What is a theory-practice gap? An exploration of the concept

Communities of reflection in nurse education programs: A qualitative multi-methods study

BACKGROUND

Nursing students often face challenges reconciling theoretical concepts with clinical realities. This study examines a novel concept 'Communities of Reflection' designed and tested to enhance coherency between theory and practice. The concept involves reflection groups comprising students, preceptors, and faculty during clinical placements.

AIM

To examine the meaning of 'Communities of Reflection' regarding the coherency between theory and practice as perceived by the involved participants.

METHOD

A qualitative multi-methods approach involved nursing students, preceptors, and faculty members who participated in 'Communities of Reflection.' Data collection methods included interviews, focus groups, written reflections, and observations.

FINDINGS

The content analysis revealed that 'Communities of Reflection' facilitate a shared engagement in nursing, fostering a deeper level of reflection. Creating a safe space and embracing vulnerability are key aspects of this shared engagement.

CONCLUSION

'Communities of Reflection' offer a valuable framework for promoting coherency between theory and practice. It appears to be crucial to students' outcomes that a well-established, equitable theory-practice partnership is the solid foundation, acknowledging that emotions can serve as a catalyst for the development of professional expertise.

Incorporating Parents' Lived Experiences Into the Pediatric Audiology Course: A Qualitative Analysis of Student Reflections

PURPOSE

This study explores the underutilized pedagogical approach of incorporating lived experiences of parents with children possessing diverse hearing profiles and their family characteristics into the audiology curriculum for students. The aim was to investigate the impact of integrating such experiences into the classroom as an andragogical learning experience through the qualitative analysis of written student reflections.

METHOD

Twelve (N = 12) third-year female audiology students enrolled in a pediatric auditory (re)habilitation course attended a parent panel presentation during their regularly scheduled face-to-face class. Five parents of children with diverse hearing differences and diverse technology, communication, and educational choices participated on the panel as guest speakers via the Zoom platform. Students completed written reflections based on Rolfe's reflective framework. Written reflections were downloaded from Canvas and de-identified prior to uploading to NVivo software for coding, utilizing an inductive grounded theory coding strategy coupled with content analysis.

FINDINGS

This study underscores the effectiveness of written reflections as an effective andragogical learning model. Through reflective practice, students gained a deeper understanding of their experiences, values, and learning journeys, enhancing their competency in pediatric audiology and auditory (re)habilitation. Students articulated previous knowledge and learning experiences, utilized newfound insights from exposure to the parent panel of shared lived experiences, and connected this knowledge with future clinical applications.

CONCLUSIONS

Key findings underscore the effectiveness of reflective practice as an andragogical learning model, facilitating the integration of prior experiences with new knowledge. Moreover, it aids the transition of the professional journey from the familiar to the unfamiliar, demonstrating the impact of combining real-world lived experiences to reinforce and highlight classroom topics. Additionally, reflective practice enhances professional efficacy by valuing patient/parent perspectives regarding clinical care and aligning with evidence-based principles.

Nursing students' reactions to a graphic novel: A multi-national descriptive qualitative study

BACKGROUND

Undergraduate nursing programme teaching and learning methods and content must evolve to meet the changing evidence base, healthcare context and needs of new generations of nurses. Art-based and narrative methods have been employed to help student nurses explore complex issues, including patient experiences of health and illness, person-centred care and social determinants of health. One creative visual teaching tool is the graphic novel. However, little is known about student perceptions of graphic novels and how they facilitate student nurses' reflection, engagement and learning. Gaining such an understanding may be of especial value for teaching Generation Z students who are used to interacting with complex visual imgery and prefer alternatives to text-heavy documents.

OBJECTIVE

The objective was to explore student nurses responses to Vivian, and graphic novels in general, as teaching resources in undergraduate nursing curricula in England, Sweden, and Aotearoa New Zealand.

DESIGN

A social constructionist critical framework informing a descriptive qualitative study.

SETTING AND PARTICIPANTS

Undergraduate nursing students in Sweden, England, and Aotearoa New Zealand.

METHODS

Data were collected using focus groups and semi-structured interviews. Braun & Clark's method for thematic analysis was used to analyse the data.

RESULTS

Three themes were developed: 1) reflections on clinical practice, including reflections on palliative care, holistic care for older people and communication between patients and staff; 2) graphic novels' usefulness as a teaching resource, in which students regarded them as an alternative way to learn; and 3) Vivian as a form of the graphic novel.

CONCLUSION

The graphic novel Vivian helped nursing students engage in critical reflection and with challenging theoretical concepts. It, and graphic novels in general offer an alternative to print-based texts, which may heighten their appeal to Generation Z learners.

Identification of a Theory-Practice Gap in the Education of Biomedical Scientists

Introduction

The Biomedical Scientist (BMS) role is established in healthcare, working in laboratory environments to provide diagnostic testing and to monitor treatment effects on a patients' health. The profession is subject to several professional standards which highlight the importance of working in the best interests of the patient and service user. However, Biomedical Scientists have little or no patient contact. This study aimed to determine how Biomedical Scientists evidence that they meet the professional standards and support the achievement of patient outcomes.

Materials and Methods

This study utilised a Delphi method to explore the opinions of professional stakeholders to determine whether there was consensus for how this professional group contributes to patient outcomes and offers evidence that they are working in the best interests of the patient. The qualitative 1st round of the study consisted of focus groups and interviews with staff and students on the BSc Biomedical Science awards, Professional, Statutory and Regulatory body (PSRB) representatives and Biomedical Scientists from the National Health Service (NHS). The first-round responses were analysed using thematic analysis which then generated attitude statements which participants scored using a 5-point Likert scale in the 2nd round. Consensus or divergence of opinion was determined based upon a 70% consensus level within each participant group and overall.

Results

Following analysis of the 2nd round data, there was divergence of opinion across all stakeholders, with consensus rates being highest in the Biomedical Scientist group (72.7% of statements reached 70% consensus), followed by the student group (54.5% of statements reached 70% consensus) and lowest in the academic group (40.9% of statements reached 70% consensus).

Discussion

This demonstrates a theory-practice gap in both the academic and student groups, suggesting that graduates are insufficiently prepared for their post-graduate role. This gap was particularly evident when discussing topics such as how Biomedical Scientists contribute to patient care, professional registration and working as part of the multi-disciplinary team (MDT). The identification of a theory-practice gap in the education of Biomedical Scientists is a novel finding, indicating that students may graduate with insufficient understanding of the Biomedical Scientist role.

