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An evaluation of the seminal work of

Patricia Benner: Theory or philosophy?
a
Tanya K Altmann
a
Assistant Professor of Nursing Division of Nursing Sacramento
State University Sacramento CA, USA
Published online: 17 Dec 2014.

To cite this article: Tanya K Altmann (2007) An evaluation of the seminal work of Patricia Benner:
Theory or philosophy?, Contemporary Nurse, 25:1-2, 114-123, DOI: 10.5172/conu.2007.25.1-2.114

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 Copyright eContent Management Pty Ltd. Contemporary Nurse (2007) 25: 114123.

An evaluation of the seminal

work of Patricia Benner:
Theory or philosophy?
ABSTRACT The purpose of this article is to review the seminal work of Patricia Benner, From
Novice to Expert, in order to assert it as a philosophy and not a theory. In the
Downloaded by [University of Western Ontario] at 03:52 13 April 2015

literature there is no clear consensus on where this model stands theory or

philosophy.There is no intent to devalue Patricia Benners work as it is valuable
and has become widely used in nursing practice, research, education and adminis-
tration. However, as a philosophy, Benners interpretive work is more constructive.
Appropriate use of this model requires an understanding of whether it is a
theory or a philosophy, its underpinnings and an assessment of its development
Key Words and testing.This can be accomplished by knowing the differences between a
nursing theory and a philosophy and by reviewing the ways of knowing and processes of
philosophy; reasoning which are necessary for skill acquisition. Much of the critique of
Patricia Benners work falls into two categories: it is not quantitative research and there
Brenner; novice are issues with the use of narratives. These will be reviewed. Judgment and

CN
to expert; skill
acquisition; understanding of the nature of Benners model allows for its appropriate use in
theory journal articles, research, or other projects and/or modification as necessary.
Received 15 March 2006 Accepted 29 March 2007

cern with the development of explanatory

frameworks for understanding the nature of
nursing practice and the development of nursing
expertise. Her research, unlike that of many of
TANYA K ALTMANN her contemporaries, progressed from practice
Assistant Professor
of Nursing to a useful model. It can be argued that this
Division of Nursing model is more practical when used as a philoso-
Sacramento State
University
phy. A nursing philosophy can be defined as the
Sacramento CA, USA study of the principles underlying conduct,
thought and the nature of the nursing practice.
atricia Benner has provided essential under- Philosophy begins when someone contemplates,
P standing of how knowledge and skills are
acquired and directly applied to nursing prac-
or wonders, about something. Key to the discus-
sion of whether Benners model is a philosophy
tice, education, research and administration. is understanding the basis of her work and her
Specifically, her work indicates a growing con- premises.

