Practice Extrapolate Strategies Propose Close Theory-Practice Gap

¶ … Practice

Extrapolate strategies propose close theory-practice gap nursing. Must 3 specific articles 2 choosing a total 5 references. This master's degree Nursing Theory Course. The paper 3-5 pages length APA format.

The theory-practice gap in nursing:

Different perspectives and strategies to close the 'gap'

According to many nurses, there exists a "gap between nursing theory and practice. In order to improve the integration of theory and practice, a high standard of clinical practice is necessary" so that nursing students can see the relevance of what they learn in the classroom to the field (Ming-Tien & Ling-Long 2004). Rona Levin writes that one important step in closing the theory-practice gap in nursing education is taking a constructivist approach to nursing education. "Within the constructivist theory, the learner is able to gain meaning from past and current learning experiences. This experience assists the learner to construct new knowledge…The constructivist facilitates experiential learning by creating an environment where the learner is an active participant in the learning process; the learner learns by doing" (Levin 2010: 217-218). One constructivist method which can be extremely effective is that of the case study approach, in which the mentor or teacher talks with the student about what the student has learned during hands-on applications and creates a connection between the student's lived personal experiences and research. "Often these clinical situations provide excellent learning opportunities for students in which they can present the case incorporating the latest and best evidence, which further guides their assessments and interventions" (Levin 218). Students can inquire what particular medications the mentor-nurse would have used, what other treatments are available, and also learn critical thinking skills regarding various cases they have dealt with personally.

For example, nurses must often make judgment calls -- such as if a rapid strep test is appropriate in a given situation. This involves weighing the accuracy of the test vs. The benefits of immediate treatment vs. The risks of overtreatment with antibiotics (Levin 2010: 218-219). Every patient and every case study is different and even for a complaint as common as strep throat; the nurse must use a mix of best practices, empirical evidence, and past clinical research in varying degrees to come to a decision. Nursing students understand the methodology behind evidence-based practice 'in the field' but also come to see that research can be conflicting, even contradictory. Constructivist concepts of education are based upon building on the existing knowledge of the student: the teacher affirms the knowledge the student possesses but challenges it and refines it, so the student can transition more easily from the roles of student learner to practitioner, although the nurse's learning never truly ends. "Learning continues throughout the life of their clinical practice. Learning continues throughout these cycles because new knowledge is being created at a rapid pace. What is learned as best practice one day is outdated the next. This is the reason that students need to learn how to identify clinical problems, access the best evidence available at the time, and make clinical decisions based on this best available evidence" (Levin 2010: 216). No theory -- not even the theory of evidence-based medicine -- is universally applicable.

However, according to Gary Rolfe, the theory-practice gap in nursing is more serious and systemic in nature. "Nursing theory has developed according to the paradigm of the natural sciences…Underlying the technical rationality model is the assumption that people are as predictable as inanimate objects" (Rolfe 1993: 176). However, human beings are not as predictable and reliable in their behavior as machines, nor can the theories of nursing and medicine be applied with the unwavering tenacity of natural laws. The question of when to administer a rapid strep test is not like the law of gravity, but nursing theory in academia tends to present it as such. Even more controversial are issues of ethics in medicine, such as the treatment of the terminally ill. Knowing that life can be preserved does not necessarily mean that the life should be prolonged, and nurses must consider the wishes of the patient; the nature of the illness and treatment; and even legal considerations in a holistic fashion before coming to a final determination. Nursing is founded upon the principles of caritas for the individual patient, not the need to create scientific experiments and laws about the natural world (Levy-Malmberg, Eriksson, & Lindholm 2008)

Rolfe states that medicine is fundamentally an inductive science, while theory and philosophy are deductive in spirit. "Popper claimed that no matter how many times something is observed to happen, we can never logically conclude that it will always happen -- the next observation might reveal something different" (Rolfe 1993: 176). Nursing by definition treats the individual patient and person and does not aspire to create abstractions for abstraction's sakes. Rolfe notes, however, that this does not mean that theory is irrelevant, but rather nursing theory must have a uniquely practical and utilitarian purpose. "Theory does not determine practice, but is generated from practice" (Rolfe 1993: 175).

Rolfe does suggest that for the experienced practitioner who knows how to use theory in a meaningful fashion, the type of seamless integration between the two is possible in the field. The type of mentorship of young students chronicled in Levin can result in "the alternating from practice to theory to practice and so on is so fast as to seem like one integrated process" (Rolfe 1993: 176). An experienced nurse can use multiple approaches and methods of thinking, and not be a slave to theory while still use theory to generate more creative and dynamic solutions about the patient's treatment, but that theory must be created so it serves the practice rather than stifle nurses

Rolfe's analysis implies an ambiguous role for theory in nursing. "This role of practitioner-as-researcher does not fit the traditional role of the nurse researcher as specialist, coming into the clinical area to 'do' research. In fact, the role of researcher cannot be separated from the role of practitioner, because to practice is to research" (Rolfe 1993: 176). Research should stem from practice, not vice versa. Traditional clinical models of controlled scientific experimentation do not apply to nursing. "If the theory-practice gap is to be closed, then theory must relinquish its hierarchical position and develop from practice, sensitive to the needs of individual practitioners in unique situations" (Rolfe 1993: 178).