Integrating what is taught with what is practised in the nursing curriculum: a multi-dimensional model

The discrepancy between nursing as it is taught in the classroom (theory) and nursing as it is experienced by students in the clinical setting (practice) has long been a source of concern to teachers, practitioners and learners This paper provides an overview of the literature on the theory-practice gap, exploring some of the many reasons cited for its existence as well as suggested ways of bridging the gap Drawing upon the findings, a comprehensive and multidimensional model designed to integrate theory and practice of nursing is proposed for use by curriculum planners Fundamental to the model is the notion of collaboration between education and service staff at all stages of the curriculum process The model highlights eight key areas for the curriculum team to consider the curriculum model to be used, sequencing of taught content and clinical practice, the content of the course, teaching methods to be used, assessment criteria, the role of tutors in the learning process, the contribution of service staff, and the influence of the hidden curriculum It is argued that only through such a comprehensive model can integration of theory and practice within the curriculum be achieved Adoption of the model, however, will require considerable individual and organizational commitment     

Should nurses be studying bioscience? A discussion paper

The growth of bioscience knowledge over the last two decades has increased the potential benefits of scientifically based patient care by contributing to the theory of clinical care. However, there is little evidence that knowledge, derived from the human biosciences is being fully incorporated into nursing theory and practice.Nursing has developed its own unique professional body of knowledge, heavily influenced by behavioural science. If nursing theory leans towards behavioural science, but practice is devoted to problems of biological disturbance, nursing may be facing a widening theory-practice gap, greater than other professions. The theory-practice gap in nursing may be widened by the exclusion of bioscience from nursing theory. Nurses' relative disinterest in the natural sciences can be attributed both to sociological reasons and to problems stemming from the symbol-object dichotomy that recur in the teaching of natural sciences. Reflection on practice and examination of education method are suggested as strategies for re-introducing bioscience into nursing theory and practice. A challenge facing nurse educators is the integration of biological science into the nurses' conceptual ecologies. For, if nursing fails to make bioscience its own, much of the clinical welfare of patients will become a medical monopoly.     

Using psychodynamic small group work in nurse education: closing the theory-practice gap?

This paper illustrates the role of psychodynamic small group work in integrating theory and practice for nursing students. Psychodynamic work with individual patients and small staff groups is established in some areas of medical and nursing practice although not widely used in general nursing. Clinical material which was brought to two group supervision sessions by student nurses on clinical placement is presented in this paper and discussed using a psychodynamic perspective. A critical review of psychodynamic small group work and a position paper is presented in this paper to argue that using a psychodynamic approach in nurse education may address the theory-practice gap for student nurses by allowing them to reflect on the emotional issues arising in clinical placements. The paper illustrates how supervision can assist students to integrate theory and practice. It is suggested that reflecting on feelings in small group work with student nurses with a tutor or supervisor who works psychodynamically may help students integrate their theoretical and practical learning. Understanding the theory-practice gap from a psychodynamic perspective may help nurse tutors in their personal tutor work to integrate theoretical and practical learning for students and thereby support students in providing good quality care for their patients.     

Mentorship in contemporary practice: the experiences of nursing students and practice mentors

Aim. This paper explores the role of the mentor in contemporary nursing practice in the UK. It presents findings from a recent study which investigated the impact of a locality‐based nursing education initiative on students, practice mentors and academic staff and draws on another study, conducted in the same setting and two Australian sites, to examine the perceptions of nursing students and mentors. Background. Within nursing, mentorship is integral to students’ clinical placement experiences and has attracted increasing interest among researchers. Despite a plethora of studies focussing on mentoring and its nature and application within the practice setting, limited attention has been paid to the extent to which guidelines provided by regulatory bodies for nursing inform and influence the practice of mentoring in contemporary health‐care settings. Design. The study used a two‐phased design with data on mentorship being focussed on the second phase. Method. Data were collected using an online survey questionnaire of pre‐qualifying students and a postal questionnaire for practice mentors. Findings. The findings highlight the importance of mentorship for prequalifying students and emphasise the need to provide mentors with adequate preparation and support. They confirm previous research, but also highlight improvements in bridging the gap between rhetoric and reality for mentorship. Results are further strengthened when compared with those of the second study. Conclusions. Findings provide new evidence of a narrowing of the gap between the theory and practice of mentoring and for the continuing implementation of national standards to clarify the roles and responsibilities of the mentor. They also suggest the benefits of developing such standards in countries with similar systems of support for nursing students. Relevance to clinical practice. Mentorship is pivotal to students’ clinical experiences and is instrumental in preparing them for their role as confident and competent practitioners.     