UK student midwives' theoretical knowledge, confidence, and experience of intermittent auscultation of the fetal heart rate during labour: An online cross-sectional survey

AIM

This study aimed to explore student midwives' theoretical knowledge of intrapartum intermittent auscultation, their confidence in, and their experience of this mode of fetal monitoring.

DESIGN AND SETTING

An online cross-section survey with closed and open questions. Descriptive statistics were used to analyse participants' intermittent auscultation knowledge, confidence, and experience. Reflexive thematic analysis was used to identify patterns within the free text about participants' experiences.

PARTICIPANTS

Undergraduate midwifery students (n = 303) from Nursing and Midwifery Council-approved educational institutions within the United Kingdom.

FINDINGS

Most participants demonstrated good theoretical knowledge. They had witnessed the technique being used in clinical practice, and when performed, the practice was reported to be in line with national guidance. In closed questions, participants reported feeling confident in their intermittent auscultation skills; however, these data contrasted with free-text responses.

CONCLUSION

This cross-sectional survey found that student midwives possess adequate knowledge of intermittent auscultation. However, reflecting individual clinical experiences, their confidence in their ability to perform intermittent auscultation varied. A lack of opportunity to practice intermittent auscultation, organisational culture, and midwives' preferences have caused student midwives to question their capabilities with this essential clinical skill, leaving some with doubt about their competency close to registration.

Clinical mentorship of midwifery students: The perceptions of registered midwives

Background

Clinical mentors are experienced practitioners who play an important role in encouraging the professional development of students in clinical areas. The responsibility of clinical mentorship in nursing is often difficult to maintain. However, there is a dire need for clinical mentorship in maternity units, especially in South African hospitals were high maternal mortality rates remain alarmingly high.

Aim

This study aimed to describe the perceptions of registered midwives regarding the clinical mentorship of midwifery students.

Setting

The study occurred in a semi-rural state regional hospital in the eThekwini district, KwaZulu-Natal.

Methods

A qualitative exploratory and descriptive design was conducted using in-depth individual interviews with midwives in maternity units. A purposive and convenient sampling method recruited 17 registered midwives from 3 maternity care areas within a single setting. Interviews were audio-recorded and all data were analysed using qualitative content analysis.

Results

Five categories emanated from this study namely, sharing knowledge and skills; encouraging role model behaviour; promoting self-worth; Is a challenging task; and requiring additional support.

Conclusion

Clinical mentorship has a reciprocal effect on teaching and learning in maternity care areas and encouraged registered midwives to lead as role-models. The process demands competence, professionalism, and leading by example. Despite the confidence, satisfaction and interest in clinical mentorship, registered midwives often find the process challenged by patient care priorities. Therefore, registered midwives require additional support to mentor students in clinical practice.

Contribution

This article shows that clinical mentorship places various challenges on registered midwives and formal mentorship training could be beneficial.

Nursing students' experiences from clinical education using the TPSN model

BACKGROUND

The TPSN model is an innovative model to create an integration and structured relationship between educational and healthcare provider institutions. This model is done to reduce the theoretical-practical gap in nursing. The present study aimed to explore the experiences of nursing students.

METHODS

In a conventional content analysis, 11 undergraduate nursing students, 7 graduate nursing students, and 4 doctoral students were selected. Data was collected through focus group discussions and individual interviews.

RESULTS

The findings from analyzing the students' experiences who had received education using this model resulted in four main categories: the feeling of being a nurse, an integrated and collaborative clinical education platform, the development of nursing clinical education, and educational challenges.

CONCLUSION

The TPSN model provides a suitable platform for nursing clinical education. This model helps students integrate theoretical knowledge with clinical practice and helps them act as professional nurses in the future.

New Graduate Nurse Transition into Rural Home: A Case Study

The global shortage of nurses and high attrition rates for newly graduated nurses along with the shifting demand for home care has created a critical need for retention strategies that address the specific challenges of rural settings. The effectiveness of structured transition or mentoring programs are primarily studied in acute care settings, making it difficult to translate to the unique context of rural home care nursing. The complexities of the independent nature of home care nursing practice and limited resources to address transition shock make it difficult to successfully transition newly graduated nurses to rural home care. A case study supports mentorship facilitation as a readily available, effective strategy that can overcome the challenges of rural home care settings. A comparative analysis will link Duchscher's (2008) transition shock theory to mentorship as an effective strategy for supporting NGNs' transition in home care nursing. Recommendations offer rural care leaders practical strategies bundled with mentorship to optimize the successful transition and retention of newly graduated nurses in their workplaces.

Development of collaboration guidelines for nursing education and related healthcare services

Background

A theory-practice gap in nursing education often occurs, and the staff from the nursing education institution and the associated healthcare services should find ways to improve their collaboration to reduce the gap during the training of nursing students.

Aim

This study aimed to develop context-specific collaboration guidelines for a nursing education institution and associated healthcare services.

Setting

Private hospital in the Gauteng province of South Africa.

Methods

Guidelines were developed from the findings of an integrative literature review. Thereafter, it was contextualised in a qualitative study with focus group discussions (FGDs) involving 9 theoretical lecturers and 10 clinical facilitators.

Results

In the partnership between the nursing education institution and the associated healthcare services, bilateral communication, cooperation between the theoretical lecturers and the clinical facilitators in delivering evidence-based patient care, intensified innovation in teaching and learning practices and an environment conducive to theory-practice integration should be emphasised.

Conclusion

A set of context-specific guidelines was developed to enable the theoretical lecturers and the clinical facilitators to collaborate in supporting nursing students to apply their theoretical knowledge in the development of clinical competencies.

Contribution

The guidelines can be adjusted to suit the context of other nursing education institutions and their associated healthcare services to improve collaboration between theoretical lecturers and clinical facilitators to the benefit students' skills development in theory-practice integration.

In situ simulation training strengthened bachelor of nursing students' experienced learning and development process- a qualitative study

BACKGROUND

In advanced clinical learning labs on campus, high-fidelity simulation has become an essential educational approach in the Bachelor of Nursing Education programme. However, simulation while in clinical placement, in situ, is rarely used in Bachelor of Nursing Education. The aim of the present study was to explore how in situ simulation training at a surgical hospital ward, according to Bachelor of Nursing students, influenced their learning and development process.

METHODS

A qualitative descriptive study was conducted. Data were collected through individual interviews with a sample of 21 s-year Bachelor of Nursing students who completed 40 in situ simulations during their eight-week clinical placement at a Norwegian University Hospital. Data were analysed using inductive content analysis.

