Bridging the theory-practice gap

In New Zealand, there is a festering debate over a "theory-practice gap" in nursing. Joint appointments may be a potential solution to this issue. Joint appointments refer to a variety of arrangements whereby concurrent employment occurs within an educational institution and a clinical setting. Advantages for the appointees include job satisfaction and professional growth. Clinical credibility for nurse educators enables improved facilitation of student learning. In clinical areas, benefits in patient care are associated with the marrying of academic rigour with clinical practice. Some appointees assist with staff development, act as consultants on nursing issues and undertake research. Disadvantages in the concept focus on role conflict, i.e. incongruity between the roles and role ambiguity, i.e. lack of clarity concerning expectations. Success depends upon the personal attributes of appointees; realistic expectations; flexibility to allow the concept to evolve; and support from colleagues and management. This research describes a case study of a joint appointment between a nurse lecturer and a staff nurse in an acute forensic psychiatry unit. Advantages, disadvantages and reasons for success are discussed in relation to the literature findings. (See p15-15) The discussion focuses on the need to develop research methodology to further clarify potential benefits and advantages.     

Using a patient satisfaction survey to close the theory-practice gap

AIM: The objective of this study was to determine whether a patient satisfaction survey could be used as a research tool to improve nursing practice. METHOD: A postal questionnaire was sent to patients after discharge. Questions covered primary nursing, information, ward environment, discharge planning and social activities. RESULTS: A number of respondents were dissatisfied with the information they had received and with their lack of involvement in decisions about care. This was often correlated with lack of primary nurse recognition. The role of the associate nurse was poorly understood. There were high levels of satisfaction with discharge procedures, but little enthusiasm for the introduction of an activities programme. CONCLUSION: The results highlighted areas where changes were needed. This resulted in a nurse-led programme of managed change, including making all experienced D and E grade nurses primary nurses, improving information provision, and involving patients in the decision-making process.     

Faculty practice: a model to bridge the theory-practice divide

It has been suggested that as a result of nurse education withdrawing from the clinical setting and becoming established in institutions of higher education, there has been a separation of theory from practice. Recognition of the theory-practice gap by clinicians and professional bodies has led to calls for nurse educators to retain a clinical focus. Faculty practice is described and critically discussed as a model of practice to bridge the theory-practice divide. In this article, the author presents the results of a 6-month pilot study to implement such a model within a community trust, and suggests that the development of such initiatives will foster collaborative working and improve nurse education and patient care.     

A classical view of the theory-practice gap in nursing

The perceived problem of the theory-practice gap is built upon the assumption that theory can and must be directly applied to nursing practice, otherwise it is irrelevant Whilst the spirit in which this claim is made is healthy, the assumption is false An examination of the Greek origins of theory and practice show that the ancient Greeks had different terms for the different types of knowledge contained with theory and within practice The type of knowledge associated with practice could not be taught through theory, nor well represented in theoretical terms The knowledge of the bicycle rider and the piano player illustrate this well If this is correct then simplistic notions of 'applied theory' are nonsensical The knowledge of the practitioner is not theory, but something else However, there is a proper relationship between theory and practice, and there are clear examples of this in the way science informs nursing practice The problem is that much of this is obscured by the false claim of theorists that nursing theory (such as normative models) is also science In fact, what it represents is inadequate attempts by theory to represent knowledge which cannot be represented in that form Nursing is practice, not theory. If so, then the term 'nursing theory' seems to be oxymoronic     

Mentors or preceptors? Narrowing the theory-practice gap

The use of mentors in the clinical field has been debated in the recent nursing literature. The notion of the preceptor has also been considered. This paper compares the roles of the mentor and preceptor and offers some suggestions as to how those roles may help to narrow the theory/practice gap in nursing.     

Mid-range theory building and the nursing theory-practice gap: a respite care case study

Nursing, with its historical roots in practice, has tended to have an uneasy relationship with theory. Whilst the benefits of theory to nursing have been propounded by many commentators, it remains that theory all too rarely informs nursing practice. This paper argues for the development and utilization of mid-range theories as representing a solution to this problem. The advantages of such an approach are illustrated by the application, testing and refinement of Chenitz's theory of relocation to a hospital-based respite care scheme for the frail elderly.     

The theory-practice gap: ECMO research example

AIM: The time taken for research findings to enter clinical practice can be very lengthy. A contributing factor is the time lag between the research literature identifying the issue, and medical and nursing texts discussing it. The example of ECMO (Extracorporeal Membrane Oxygenation) is used to examine this issue, specifically the extent to which relevant nursing journals and textbooks discuss the effects of ECMO on medication. METHOD: A systematic review of papers identifying the problem (pharmacokinetics in ECMO patients) and the dissemination of this to clinicians was undertaken. Publications used by those exploring the problem were most likely to be found in Medline, and those disseminating to nurses in CINAHL. Textbooks on neonatal nursing and paediatric intensive care with sections on ECMO were also explored. RESULTS: There are several studies that show drug delivery is altered in patients receiving ECMO, dating back to 1989. Only three papers likely to be accessed by clinicians were found to address the effect of ECMO on drug delivery. Two of the textbooks addressed these issues but it took eight years from the issue being first raised to any medical or nursing text discussing it. CONCLUSION: Nurses will most likely not be aware of the latest research in their area if they rely on textbooks. Advanced education that gives critical appraisal and literature-searching skills, such as found in master's courses, should help the clinical nurse employ evidence based practice.     

