Dr Benner guided Aurora Health Care nurses in identifying
the domains and characteristics of practice drawn
from their own clinical practice narratives. Domains are
themes or categories that emerge repeatedly from the
nurses’ narratives. Characteristics of practice describe the
unique features of each domain for each level of expertise.
In the original model, the domains consisted of clinical
knowledge and decision making, patient education
and professional development, caring, and collaboration.
When the model was evaluated in 2007, the nurses again
used clinical narratives to validate the existing domains
and characteristics of practice, giving special attention to
aligning the domains and characteristics with the existing
nursing conceptual framework. Nurses added a new
domain of “empowering the patient” and its corresponding
characteristics of practice because the need for this
category was evident in the narratives. In addition to
adding the new domain, the nurses revised the labels of
the existing domains to reflect the language used in the
nursing conceptual framework. The current domains are
clinical knowledge and decision making, sharing knowledge
and competence with family, coordination/collaboration,
developing a relationship with patient/family, and
empowering the patient. Based on the narratives, new
characteristics of practice were also added to each
domain. An example of the characteristics of practice for
the clinical knowledge and decision-making domain at
each level of expertise demonstrates the progression from
Accomplished through Expert nurse (Table 3).