RESULTS

The data analysis generated six subcategories constituting two descriptive categories: building professional confidence and internalising nursing knowledge. Although the students found in situ simulation stressful and uncomfortable for being assessed by student peers, the teacher and preceptor, the process of managing clinical situations in simulation helped build professional confidence. What the students had learned in the simulation was directly transferable to real clinical situations because they were in the hospital setting. The simulation sessions enabled them to connect theoretical knowledge and clinical skills. They could test their skills in a safe environment, performing procedures that made them aware of how their knowledge could be used in real life.

CONCLUSION

According to the Bachelor of Nursing students' own experiences, in situ simulation supported the students' learning process, connected theory and practice and contributed to developing confidence in the performance of clinical skills. Including simulation in clinical practice could prove to be an effective way of teaching and learning clinical skills in nursing regarding resources and learning outcomes.

Longitudinal impact of an online interdisciplinary perinatal mental health module on Healthcare Professionals' knowledge, skills, attitudes and confidence: A qualitative evaluation

AIM/OBJECTIVE

The current study aimed to explore the following research question; 'What is the longitudinal impact, if any, of an online interdisciplinary perinatal mental health module on HCP knowledge, skills, attitudes and confidence'.

BACKGROUND

Research suggests that one in five women/people will experience a mental health issue during the perinatal period. Healthcare Professionals (HCPs) play a critical role in identifying, supporting and referring those who disclose health or psychosocial concerns in pregnancy or after birth and consistent research findings highlight the need for appropriate targeted perinatal mental health education among this cohort. To address this need, a thirteen-week (Masters Level) interdisciplinary online module in perinatal mental health was collaboratively developed between one Irish Higher Education Institution and national mental healthcare specialists. The module aims to develop HCP knowledge, skills, attitude and confidence in sustainably supporting women/people and families experiencing perinatal mental health issues. However, a recent scoping review concluded that there was insufficient evidence with respect to the longitudinal impact of such courses on HCP practice.

DESIGN/METHODS

The study design adopted a qualitative descriptive design that used online individual interviews for data collection. The evaluation was informed by the Kirkpatrick and Kirkpatrick Evaluation Model. The study group consisted of six voluntarily self-selected perinatal mental health module participants. Longitudinal impacts of the module were explored 8-10 months following module completion. Thematic Analysis was undertaken using Braun and Clarkes Framework. Ethical approval for the study was obtained from the author's Higher Education Institution (HEI).

RESULTS

Findings revealed several interrelated and reinforcing themes that had an impact on the longer-term application of enhanced knowledge, skills, attitude and confidence in practice. These were; pedagogical features of the interdisciplinary perinatal mental health education module, sociocultural and professional influences, persistent enthusiasm and commitment to improve care in spite of systemic obstacles and, ongoing need for perinatal mental health education.

CONCLUSIONS

Provision of targeted, agile and manageable professional education courses on perinatal mental health care will continue to be required. However, despite sustained commitment and enthusiasm to implement enhanced knowledge and skills, systemic obstacles continue to exist and these may have an impact on the efficacy of such courses in the longer term.

Block learning: Evaluation of a new teaching approach for nursing and midwifery education

AIM

The aim is to present outcome and engagement data from the initial years of the implementation of a new teaching approach in entry to practice nursing and midwifery education.

BACKGROUND

The Block Model (TBM) is a teaching approach that involves studying one unit of study at a time over a four-week period, as opposed to the traditional semester model. This paper presents data revealing the impact of TBM on student engagement and overall experience in entry to practice Bachelor of Nursing and Midwifery programs.

DESIGN

The evaluation retrospectively compared key indicators pre- Block Model implementation with outcomes for nursing and midwifery students using TBM approach using standard data sets and external comparators such as the Student Experience Survey and National Employability Survey.

METHODS

The study presents a comparative analysis of key indicators and graduate outcomes for students. We use reportable data and two external comparators, the Student Experience Survey and the National Employability Survey, to gauge student learning and graduate employability. The evaluation was conducted in a tertiary institution in Australia with for nursing and midwifery students who completed their studies using TBM approach at the university.

RESULTS

The implementation of TBM in nursing and midwifery programs resulted in improvements in learner engagement, retention rates and pass rates. Improvements were also noted graduate outcomes, with an increase in full-time graduate employment.

CONCLUSIONS

The results suggest the Block Model is a promising new teaching approach in nursing and midwifery education, with potential benefits for learner engagement, retention and pass rates.

Knowledge about the best practice guidelines in the nursing degree: A non-randomized post-test design

AIM

To compare knowledge of Nursing Degree students about Best Practice Guidelines when there are included as teaching content in a subject vs knowledge through having the usual internship experience without teaching specific guidelines contents.

DESIGN

Non-randomized post-test-only design with a comparison group.

METHODS

143 students of the nursing degree at the Autonomous University of Barcelona were recruited. The intervention group received a classroom training in three Best Practice Guidelines with Problem-Based Learning methodology. The comparison group only attended internship, without specific guidelines contents. Knowledge was evaluated with an ad hoc post intervention questionnaire. The information was collected between 2016 and 2018.

RESULTS

The average score of knowledge was low, 5.1 out of 10, and differs between guides. The best results were obtained by the students with internships and that had consulted the guides on some occasions. Synchronized effort and leadership in Academia and Healthcare are needed to favour evidence-based practice. The combination of the consultation of the Best Practice Guidelines in theoretical learning combined with the practice, increases the knowledge of the Best Practice Guidelines and will favour the implementation of evidence-based practice. Some students were involved in questionnaire design.

Causes and effects of theory-practice gap during clinical practice: the lived experiences of baccalaureate nursing students

PURPOSE

This study evaluated the baccalaureate nursing students' lived experiences of the causes and effects of TPG during clinical practice in a tertiary health institution in Enugu, Nigeria.

METHOD

A qualitative design using existential descriptive phenomenological approach was adopted to explore 20 baccalaureate nursing students at 500 level of study. The class level of the students was purposively sampled and the exact number of students sampled using snowball technique. Semi-structured interview guide was the instrument for data collection. Data were collected using audio-tape recorder, face to face in depth discussions, and analyzed using qualitative thematic analysis.