护理本科院校理论教学与临床实践差距的研究

目的探讨护理本科院校理论教学与临床实践的差距。方法采用现象学研究方法,对12名临床护理教师和18名本科护理专业实习学生进行深度访谈。结果导致护理本科院校理论教学与临床实践差距的主要因素有:部分书本知识更新滞后于临床发展;学校部分课程设置与课时安排不合理;学校教学情境与临床实践情境不一致;基础护理教学与临床实际应用的侧重点不同;学校教师与临床教师沟通欠缺等。结论为缩短理论与实践的差距,应发展与临床紧密结合的护理师资队伍,注重培养学生评判性思维和应变能力,优化课程设计,合理安排学生实践。     

理论与实践交叉培训模式在新护士危重症护理能力训练中的应用

目的探讨理论与实践交叉培训模式在新护士危重症护理能力训练中的应用效果。方法根据新护士对急危重症护理知识的需求情况,应用理论-实践交叉的培训模式对新护士实施培训。结果培训后新护士的理论成绩、技能成绩和临床综合能力较培训前提高,经统计学分析,均P0.01,差异具有统计学意义。结论理论与实践交叉的培训模式充分发挥了新护士的主体作用,使培训在时间和内容得以整合,相互贯通,护士综合素质得到提高。     

Effects of spiritual care training for palliative care professionals

Little is known about the effects of spiritual care training for professionals in palliative medicine. We therefore investigated prospectively the effects of such training over a six-month period. All 63 participants of the three and a half-day training were asked to fill out three questionnaires: before and after the training, as well as six months later. The questionnaires included demographic data, numeric rating scales about general attitudes towards the work in palliative care, the Self-Transcendence Scale (STS), the spiritual subscale of the Functional Assessment of Chronic Illness Therapy (FACIT-Sp) and the Idler Index of Religiosity (IIR). Forty-eight participants (76%) completed all three questionnaires (91% women, median age 49 years; 51% nurses, 16% hospice volunteers, 14% physicians). Significant and sustained improvements were found in self-perceived compassion for the dying (after the training: P=0.002; 6 months later: P=0.025), compassion for oneself (P <0.001; P =0.013), attitude towards one's family (P =0.001; P =0.031), satisfaction with work (P < 0.001; P = 0.039), reduction in work-related stress (P < 0.001; P = 0.033), and attitude towards colleagues (P = 0.039; P = 0.040), as well as in the FACIT-Sp (P < 0.001; P = 0.040). Our results suggest that the spiritual care training had a positive influence on the spiritual well-being and the attitudes of the participating palliative care professionals which was preserved over a six-month period.     

The theory-practice gap in nursing: the role of the nurse teacher

The increasingly complex requirements of today's nursing practitioners, have been accompanied by demands on nurse educators to look at new ways to facilitate learning in the clinical area (Camiah 1996). In recent years nursing education has undergone a period of major change in many countries through integrating with universities. While nurse educators are striving to respond to changes in education the dichotomy between the theoretical input taught in the classroom and what is practised or experienced on the wards remains a problem (Ashworth & Longmate 1993, Ferguson & Jinks 1994). Dale (1994) postulates that theory provides the basis for understanding the reality of nursing, it would seem reasonable, therefore, to assume that the content studied in the classroom correlates with what the student experiences on the ward. It should also follow that if a gap exists between theory and practice, efforts should be taken for its reduction (Rafferty et al. 1996). According to MacNeil (1997) many initiatives have been introduced in an effort to bridge the theory-practice gap and these have focused around the role of the nurse teacher. These changes in education are redefining the role of the nurse teacher, therefore, the part that they currently play and will play in the future needs to be carefully considered (Phillips et al. 1996b). The aim of this paper is to provide an overview of the literature on the theory-practice divide in nursing. First, some of the reasons cited for its existence will be explored. Second, suggested ways of bridging the divide will be considered focusing on the role of the nurse teacher.     

The theory-practice gap in nursing: from research-based practice to practitioner-based research

The aim of nursing research is generally agreed to be the generation of knowledge, and whilst this is a relevant aim in theory-based disciplines such as sociology, the primary concern of nursing is with practice. Using examples drawn mainly from the field of mental health, it will be argued in this paper that the application of generalizable, research-based knowledge to individual, unique, person-centred practice, the so-called 'research-based practice' advocated by the Department of Health, is one of the main causes of the theory-practice gap. It will be further suggested that nursing requires a paradigm of clinical research which focuses on the individual therapeutic encounter in order to complement the existing sociological paradigm of theoretical research which is best suited to the generation of generalizable knowledge and theory. The paper will conclude by suggesting that such a clinically based research paradigm must not only focus on the individual nurse-patient relationship, but that it must be carried out by the nurse herself. Clinical research, if it is to make a difference to practice, must therefore be practitioner-based research.