Theory-Practice Gap in Nursing

Introduction

Theory-practice gap in nursing has been a subject of research for many years. The research has been a result of the differences between the events that nursing students go through in formal education and the actual events that take place in clinical practice. As a result, a debate has emerged due to the need to reduce this gap or close it completely (Crane, 1991). This can be explained by the fact that the image of an object is not the real object, which means that what is taught in class is not what actually happens in the field. Theory gives a rough idea of what is to be encountered in the field, but it cannot provide the flesh that we encounter in practice (Ousey & Gallagher, 2007).

The relationship between what is taught in nursing school and what takes place in practice can be subdivided into three factors, which are theory, practice and the gap between theory and practice. Theory is what one goes through in college especially what is learned from books while being prepared for practice. Practice is delivery of the services by the nurses who have graduated from college in attending to patients (Bandman & Bandman, 1995).

Theory and practice

Theory in nursing education refers to what is taught in class in the school of nursing whereas practice is the clinical activity that takes place in hospitals or any health centre (Laudan, 1977). Theoretical knowledge possessed by those from training has to be applied in practice in order to bridge the gap between theory and practice (Reed & Shearer, 2007). To bridge the gap between theory and practice, the content of what is taught in the classroom has to be taken from actual nursing practice or from research in the natural environment. This means that books have to be written from a practical dimension. Student nurses are also, at times, blamed for the mess, and not the curricula or training programs. Some of them fail to apply their theory in practice. Therefore, their teachers and trainers have to come in and ensure that students take theoretical knowledge gain seriously, and are able to link it to clinical use.

According to Cash (1995), nursing the students cannot relate between nursing theory and practice because the complexity of the practice and its variation have not been considered. In addition to this, Omery, Kasper, & Page (1995), claim that the students are very comfortable and have ease with their practice, but theoretical knowledge is not applicable in practice. The colleges offering nursing, and hospitals where nursing practice takes place, are indifferent, yet they are supposed to be working together. This issue was addressed in the 20th century when western countries moved the two together so that both institutions could coexist and work towards producing competent nurses.

Gap between theory and practice

The gap between nursing theory and practice is already wide and thus has been a major concern worldwide. This gap can be reduced but if care is not taken this gap can be widened with time. There is the need to have proper arrangement of learning in schools and the practice environment, in order to tackle this problem, otherwise worse is expected (Cash, 1995).

What it takes to get to required standards in learning is not under the control of the nursing students but rather on the teachers who train them. Adequate selection of training location, proper selection of the subjects in the curricula and allowing qualified personnel to train the students is of paramount importance in dealing with our immediate problem. Nursing students have to use all the available resources like textbooks, journals, lecture notes, the internet and information from others to equip themselves with appropriate knowledge to face the challenges in the actual working environment, failure to which, they are answerable for their negligence (Cash, 1995).

The using of theoretical practical gap is just a “metaphor” we can’t consider it a real gap. The difference between theory and practice is a vital issue in the development of nursing theory and practice. The difference opens the gate of communication between educators and practitioners; a difference that is no more than an evolvement in both disciplines to improve the health care system.

The picture

The picture drawn for students in their education is that nurses: have an independent identity; deal with the patients need in a holistic approach; work together with the patient to set health goals; and work based on theories and models, since nursing teachers are far from the clinical field. The nursing theory draws an idealistic picture for the nurse; and their curricula mainly focus on the theoretical aspect of nursing. On the other hand, the picture drawn for nurses in the hospital is different. Nursing is not viewed as an independent identity, because the nurses depend on doctors, and on hospital policies and protocols. Nurses use their own experience to solve patients’ problems. Nurses also focus more on routine practice, than the theory behind it; and more on cure than care.

There may be some truth in the perception that there are differences in nursing when it comes to theory and practice. But a question arises as to why people do not see the purpose of theory as to draw an ideal picture for the nurses, in order to help them improve their practice by searching for that ideal picture. On the other hand, practitioners work to justify the theoretical knowledge in their daily practice. This implies that the educated never believe that they will reach the level of the ideal nurse, but they try to draw a picture for “a role model” of the nurse.

The language

The language of nurses in both theory and practice varies in terms of expressing their emotions. For example, the main work of nurses based on nursing process and theory uses the abstract concept in their model, though it is difficult to utilize it in the clinical field. Concepts in theory such as: healing, helping relationship, and caring” are not found in the practice dictionary. Practitioners mainly do routine work based on the language of medical community. They pay little attention to concepts like evidence based practice, and focus more on cure than care.