Registered nurse stress in intensive care unit — an Australian perspective

This paper describes a study of stressors and coping mechanisms in different grades of registered nurses in Intensive Care Units (ICUs). The research demonstrated that significant correlation existed between relating what and when to report clinical patient changes and relating theory to practice. Significant dofferences existed between groups with regard to the stress associated with caring for acutely ill patients, role conflict with medical staff and relationships with senior medical and nursing staff. The findings confirm that environmental stressors are the major stressors in ICU and demonstrate that sound knowledge and clinical assessment skills are important factors in reducing perceived stress, thus supporting the continued need for competency and skills focused post registration courses and in-service education.     

The use of bedside electronic medical record to improve quality of care in nursing facilities: a qualitative analysis

It appears that the implementation and use of a bedside electronic medical record in nursing homes can be a strategy to improve quality of care. Staff like using the bedside electronic medical record and believe it is beneficial. Information gleaned from this qualitative evaluation of four nursing homes that implemented complete electronic medical records and participated in a larger evaluation of the use of an electronic medical record will be useful to other nursing homes as they consider implementing bedside computing technology. Nursing home owners and administrators must be prepared to undertake a major change requiring many months of planning to successfully implement. Direct care staff will need support as they learn to use the equipment, especially for the first 6 to 12 months after implementation. There should be a careful plan for continuing education opportunities so that staff learn to properly use the software and can benefit from the technology. After 12 to 24 months, almost no one wants to return to the era of paper charting.     

Nursing scholarship: sense and sensibility

This paper explores the relationship between nursing theory, research and practice. It suggests that the frequently discussed difficulties in operationalizing, testing and implementing nursing theories are perhaps indicative of their lack of fit with clinical practice. The insistence of fitting theories within the four metaparadigm concepts—person, environment, health and nursing—forces nursing theory to an inappropriate level of abstraction and to a level that dilutes its relevance for clinical application. It is possible that, while these theories are useful as philosophies, they lack the clinical relevance that is a critical criterion for theory. Confounding the status quo, the present practice of teaching theory as fact within education and using theory to drive nursing curricula removes the tentative and guiding contribution that a theory contributes to a profession. A plea is made for research that supports the exploration and identification of nursing concepts and for the development of appropriate theory that will guide both nursing research and nursing practice. Since nursing is an applied discipline, this responsibility necessarily falls on the shoulders of researchers who, in partnership with clinicians, can explore, test and refine theory.     

临床护理人员护理继续教育现状分析

[目的]分析临床护理人员继续教育的现状,了解护理继续教育的影响因素,为科学开展继续教育提供依据.[方法]随机抽取国内10所综合医院临床护理人员2 727人,使用"临床护理人员继续教育问卷"进行调查.[结果]92.0%以上的护理人员认识到护理继续教育的必要性和重要性,90.1%护理人员护理继续教育的目的是荻取知识、提升技能,影响其参加护理继续教育的因素主要是精力和时间不足(68.7%)、机会欠缺(48.6%)及经费问题(44.5%).[结论]更新观念、强化认识,科学统筹、激发动力,拓宽渠道、突出实效,切实达到护理继续教育的最终目的.     

Rationale and development of an institutional pediatric chemotherapy certification course

In a large pediatric teaching hospital located in the southwestern part of the United States, few nurses had participated in a formal program that taught the knowledge and skills required for the nurse to care for the patient receiving chemotherapy. In order to enhance the necessary clinical competency of the nursing staff, a Chemotherapy Certification Course was developed for this institution. In reviewing the literature there was minimal information on how to develop such a program. The purpose of this article is to describe the development of this course with the intent that it can serve as a guide in facilitating and implementing such a course in other institutions. As more hospitals adopt institutional certification as a form of continuing education in cancer nursing, perhaps the gap between knowledge and practice will decrease. The institutional certification course will be a significant step toward improving the level of practice of nurses caring for patients receiving chemotherapy. The goal of promoting professional competence will benefit the nurse, the institution, and patients and their families.     