114 CN Volume 25, Issue 12, MayJune 2007

 An evaluation of the seminal work of Patricia Benner:Theory or philosophy?
SUMMARY OF BENNERS FROM
NOVICE TO EXPERT
Patricia Benner was the author and project
director of a federally funded grant titled:
Achieving Methods of Intraprofessional Consen-
sus, Assessment and Evaluation Project (the
AMICAE Project). This research attempted to
discover and describe knowledge embedded in
nursing practice. It led to the publication of
Benners first book in 1984, From Novice to
Expert and numerous articles.The AMICAE Pro-
ject was an interpretive, descriptive study that
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led to the use of Dreyfus five levels of compe-
tency to describe skill acquisition in clinical
nursing practice (Brykczynski 2002: 169).
The Dreyfus Model of Skill Acquisition (orig-
inally developed with pilots) considers advance-
ment in skilled performance, based upon
experience as well as education, clinical knowl-
edge development and career progression in
clinical nursing (Myrick & Barrett 1992: 55).
The model posits that individuals, while acquir-
ing and developing skills, pass through five lev-
els of proficiency: novice/beginner, advanced
beginner, competent, proficient and expert.The
five different levels reflect changes in three gen-
eral aspects of skilled performance:
1. A move from a reliance on abstract prin-
ciples to the use of past concrete experi-
ences;
2. A change from viewing a situation as multi-
ple fragments, to seeing a more holistic
picture with a few relevant factors; and
3. A movement from detached observer to
active performer.
A move from novice to expert is characterized
by the transition from explicit rule-governed
behavior to intuitive, contextually determinate
behavior. Progression from novice to expert is
not guaranteed; not every nurse becomes an
expert.
The Dreyfus model provides the concepts
needed to differentiate between what can be
taught by precept and what must be learned
Volume 25, Issue 12, MayJune 2007
CN
experientially from comparison of similar and
dissimilar cases (Benner 1984: 186). It is im-
portant to understand that Benners and Drey-
fuss work was specifically directed at proposing
a viable alternative to traditional ways of under-
standing practice, theory and knowledge; not to
devalue science.
Benner believes that skilled pattern recogni-
tion can be taught and will lead to advancement
through the stages. This teaching is done by
a holistic assessment of the situation, not by
breaking the situation down into individual
parts. Immediate feedback about the accuracy
of this type of clinical judgment is required.
Benner has continued to research nursing
knowledge. Benner, Tanner and Chesla (1996)
used the Dreyfus Model in an attempt to identi-
fy educational strategies that encourage the
development of expertise.
PHILOSOPHICAL UNDERPINNINGS
Benners ideas are based on the difference
between practical and theoretical knowledge
(Cash 1995: 527). Practical situations are more
complex than they initially appear. Benner
asserted that formal models, theories and text-
book descriptions were inadequate to explain
practical situations in their complexities. Both
experience and mastery are necessary for a skill
to be transformed to a higher level skill. Other
central tenets underpinning Benners philosophy
are the connections between external and inter-
nal events (English 1993). Benner believes that
nurses develop and accrue, global sets and para-
digms about patients.These paradigms develop
expert intuition and sets not readily apparent to
the outside observer. Expert nurses use empir-
ics, ethics and personal knowledge. Benner
espouses that individuals interpret their own
concerns, practices and life experiences. Persons
are always situated; they are engaged meaning-
fully within the context of the situation.
Benners model has been criticized for not
being quantitative; her research used a qualita-
tive approach. The philosophical basis of Ben-
CN 115
 CN Tanya K Altmann
ners work challenges the traditional notion of
objective science (Darbyshire 1994). It uses a
Heideggerian phenomenological approach. In
particular, Benner uses the Heideggerian ap-
proach as interpreted by Dreyfus.The Heideg-
gerian approach is an interpretive approach
where synthesis, rather than analysis, is used.
Conclusions are derived from interviews, expe-
rience, and/or observations. Benner justifies her
use of interpretive research stating that it allows
a manageable yet rich description of actual nurs-
ing practice (Benner 1984: 39). This view is
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gaining support from the research community as
qualitative research becomes more respected.
Benners model could also considered to be
hermeneutic (interpretive) and holistic. In her-
meneutics,observation and narrative accounts of
actual nursing practice provide the text for in-
terpretation (Brykczynski 2002: 169). Although
Benners model fits this description, she des-
cribes her work as interpretive phenomenology.
Phenomenology describes the meaning of the
lived experiences, the human experiences, for
several individuals about a concept or the phe-
nomenon (Creswell 1998).
Qualitative research is an inquiry process
designed to help understand events, situations
and individuals. Since Benners model deals
with the way in which skills are learned, under-
standing the ways of knowing is pivotal.
WAYS OF KNOWING
In 1978, Carper described four patterns of
knowing in nursing: empirics, moral/ethical
knowledge, personal knowing and aesthetics.
These ways of knowing are all valid and essen-
tial, to the professional nurse although Benner
only specifically discusses ethical and personal
knowing.
Empiric refers to traditional research that is
quantitative and has factual descriptions, expla-
nations, or predictions based on subjective or
objective group data. Benner does not specifi-
cally address the issue of empiric knowledge,
116 CN Volume 25, Issue 12, MayJune 2007
but refers to the expert as having synthesized
