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132 UNIT II Nursing Philosophies

Benner & Tanner, 1987; Benner, Tanner, & Chesla, realized that learning needs at the early stages of
1996, 2009; Benner, Hooper-Kyriakidis, & Stannard, clinical knowledge development are different from
1999, 2011). Benner edited a clinical exemplar series those required at later stages. These differences need
in the American Journal of Nursing during the 1980s. to be acknowledged and valued to develop nursing
In 2001, she began editing a series called “Current education programs appropriate for the background
Controversies in Critical Care” in the American Jour- experience of the students.
nal of Critical Care. Benner’s work with the National In Expertise in Nursing Practice, Benner, Tanner,
Council of State Boards of Nursing constitutes a and Chesla (1996) emphasized the importance of
major contribution to error recognition and enhance- learning the skills of involvement and caring
ment of the safety of nursing practice (Benner, Sheets, through practical experience, the articulation of
Uris, et al., 2002). This research examines practice knowledge with practice, and the use of narratives
breakdowns from a systems perspective, with the goal in undergraduate education. This work provides
of transforming the culture of blame in the health further support for the thesis that it may be better
care system to dramatically reduce health care errors to place a new graduate with a competent nurse
(Benner, Malloch, & Sheets, 2010). preceptor who can explain nursing practice in ways
that the beginner comprehends, rather than with
Education the expert, whose intuitive knowledge may elude
Benner (1982) critiqued the concept of competency- beginners who do not have the experienced know-
based testing by contrasting it with the complexity of how to grasp the situation. This work, now in its
the proficient and expert stages described in the second edition (Benner, Tanner, & Chesla, 2009),
Dreyfus Model of Skill Acquisition and the 31 compe- led to the development of internship and orienta-
tencies described in the AMICAE project (Benner, tion programs for newly graduated nurses and to
1984a). In summary, she stated, “Competency-based clinical development programs for more experi-
testing seems limited to the less situational, less inter- enced nurses.
actional areas of patient care where the behavior can In Clinical Wisdom in Critical Care, Benner,
be well defined and patient and nurse variations do Hooper-Kyriakidis, and Stannard (1999) urged greater
not alter the performance criteria” (1982, p. 309). attention to experiential learning and presented the
Fenton (1984, 1985) applied the domains of clini- work as a guide to teaching. They designed a highly
cal nursing practice as the basis for studying the interactive CD-ROM to accompany the book (Benner,
skilled performance of clinical nurse specialists Stannard, & Hooper-Kyriakidis, 2001). The second
(CNSs). Her analysis validated that the CNSs studied edition (Benner, Hooper-Kyriakidis, & Stannard,
demonstrated competencies in common with those 2011) includes a chapter on the educational implica-
skills of expert nurses reported in the AMICAE proj- tions of this research on knowledge embedded in
ect. She also identified additional areas of skilled acute and critical care nursing and incorporating
performance for CNSs, including the consulting the teaching approaches recommended in Benner,
role, and she delineated five preliminary categories Sutphen, Leonard, & Day (2010). Two major types of
relevant for curriculum evaluation in the graduate integrative strategies presented in the 2011 edition are
program. Ethical, clinical, and political dilemmas, multiple examples of coaching situated learning and a
positions, or stances that promote success or failure, thinking-in-action approach to integrating classroom
and new knowledge that blends the empirical and the with clinical teaching.
theoretical were among these categories. A national study of nursing education was de-
According to Barnum (1990), it was not Benner’s signed to identify and describe “signature pedago-
development of the seven domains of nursing prac- gies” that maximize the nurse’s ability to cope with the
tice that has had the greatest impact on nursing edu- challenges of nursing that have developed during the
cation, but the “appreciation of the utility of the 30 years since the last national study of nursing edu-
Dreyfus model in describing learning and thinking in cation (Schwartz, 2005). The book Educating Nurses
our discipline” (p. 170). As a result of Benner’s appli- (Benner, Malloch, & Sheets 2010) reports details
cation of the Dreyfus model, nursing educators have of this national study of nursing education, and it