It should definitely be different, though they should take into consideration that the abstract concepts mainly used in theory apply in more concrete ways in the clinical field. One specific theory cannot be used in the clinical field, but we know that our work is based on the theoretical model. For example, the routine work done by nurses in their daily care is taken from theory and evidence based practice research.

The Culture

The culture of theoretical and practice nursing varies depending on the education of the nursing student. Culture focuses on the personal identity of the patient and health education. The knowledge of the nurse is more important than the skills acquired, but when the students become established in the culture of their areas of placement, they adapt to behavior that is regarded as acceptable to both their peers and seniors, by emulating them. This is because the students consider building a relationship with them as vital in order to be accepted in their culture, and they therefore do not question the practices. This implies that the conventional position of the relationship between theory and practice is very much alive. Theories learnt in class are not practiced in the clinical areas, since the students adjust to the practical setting in order to fit in (Kuhn, 1996).

Regarding to the culture, I believe that any institution have different culture (academic and theory) and this is normal to find different between it since they act in a different sitting, different work and different concerns, but I think you have offend the culture of practice because the most of hospital apply standers of care, nursing today become more professional than before. It’s normal for the student to adapt with the practical environment.

Bridging the Theory-Practice Gap

It is argued that nurse training has become more process focused than product focused, which has led to an increment of the gap between theory and practice. This transformation is a result of the shift of nurse education into Higher Education Institutions (HEIs) and the adoption of androgenic principles, where the students are facilitated to be self directed, critical and reflective thinkers. The environments of theory and practice are conflicting in nature due to the “humanistic values of nurse education and the increasing management values where targets and finance are priority within the clinical environment” (Omery, Kasper, & Page, 1995).

A critical engagement of the students with clinical governance can be achieved by incorporating together principles of evidence based practice, reflective practice and change theory. The focus of the initiative is on action planning by assigning the students tasks that require them to link theory to practice, within the setting of practice. The students are supposed to critique a nursing standard that is in implementation or benchmark with reference to its evidence base and make recommendations for practice based on the audit findings that they make, within their field of practice (Laudan, 1977).

The benchmarking activities involve classroom sessions that provide the students with opportunities to reflect on activities in which they had carried out clinical tests, when working within their groups. The introduction of benchmarking is aimed at helping the nurses to comprehend relevance and application of knowledge in practice, and help them to develop understanding. Cash (1995) further states that the motivation of adult nurses increases when they perceive their knowledge as useful.

The benchmarking exercise is dependent on the information and proficiency, acquired in previous lessons, which involve searching for evidence, critiquing that evidence and analyzing the implications for practice. In addition, students are required to draw from their own experiences of good practice, be able to articulate their reasons why this practice could be defined as ‘better’ then the rest, and discern if it is appropriate for inclusion as a basis for their ‘A grade.

Conclusion

Cash (1995) suggests that the gap in nursing is partly a result of the influence of ‘the hidden curriculum’. This is defined as “the unplanned and unintended learning that takes place in any given learning setting”. Nursing students are vulnerable to the many changes in the learning environment and can as a result, assimilate the norms and attitudes that they meet in different particular clinical settings. History of nursing education demonstrates that efforts made to bridge the ‘gap’ have proved at best to be only partially successful. This implies that the conventional position is incomplete and that an alternative explanation, may prove to be helpful. An alternative explanation can be sought by examining the experience of the student nurse as they tackle the differences between the theory and the practice of nursing. In conclusion, it may be best if the gap could not be fully bridged. This will be helpful in ensuring that students are encouraged to question practices and that the practitioners question what they practice, in order to maintain the best possible practice for the patients.

References

Bandman, E., & Bandman, B. (1995). Critical thinking in nursing. 2nd edition. East Norwalk CT: Appleton & Lange.

Cash, K. (1995). Benner and expertise in nursing: a critique. International Journal of Nursing Studies , 32(6), 527-534.

Crane, S. (1991). Implications of the critical paradigm: Towards a Discipline of Nursing. Melbourne: Churchill Livingstone.

Kuhn, T. (1996). The structure of scientific revolutions, 3rd Edition. Chicago: University of Chicago Press.

Laudan, L. (1977). Progress and its problems: Towards a theory of scientific growth. Berkeley: University of California Press.

Omery, A., Kasper, C., & Page, G. (1995). In search of nursing science. Thousand Oaks, CA: Sage.

Ousey, K., & Gallagher, P. (2007). The theory–practice relationship in nursing: A debate. Nurse Education in Practice , 7, 199–205.

Reed, P., & Shearer, N. (2007). Perspectives on nursing theory. 5th edition. Philadelphia: Lippincott, Williams & Wilkins.

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