The CCARE model of clinical supervision: bridging the theory-practice gap

Clinical supervision of nursing students is a key component of nursing education. The clinical setting provides students with an opportunity to develop a professional identity, knowledge base, and the ability to transfer classroom knowledge to the clinical setting. This paper suggests a model of clinical supervision that will address how to bridge the pre-existing theory-practice gap in nursing education through an attitude of caring and the utilization of caring behaviours based on Leininger's theory of culture care. Key concepts included in this model are: communication, collaboration, application, reflection and evaluation, these concepts comprise the CCARE model of clinical supervision.     

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。     

Minding the gap: some theory-practice disjunctions in nursing education research

Nursing and nurse education are currently experiencing 'turbulence' as a result of the rapid, unpredictable and often divergent forces in the macro- and micro-institutional settings. Research-based knowledge seeks to 'smooth-over' this 'turbulence', which the literature cites as 'gaps' between the rhetorical ideals and practical realities. This paper deconstructs three influential ENB-sponsored research projects. It is argued that these research reports introduce forms of 'Utopianism', reinserting theory-practice gaps they sought to close down. Finally, as a result of the idealism revealed by the deconstruction, five key issues for future development in nursing research are discussed. These issues are of significance to educationalists since educational policy and practice in nursing are often developed from research findings.     

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.     

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.     

Academic nursing education guidelines: tool for bridging the gap between theory,research and practice

Abstract The aim of the present study was to develop educational guidelines to be used as a tool for the integration of theory, research and practice to ensure that nursing knowledge and practical skills form the basis of academic nursing education. An additional aim was to describe the nursing competence expected of the students at four academic levels: introductory, intermediate and advanced levels I and II. Clinical nursing education plays a crucial role in assisting nursing students to integrate the theory and practice of nursing at the baccalaureate level, as well as in further specialization and in‐depth nursing studies at the advanced level. A research group consisting of lecturers from the Institute of Nursing, Göteborg University, Sweden, was given the objective to formulate educational guidelines for clinical practice within nursing education. The study took the form of a literature search. In addition, the Delphi method, aimed at reaching a consensus of opinion among colleagues, was used. Based on the literature review and the collegial discussions, four core concepts emerged: professional stance, reflective processes, problem‐solving processes, and practical skills, from which the educational guidelines were developed. Guidelines were formulated both in general and abstract form. They were not connected to a specific care context, specific patient group or specific nursing problems. The most important objective of academic education is that the student develops abilities and techniques necessary for life‐long learning. Students will, in their professional life as nurses, continuously meet situations where they are challenged to take appropriate decisions and actions. This demands training in problem‐solving, reflection, decision‐making and the ability to use both deductive and inductive learning strategies. The guidelines describe what is expected of the students in terms of nursing competence and personal qualifications to ensure that they will be ready to meet the demands of their future profession.     

Nursing theory-based independent nursing practice: a personal experience of closing the theory-practice gap

The article presents a narrative and exemplar from an independent nursing practice underpinned by the theory of health as expanding consciousness. The journey illustrates the importance of developing personal and professional awareness of theories that are congruent with one's worldview. This enhances meaning in nursing practice and contributes to closing the theory-practice gap. The benefits of independent nursing practice to closing the gap are also discussed.     

A clinical practice journal club: bridging the gap between research and practice

The value of applying the findings of research to nursing practice is obvious. A clinical practice journal club may assist in this process. Monthly in our clinical settings. Our journal club helped to bridge the gap between research and our professional practice.     

Going to extremes: action research, grounded practice and the theory-practice gap in nursing

Action research is growing in popularity with nurse researchers, where it is often seen as a way of bridging the theory-practice gap However, there is little agreement on exactly what is meant by the term, and most nurse researchers stop short of exploring the full potential of this methodology This paper argues that, if taken to its logical conclusion, action research methodology goes beyond the confines of the scientific paradigm and is able to bring about improvements in practice directly without the mediation of theory This has some important implications for how the research process is viewed, and results m a model of research which is participative, reflexive and unashamedly subjective, and which generates non-generalizable, personal knowledge directly out of practice     

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.     

Health promotion and health education viewed as symbiotic paradigms: bridging the theory and practice gap between them

A recognized 'paradigm war' exists between the two distinct approaches of health education and health promotion practice. This tension is both unhealthy and unhelpful and is known to have a profound effect on nursing activity. Leading health promotionalists have begun to acknowledge the futility of the stated paradigm tension, realizing that health education and health promotion interventions are not that dissimilar in their origins and intentions. Progressive health education and health promotion programmes acknowledge the interrelatedness of both approaches and seek to incorporate favourable aspects of the two. The aim of this article is to present arguments and stances that help to diffuse/avoid the stated paradigm conflict, as a basis for health education and health promotion reform in nursing. It also seeks to clarify the nature of both health education and health promotion practice so as to avoid contextual confusion. In doing so, this article draws significantly from the author's previous work. This article concludes that the constructive review of any intended health education/health promotion programme lies in the consideration of each approach according to its own relative merits, what is required of the programme, and the nature of the setting in which the intervention takes place.     

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     

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.