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134 UNIT II Nursing Philosophies

(http://www.educatingnurses.com) provides video- A degree of complexity is encountered in the
taped teaching resources, curriculum development, subconcepts for differentiation among the levels of
and teacher training resources, and NovicetoExpert. competency and the need to identify meanings and
org (http://www.NovicetoExpert.org) offers online intentions. This interpretive approach is designed to
evidence-based learning and applies the recommen- overcome the constraints of the rational-technical
dations of the Educating Nurses study. In addition, approach to the study and description of practice.
an educational newsletter was initiated to share Although a de-contextualized (object) description
study recommendations and create ongoing dialog of the novice level of performance is possible, such
with nurse educators (Benner, 2011; 2012b, 2012c; a description of expert performance would be diffi-
2012d). cult, if not impossible, and is of limited usefulness
because of the limits of objectification. In other
Critique words, the philosophical problem of infinite regress
would be encountered in attempts to specify all the
Clarity aspects of expert practice. Rather, a holistic under-
The clarity of Benner’s Novice to Expert model has standing of the particular situation is required for
led to its utilization among nurses around the world. expert performance.
An identification with the idea of clinical wisdom and
varying levels of clinical expertise development pro- Generality
gressed very quickly. Benner’s work not only contrib- The Novice to Expert skill acquisition model has uni-
uted to appreciative understanding of clinical practice versal characteristics, that is, it is not restricted by age,
but also revealed nursing knowledge embedded in illness, health, or location of nursing practice. How-
practice. ever, the characteristics of theoretical universality
imply properties of operationalization for prediction
Simplicity that are not a part of this perspective. Indeed, this
Benner has developed interpretive descriptive phenomenological perspective critiques the limits of
accounts of clinical nursing practice. The concepts universality in studies of human practices. The inter-
are the levels of skilled practice from the Dreyfus pretive model of nursing practice has the potential
model, including novice, advanced beginner, compe- for universal application as a framework, but the
tent, proficient, and expert. She used these five descriptions are limited by dependence on the actual
concepts to describe nursing practice based on in- clinical nursing situations from which they must be
terviews, observations, and the analysis of tran- derived. Its use depends on an understanding of the
scripts of exemplars that nurses provided. From five levels of competency and the ability to identify
these descriptions, competencies were identified, the characteristic intentions and meanings inherent at
and these were grouped inductively into seven do- each level of practice.
mains of nursing practice on the basis of common Although clinical knowledge is relational and
intentions and meanings (Benner, 1984a). Benner contextual and involves local, specific, historical is-
and colleagues’ (1996) study of critical care nursing sues, it is generalizable in terms of the translation of
explored the differentiation of levels of practice in meanings to similar situations (Guba & Lincoln,
depth and suggested that nurses at different levels 1982). To capture the contextual and relational as-
live in different worlds. Benner’s ongoing articula- pects of practice, Benner uses narrative accounts
tion research has produced nine domains of critical of actual clinical situations and maintains that this
care nursing practice (Benner, Hooper-Kyriakidis, approach enables the reader to recognize similar in-
& Stannard,1999). The model is relatively simple tents and meanings, although the objective circum-
with regard to the five stages of skill acquisition, stances may be quite different. An example of
and it provides a comparative guide for identifying generalizability or transferability as used here fol-
levels of nursing practice from individual nurse lows: Upon reading or hearing a narrative about a
descriptions and observations and interpretations nurse connecting with a family whose child is dying,
validated by consensus. other nurses can relate the knowledge and meanings