How can we achieve evidence-based practice if we have a theory–practice gap in nursing today?

The purpose of this paper is to discuss how nursing can achieve evidence-based practice when a theory-practice gap exists in nursing today. The paper commences with an introduction to the concept of evidence-based practice and a discussion of the relationships between theory, practice and the theory-practice gap. An analysis of the two concepts will then be presented from within the four pillars of nursing, namely management, practice, research and education. The paper will conclude with a discussion of whether evidence-based practice can be achieved in view of the theory-practice gap.     

A new paradigm for practice education

This paper explores the complex nature of professional practice. It suggests that educating for all practice disciplines is about to undergo a paradigm shift whereby the value of practical education and experience will be better understood, more rigorously analyzed and integrated with propositional knowledge in the construction of personal professional knowledge and identity. It relates this cross disciplinary position to the present problems of skills deficits which are evident in nurses at the point of registration and demonstrates how routinization and internalization of process and tacit knowledge can create problems for students and newly qualified staff nurses. It also suggests how this can be addressed.It discusses the present culture of 'clinical education by default', unavailability of mentors and resources, and general lack of formal collaborative structures between education and service institutions and suggests that the present system cannot sustain the complex demands, expectations and pace of the clinical context and the evolution of nursing practice. Clinical credibility is an issue as is the current heavy clinical workload of staff nurse mentors, and several collaborative clinical education models are outlined which ensure that staff nurses or resident clinical educators are available and can make clinical teaching their priority. History and the present crisis in nursing suggest that there is a case for mandatory collaborative education/service structures to ensure adequate funding and to monitor the effectiveness of selected models so that staff nurse mentors can work with lecturer colleagues to articulate and teach the complexities of clinical practice through related research.It is predicted that this collaborative approach is capable of addressing both the skills deficits and the wider intellectual challenge of developing a new paradigm of practice education and providing an integrated base for continuing professional development.     

Perceptions of faculty image

The gap between the worlds of nursing practice and nursing education became a reality for the authors when they entered academia after several years of practice. Expecting openness and respect from nursing staff, they often encountered subtle resistance and skepticism instead. The experience inspired them to conduct a study comparing staff and faculty perceptions of nurse educators. What they found led them to believe that faculty and staff may need to correct and align perceptual differences in order to work together more effectively.     

A constructivist model for teaching evidence-based practice

The Institute of Medicine has reported that it takes roughly 17 years for evidence generated through research to move into clinical practice. Bridging that gap is an urgent need and will require educators to rethink how nurses are prepared for evidence-based practice. The constructivist theory for learning--in which it is assumed that students construct knowledge and meaning for themselves as they learn--may provide a framework for a redesigned baccalaureate curriculum, one that supports evidence-based practice throughout a nursing student's education.     

Nursing education in Norway

AIM: The aim of this paper is to describe nursing education in Norway and some essential questions and challenges regarding the undergraduate and newly graduated nurses' competencies and functionally preparedness. BACKGROUND: The first formal training of nurses in Norway started in Oslo in 1886. Since then the education has changed considerably. As long as society is changing, and nurses are going to meet and adapt to societies needs, the education of nurses will also have to change continuously. The present general plan of nursing education has gone through a long process. The discussions have concerned the content of medical and natural science subjects, the practical part of the training and the relation between theory and practice. CHALLENGES: There are challenges in nursing education in Norway today. We have seen that recruitment has decreased, and that nurses seek jobs where they are better paid. To increase the accessibility distance and part-time education has been established. The theory-practice gap will always exist. Therefore we should aim to prepare the students to minimize this gap in a way that they can combine training of nursing with training in improvement. The demand of a masters degree to be a nursing teacher has reduced the teachers' ability to keep up their practical skills. The government pays nursing teachers who want to practice as nurses for several months to maintain their salary level during that period. CONCLUSIONS: There are many possibilities to improve nursing education in Norway. We are on our way with highly qualified teachers and students, and we still have enough good applicants. The new general plan and new law for universities and university colleges offer great opportunities. However, the shortage of nurses is a great challenge for further quality improvement both in clinical practice and in education.     

