Page 150 - alligood 8th edition_Neat

CHAPTER 9 Patricia Benner 131

• “Expertise develops when the clinician tests and further develop clinical knowledge; and Fenton
refines propositions, hypotheses, and principle (1984) reported the use of Benner’s approach in an
based expectations in actual practice situations” ethnographic study of the performance of clinical
(Benner, 1984a, p. 3). nurse-specialists.
Balasco and Black (1988) and Silver (1986a, 1986b)
used Benner’s work as a basis for differentiating
Logical Form clinical knowledge development and career progres-
Through qualitative descriptive research, Benner used sion in nursing. Neverveld (1990) used Benner’s ra-
the Dreyfus Model of Skill Acquisition to better under- tionale and format in her development of basic and
stand skill acquisition in clinical nursing practice. By advanced preceptor workshops. Farrell and Bramadat
following the model’s logical sequence, Benner was (1990) used Benner’s paradigm case analysis in a
able to identify the performance characteristics and collaborative educational project between a university
teaching-learning needs inherent at each skill level. In school of nursing and a tertiary care teaching hospital
reporting her research, Benner used exemplars taken to better understand the development of clinical rea-
directly from interviews and observation of expert soning skills in actual practice situations. Crissman
practice to help the reader form a clear picture of such and Jelsma (1990) applied Benner’s findings in devel-
practice. Guidelines for describing exemplars or clini- oping a cross-training program to address staffing
cal narratives, first termed “critical incidents” were imbalances. They delineated specific cross-training
presented in From Novice to Expert (1984a) and are performance objectives for novice nurses, but also
developed further in Clinical Wisdom and Interven- provided support for the experiential judgment
tions in Acute and Critical Care: A Thinking-in-Action needed to function in unfamiliar settings by designat-
Approach (Benner, Hooper-Kyriakidis, & Stannard, ing a preceptor in the clinical area. The aim is for the
2011). The approach for describing clinical narratives is novice to be able to perform more like an advanced
consistent throughout the body of Benner’s work beginner, with an experienced nurse available as a
whether the narratives are used in research, practice, or resource.
education. The goal of Benner’s research is to bring Benner’s approach continues to be used to aid in
meanings and knowledge embedded in skilled practice the development of clinical promotion ladders, new
into public discourse. Benner (1984a) claims that new graduate orientation programs, and clinical knowl-
knowledge and understanding are constituted by ar- edge development seminars (Benner & Benner,
ticulating meanings, skills, and knowledge that previ- 1999; Benner, Tanner, & Chesla, 2009; Coyle, 2011,
ously were taken for granted and embedded in clinical Hargreaves, Nichols, Shanks, & Halamak, 2010).
practice. Mauleon and colleagues (2005) conducted an inter-
pretive phenomenological analysis of problematic
Acceptance by the Nursing Community situations experienced by nurse anesthetists in
anesthesia care of elderly patients which indicated a
Practice need for ethical forums for dealing with moral dis-
Benner describes clinical nursing practice by using tress arising from their experiences. Uhrenfeldt
an interpretive phenomenological approach. From (2009) based their study of how first-line nurse
Novice to Expert (1984a) includes several examples leaders care for their nursing staff on Benner and
of the application of her work in practice settings Wrubel’s (1989) caring framework. Cathcart (2010)
as follows: Dolan (1984) describes its usefulness articulated the experientially acquired knowledge,
for preceptor development, orientation programs, skill, and ethics embedded in nurse manager prac-
and career development; Huntsman, Lederer, and tice following Benner’s approach.
Peterman (1984) detail their implementation of a Benner has been cited in nursing literature regard-
clinical ladder to recognize and retain experienced ing nursing practice concerns and the role of caring in
staff nurses; Ullery (1984) presents its usefulness for such practice. She continues to advance understand-
conducting annual excellence symposia where nurses ing of the knowledge embedded in clinical situations
present their clinical narratives to recognize and through her publications (Benner 1985a, 1985b, 1987;