing the skills levels of stimulation facilitators had been identified. In the novice stage, researchers had found that novice facilitators start relating known educational theories for effective stimulation in an inflexible linear manner. This is mainly because they fail in judging the relative importance of the various aspects of stimulation for different educational situations. In the advanced beginner stage, the simulators try to attend to the individualised simulation scenarios at the same time while relating it to the bigger curriculum levels. They graduallytendtounderstandhowtheirexperiencesasclinicianscanbesuccessfully incorporated in simulation. They start feeling the complexities of the situations and they cannot manage the vast knowledge that had been acquired. Hence they use checklists. In the competent stage they had already gone through various positive and negative simulation experiences. They no longer need checklists as they have mastered the standardised tasks and developed new rules for the action. In the proficiency level, the professionals have developed perceptual skills that help them in effective identification of the significant learner issues for follow up. In the expert stage, the facilitators are seen to use “vision, confidence, ability to rationalizeappropriaterisks,driveandenergy,competitivespirit,self-criticism,and leadership qualities” for advancement of the field. Hence with the help of this model, trainers can understand the development of facilitator skills and accordingly provide interventions for developing expert facilitators. Maranon and Pera (2015) had also discussed about its impacts in nursing profession successfully.Theyhavestatedthatthemodelisexceptionallyusefulindeveloping knowledge in clinical placements in comparison to that of theoretical knowledge. Acquired theoretical knowledge can only restrict to development of a particular specific limit of knowledge but clinical placements can result in varied types of experiences and hence developing new varied knowledge. They are also of the opinion that this model is highly
6 BENNER’S THEORY important for people in clinical placements as it guides them in self evaluation about their owndevelopmentofexpertiseandmakesthemunderstandtheircompetencylevels successfully. Conclusion: The Benner model of novice to expert states that in order to to acquire and develop new skills, a student needs to pass through five important steps. These are novice, advanced beginner,competent,proficient,and expert.Thismodelshowshowthrough effective experiences, nurses can gradually develop knowledge and skills for effectively providing holistic acre to patients. Along with the achievement of each level, nurses gain confidence and become more competent in providing expertise care successfully. They are also found to be important not only for students but also for nurse educators in developing their skills for training and mentoring new nurses.
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