ABSTRACT
The overall goal of this research work was to explore the
understanding of theory-practice gap from the perspective of nurse faculty and
nursing students in University for Development Studies, and clinicians in
Tamale Teaching Hospital. Despite several attempts by nurse faculty and
clinicians to address the theory-practice gap, it remains a central issue in
both nursing education and practice. Most of the initiatives to bridge the
theory-practice gap have evolved in geographic areas such as the USA, UK, and
other developed nations. Little research addressing the issues is evident in
sub-Saharan Africa. A descriptive phenomenological methodology was used. Data
were collected using focus group discussions. A purposive sampling technique
was used in recruiting 32 study participants. The sample consisted of 32
participants, comprising 8 nurse faculty, 12 clinicians (6 in each discussion
session) and 12 nursing students (6 in each discussion session). The study
adopted Colaizzi's descriptive phenomenology data analysis process. Five themes
were identified: system inadequacies; resource constraints; challenges of the
clinical learning environment; clinical placement and supervision; nurse
faculty factors. In Ghana, stakeholders in nursing education and practice are
yet to realise the implications of the theory-practice gap and its associated
challenges on contemporary nursing education and nursing practice.Based on this
evidence of the scope and factors contributing to theory-practice gap in Ghana,
further research could be conducted to identify and develop research-based
strategies to bridge the gap.
CHAPTER ONE
INTRODUCTION
In recent times the clinical competence of nurses has been
increasingly criticised to be on the decline. During the past decade, the image
of nursing in Ghana has fallen at a steady rate due to poor nursing care
rendered to patients by qualified nurses (Ghana Registered Nurses' Association
[GRNA], 2011). There is widespread criticism that graduate nurses though
proficient in theory are less proficient in clinical skills at the time of
registration (Glen, 2009). This has been and continues to be a major concern
for all, especially nurse educators in Ghana.
Theintegration of theoretical knowledge and practical skills
does not usually occur smoothly; leading to the occurrence of a theory-practice
gap in nursing (Bendal, 2006; De Swart, Du Toit, & Botha, 2012; Monaghan,
2015). The gap between theory and practice of nursing is an issue of great
concern for nurse faculty, students and clinicians. Though widely studied
globally, there is little research on theory-practice gap in sub-Saharan Africa
(SSA) (Lugina, 2009).
The chapter is organized into the following sections;
background to the study, problem statement, statement of purpose, research
objectives, research questions, significance of the study, delimitations,
limitations, definition of terms, and organization of the report. The
background of the study entails the definition of theory-practice gap, factors
influencing theory-practice gap, and effects of theory-practice gap in nursing
practice.
The theory-practice gap in nursing and midwifery has been
discussed and debated in the literature for decades. Review of professional
nursing literature from several countries in Europe and North America as well
as Australia provides sufficient support for the existence of a theory-practice
gap in nursing and midwifery (Gardner, 2006; Haigh, 2008; Landers, 2000; Maben,
Latter, & Clark, 2006; Rafferty, Allcock, &Lathlean, 1996; Sellman,
2010; Sullivan, 2010; Upton, 1999; Wilson, 2008). Although well documented globally,
there is a paucity of research on this topic in sub-Saharan Africa (SSA)
(Lugina, 2009). However, there is a general consensus among Ghanaian educators
and practitioners that a theory-practice gap exists (Lugina, 2009).
Though often defined imprecisely and subjected to differing
individual interpretations, it is rife in scholarly literature that
theory-practice gap relates to the discrepancy between classroom theoretical
preparation and what nursing students encounter in clinical practice (Baxter,
2007; Corlett, Palfreyman, Staines,
Marr, 2003; Higginson, 2004; Holton, Bates, Bookter,
&Yamkovenko, 2007; Maben, Latter, & Clark, 2006, Rolfe, 2002; Scherer
& Scherer, 2007; Wolf, Bender, Beitz, Weiland, & Vito, 2004).
Seemingly, the theory-practice gap manifests on two main levels: first, for
nursing students on clinical practicum placements, and second, for newly
qualified nurses (Kellehear, 2014; Monaghan, 2015; Scully, 2010). The gap
between the theory and practice of nursing is an
issue of great concern for nurse faculty, students and
clinicians given that it challenges the concept of
evidence-based nursing practice, which is the basis of contemporary nursing
practice (Scully, 2010; Webber, 2010).
Ultimately, this influences the delivery of competent nursing
care and patient outcomes. Grounding clinical practice in evidence and research
is fundamental in evidence-based nursing practice. Upton (1999) wonders how
there could be evidence-based nursing practice when theory-practice gap exists.
Moreover, inadequate theory-practice integration results in medication errors
and poor nursing care decisions (Gregory, Guse, Davidson, Davis, &Russel,
2009; Jones &Treiber, 2010). Additionally, the theory-practice gap
adversely impacts the socialisation of nursing students to their professional
roles (Maben et al., 2006; Spouse, 2001).
Given the importance of nursing care in the health delivery
system of every country, it is imperative that steps are taken to improve the
clinical competence of nurses. Globally, the goal of nursing education is to
ensure professional clinical competencies and to enhance the delivery of safe,
quality nursing care (Forsberg, Georg, Ziegert&Fors, 2011; Tseng, et al.,
2011; World Health Organisation [WHO], 2007). This could only be achieved by
ensuring that nursing students apply what they have learned in the classroom
and simulation laboratories to real-world situations (Lauder, Sharkey, &
Booth, 2004). Skill acquisition is one element of attaining clinical competence
in nursing practice and this can be achieved through adequate theory-practice
integration.
Several reasons have been proposed as to why the
theory-practice gap manifests in nursing education. One of these is the
relatively recent increase in the research output and the focus on an
evidence-based practice agenda for nursing and midwifery (Gardner, 2006).
Another explanation for the theory-practice gap in literature
is the shift of nursing education into the university/college setting, albeit
this occurred at different rates globally. Despite the movement of nursing to
higher education, providing a new approach aimed at preparing students to meet
health care needs, it is argued that those changes have not had much positive
influence in bridging the theory-practice gap (Andrews & Reece, 1996;
Hewison& Wildman, 1996; Ousey& Gallagher, 2007). They contended that
the progression of nursing into higher education demonstrated in a tangible
way, the dichotomy between theory and practice in that learning occurs in two
separate institutions which hitherto was considered as one. The seeming
disconnect has resulted in the theory and practice of nursing being treated as
separate entities (Ousey& Gallagher, 2007).
The sheer complexity of the theory-practice gap means that it
has remained a perennial problem in nursing. Indeed one of the main criticisms
of nursing education programmes today, is the failure to bridge the theory
practice gap (Monaghan, 2015). Despite the introduction of several strategies
in nursing education, including role models (nurse practitioners, clinical
facilitators, nurse educators, mentors and preceptors) to bridge the
theory-practice gap, it continues to defy resolution (Bendal, 2006; Clark &
Holmes, 2007; De Swardt et al., 2012; Maben et al., 2006; Sedgwick &Yonge,
2008). This phenomenon has plagued nurse educators for decades in their pursuit
of ensuring that what is taught in the classroom accurately reflects the
realities of clinical practice and that the theory is relevant to current
practice in the clinical setting (Corlett et al., 2003).
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