RESULT

Five broad themes and 12 subthemes emerged from this study namely: Resource constraints (limited resources, resource improvise); Unhealthy human attitudinal and behavioural factors (nurse clinicians, nurse educators, student nurses factors); Environmental system challenges (paradoxical academic design and structure, paradoxical clinical setting); Integration Inadequacy (team cooperation paucity, scarce surveillance, insufficient timing of clinical placement); Observing effects of TPG (observing adverse impacts, observing positive implications).

CONCLUSION

The causes of TPG during clinical practice emerge from nursing education and practice. TPG have adverse impacts on patients, nursing students, nursing education and practice, other health practitioners, while linkage to response is its positive implication.

Applying Legitimation Code Theory to teach breastfeeding in nurse education: A case study

AIM

To use Legitimation Code Theory as a framework to inform the design of nursing education and gain insights into student perspectives of this design.

BACKGROUND

Internationally, the World Health Organization's breastfeeding recommendations are not being met. One contributing factor is that healthcare providers including registered nurses lack the knowledge to support breastfeeding women on an ongoing basis and rely on their personal experiences to inform the care they provide. Undergraduate nursing students should receive education to assist breastfeeding women in practice.

DESIGN

The study is underpinned by case-study methodology. The Legitimation Code Theory (LCT) dimension of Semantics and the concepts of semantic gravity and semantic density were used to theoretically frame and develop an intervention module to teach undergraduate nurses about breastfeeding.

METHODS

This module was part of an elective seven-week paediatric nursing course. University Human Research Ethics Committee (HREC201/203) reviewed the study. Participants (n = 9) completed semi-structured interviews and thematic analysis helped us to understand their experiences of the module. The Template for Intervention and Description and Replication (TIDeR) framework was used to report the intervention.

RESULTS

The breastfeeding module was positively received by participants who noted the module's structure differed from previous courses. Three main themes were identified in the student experience. These are: a) threads and links; b) engaging structure; and c) seedlings.

CONCLUSION

Legitimation Code Theory is an effective course development framework to harness the learners' prior informal knowledge and weave learning activities between theory and contextual practice to develop cumulative knowledge.

IMPACT

With an increased understanding of how undergraduate nursing students develop knowledge, the LCT dimension of Semantics can be ussed to structure content knowledge in instructional design. This approach builds explicit bridges between knowledge development in the nursing curriculum and learners' informal knowledge and contextual practice in clinical settings.

The nursing process: A supportive model for nursing students' learning during clinical education - A qualitative study

AIM

The aim of this study was to increase understanding of nursing students' learning during clinical education in relation to the nursing process.

BACKGROUND

Nursing students' learning during clinical education is of great importance in creating meaning for theory and development of core competencies. As a theoretical model, the nursing process is challenging to apply in practice for both students and registered nurses, although use of the model has benefits for patient care.

DESIGN

This is a descriptive qualitative study with an abductive approach.

METHODS

Twelve semi-structured interviews with nursing students in education from six universities in Sweden were conducted in 2021-2022. Data were examined using qualitative content analysis.

RESULTS

The results revealed that the nursing process supported learning when theory and practice 'spoke the same language'. This allows for the opportunity to perform in a consistent way with the theory, while obtaining awareness of an invisible process. Furthermore, the nursing process supported learning by incorporating a thought structure for the student´s professional role through developing independence to conduct a holistic assessment and increasing an understanding of the nurse´s area of responsibility.

CONCLUSION

The results revealed that when theory and practice were aligned, the nursing process became a meaningful structure to develop a sustainable, safe way of thinking for one's future professional role. It is important to use supportive pedagogical models for students and supervisors that facilitate the integration of concepts of the nursing process in practice.

Understanding competency of nursing students in the course of case-based learning in Cambodia: a convergent mixed method study

BACKGROUND

In the last decade, nursing education has begun to reform to competency-based education worldwide, including in low-and middle-income countries. Case-Based Learning (CBL), an approach to delivering competency-based education, contributes to acquiring critical thinking competency, problem-solving, higher knowledge, professional value and attitude. However, it needs to be taught in a culturally appropriate manner. In Cambodia, CBL was initiated in a classroom and clinical practicum by faculty and preceptors who graduated from the upgrading course. This study examined the factors associated with the competency level of nursing students, explored the practice and perceptions of teaching-learning activities among students, faculty members and preceptors and assessed the coherence of qualitative and quantitative findings.

METHODS

This was a convergent, mixed methods study. Data were collected from eight educational institutions for quantitative and qualitative studies and seven hospitals for qualitative studies. From June to September 2019, a cross-sectional survey of nursing students in the third year of the three-year programme (n = 719), eight focus group discussions (FGDs; n = 55) with 6-8 members and 15 FGDs with faculty (n = 38) and clinical preceptors (n = 37) with 4-7 members were conducted to elicit the teaching-learning experience and perceptions. Multiple linear regression was performed to investigate the factors associated with student competency. Moreover, the study conducted thematic content analysis on the qualitative data. The integrated analysis was presented as side-by-side joint displays.

RESULTS

First, the quantitative and qualitative findings confirmed each other 's CBL learning experiences. Students had higher levels of nursing competencies if they had CBL experiences, both in the classroom and clinical practicum, both in a group manner. Next, the quantitative and qualitative findings complemented students' academic satisfaction with the teaching by faculty members and preceptors. Finally, the quantitative and qualitative findings were expanded to explain students' academic satisfaction with the programme.

CONCLUSIONS

The finding of CBL experiences in a group and students' satisfaction with faculty members' and preceptors' teaching improved nursing students' competency development. Meanwhile, students' satisfaction with the design and delivery of the educational programme provides implications for policy level to narrow the theory and practice gaps in low- and middle-income countries.

Valuing the emotions of leadership learning experience in nursing education

AIM

This paper argues that a greater understanding of the role of emotions in experiencing leadership, the impact of role models and cultures of the workplace and profession, may enable further development for effective leadership development at undergraduate level and beyond.

BACKGROUND

Leadership has gained prominence as a necessary skill in nursing literature and policy, linking its importance to patient safety, working cultures, resilience and emotional labour globally. Viewed as essential in many undergraduate nursing programmes and a requirement by professional regulators, there is a globally agreed acceptance of its importance. Despite this, the focus on evaluating and researching the effectiveness of leadership learning and through experiences of students in contexts of learning remain limited. This paper presents a discussion on the importance of experiences of leadership, exploring the emotional impact and how enabling reflexivity and critical analysis can be integrated in education. An approach is proposed for nursing education where the emotional impact of experiencing leadership is given significance. Experiences of leadership in practice and educational learning in higher education should allow students to reflect and conceptualise experience, aligning educational contexts of learning. Acknowledgement of emotional experience and pragmatism provides opportunity to strengthen evidence and knowledge and establish leadership as a concept of value in the profession from an early stage.

