Page 144 - alligood 8th edition_Neat

CHAPTER 9 Patricia Benner 125

MAJOR CONCEPTS & DEFINITIONS—cont’d
the everyday ethical comportment of the nurse transition into expertise (Benner, Tanner, & Chesla,
(Benner, 2005). 1996).
Anxiety is now more tailored to the situation
than it was at the novice or advanced beginner stage, Expert
when a general anxiety exists over learning and per- The fifth stage of the Dreyfus model is achieved
forming well without making mistakes. Coaching at when “the expert performer no longer relies on
this point should encourage competent-level nurses analytical principle (i.e., rule, guideline, maxim) to
to follow through on a sense that things are not as connect an understanding of the situation to an
usual, or even on vague feelings of foreboding or appropriate action” (Benner, 1984a, p. 31). Benner
anxiety, because they have to learn to decide what is described the expert nurse as having an intuitive
relevant with no rules to guide them . . . Nurses at grasp of the situation and as being able to identify
this stage feel exhilarated when they perform well the region of the problem without losing time
and feel remorse when they recognize that their considering a range of alternative diagnoses and
performance could have been more effective or solutions. There is a qualitative change as the expert
more prescient because they had paid attention to performer “knows the patient,” meaning knowing
the wrong things or had missed relevant subtle signs typical patterns of responses and knowing the
and symptoms. These emotional responses are the patient as a person. Key aspects of expert practice
formative stages of aesthetic appreciation of good include the following (Benner, Tanner, & Chesla,
practice. These feelings of satisfaction and uneasi- 1996):
ness with performance act as a moral compass that n Demonstrating a clinical grasp and resource-
guides experiential ethical and clinical learning. based practice
There is a built-in tension between the deliberate n Possessing embodied know-how
rule- and maxim-based strategies of organizing, n Seeing the big picture
planning, and prediction and developing a more n Seeing the unexpected
response-based practice, as pointed out in our study The expert nurse has the ability to recognize pat-
of critical-care nurses (Benner, 2005. p.195). terns on the basis of deep experiential background.
For the expert nurse, meeting the patient’s actual
Proficient concerns and needs is of utmost importance, even if
At the proficient stage of the Dreyfus model, the it means planning and negotiating for a change in the
performer perceives the situation as a whole (the plan of care. There is almost a transparent view of the
total picture) rather than in terms of aspects, and self (Benner, Tanner, & Chesla, 1992).
the performance is guided by maxims. The profi-
cient level is a qualitative leap beyond the compe- Aspects of a situation
tent. Now the performer recognizes the most The aspects are the recurring meaningful situational
salient aspects and has an intuitive grasp of the components recognized and understood in context
situation based on background understanding because the nurse has previous experience (Benner,
(Benner, 1984a). 1984a).
Nurses at this level demonstrate a new ability
to see changing relevance in a situation, including Attributes of a situation
recognition and implementation of skilled responses The attributes are measurable properties of a situa-
to the situation as it evolves. They no longer rely on tion that can be explained without previous experi-
preset goals for organization, and they demonstrate ence in the situation (Benner, 1984a).
increased confidence in their knowledge and
abilities (Benner, Tanner, & Chesla, 1992). At the Competency
proficient stage, there is much more involvement Competency is “an interpretively defined area of skilled
with the patient and family. The proficient stage is a performance identified and described by its intent,
Continued