In medical sciences, nursing research is of particular importance. The history of nursing begins with the distant past, and during its existence, it has undergone many changes and revisions, especially in recent decades. One of the most prominent figures in this field is Patricia Benner, who has developed a theory of nursing skills and professionalism. Her approach, based on a philosophical understanding of the concept of care, has become one of the most important works for beginners and practicing nurses. This essay aims to analyze Patricia Benner’s theory of nursing.
History of Nursing
Nursing as an organized profession with its theories and practices is a relatively recent phenomenon. However, throughout history, medical practice and care for the sick and wounded have tended to be provided by their relatives, since the nursing profession did not yet exist. Treatment and subsequent rehabilitation usually took place at home (Egenes, 2017). People who participated in the therapy were prone to traditionalism and followed the experience of previous generations to help the whole community.
The first more or less organized medical practice emerged in Europe from Christian ideals of self-sacrifice and charity. Priests and herbalists were replaced by the category of deaconesses, women who acted as nurses in public hospitals or at home in the sick. In addition, according to Egenes (2017), hospitals were organized by religious groups and provided shelter and care for those who had no home or relatives. Religious groups and organizations could be considered an influential innovation of the time, as they largely determined the future of nursing. Their mission was to provide medical training conditions for selected women enrolled in their studies. Moreover, organizations have implemented reforms in hospital centers if, for example, a new fundamental concept of patient care has been developed and implemented (Egenes, 2017). It is important to note that the main activity of such groups was religious rather than medical.
The history of the nursing profession in its present form begins with the British nurse and social activist Florence Nightingale. She has gained much of her knowledge about the care of the sick through travels to different countries, where she learned about local nursing traditions (Pfettscher, 2017). It can be assumed that, primarily due to the Crimean War, Nightingale was able to sharpen her skills. Having mastered a profession not typical of aristocratic society, during the Crimean War, the woman held a prominent position at the front and was engaged in organizing care for wounded soldiers. By writing a series of simple and accessible first aid manuals, Nightingale used social statistics methods and organized patient data collection, which was widely used to analyze the situation in the country (Pfettscher, 2017). Florence Nightingale has laid the groundwork for what we consider the best practice to this day, and thus it has a significant impact.
The teachings of Nightingale have gone far beyond the UK and Europe. A few years later, already during the Civil War in the United States, local nurses actively advocated for the formalization of medical training. Their proposals included the creation of special schools to train nurses. With the expansion of “Florence Nightingale” practice around the world, similar reforms have come to American health care (Egenes, 2017). Hundreds of nursing schools have been organized by hospitals to improve service delivery. Nursing became increasingly separate from the rest of the medical profession and became an independent medical and scientific discipline. Today nursing is a major scientific field, with many scientific journals, peer-reviewed articles, and theoretical foundations.
Evolution of Nursing History
As the nursing practice became more scientific and complex, it inevitably created its conceptual paradigms. They derive from the professional and personal experiences of each practitioner, a set of beliefs, and accumulated knowledge. The nursing theory usually emerges from broad conceptual models influenced by the philosophy and reality of the practitioner’s environment (Masters, 2014). Because of the diverse approach to concept creation, there are many professional concepts associated with this field in the medical field. However, regardless of the idea, theories include the patient, health, environment, and nursing. The patient is the person who currently needs and receives nursing care. The patient is characterized by a state of health, understood as the dynamic harmony of the individual with the environment, achieved through adaptation. The totality of natural, social, psychological, spiritual factors of human activity forms the background. Finally, all the concepts described are united by the idea of nursing – that part of health care, which aims to address existing and potential health problems in a changing environment.
