Development of Benner’s Philosophy of Expert Nursing Practice.
Benner identifies Virginia Henderson as a significant early influence on her nursing career (Benner & Wrubel, 1989).
Benner identifies Virginia Henderson as a significant early influence on her nursing career (Benner & Wrubel, 1989). Benner’s earlier work relating to expert nursing practice investigated the progression of skill acquisition for nurses based on the skill acquisition theory developed by philosopher Hubert Dreyfus and his brother, mathematician and systems analyst Stuart Dreyfus (Dreyfus & Dreyfus, 1980). It is important to clarify that Benner has consistently referred to this model as the “Dreyfus Model of Skill Acquisition.” Benner, rather than developing a model of skill acquisition, merely validated and extended the existing Dreyfus model to exemplify the process of skill acquisition in nursing. In addition, much of Benner’s writing is the result of collegial effort. For the sake of preventing redundancy, general references contained in this chapter to Benner’s work must be assumed to refer to Benner and colleagues.
Benner served as project director for the Achieving Methods of Intrapersonal Consensus, Assessment and Evaluation project from 1979 through 1981. This project was designed to identify differences between beginning and expert nurses’ clinical performance and situational appraisals (Benner, 1984/2001). A sample of 21 pairs of nurses in a preceptor relationship (newly graduated nurse and expert) was examined using an interpretive phenomenological method and structured using the Dreyfus Skill Acquisition Model (Dreyfus & Dreyfus, 1980). The pairs were interviewed separately and asked to describe a clinical incident that they had in common to determine if there were differences in the descriptions, indicating differing perceptions and approaches. In addition to the 21 pairs, 51 experienced nurses selected by administrators as being highly skilled, 11 new graduates, and five senior nursing students were interviewed (individual and small group) and/or observed to identify characteristics of performance in other skill levels of nurses. Six hospitals were represented. The results of this study are reported in From Novice to Expert: Excellence and Power in Clinical Nursing Practice (FNE). Findings indicated discernable differences in skill level between novices, advanced beginners, and competent, proficient, and expert nurses. Narrative descriptions were interpreted, and 31 nursing competencies were identified. These competencies were further examined and classified into seven domains of nursing practice. The information presented in FNE regarding skill acquisition domains of nursing practice provides a structure for later works in that frequent reference is made to the differences between inexperienced and expert nursing in terms of concepts such as critical thinking, intuition, and ethical agency.
While the levels of skill acquisition along with the related competencies and domains of nursing practice identified in FNE are frequently used as a framework for practice and education, Benner did not state an intent to develop an interpretive theory until the publication of Primacy of Caring (Benner & Wrubel, 1989). Here, Benner and Wrubel comment on the limitations of existing nursing theories in capturing the essential human issues that are central to nursing. They state, “A theory is needed that describes, interprets, and explains not an imagined ideal of nursing, but actual expert nursing as it is practiced day by day” (p. 5) with a goal to “make visible the hidden significant work of nursing as a caring practice” (p. xi). Benner and Wrubel note, “This book is devoted to an interpretive theory of nursing practice as it is concerned with helping people to cope with the stress of illness” (p. 7).