experience and theory.
Moral or ethical knowledge incorporates
descriptions of moral obligations, what is right
and what is wrong and our desired ends. Benner
states that for the practicing clinician, ethical
and clinical knowledge are inseparable. Clini-
cians deal with ethical principles relating to
patients rights, autonomy and beneficence in
everyday decision making. It is the emotional
responses of the nurse which acts, to an extent,
as his or her moral compass (Nelson 2004).
Clinical experiences and nurses stories provide
the necessary background understanding for
everyday ethical comportment and for formal
ethical judgments (Benner et al. 1996: 233).
Personal knowledge is the expression of the
quality and authenticity of the interpersonal
relationships.We acquire personal knowledge,
at least in part, by immersing ourselves in prac-
tice. Benner discusses experiential learning
where knowledge is acquired by the appren-
tice observing the master within a social con-
text. Benner admits that sometimes background
personal knowledge can interfere with expert
practice.
Aesthetics, the art and act of nursing, is the
expression of the nurses belief of what is the
deeper meaning in an individual patients behav-
ior.When actions are taken, they are a result of
synthesis of all forms of knowing. Benoliel (as
cited in Carper 1997) agreed that Benners
study provided evidence that expert nurses
used empirics, ethics and personal knowledge
and the action they took reflected an esthetic
sense of what was significant in the situation and
contributed to care that can best be described as
holistic (p. 332).
The ways of knowing described in Benners
philosophy include all of those proposed by
Carper (1978) and Polanyi (1958) although
Carper is not explicitly referenced. Benner
emphasizes intuition, or tacit knowing (a term
coined by Polanyi) and the experiential knowing
of the expert nurse. The use of intuition has
 An evaluation of the seminal work of Patricia Benner:Theory or philosophy?
been criticized as a non-scientific type of
knowledge.
Benner explains that the terms expertise or
expert are used to describe mere personality
traits or a collection of talents which could be
gathered up and pronounced as expert.
Expert practice is characterized by a specific
mode of thinking evolved from the merger of
knowledge, skill and experience (Effken 2001:
247). Expertise is a function of experience and
ability to negotiate through complex clinical sit-
uations (Nelson and McGillion 2004).
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Benner also discusses the difference between
knowing that and knowing how. Kuhn (1970)
and Polanyi (1958) suggest that know how are
the skills acquired without knowing that. It is
not always possible to theoretically account for
our know how for many common activities
because advanced levels are based on embodied
intelligence.The imperious distinction of know-
ing-that from knowing-how reflects or embod-
ies or at least fails to challenge the bias that pure
knowledge is something noble, more elevated
than that applied knowledge that guides
action (Dickoff and James 1997: 656). Knowl-
edge is often separated from intuition and ex-
perience.
Experience is more than the passage of time
or longevity. When experience is studied, the
focus of the research is no longer on the event
but on the individuals (Allen and Cloyes 2005).
It is the refinement of preconceived notions
and theory through encounters with many actu-
al practical situations that add nuances or shades
of differences to theory (Benner 1984: 36). It is
the learning of exceptions, shades of meaning
and individual contexts that are acquired
through concrete experiences. As the nurse
develops, he/she encounters experiences which
have such an impact that they change his/her
perceptions and become paradigm cases. Often
paradigm cases are too complex to be exempli-
fied through cases or simulations; interactions
with the individuals prior knowledge created
the experience and refines, or turns around,
Volume 25, Issue 12, MayJune 2007
CN
preconceptions and prior understanding. Expe-
rience is a requisite for expertise. The essence
of intuition is the recognition of previously
experienced patterns and the detection of sub-
tle clinical changes (Benner 1984).
Polanyi (1958) describes tacit knowledge as
our cognitive processes or behaviors that are
performed without reference to a conscious
effort on our part. Essentially, we all know more
than we are able to say.Tacit knowledge is some-
thing we just know or do because we have had
multiple exposures or experiences in the focus.
The term tacit knowledge does not evoke the
negative stereotype associated with intuition.
Characterized as direct perception, intuition
is an observable, lawful phenomenon that is
measurable, potentially teachable and appropri-
ately part of nursing science (Effken 2001:
252). Benner proposes that intuition can be
developed subconsciously and/or purposively.
The later is developed through education and
extensive, deliberate practice with appropriate
exemplars.We acquire our intentions in various
ways and one of them is by making a decision.
To decide is to form an intention deliberately, in
other words, by reasoning. Practical reasoning is
the processes of reasoning that concludes in an
intention. Theoretical reasoning concludes in a
belief. All arguments are either abductions,
inductions, deductions, or mixed arguments.
The whole operation of reasoning begins with
abduction.
PROCESSES OF REASONING
Abduction, or retroduction, permits the re-
searcher to investigate phenomena and make
inferences and explanations as to why something
might be true. Abduction consists in examining
facts or data describing something to suggest a
theory or hypotheses that best explains the
data (Nubiola 2000). Inductive reasoning moves
from specific observations to broader general-
izations. Deduction is a form of reasoning that
moves from general to specific.
Benners philosophy is based on her study in
CN 117
 CN Tanya K Altmann