For scientific concepts in a particular field to improve and evolve, they must possess as many educated people as possible. Although Florence Nightingale’s contribution to world nursing took place back in the late nineteenth century, the first standardized nursing education program will not appear until the mid-1930s (Leistner, & Carlin, 2019). By that time, there was a push to move nursing from hospital schools to higher education, which will only happen in a few decades (Egenes, 2017). There was a significant increase in academic teaching after the 1970s. At that time, researchers were producing various concepts on a massive scale, among which, however, theories of meta paradigms, which managed to classify the collected knowledge, had a more significant influence. In the 1980s and 1990s, there was a burst of theoretical ideas, and there were so many of them that researchers called this time the “theory utilization era” (Pfettscher, 2017). As a result, this accumulated experience has led to the formation of a fine-tuned system of medical practice operating today all over the world.
One of the crucial figures among theorists of the time of active research in nursing is Patricia Benner. An American nurse born during World War II, Benner lived with her family in California, where she studied at a small college. However, this college could not give her the desired education as a nurse, so she had to transfer to Pasadena City College, where she was able to get a bachelor’s degree with the simultaneous assignment of the title of junior research fellow in 1964 (Masters, 2014). Her professional career did not end there, and in 1982 Benner was awarded the title of Doctor of Medical Sciences at the University of Berkeley. The personal life of a nurse includes a husband and two already adult children.
Her work was informed by two UoC Berkley professors, Stuart Dreyfus and Hubert Dreyfus. Together they developed a five-step competency model of mastering skills that breaks down the path to mastery in five stages, stating what needs to be improved to pass each of them (Leistner, & Carlin, 2019). The five steps consist of successive phases: beginner, advanced beginner, competent, specialist, and expert. Being in a particular stage depends on a person’s attitude towards the rules: it can be followed, or a person can build their own. The Dreyfus brothers’ theory was based on qualitative research and phenomenology. Benner’s work inherited these influences, and she believed that care for the sick was always practical.
Benner’s theory describes the transition from a novice to an expert in the field of nursing in five successive steps. According to Leistner and Carlin (2019), a beginner is a person without practical experience who has been taught to recognize situations based on rules and theory. An advanced novice is experienced enough to understand the principles that guide them. A competent nurse starts to see his actions as part of the goal and is governed by abstract thinking. An experienced nurse looks at everything as a whole, not as aspects, and can distinguish between critical and unimportant. The expert nurse does not rely on analytical aspects of the work and instead operates with a deep holistic understanding of the situation, using only analytical methods in the case of anomalies (Ozdemir, 2019). Improving professional skills is inextricably linked to a nurse’s movement from one status to another.
While the theory may seem disparaging to quantitative and formal education, its qualitative approach is its leading force. This creates a competence structure in nursing practice that emphasizes the importance of practical experience (Leistner, & Carlin, 2019). Experienced practitioners become skilled at recognizing models and adapting to context. The real healthcare institution is more complicated than any modeled education. For this reason, experience is necessary for development as a nurse.
Nursing developed out of traditionalistic and religious practices under the influence of key figures, such as Florence Nightingale. Over the years, nurses became more educated, and the field evolved into a full-fledged science. The second half of the XX century saw many nursing theories develop. Patricia Benner created one of them, and it describes how nurses develop professionally and personally as they gain real work experience.
Egenes, K. J. (2017). History of nursing. In G. Roux & J. A. Halstead (Eds.), Issues and trends in nursing: Essential knowledge for today and tomorrow (pp. 3-29). Amsterdam, Netherlands: Elsevier Health Sciences. Burlington, MA: Jones and Bartlett Learning.
Leistner, L., & Carlin, J. (2019). Assisted living nurse competencies. Geriatric Nursing, 40(2), 225–227.
Masters, K. (2014) Nursing theories: A framework for professional practice (9th ed.). Burlington, MA: Jones & Bartlett Learning.
Ozdemir, N. G. (2019). The development of nurses’ individualized care perceptions and practices: Benner’s novice to expert model perspective. International Journal of Caring Sciences, 12(2), 1279-1285.
Pfettscher, S. (2017). Modern nursing. In M. R. Alligood (Eds.), Nursing theorists and their work (9th ed.) (pp. 50-65). Amsterdam, Netherlands: Elsevier Health Sciences.