Page 154 - alligood 8th edition_Neat

CHAPTER 9 Patricia Benner 135

conveyed to the experiences they may have had with skilled know-how and action are linked” (Benner,
families of patients of any age who were dying. 1999, p. 316). The significance of Benner’s research
findings lies in her conclusion that “a nurse’s clinical
Accessibility knowledge is relevant to the extent to which its mani-
The model was tested empirically using qualitative festation in nursing skills makes a difference in pa-
methods; 31 competencies, 7 domains of nursing prac- tient care and patient outcomes” (Benner & Wrubel,
tice, and 9 domains of critical care nursing practice 1982, p. 11).
were derived inductively. Subsequent research suggests Generalization is approached through an under-
that the framework is applicable and useful for contin- standing of common meanings, skills, practices, and
ued development of knowledge embedded in nursing embodied capacities rather than through general ab-
practice. This approach to knowledge development stract laws that explain and predict. Such common
honors the primacy of caring and the central ethic of meanings, skills, and practices are socially embedded
care and responsibility embedded in expert nursing in nurse schooling and in the practice and tradition of
practice (Benner, 1999). nursing. The knowledge embedded in clinical nursing
The use of a qualitative process of discovering practice should be brought forth as public knowledge
nursing knowledge is more difficult to address the to further a greater understanding of nursing prac-
body of Benner’s work for critique. The qualitative tice. Benner (1984a) believes that the scope and
interpretive approach describes expert nursing prac- complexity of nursing practice are too extensive for
tice with exemplars. Benner’s work can be consid- nurses to rely on idealized, de-contextualized views of
ered as hypothesis generating rather than hypothesis practice or experiments. Benner (1992) stated, “The
testing. Benner provides a methodology for uncov- platonic quest to get to the general so that we can get
ering and entering into the situated meaning of ex- beyond the vagaries of experience was a misguided
pert nursing care. Altmann (2007) pointed out that turn . . . . We can redeem the turn if we subject our
criticism of Benner’s work has often developed from theories to our unedited, concrete, moral experience
misinterpretation of her philosophy as theory and and acknowledge that skillful ethical comportment
evaluation of her qualitative research with quantita- calls us not to be beyond experience but tempered
tive parameters. and taught by it” (p. 19).
The generalizations possible with the interpretive
Importance approach are depicted through exemplars that dem-
Although clinical nurses around the world enthusiasti- onstrate relational and contextually relevant intents
cally received From Novice to Expert (1984a), some and aspects of clinical knowledge. The applicability
academicians and administrators initially interpreted it and relevance of the common approaches used for
as promoting traditionalism and devaluing education universality or generalization in physics and the natu-
and theory for nursing practice (Christman, 1985). ral sciences are questioned by the interpretive ap-
Benner’s qualitative interpretive approach to interpre- proach, which claims that the basis for generalization
tation of the meaning and level of nursing practice has in clinical knowledge cannot be structural or mecha-
generated questions among some researchers. An on- nistic, but must be based on common meanings and
going debate has developed over cognitive interpreta- practices. Preferred strategies for generalization in
tions of Benner’s concepts of expertise and intuition clinical practice are based on the skilled knowledge,
(Benner, 1996b; Cash, 1995; Darbyshire, 1994; English, intent, content, and notion of good in clinical knowl-
1993; Paley, 1996). Scholarly debate around these phe- edge depicted by exemplars that illustrate the role of
nomenological concepts contributed to clarification of the situation.
the nature of the research approach. Benner claims that nurses need to overcome the
Benner’s perspective is phenomenological, not limits of subject-object descriptions. Her call is to
cognitive. She stated, “Clinical judgment and caring “increase public storytelling” to validate nursing as
practices require attendance to the particular patient an ethical caring practice, and “to extend, alter, and
across time, taking into account changes and what has preserve ethical distinctions and concerns” (Benner,
been learned. In this vision of clinical judgment, 1992, pp. 19-20). Benner (1996a) stated, “We have