Bridging the Theory-Practice Gap in Nursing Education

Introduction

The development of nursing theory has followed the natural sciences paradigm, commonly referred to as the technical rationality model (Rolfe, 1993). In nursing, the term "theory" is used in a general sense to refer to the systematic concepts, deductions, and definitions that are interrelated so as to explain, describe, or predict interconnections and relationships. As in other sciences — particularly chemistry and physics — theory and research in nursing serve to provide and build a firm, established foundation of knowledge. The foundation of research is normally a given phenomenon, and research findings are generally accepted with minimal question. However, these findings carry serious implications for actual fieldwork, because the natural sciences paradigm creates a separation between the researcher and the professional who works at the field level.

In nursing, this paradigm creates a scenario in which theory is elevated above practice, a rift develops between theorists and practitioners, and practitioners are reduced to mere implementers of theories they played no role in developing. For instance, theorists may develop a clinical model, and after it is published, practitioners adopt it for application in clinical settings. Such a model rests on the assumption that people are predictable, as an inanimate object might be. It is important to note, however, that people cannot be reduced to a single assumption; they can only be predicted based on statistics (Rolfe, 1993). As a result, such a model creates a dilemma regarding its applicability to real-life situations. This paper addresses this theory-practice gap by suggesting strategies to overcome it, drawing primarily on a review of available literature.

In the nursing profession, the main stakeholders with regard to theory and practice are students, nurses, and teachers. Based on the literature, the theory-practice gap has created a variety of challenges for these groups. The first challenge concerns how nursing theory is taught to students and how the knowledge acquired is then applied in the field. There is a clear difference between the two, and this discrepancy has raised concerns among various researchers (Levin, 2010; Sellman, 2010; Holzemer, 2008). Consequently, numerous researchers have undertaken studies aimed at understanding the gap between theory and practice in nursing and at offering potential strategies to close it.

Reflection: How the Gap Manifests

The theory-practice gap has generated concern about the development of the nursing profession as a whole. The groups most affected are nursing students, who encounter difficulties in a system that should interlock theory and practice (Levin, 2010). This challenge is clearly illustrated by the inability of nursing students to respond effectively to the nature and demands of both theory and practice (Rafferty, Allcock, & Lathlean, 1996; Silva, 1999). Research consistently shows that nursing students face a crossroads when they are required to translate classroom knowledge into actual practice in clinical settings. The growing body of research documenting this gap underscores the need for well-considered strategies to address the problem.

One of the primary problems in nursing with regard to the theory-practice gap is that the profession as a whole is structured in a way that leaves various parties ill-equipped to manage expected outcomes. Both the theoretical side and the practice side offer divergent explanations for the gap; without consensus, the gap continues to widen (Holzemer, 2008). Without agreement, theorists fail to develop an operational environment aligned with expected results, while clinical nurses fail to establish practices that reflect what they have learned in theoretical classes. To address this, the first recommended strategy is to reach consensus on the reasons for the gap, with each side working toward bridging it through clear rules, operational directions for the various situations encountered in the field, and shared definitions of terms, events, and systems.

Strategies for Bridging the Gap

According to Levin (2010), there is a need to expand nursing theory so as to prepare students adequately for the practical aspects of the profession. Teachers in nursing schools play a crucial role, having navigated the full cycle of the profession successfully; they therefore have a better understanding of what is missing and what is needed to address the gap. Teachers are consequently called upon to create strategies that tackle the theoretical deficiencies of the curriculum. One such strategy is to explain the theoretical perspectives of nursing teaching more clearly, because students who are well equipped with appropriate knowledge are more likely to develop sound practical competencies (Levin, 2010). This strategy rests on the understanding that teachers and students together stand a genuine chance of creating a healthier practical environment in nursing.

Some researchers argue that another contributor to the theory-practice gap is the difference between knowledge theory and practice theory. Based on real-life experience, this argument is persuasive: theoretical knowledge differs substantially from practical knowledge, regardless of the setting. This difference is clearly illustrated by employers' insistence on experience when hiring in the nursing profession. Classroom theoretical knowledge — as argued by Landers (2000) and Holzemer (2008) — is simply insufficient for a nursing student to claim readiness to deliver positive results in the clinical environment. To address this, teachers bear a responsibility to ensure that nursing students are taught both theoretical and practical knowledge. Through such an approach, it becomes possible to minimise the gap by ensuring that students entering clinical settings directly from the classroom are adequately equipped with practical knowledge to work successfully.

A further insight is that personal knowledge and practical knowledge, while both relevant to nursing, are two very different things. Nursing students acquire personal knowledge through classroom learning, but translating that knowledge into practice has proved problematic (Landers, 2000; Rafferty et al., 1996). This problem is attributed to the inadequate manner in which students are sometimes taught in the classroom. The proposed solution is to teach nursing students in ways that allow them to develop and grow practical skills — specifically through strategies and activities that require students to apply what they have learned (Landers, 2000). If such a strategy is adopted across nursing schools, a significant portion of the theory-practice gap can be closed.

Conclusion

According to Levin (2010) and Rolfe (1993), practical knowledge is as vital as theoretical knowledge for nursing students. With the understanding that such knowledge must begin somewhere and develop gradually toward the capability to manage complex clinical situations, nurse students and new entrants to the practitioner phase of the profession should be open, willing, and ready to build their practical knowledge through a hands-on approach. Not all potential nursing scenarios can be taught in a classroom; practitioners will inevitably encounter new practical problems regularly. It is therefore suggested that nurse practitioners learn from each health problem they address — whether the outcome is successful or not — and carry the practical knowledge gained forward into the next clinical challenge they face.

The theory-practice gap in nursing is real, and closing it successfully requires the involvement of all stakeholders. From nursing students to practitioners and nursing educators, each party must be engaged, and all must work closely together — each contributing from their own position — to bridge the gap. The key recommendations are as follows: first, all stakeholders need to reach consensus on the issues underlying the gap; second, students need to be equipped with sound theoretical knowledge to facilitate an easier transition to practical knowledge; third, students should be taught both theoretical and practical knowledge concurrently; fourth, students need structured avenues in which to practise what they learn; fifth, expert practitioners need to document and package the knowledge they have gained so that it is accessible to those newer to the profession; and sixth, practitioners and nursing students alike must commit to learning continuously on the job and carrying practical knowledge gained forward throughout their careers.

Holzemer, W. L. (2008). Nursing theory — remembering our future. Japan Journal of Nursing Science, 5(2), 71–71.

Landers, M. G. (2000). The theory-practice gap in nursing: The role of the nurse teacher. Journal of Advanced Nursing, 32(6), 1550–1556.

Levin, R. F. (2010). Integrating evidence-based practice with educational theory in clinical practice for nurse practitioners: Bridging the theory-practice gap. Research and Theory for Nursing Practice, 24(4), 213–216.

Rafferty, A. M., Allcock, N., & Lathlean, J. (1996). The theory/practice 'gap': Taking issue with the issue. Journal of Advanced Nursing, 23(4), 685–691.

Rolfe, G. (1993). Closing the theory-practice gap: A model of nursing praxis. Journal of Clinical Nursing, 2(3), 173–177.

Sellman, D. (2010). Mind the gap: Philosophy, theory, and practice. Nursing Philosophy, 11(2), 85–87.

Silva, M. C. (1999). The state of nursing science: Reconceptualizing for the 21st century. Nursing Science Quarterly, 12(3), 221–226.