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Introduction
Nurse experts begin as nursing students. Students are overwhelmed by the practice of an expert nurse and fail to see their own progression toward expert practice. In her book, From Novice to Expert, Patricia Benner (1984) describes research that applies the Dreyfus model of skill acquisition to clinical nursing. This article describes how Benner's research provides a paradigm that assists nurse educators and students to see clinical practice as a developmental process. This paradigm was implemented in a senior level clinical nursing course in an articulated associate degree/baccalaureate degree (AS/BS) program. Believing that quality nursing practice is born of quality nursing education, the faculty wish to share their successful experience.
Benner's Research
Benner's (1984) research applied the Dreyfus model of skill acquisition to clinical practice as reported by expert nurses. Her research revealed the knowledge that is embedded in actual nursing practice accrued over time. Benner's study also revealed how nurses change their intellectual orientation, integrate and sort out knowledge, and refocus decision-making based on perceptual awareness rather than on process orientation. From her research, Benner identified five levels of nursing proficiency and seven domains of nursing practice.
The Dreyfus model posits that in skill acquisition, a student passes through five levels of proficiency: novice, advanced beginner, competent, proficient and expert (Benner, 1984). Novices are persons who have had no experience of the situations in which they are expected to perform. Their rule-governed behavior is limited and inflexible. Advanced beginners are those who demonstrate marginally acceptable performance and relate with recurring meaningful situational components. Compétents begin to see their action in terms of deliberately planned, long-range goals with clear priorities. Proficients perceive situations as wholes and their performance is guided by maxims and keen perception. Experts have an enormous background of experience with an intuitive grasp of each situation. They zero in on the accurate region of the problem and are fluid, flexible, and highly proficient (Benner, 1984).
Benner (1984) also describes seven domains of nursing practice. These domains were derived inductively from 31 competencies that emerged from an analysis of descriptive patient care episodes. The domains are: the helping role, the teaching-coaching function; the diagnostic and patient monitoring function; effective management of rapidly changing situations; administering and monitoring therapeutic interventions and regimens; monitoring...