which she identified 31 interpretively defined
skills and then grouped them into seven domains
of nursing, based on similarity of function and
intent. In other words, Benner identified specific
skills which she generalizes into groups, thus
using inductive reasoning. McKee, Abel and
Bonafini-Nordin (n.d.), agree by stating that
Benners model was developed inductively from
data collection and that the seven domains were
derived inductively from the competencies
themselves.
According to Meleis (1991), a theory with
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this light. It is also appropriate to evaluate her
work using some qualitative categories.
The two most referenced critiques of Ben-
ners model are by English (1993) and Cash
(1995). Common areas of critique are a lack
of social knowledge or structure, difficulty in
testing, methodological difficulties and a bias
toward the positive.
Thompson (1990), Purkis (1994) and Rudge
(1992) criticized Benners model because of its
apparent absence of social structure or social
knowledge. It is seen as lacking acknowledge-

a constructive beginning is also called a deduc-
tive theory because it emphasizes a conceptual
structure deduced from another conceptual
structure (p. 228). A constructive beginning is
not only hypothetical but is intended to develop
a picture of more complex phenomena. Benner
used the Dreyfus model to construct her final
model but, according to her, it was utilized after
the 31 skills were identified. Although she did
not set out to test Dreyfus model, Benner
found the model facilitated explanations of her
findings.The Dreyfus model allowed Benner to
move her findings from the practice setting to
an explanation to a model for nursing practice.
Meleis (1991) states that a principle theory
beginning, or inductive beginning, is more
empirically grounded (discovered) is more
analytical and addresses the is rather than the
ought to be (p. 228). Benner shows how
embedded knowledge is and its stages, not
how it should be. Her findings validated that
the Dreyfus model can be usefully applied to
nursing. This supports Benners model as in-
ductive and deductive. But was this theory
development?
CRITIQUE OF THE MODEL
It is through the critique of a model that one
can determine whether the model is useful,
needs modification, or should be set aside. Most
of the written critiques of Benners model tar-
get aspects expected from quantitative research
hence, it is appropriate to evaluate her work in
ment of how nursing practice both depends
on and reproduces social conventions, social
knowledge and arrangements of power. In her
defense, Benner claims that clinical knowledge
is socially embedded and that knowledge is situ-
ated historically and in a community context.
The question is: What does Benner mean by
socially embedded and historically situated?
Operational definitions are needed for testing of
concepts.The terms expertise and intuition do
not have operational definitions.The terms have
been described phenomenologically. Structured
measurement has been elusive because of the
complexity of the domain and the degree to
which skill is embedded in a particular situation
(Effken 2001: 247).The criterion for expertise
appears to contain an experience element as
well as a recognition element, but is it possible
to recognize this objectively? Since Benner uti-
lizes peer assessment and the experts them-
selves for evaluation, the concept of expertise
seems arbitrary. The criterion that the expert
or expert practice is characterized by the use of
intuition therefore seems to be too general. It
might be a necessary condition of expertise but
it is not sufficient (Cash, 1995: 533).
According to English (1993: 387), the stages
are merging points on a continuum which
impede measurement. Along this continuum,
Benner does not demonstrate what suddenly
happens to transition a nurse from one stage to
another.There is no guidance to assist nurses to
become experts. In fact, Benner states that not

