Do Student Nurses experience a Theory-Practice Gap? A Case Study
Receiving mixed messages between what they learn at university and what they observe occurring in the clinical learning environment can make learning nursing skills a difficult, challenging, and complex process for students. A theory-practice (T-P) gap has previously been acknowledged within nursing (Rolfe 2002, Maben, Latter and Macleod Clark 2006, Monaghan 2015), yet no clear definition of the concept exists. Therefore a concept analysis of the term ‘theory-practice gap’ was initially undertaken in order to seek clarification of the concept and to provide an original and operational definition for the research study that followed. This interpretivist study aimed to gain an insight from second-year nursing students regarding their experiences, if any, of a T-P gap as they learned to administer intramuscular injections (IMI). Yin’s (2003) single case study with embedded units design was used as a methodological construct for the research providing the researcher with the ability to analyse the data within, between and across the cases. Nineteen pre-registration adult nursing students subsequently attended one of four focus groups, with nine proceeding to undertake semi-structured, one–to–one, interviews. The students were asked to share their experiences of learning to administer IMIs and to explore what they believed enabled and influenced them in learning this skill. They were also asked about how they made sense of the associated nursing knowledge and practice related to giving IMIs. A documentary analysis of the IMI skills lesson plan, and relevant parts of the course handbook, was also performed. Utilising Thomas’ (2016) adapted constant comparative analysis four key themes emerged from the data, namely: i. Simulation based education; ii. Students challenging practice; iii. Cognitive dissonance; iv. Mentors’ practice and supervision. Interpretation of the results showed that a T-P gap existed, however not all students experienced cognitive dissonance as a result. The key factors involved included how the theories of conformity, belonging, moral distress and moral courage could be used to explain and explore the behaviours of the students and how students might seek consonance for any cognitive dissonance experienced. The study findings recommend providing students with a range of educational experiences which situate their learning in a meaningful way, with the complexities in the nature of care duly recognised. Thereby students will be able to construct an understanding of the complex relationship between theory and practice, and also empower themselves with the important skills of questioning and challenging the practice they see. Considering that the NHS currently operates in a culture of ‘missed’ or ‘sub-optimal’ care (Bagnasco et al 2017, Price 2015), enabling students to share their concerns is an important factor in developing a culture of openness. In addition to the original definition of the T-P gap, this thesis reveals how student nurses are affected by their clinical placement experiences, and how the need for collaboration between the university and clinical practice communities is paramount. Further research into effective methods of enabling students to debrief after experiencing discrepancies in care or sub-optimal care, and to cognitively rehearse how to plan their future behaviours or reactions to these events, is needed. This would begin to advance existing discussions about the ways in which the NHS might respond to issues raised by staff, and encourage the organization to act in open and honest ways in reporting and responding to such events.
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