Participation in continuing professional education in nursing: findings of an interview study

The evidence suggests that enrolled nurses and those working part-time and on night duty consistently attend less continuing professional education than their more senior, full-time and day duty colleagues This was substantiated in the findings of this study which also highlighted the paucity of opportunities for continuing education among unqualified practitioners In the light of recent developments within the health services, this inequitable provision of continuing professional education to all nursing practitioners will need to be addressed and resolved Continuing professional education provided on an arbitrary and random basis will not afford maximum positive outcomes for clients, the service and practitioners and has the potential to increase the levels of frustration among disadvantaged groups of nursing staff     

基于扎根理论的肿瘤科护士临终关怀能力框架构建

目的 探索构建护士照护患肿瘤的临终患者应有的临终关怀能力框架,为护理专业教育及临床继续教育提供参考。方法 选取3所综合医院的肿瘤科内29名医务人员、患肿瘤的临终患者以及患者家属,采用扎根理论分析法对其进行面对面的半结构式访谈,并应用 Nvivo 11软件对获得的资料进行对比、分析。结果 最终确立基于“满足需求”的肿瘤科护士临终关怀能力框架,7项一级要素、16项二级要素。结论 以满足需求为基础的肿瘤科护士临终关怀能力框架由临终关怀知识、交流能力、教育能力、支持性照护、自我发展、个人特质、人际关系7个维度构成。     

Increasing understanding of nursing research for general duty nurses: an experiential strategy

Misconceptions and trepidation about research abound among practicing nurses. However, in light of the movement toward increasing accountability to consumers and the concurrent drive toward evidence-based practice, the need for nursing research can no longer be ignored. Innovative approaches to augment nurses' training and education in research and evidence-based practice must be incorporated into continuing education programs. The Nursing Research and Evidence-Based Practice Committee of a large tertiary care teaching hospital in Winnipeg, Manitoba, Canada, developed a series of opportunities for staff nurses to participate in research projects and have ongoing exposure to the steps in the research process. The Great Canadian Cookie Experiment was an opportunity to participate in quantitative research. Qualitative data from patients' thank you cards were analyzed in an interactive fashion during luncheon seminars held during Nursing Week in 2 subsequent years. A survey of nurses who participated in the luncheon seminars indicated an overall increase in their knowledge about qualitative research methods and an appreciation for participating in the process of nursing research. Continued visibility of nursing research will contribute to changing nurses' attitudes toward fostering an evidence-based approach to clinical 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。     

Nursing educators: perceptions of the curricular role of human genetics/bioethics

In recent years medical geneticists have made tremendous advances in understanding hereditary diseases. Applying this new knowledge raises serious ethical questions which have relevance to nursing practice. Nursing educators must ask themselves: (1) what effects do these advances have on nursing practice; (2) have the subjects of human genetics and bioethics been sufficiently integrated into nursing educational programs; and (3) are professional nurses prepared to help patients become scientifically literate relative to principles of human genetics? A 35-item questionnaire was prepared, and 616 copies were mailed to the chief administrators of 31 Indiana state-approved nursing programs listed by the Indiana State Board of Nurses' Registration and Nursing Education. Data obtained from the 250 questionnaire respondents led to the conclusion that Indiana nursing educators are aware of the relevance of human genetics to their work, but they need direct access to helpful information to incorporate genetics instruction as a part of nursing education programs in Indiana. To accomplish this task, the respondents favor continuing education programs in human genetics. Although the data are based on responses of Indiana nursing educators, we believe that our findings can be generalized, at least, to nursing programs throughout the midwest. On the basis of our study, we recommend that continuing education programs in human genetics be implemented with the goal of providing all practicing nurses with a better understanding of the genetic basis of disease, thereby enabling them to counsel wisely those patients entrusted to their care.