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Nurse Education Today
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Big Ideas
Benner, reflection and expertise: Some further thoughts guidelines’ (p. 37). Furthermore, this is not merely a different kind of theory, nor is it the case ‘that the rules and formulas just move to the unconscious level or go underground’ (p. 37). Rather, the expert I would like to thank Higham and Arrowsmith (2012) for their draws on a body of knowledge that is diametrically opposed to thoughtful response to my paper From Novice to Expert: Benner's legacy so-called ‘theoretical knowledge’. Whilst theoretical knowledge com- for nurse education. I agree with much of what they say, but wish to take prises ‘a formal statement of the necessary and sufficient conditions issue with their interpretation of Benner's view of the relationship be- for the occurrence of real situations’ (p. 298), expert knowledge is tween theory and practice, and in particular their assertion that Benner tacit and case-specific. Whilst theoretical knowledge is ‘knowing that’, regarded theoretical knowledge as ‘the basis for practice’. I believe that expert knowledge is ‘knowing how’. And whilst theoretical knowledge this misrepresents her position and has led them to the questionable can be broken down, analysed and communicated to others, expert conclusion that the ideas expressed in From Novice to Expert were knowledge is holistic and intuitive. broadly compatible with Schön's notion of reflection in- and on-action. Perhaps this disagreement rests to some extent on Benner's asser- Firstly, I think that Higham and Arrowsmith are broadly correct in tion that expertise is a hybrid of practical and theoretical knowledge. their assertion that the ‘novice to expert’ framework is generally Whilst Higham and Arrowsmith appear to interpret this as an amal- inappropriate as a curriculum model for pre-registration nurse educa- gam or mixture of the two, in that theoretical knowledge continues tion since, by definition, nurses are expected only to have reached to have a role to play in expert practice, my understanding is that a Benner's third stage of ‘competent’ by the time they qualify. Never- hybrid refers to something new, neither practical nor theoretical theless, her initial three stages of ‘novice’, ‘advanced beginner’ and knowledge but something different and distinct from either. Thus, ‘competent’ offer a useful framework through which to understand whilst formal theory clearly has a role to play in the development of the acquisition by the student of new theoretical knowledge, the (that is, in the stages leading up to) expertise, expert knowledge attempts to apply that theory to practice, the gradual development shares none of the characteristics of formal theory: it is holistic, con- of heuristic rules of thumb, and the beginnings of an intuitive ‘Gestalt’ crete and intuitive; it cannot be expressed in words and it cannot be approach to practice. Of course, formal theory is necessary for newly- formally taught. qualified competent nurses who have only a limited store of experi- This question of whether expert practice is grounded in formal, ence to draw upon, but as they continue to accumulate what Benner theoretical, analytical ‘knowing that’ or intuitive, tacit, holistic ‘know- calls ‘paradigm cases’, she argues that the theories they learned as ing how’ is not just an issue for academic speculation. It also has a students feature less and less in their clinical decision-making. Even- bearing on how we as educators can best prepare expert practitioners tually, as expert practitioners, they act solely from a tacit intuitive and whether reflection is a useful approach for exploring and develop- grasp of each individual situation, and ‘if experts are made to attend ing practice at this advanced level. I stated in my original paper that to the particulars or to a formal model or rule, their performance Benner offers no scope for reflection on or in expert practice, since actually deteriorates’ (Benner, 1984, p. 37). there are no underlying rules, formulas or theories on which to reflect. Whilst Higham and Arrowsmith accept that expert practice is Higham and Arrowsmith challenge this view, claiming that Benner founded on experience rather than formal learning, they nevertheless herself ‘commends teaching reflection’, and illustrate their claim maintain that theoretical knowledge is essential to the development of with a quotation in which Benner appears to be advocating a reflective such experience. Thus, they cite Benner's claim that ‘experience is gained approach. However, I returned to my copy of From Novice to Expert, but when theoretical knowledge is refined, challenged or disconfirmed could find no trace of it, and it appears that the quotation cited by by actual clinical evidence’ (Benner, 1984, p. 294), concluding that Higham and Arrowsmith was first published in the 2001 commemora- ‘theoretical knowledge remains the basis for practice’ (Higham and tive edition of Benner's book, a full 17 years after its initial publication, Arrowsmith, 2012). However, the Benner quotation above that they by which time reflective practice had become commonplace in nurs- use to justify their view is taken from the Glossary at the end of ing. Importantly, Benner was not referring to reflective practice per From Novice to Expert, and therefore lacks the context and nuances of se, but rather to what she described as ‘narrative accounts of experien- the somewhat more complex view of the relationship between experi- tial learning’ (Benner, 2001, p. vii), that is, to simple descriptive ‘prac- ence and theoretical knowledge expressed throughout her book. Fur- titioners' stories’. In fact, this is no different from the position outlined thermore, nurses' relationships to theoretical knowledge change and in the original 1984 edition, where Benner acknowledged that whilst develop as they progress along the novice to expert continuum. The experts can describe their practice, they cannot reflect on it in any novice nurse simply applies theory to practice more or less without usually understood meaning of the term. Thus: question, whilst competent and proficient nurses enter into a critical dialogue with theoretical knowledge. However, Benner suggests that experts have little or no need for formal theory, and revert to it only It is possible to describe expert practice, but it is not possible when placed in unfamiliar situations. So long as they are working with- to recapture from the experts in explicit, formal steps, the mental in their sphere of expertise, experts draw predominantly on what processes or all the elements that go into their expert recognitional Benner (1984) refers to as ‘multifaceted knowledge with its concrete (sic) capacity to make rapid patient assessments. (Benner, 1984, referents [which] cannot be put into abstract principles or even explicit p. 42)
http://dx.doi.org/10.1016/j.nedt.2012.09.013 184 Big Ideas
The purpose and function of reflection-on-action is not simply to References
tell a story but to unpick, analyse and learn from prior experience Benner, P., 1984. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. and that accordingly, in this sense, expertise as Benner describes it Addison-Wesley, Menlo Park, California. is not amenable to reflection; indeed, intuitive expert practice is in Benner, P., 2001. From Novice to Expert: Excellence and Power in Clinical Nursing Practice many ways the antithesis of mindful reflective practice. (Commemorative Edition). Prentice Hall, New Jersey. Higham, S., Arrowsmith, V., 2012. A response to Gardner (2012) From novice to expert: To end on a positive note of agreement, I think that Higham and Benner's legacy for nurse education. Nurse Education Today 32 (4), 339–340. Arrowsmith are right to point out that Benner's accounts of expert prac- tice offer some inspiring examples of nursing practice at its best, and Lyn Gardner that it deserves to be read for its descriptive accounts of nursing inter- College of Human and Health Sciences, Swansea University, ventions. Further, it offers a counter to the growing research-based United Kingdom technical–rational approach to practice that, in Benner's own words, E-mail address: l.d.gardner@swan.ac.uk. ‘are far more complex than can be described by formal models, theories, and text-book descriptions’ (Benner, 1984, p. 178), which is perhaps the most significant legacy of From Novice to Expert.