118 CN Volume 25, Issue 12, MayJune 2007

 An evaluation of the seminal work of Patricia Benner:Theory or philosophy?
all nurses will become experts without explain-
ing why.
Methodological problems include sampling
limitations, a bias toward the positive and the
use and interpretation of the narratives. Most of
Benners interviews were conducted with criti-
cal care nurses as individuals or in small groups,
the nurses were presorted based on experience
and/or managers evaluations and observational
data is not included. Researchers treat partici-
pants as if they have direct and always-accurate
access to their own minds and to the experi-
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ences that are stored therin (Allen & Cloyes
2005: 100). This leads to questions of internal
validity or credibility and difficulty generalizing
the findings.
Benners model is interpretive, thus, it is
alarming that her model is frequently cited
in the nursing literature as if her findings
were quantitative. Interpretation is subjective in
nature for both the individual telling the experi-
ence and the researcher.The subjectivity of the
participant should lead to questioning the valid-
ity and appropriateness of judging expertise
based on first person accounts (Nelson &
McGillion 2004). In Benners model,the mean-
ings of the narratives produced by the nurses,
the interpretations made by the researchers and
the clinical practices of the nurses are treated by
Benner, in effect, as if they were identical (Pad-
gett 2000: 256). Benner and her colleagues
offer only one interpretation of the narratives
without discussion of the conceptual learning
and background of the researcher. It is not
known if the interpretation given is the only
possible one, the most plausible one, or the
most interesting one. It has been suggested that
the differences in narratives between novices
and experts may demonstrate changes in lan-
guage, more than changes in practice.
In qualitative research, simply engaging in
the research project sets the stage for question-
able narratives. The researcher, whether con-
sciously or not, places the interviewees under
pressure by first preparing the participant for
Volume 25, Issue 12, MayJune 2007
CN
the interview and setting the stage; this often
includes coaching the participants in order to
create the desired interview milieu (Nelson &
McGillion 2004: 634). These raise both philo-
sophical and methodological questions about
the use of subsequent narratives in research.
All of the narratives utilized by Benner, in
support of her philosophy, emphasize excel-
lence, success and beneficence (a bias toward
the positive). Benner proceeded the recording
of the narratives with asking participants to
think of exemplary, as oppose to ordinary or
unpleasant, situations in which they made a dif-
ference (Nelson & McGillion 2004). The good
of the patient is always the focus, yet the
patients point of view is never expressed. The
experts judgment is seldom faulty and intu-
itions are always timely and fruitful. Negative
exemplars, when used, deal with boundary dis-
putes and power issues, mostly with physicians,
not between nurses or with patients. It could be
argued that, as such, these exemplars do not
display the common events in nursing practice.
Critique of the model does not invalidate it
but evokes thoughtful consideration and analy-
sis. Analysis also involves discussion of the mod-
els development.
THEORY DEVELOPMENT
Theory synthesis is a strategy of constructing a
theory from empirical evidence in which the
theorist may combine information from various
sources during theory building (Walker & Avant
1995: 156). Aspects may be borrowed but are
not changed.
In contrast, theory derivation is the process
of using analogy to obtain explanations or pre-
dictions about a phenomenon in one field from
the explanations or predictions in another field
(Walker & Avant 1995: 171). In this process,
the theorist moves either a whole set of interre-
lated concepts or a whole structure from one
field to another, then modifies them to fit the
new field.
CN 119
 CN Tanya K Altmann

It has been argued that Benners model,
although based on the Dreyfus model, was not
borrowed from another field but was specifically
designed for nursing (McKee et al. nd). Benner
contradicts this statement. Benner acknowl-
edges that she utilizes the same five stages which
Dreyfus posited. The stages are utilized after
Benners initial observations of 120 nurses
and identification of 31 skills. They are used
unchanged from Dreyfus model, thus Benner
utilized theory synthesis suggesting that the
model provides a theory for nursing instead of a
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with how knowledge is embedded in nursing
practice. It does not, however, attempt to
answer questions related to the development of
theory.
A theory is both more precise and more lim-
ited in scope than its parent conceptual scheme,
thus can be tested. Many studies have been con-
ducted which tested aspects of the model, yet no
articles were found that specifically tested Ben-
ners model. In fact, McKee et al. (nd) contend
that because of the subjective nature of intuition,
it cannot be defined or measured objectively or