DESIGN

A critical theoretical discussion paper METHODS: Based on a narrative inquiry study, drawing on theory and philosophies of emotions in education and leadership from 1907 to 2023 RESULTS: Acknowledgement of emotional experience and pragmatism provides opportunity to strengthen evidence and establish leadership as a concept of value in the profession from an early stage.

CONCLUSIONS

Placing value on the experience of leadership by reflexivity and pragmatic, experiential approaches to learning can align educational contexts of learning and focus on effective leadership learning for the nursing profession.

TWEETABLE ABSTRACT

Pragmatic approaches and reflexivity rationalise emotional experiences of leadership and encourage critical thinking and learning.

Exploring the complex realities of nursing work in Kenya and how this shapes role enactment and practice-A qualitative study

AIM

We explore how nurses navigate competing work demands in resource-constrained settings and how this shapes the enactment of nursing roles.

DESIGN

An exploratory-descriptive qualitative study.

METHODS

Using individual in-depth interviews and small group interviews, we interviewed 47 purposively selected nurses and nurse managers. We also conducted 57 hours of non-participant structured observations of nursing work in three public hospitals.

RESULTS

Three major themes arose: (i) Rationalization of prioritization decisions, where nurses described prioritizing technical nursing tasks over routine bedside care, coming up with their own 'working standards' of care and nurses informally delegating tasks to cope with work demands. (ii) Bundling of tasks describes how nurses were sometimes engaged in tasks seen to be out of their scope of work or sometimes being used to fill for other professional shortages. (iii) Pursuit of professional ideals describes how the reality of how nursing was practised was seen to be in contrast with nurses' quest for professionalism.

Practice education facilitators perceptions and experiences of their role in the clinical learning environment for nursing students: a qualitative study

BACKGROUND

Clinical placement is recognised as essential for nursing students' development of clinical competence. However, difficulties in providing supportive clinical learning environments are a well-known challenge in nursing education. In Norway, the use of nurse educators in joint university and clinical roles has been recommended as an initiative to strengthen the clinical learning environment and enhance the educational quality. In this study we use the term practice education facilitator in a generic sense for these roles. The aim of this study was to explore how practice education facilitators can contribute to strengthen the clinical learning environments for nursing students.

METHODS

This study has a qualitative explorative design with a purposive sample of practice education facilitators affiliated to three different universities located in southeast, mid-, and northern Norway. Individual in-depth interviews with 12 participants were conducted during spring 2021.

RESULTS

A thematic analysis resulted in four themes: "coherence between theory and practice"; "student support and guidance during placement"; "supporting the supervisors to support the students" and "factors influencing the practice education facilitators' performance in their role". The participants experienced that the practice education facilitator role contributed to strengthened clinical learning environments. However, their performance in the role was found to be contingent upon factors such as time allocated for the role, personal and professional attributes of the post holder, and a common understanding within the organisations regarding practice learning and role remits for the practice education facilitator.

CONCLUSIONS

Findings indicate that the practice education facilitator role can be a valuable resource for clinical supervisors and nursing students in clinical placement. Moreover, nurse educators who are familiar with the clinical area, and who are insiders in both settings, are ideally placed to contribute to bridge the theory-practice gap. The benefits of using these roles, however, were influenced by personal attributes of the post holder, time allocated for the role and the number of practice education facilitators positions, and management anchorage. Thus, to achieve the full potential of these roles, efforts to reduce these barriers should be considered.

Implementation of a virtual student placement to improve the application of theory to practice

BACKGROUND

The primary aim of undergraduate, pre-registration nursing education is to prepare students to be nurses who can apply theory to practice, with clinical placements to support the practice element of the clinical programme. However, the theory-practice gap is a longstanding problem within nurse education, as nurses continue to practise with incomplete knowledge to support their actions.

PROBLEM

In April 2020, the COVID-19 pandemic caused a reduction in clinical placement capacity that affected student learning opportunities.

APPROACH

Based on Miller's pyramid of learning, a virtual placement was created using evidence-based learning theories and an array of multimedia technologies with the intention of replicating real-life experiences and promoting problem-based learning. Scenarios and case studies were collated from clinical experiences and mapped against student proficiencies to produce an authentic and immersive learning environment.

CONCLUSION

This innovative pedagogy provides an alternative to the placement experience while enhancing the application of theory to practice.

Patient Goals in Hospice Cancer Pain Management: A Total Pain Case Scenario

Evidence-based clinical practice guidelines and hospice agency policies and procedures direct nursing assessment and interventions for the care of persons with cancer-related pain. Guidelines assert that pain should be assessed from a holistic perspective that considers physical, psychological, social, and spiritual aspects. In addition, guidelines maintain that hospice nurses should ascertain patient goals for pain management. Assessment and documentation of goals other than pain intensity goals is an area of nursing practice that has not been developed. Without inclusion of personally meaningful goals in pain assessment instruments, such goals cannot be routinely or consistently included in the hospice care plan. To address the assessment of pain and patient goals for pain management, this scenario-based article merges theoretical knowledge about pain from concept analyses with clinical guideline recommendations. Although research is needed to develop pain goal assessment tools, nurses can use this empirically based approach for asking about goals and integrating them into the plan of care.

Exploration of nursing students' views on the theory-practice gap in surgical nursing education and its relationship with attitudes towards the profession and evidence-based practice

AIM

The aim of this study was to explore nursing students' views on the theory-practice gap in surgical nursing education and determine its relationship with attitudes towards the profession and evidence-based practice.

BACKGROUND

In nursing education, the discrepancy between the theoretical knowledge and clinical practices is known as the "theory-practice gap". Although this problem was defined many years ago, scientific information on the subject is very limited in terms of surgical nursing.

METHOD

This descriptive-analytical and cross-sectional study was carried out in three different universities in the Black Sea Region of Türkiye. The sample consisted of 389 nursing students. The data collection was carried out in May-July 2022 through the use of the following tools: The Attitude Scale for the Nursing Profession (ASNP), the Knowledge, Attitudes and Behaviors Questionnaire for Evidence-Based Practice (KABQ-EBP) and the researchers made form to determine students' views on the theory-practice gap. The data were analysed with Student's t-test, multiple linear regression analysis.

