The 4 Metaparadigms in Nursing as Defined by Patricia Benner

The 4 Metaparadigms in Nursing as
defined by Patricia Benner:
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 person‟s 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 I‟ll 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 nurse‟s 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 I‟ll 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 learner‟s 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