philosophy. But does it meet the definition of a
theory?
THEORY OR PHILOSOPHY?
When determining if a model best fits the defi-
nition of a theory or philosophy, it is helpful to
review each along with how each is developed.
This should be done in conjunction with provid-
ing examples from the model in question.
In reviewing many theory texts, both in nurs-
ing and learning, neither Benner nor Dreyfus
received mention consistently. In Schunk (1996),
there is a section on Novice-to-Expert Re-
search Methodology which is surprisingly lack-
ing any reference to either Benner or Dreyfus.
Walker and Avant (1995) outline four levels
of theory development:
1. meta-theory
2. grand nursing theories
3. middle-range theory and
4. practice theory.
Using these levels, Padgett (2000: 255) states
that the Dreyfus Model might then be consid-
ered as a sort of middle-range theory, useful
because it is testable . According to McKee et
al. (nd), Benners theory is only approaching
being a mid-range theory.
A meta-theory focuses on philosophical and
methodological questions related to the devel-
opment of a theory base for nursing (Walker &
Avant 1995: 5). Benners model is close to this
kind of theory as it is philosophical and deals
consistently.Within a theory, its concepts should
be both conceptually and operationally defined
so that the theory can be consistently used and
tested. As previously discussed, operational defi-
nitions are not specified.
Benner believes that her model has been test-
ed since many interviews were conducted with
nurses. Also, the model was based on the Drey-
fus Model of Skill Acquisition which had been
proven valid. Benner validated the Dreyfus
model as it related to nursing practice, with her
systematic description of the five stages of skill
acquisition.
Chitty (2005), in a text on professional nurs-
ing, lists Benners work as a philosophy. Mar-
riner-Tomey (1994) and Marriner-Tomey and
Alligood (2002), in their books on nursing the-
orists, list Benners model as a philosophy or
philosophical theory.This second classification
adds to the confusion about whether it is a
theory or philosophy.
A philosophy is defined as the exploration
of effects which underlie reality by questioning
the nature of things using logical/practical rea-
soning instead of empirical methods (Marriner-
Tomey 1994). The purpose of developing a
philosophy of nursing is to shape and guide
nursing practice. Benners model fits this des-
cription best because it investigated how nursing
proficiency developed and why it developed dif-
ferently for each nurse.The model relies on per-
sonal narratives which are a kin to confessions
and are subject to embellishment or manipula-

