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124 UNIT II Nursing Philosophies

MAJOR CONCEPTS & DEFINITIONS
Novice them rather than in terms of patient needs and
In the novice stage of skill acquisition in the Dreyfus responses (Benner et al., 1992). Advanced beginners
model, the person has no background experience feel highly responsible for managing patient care,
of the situation in which he or she is involved. yet they still rely on the help of those who are more
Context-free rules and objective attributes must experienced (Benner et al., 1992). Benner places
be given to guide performance. There is difficulty most newly graduated nurses at this level.
discerning between relevant and irrelevant aspects Competent
of a situation. Generally, this level applies to stu-
dents of nursing, but Benner has suggested that Through learning from actual practice situations
nurses at higher levels of skill in one area of practice and by following the actions of others, the advanced
could be classified at the novice level if placed in an beginner moves to the competent level (Benner,
area or situation completely foreign to them such as Tanner, & Chesla, 1992). The competent stage of
moving from general medical-surgical adult care to the Dreyfus model is typified by considerable con-
neonatal intensive care units (Benner, 1984a). scious and deliberate planning that determines
which aspects of current and future situations
Advanced beginner are important and which can be ignored (Benner,
The advanced beginner stage in the Dreyfus model 1984a).
develops when the person can demonstrate margin- Consistency, predictability, and time management
ally acceptable performance, having coped with are important in competent performance. A sense of
enough real situations to note, or to have pointed mastery is acquired through planning and predict-
out by a mentor, the recurring meaningful compo- ability (Benner Tanner, & Chesla, 1992). The level
nents of the situation. The advanced beginner has of efficiency is increased, but “the focus is on time
enough experience to grasp aspects of the situation management and the nurse’s organization of the task
(Benner, 1984a). Unlike attributes and features, world rather than on timing in relation to the patient’s
aspects cannot be objectified completely because needs” (Benner, Tanner, & Chesla, 1992, p. 20). The
they require experience based on recognition in the competent nurse may display hyperresponsibility
context of the situation. for the patient, often more than is realistic, and may
Nurses functioning at this level are guided by exhibit an ever-present and critical view of the self
rules and are oriented by task completion. They have (Benner, Tanner, & Chesla, 1992).
difficulty grasping the current patient situation in The competent stage is most pivotal in clinical
terms of the larger perspective. However, Dreyfus learning, because the learner must begin to recog-
and Dreyfus (1996) state the following: nize patterns and determine which elements of
the situation warrant attention and which can be
“Through practical experience in concrete situ- ignored. The competent nurse devises new rules
ations with meaningful elements which neither and reasoning procedures for a plan, while apply-
the instructor nor student can define in terms ing learned rules for action on the basis of relevant
of objective features, the advanced beginner facts of that situation. To become proficient, the
starts intuitively to recognize these elements competent performer must allow the situation to
when they are present. We call these newly guide responses (Dreyfus & Dreyfus, 1996). Stud-
recognized elements “situational” to distinguish ies point to the importance of active teaching and
them from the objective elements of the skill learning in the competent stage for nurses making
domain that the beginner can recognize prior to the transition from competency to proficiency
seeing concrete examples (p. 38).” (Benner, Tanner, & Chesla, 1996; Benner, Hooper-
Clinical situations are viewed by nurses who are Kyriakidis, & Stannard, 1999; Benner, 2005;
in the advanced beginner stage as a test of their Benner, Malloch, & Sheets, 2010). The competent
abilities and the demands of the situation placed on stage of learning is pivotal in the formation of