RESULTS

72.8% of the students stated that they thought there was a discrepancy between their theoretical surgical nursing courses and clinical practice. While the total ASNP score of students who thought that there was a discrepancy between theoretical education and clinical practice was lower than that of the other students (p = 0.002), no difference was found among the students in terms of the total KABQ-EBP score (p > 0.05). In the multiple linear regression analysis, it was determined that thinking about gap (β = -0.125, p = 0.009), gender (β = -0.134, p = 0.006), willingness to choose the profession (β = 0.150, p = 0.002) and KABQ-EBP score (β = 0.247, p < 0.001) had significant effects on nursing students' attitudes towards the profession. In the model, %12 of the total variance was explained by the variables.

CONCLUSION

The study shows that the gap between theory and practice for the surgical nursing course is a problem perceived by most students. Also, students who thought that there was a theory-practice gap for the surgical nursing course had a more negative attitude towards the profession, while their attitudes towards evidence-based nursing were not different from others. The results of this study encourage further research to gain a better understanding of the impact of the gap between theory and practice on nursing students.

Academic-Practice Collaboration Using Virtual Telesimulation to Support Students' Clinical Practice

BACKGROUND

Collaboration between academic institutions and clinical practice plays an important role in supporting students' learning in clinical practice. A virtual telesimulation was incorporated to provide academic-practice collaboration between academic educators and nurse preceptors to support students' clinical education.

PURPOSE

The purpose was to evaluate the experiences of nursing students and academic educators on the perceived impact of virtual telesimulation in clinical education.

METHODS

A descriptive qualitative study using focus group discussions was conducted.

RESULTS

Four themes emerged: "coming together to know one another" for rapport building, "learning from different perspectives" to foster clinical learning and practice, "application of learning strategy" to stimulate case-based discussion, and "reaching out to more preceptors" to optimize its impact in clinical practice.

CONCLUSIONS

Academic-practice collaboration using virtual telesimulation enabled students and academic educators to build rapport with clinical preceptors and learn from other practices, which in turn enhanced students' clinical learning experiences.

A systematic review on the use of action research methods in mental health nursing care

AIMS

To identify and synthesize evidence on the use of action research methods in mental health nursing care.

DESIGN

Systematic review.

DATA SOURCES

CINAHL, Web of Science, PubMed and Scopus databases were searched in January 2021.

REVIEW METHODS

Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Two reviewers independently conducted the study selection, and quality appraisal using Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, data extraction and data analysis procedures.

RESULTS

Sixteen studies, half of which used participatory action research, were included in this review. Nurses, along with other stakeholders, were an active part of the action research process. The main topics of interest addressed were categorized as improving the adoption of a person-centred approach to care and improving decision-making procedures. The use of action research helped the participants to identify the meaning they attached to the topic of interest to be improved. Moreover, this method helped to identify needs and strategies for improving care. The studies concurred that the use of action research enabled participants to gain awareness, improve attitudes and acquire knowledge. In addition, it enabled participants to gain confidence and security in the group context, as key aspects of their empowerment.

CONCLUSION

This review shows the usefulness of action research in any mental health nursing context, contributing to the improvement of care at both the individual and collective levels.

IMPACT

This paper demonstrates the use of the action research method in the field of mental health nursing. Its use has improved the clinical practice of nurses as well as that of teams in both community and hospital settings, addressing issues of the person-centred approach to care and decision-making procedures.

Learning in and across communities of practice: health professions education students' learning from boundary crossing

Learning to adapt to new contexts is crucial in health professions education (HPE). Boundaries between and within contexts challenge continuity in students' learning processes. Little is known about how HPE students can make these "boundary experiences" productive for learning. We investigated how and what nursing students learn from boundary experiences while they are simultaneously growing into a community of practice (CoP). Using a boundary-crossing lens, experiences of discontinuity were identified in pre-placement and post-placement interviews and diary fragments with 14 nursing students during their placement in an academic hospital. We found that students experience discontinuity as a result of different approaches to nursing care and to learning, both between (academic and clinical) settings and within a setting. When students feel safe enough, they can convert boundary experiences into meaningful learning situations, such as critical discussions with staff. Successfully overcoming boundary experiences improves students' understanding of healthcare and professional development and helps them to develop a personal approach to learning. Students critically address boundary experiences when they are motivated to learn and when they perceive a violation of ethical standards but not when they are concerned that it will affect their assessment. Objects designed to bridge theory and practice can generate additional barriers. This study adds to the HPE literature by demonstrating the learning potential of boundaries and to the broader literature by showing how responses to boundary experiences are intertwined with the process of growing into a CoP. The findings can be used to design future boundary objects.

The Outcomes of an Interprofessional Simulation Program for New Graduate Nurses

This study explored the learning outcomes of an interprofessional simulation program for new graduate nurses during their training program. It was a single-group, pre-test and post-test research design. Ninety-three new graduate nurses participated in the study. The Nursing Competence Instrument and program satisfaction survey questionnaires were used to evaluate the learning outcomes of the program. Data were collected between 1 July 2019 and 30 June 2020 in a medical center in Taiwan. It was found that four nursing core competencies were significantly higher after the simulation, including advancing career talents (t = 10.12, p < 0.0001), integrating care abilities (t = 10.19, p < 0.001), dealing with tension (t = 6.87, p < 0.0001), and leading humanity concerns (t = 6.86, p < 0.001). The average satisfaction score for the interprofessional simulation training among nurses was 4.42 out of 5. In conclusion, interprofessional simulation education can help novice nurses improve their nursing core competencies. The results of this study provide an important indicator for hospitals and governments when making policy and training programs for new graduate nurses.

Critical thinking abilities among newly graduated nurses: A cross-sectional survey study in China

AIM

The aim of this study is to describe critical thinking dispositions among newly graduated nurses with different educational background in China and to explore related factors.

DESIGN

A cross-sectional questionnaire survey.

METHODS

The data were collected using the Chinese Version of Critical Thinking Dispositions Inventory (CTDI-CV). Overall, 588 newly graduated nurses finally completed the survey. Spearman and Pearson's correlation coefficients were used to examine the correlation between the CDTI-CV and nurses' general characteristics.

RESULTS

In terms of open-mindedness, analysis and inquisitiveness subscales, significant differences were found among nurses based on three educational level. When dichotomizing total CTDI scores into high and low, nearly 80% of the respondents fell into low score group. Pressure from workplace was high for 68.4% of them. Significant correlation was found among the new graduated nurses' critical thinking ability and their age, education level, reading habit and attitude towards nursing profession.