120 CN Volume 25, Issue 12, MayJune 2007

 An evaluation of the seminal work of Patricia Benner:Theory or philosophy?
tion to meet expectations. Narratives are used as
foundational exploration of reality and must be
empirically validated in order to become theory.
Benner maintains that practical knowledge
may extend theory or be developed before sci-
entific formulas. Clinical situations are always
more varied and complicated than theoretical
accounts; therefore, clinical practice is an area
of inquiry and a source of knowledge develop-
ment (Brykczynski 2002: 167). Benners method-
ology has been criticized as not being empirical
because it was not developed from quantitative
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research. This point could be methodologically
argued.
CRITIQUE OF THE MODEL
AS A THEORY
Although Benners model most closely fits the
definition of a philosophy, certain aspects can be
critiqued as if it were a theory. This is done
to demonstrate the value of the model. Meleis
(1991) describes a method for critiquing a
theory suggesting the following areas be asses-
sed: clarity, consistency, simplicity verses com-
plexity, visual representation, contagiousness,
usefulness (in practice, research, education and
administration), values (personal, other profes-
sionals and social) and social significance.
Clarity denotes precision of boundaries, a
communication of a sense of orderliness, vivid-
ness of meaning and consistency throughout the
theory (Meleis 1991: 231). Benner provides
theoretical definitions for all major concepts,
but not the operational definitions necessary for
empirical measurement. She follows the logical
sequence developed by Dreyfus, does not devi-
ate by introducing other concepts and states
her philosophy simply and briefly. Benners phil-
osophy is general, yet situation dependent; it
encompasses many aspects of nursing from stu-
dents through expert practitioners and espouses
a broad range of applications within nursing
such as in administration and research.
Consistency is determined by evaluating the
congruency between each component of a theo-
Volume 25, Issue 12, MayJune 2007
CN
ry. Benners model contains concepts which are
consistent with each other and are consistently
utilized. Since first proposing the philosophy,
Benner has continued to research the phenome-
na and has not changed her concepts. This is
difficult to quantify, however, since specific oper-
ational definitions have not been articulated.
Simplicity verses complexity relates to the
number of phenomena the theory considers and
the relationships which could develop. Depend-
ing on the purpose of the theory, either simplic-
ity or complexity could be preferred. The
model is relatively simple in regard to the five
stages of skill acquisition and it provides a com-
parative guide for identifying levels of nursing
practice from individual nurse descriptions and
observations of actual nursing practice (Brykc-
zynski 2002: 177). The essence of the model is
easy to grasp and explain. A degree of complex-
ity is, however, encountered when trying to dif-
ferentiate between the stages and exactly what
prompts progression.
Visual representations of the theory may fur-
ther enhance its clarity. Benner does not present
a visual representation, but the stages can be
referred to as being along a continuum. Prog-
ress along this continuum is sequential from
novice to expert, but may include regression
when the nurse is in an unfamiliar situation.
Contagiousness is whether or not it is adopt-
ed by others (Meleis 1991: 232) and must look
at the geographical location and type of institu-
tion which adopted the theory.This philosophy
has been adopted in many countries and by
many different types of institutions.This is evi-
dent, in a simple form, by reviewing the litera-
ture, noting articles from different countries
and relating to different uses of the philosophy.
Benners model has been adapted by schools
of nursing, hospitals, social agencies and by
developers of nursing continuing education
programs.
Assessing the usefulness of a theory includes
its usefulness in practice, research, education
and administration. Benners model has been
CN 121
 CN Tanya K Altmann
utilized in all areas to be assessed (Darbyshire
1994; Effken 2001; McKee et al. nd; Shapiro
1998). Benners model has become the founda-
tion for preceptor programs for students and
new graduate nurses (Myrick & Barrett, 1992),
as well as continuing education programs. Many
research studies have been conducted based on
the concepts proposed by Benner. Many schools
of nursing adopted this model as a basis for pro-
viding education, as noted by English (1993).
Nursing administration has utilized this model
to develop career ladders, staff development
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and recognition and rewards programs (Nelson
& McGillion 2004).
Values include those of the theorist and the
critic, other professions and society.Values are
not explicitly identified in this philosophy.This
philosophy was borrowed from another profes-
sion which demonstrates congruence. The
knowledge level of the practicing nurse is espe-
cially important to the individual receiving the
care, thus to society.
Finally, the social significance must be
assessed because in our attempt to enhance
nursing science and articulate the discipline of
nursing we must not neglect the significance of
its practice to humanity and society (Meleis
1991: 237).This model is proposed as a method
for determining the expert practitioners and
developing more expertise in practitioners.This
has social ramifications as it is optimal to have
the best, most knowledgeable, practitioners
providing care.
CONCLUSION
Benners model in its current form provides a
philosophy for nursing. It is seminal qualitative
research which lays the foundation for under-
standing nursing expertise and skill acquisition.
This philosophy began with nursing practice
and with an understanding that practical situa-
tions were more complex than they appear.
Benner uses a Heideggarian phenomenological
approach in her research. Conclusions are
drawn from interviews, experience and obser-
122 CN Volume 25, Issue 12, MayJune 2007
vations. The nurses experience and skill mas-
tery are said to be necessary for expert nursing
practice. Experience leads to intuition, ethical/
moral reasoning and personal knowledge. This
model uses practical reasoning, looks at what
effects underlie reality and proposes a guide
to shape nursing practice all qualities of a
philosophy.
Most criticisms of this philosophy focus on
the facts that the research was qualitative and
had not subsequently been quantitatively vali-
dated. Another concern is that the work trusted
both in the value of narratives and in the in-
dividuals ability to articulate experiences ac-
curately. These criticisms do not devalue but
model but make it more practical as a philoso-
phy rather than a theory.
From Novice to Expert is coherent, well
written, most importantly, strongly theoreti-
cally grounded (Cash 1995: 527). It provides a
framework that supports lifelong learning for
nurses, thus is applicable to nursing practice,
research and education. It relates the use of
both theoretical and practical knowledge and is
particularly useful as a philosophy.
Acknowledgement
The faculty of Duquesne University School of
Nursing who stimulated my thinking through-
out my doctoral work and encouraged publi-
cation.
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