An introduction to the TPSN model: a comprehensive approach to reducing the theory-practice gap in nursing

Background

There are still concerns about the effectiveness of clinical education models which are done with the aim of reducing the theoretical-practical gap in nursing. In this article, we intend to describe an innovative model to create an integration and structured relationship between educational and healthcare provider institutions. The basis of this work is the full-time presence of nursing teacher in the clinical settings and the development of their role to improve the education of students and nurses and the quality of nursing services.

Methods

This was a participatory action research. This action research was implemented in four steps of problem identification, planning, action and reflection. Interviews, focus groups and observation were used for the qualitative part. Clinical Learning Environment Inventory (CLEI), Job Satisfaction in Nursing Instrument questionnaires and Patient Satisfaction with Nursing Care Quality Questionnaire were completed before and after the study. Qualitative content analysis, paired and independent t test were used for data analysis.

Results

The academic-practice integration Model of TPSN is a dynamic and interactive model for accountability in nursing Discipline. Unlike the medical education model that includes patients, students, and physicians as the three points of a triangle, this model, which is shaped like a large triangle, places the person in need of care and treatment (patient, client, family, or society) in the center of the triangle, aiming to focus on the healthcare receiver. The model consists of three components (Mentoring component, Preceptorship component, and integrated clinical education component). Each of the components of this model alone will not be able to eliminate the ultimate goal of bridging the theory-practice gap.

Conclusions

A new and innovative model was proposed to reduce the theory-practice gap in the present study. This model increases the collaboration between educational institutions and healthcare settings compared with the previous models. The TPSN model helps students, nurses, and nursing instructors integrate theoretical knowledge with clinical practice and act as professional nurses.

Development of entrustable professional activities for advanced practice nurses education

BACKGROUND

Entrustable professional activity (EPA) framework has gained popularity within competency-based healthcare education programmes across disciplines, professions, and countries. As opposed to traditional time-based approach, EPAs bridge the gaps between competency framework and clinical practice, however, limited information on nursing EPAs highlights a need to develop EPAs specific to graduate nursing education to promote patient safety and quality patient care.

OBJECTIVES

This paper described comprehensively the four-stage approach used to develop and pilot test a set of core EPAs for advanced practice nurse (APN) education.

METHOD

The four-stage approach used to develop and pilot the EPAs included: 1) team formation, 2) development of conceptual framework, 3) identifying and reviewing core EPAs, and 4) pilot testing the EPAs. Post pilot test and surveys were conducted for the EPA developers, APN preceptors and interns to explore their perceptions and experiences using the EPAs.

RESULTS

A framework of nine core EPAs was developed for APN education, including: 1) perform an initial assessment and formulate management plans, 2) manage follow-up care for a clinical encounter, 3) plan, perform and evaluate care procedures, 4) recognise and manage patients requiring urgent care, 5) manage care transitions within and between health care organisations, 6) recognise and manage pharmacological needs of patients, 7) collaborate with patients, families, and community to improve health through disease prevention and health promotion, 8) participate in health quality improvement initiative, and 9) develop self and others for professional practice.

CONCLUSION

Despite the stakeholders having generally positive attitudes towards the use of EPAs, it has its drawbacks. More research is needed to examine the psychometric properties of the EPA assessment tools and evaluate the effectiveness of EPAs in graduate nursing education. Additionally, the described set of core APN EPAs needs more refinement and rigorous testing before it can be implemented on a larger scale.

Pragmatism as a philosophical foundation to integrate education, practice, research and policy across the nursing profession

AIM

A discussion of the philosophy of pragmatism and how it can underpin and integrate nursing education, practice, research and policy across the nursing profession.

BACKGROUND

Although the concepts of plurality, truth, fallibilism, subjectivity and meliorism have been discussed across foundational philosophical literature, the relation of these concepts across various facets of the nursing profession have not been thoroughly articulated in the nursing literature.

DESIGN

Critical theoretical reflection.

DATA SOURCES

In this article, we draw from literature written on the philosophy of pragmatism from 1907 through to 2021.

IMPLICATIONS FOR NURSING

We propose an integrative approach for the nursing profession where education, practice, research and policy speak and contribute to each other through a lens of pragmatism. In this approach, education has a relationship with practice and practice has a direct line to research where nurses on the front lines can engage with pragmatic inquiry. Researchers in return can inform frontline nurses and policymakers of evidence emerging in areas pertinent to practice. These relationships are made possible through integrated knowledge translation by including all stakeholders at every point of knowledge generation. Each facet of the nursing profession is filled with stakeholders of nursing knowledge, who are invested in its utility. Although it requires focused effort to integrate knowledge across the profession, pragmatism calls for action in the face of challenges in hope for a stronger body of nursing knowledge and ultimately profession.

CONCLUSION

Pragmatism is an apt philosophy to underpin and integrate nursing education, practice, research and policy across the nursing profession.

Clinical placement challenges associated with radiography education in a low-resource setting: A qualitative exploration of the Ethiopian landscape

INTRODUCTION

Clinical placements (CP) are of paramount importance in the learning and the acquisition of key competencies in terms of knowledge, skill and professional attributes required for clinical radiography practice. This study explored the challenges faced by radiography students and educators in relation to clinical placement and training in Ethiopia.

METHODS

A qualitative approach using focus group discussion and interviews were used to explore the experiences of students and educators, respectively, pertaining to challenges encountered in relation to the clinical placement of students across four university affiliated hospitals. Data obtained was analysed using a structured three step framework and the coding approach employed in a thematic analysis.

RESULTS

Participants comprise of third- and fourth-year undergraduate radiography students (n = 14) and educators [academic faculty (n = 7) and clinical practice educators (n = 8)]. Four main themes were identified, which relate to deficiencies of an existing training curriculum and its implementation strategies, inadequate resource and infrastructure within the CP environments and absence of advanced training opportunities.

CONCLUSION

This research showed that there are many and varied challenges encountered by both students and educators in relation to CP and training of radiography students in Ethiopia. These challenges could potentially affect the future performance of students/practitioners and/or the appropriate application of the core clinical radiography skills and competencies in the world of work.

IMPLICATIONS FOR PRACTICE

Clinical radiography training in resource-limited settings will require urgent attention and support with modern infrastructure including simulation to augment their clinical development to acceptable standards.

Perceptions and experiences of leadership in undergraduate nurse education: A narrative inquiry

BACKGROUND

This research explored the experiences and perceptions of leadership preparation in pre-registration nursing education. The development of leadership skills in the pre-registration period is often considered a continuous process, and evidence suggests there has been an inconsistent approach to leadership within undergraduate nurse education. Exploring perceptions of experiences in this area was deemed important to guide future leadership development for undergraduate nursing students and formed the rationale for this Doctoral study.

DESIGN AND METHODS

The phenomena of interest were the expectations, experiences and perceptions of student nurses, academics, and nurses in preparation for the role of leadership. A narrative methodology to learning and contexts of learning was applied, data collection included semi structured interviews conducted early in 2020. Metaphorical associations through images are thought to support leadership development and philosophies; therefore, photographic elicitation was used to evoke association and emotions, facilitate reflection, and enable expression. The framework for narrative inquiry combined with the theoretical background was used for data analysis.

RESULTS

Leadership is perceived to be an important aspect of the role of a qualified nurse and should be considered as central to learning development for undergraduate students. While all participants valued the importance of leadership in nursing, this research revealed how each narrated experience of leadership holds emotional impact on how leadership is viewed in self and others.

CONCLUSIONS

Participants' experience shaped each story of perceptions of leadership, both within education and in clinical practice. Students' narratives revealed tensions between expectations of leadership, defining leadership and associating their experiences with a personal vision of self as leader in the future role, along with a perceived disconnect between the social and cultural experiences and context of learning. Tensions within the experiences of the academics also revealed a juxtaposition between aligning their experience of leadership with the educational preparation of students and the experiences from clinical leadership, within the social constructs of dual professions and learning contexts.

Midwives' knowledge and practices regarding the screening for and management of chorioamnionitis: A qualitative study

BACKGROUND

Screening for chorioamnionitis, or the risk thereof, by midwives is largely lacking during antenatal care and no best practice guidelines for chorioamnionitis in South Africa was noted.

AIM

To explore and describe midwives' knowledge and practices related to the screening and management of women who are at risk of or diagnosed with chorioamnionitis.

SETTING

Public healthcare institutions in a health district in the Eastern Cape province of South Africa.

METHODS

A qualitative, exploratory, descriptive and contextual research design was used. Ten midwives were purposively included in this study, and semi-structured interviews were conducted with them. The data were analysed using an adapted version of Tesch's eight steps for data analysis.

RESULTS

The main theme revealed that midwives lack knowledge regarding chorioamnionitis, resulting in incorrect practices including a lack of screening, misdiagnosis and mismanagement of the infectious condition.

CONCLUSIONS

Findings of this research showed that midwives lacked knowledge regarding the screening and management of women with chorioamnionitis resulting in incorrect practices in this regard. There is thus a need for midwives to update their knowledge regarding the screening and management of chorioamnionitis and training (e.g. through a short learning programme).

CONTRIBUTION

Findings of this study could be used by midwives to update their knowledge regarding screening and managing women with chorioamnionitis, which is expected to translate to better practices. Moreover, study findings were synthesised with the results of a literature review study to form the basis for the development of a best practice guideline for screening and managing women with chorioamnionitis.

Solutions to bridge the theory-practice gap in nursing education in the UAE: a qualitative study

BACKGROUND

The theoretical knowledge of nursing underpins the practice, while the practice environment determines the circumstances within which the theoretical knowledge is applied. The biggest challenge facing nursing as an academic field is the theory-practice gap, which is a universal issue in nursing. This study aimed to raise solutions to close the gap between theory and practice in nursing education through the eyes of nursing students in UAE.

METHODS

A qualitative descriptive approach was followed; whereby 25 Emirati nursing students were interviewed.

RESULTS

Two main themes are discussed in this study: 'Clinical Culture Creation' and 'Curriculum Content Reformation'. The students suggested to decreased the loud and stress on their clinical educators. They also suggested creating synchronization between what is taught in classrooms and labs and what is offered in the clinical training. Moreover, some of the students expected to have more benefit if they get their clinical training in health institutions owned by their college. On the other side, many of the participants suggested to move from the integration system to the block system. Another interesting suggestion includes having the same college staff to teach the theory and the clinical. The final suggestion includes decreasing the paper work during clinical training.

CONCLUSIONS

This study explored the solutions to bridge the theory-practice gap in nursing education in the UAE. The study has implications for nursing education and practice within the UAE and is imperative for graduating workplace ready professional nurses within the country.

Teaching emergency situations during a psychiatry residency programme using a blended learning approach: a pilot study

BACKGROUND

Emergency psychiatry is an essential component in the training of psychiatry residents who are required to make patient-centred orientation decisions. This training calls for specific knowledge as well as skills and attitudes requiring experience. Kolb introduced a theory on experiential learning which suggested that effective learners should have four types of abilities: concrete experience, reflective observation, abstract conceptualisation and active experimentation. We aimed to evaluate a resident training programme that we designed for use in an emergency psychiatry setting based on the experimental learning theory.

METHODS

We designed a four-step training programme for all first-year psychiatry residents: (i) theoretical teaching of psychiatric emergency knowledge, (ii) concrete experience of ability teaching involving an initial simulation session based on three scenarios corresponding to clinical situations frequently encountered in emergency psychiatry (suicidal crisis, hypomania and depressive episodes), (iii) reflective observation and abstract conceptualisation teaching based on videos and clinical interview commentary by a senior psychiatrist for the same three scenarios, (iv) active experimentation teaching during a second simulation session based on the same three frequently encountered clinical situations but with different scenarios. Training-related knowledge acquisition was assessed after the second simulation session based on a multiple-choice quiz (MCQ), short-answer questions and a script concordance test (SCT). The satisfaction questionnaire was assessed after the resident had completed his/her initial session in order to evaluate the relevance of teaching in clinical practice. The descriptive analyses were described using the mean (+/- standard deviation). The comparative analyses were conducted with the Wilcoxon or Student's t tests depending on data distribution.

RESULTS

The residents' mean MCQ and short-answer question scores and SCT were 7.25/10 (SD = 1.2) 8.33/10 (SD = 1.4), 77.5/100 (SD = 15.8), respectively. The satisfaction questionnaire revealed that 67 % of residents found the teaching consistent.

CONCLUSION

We designed a blended learning programme that associated, classical theoretical learning to acquire the basic concepts, a learning with simulation training to experiment the clinical situations and a video support to improve learning of interview skills and memory recall. The residents indicate that this training was adequate to prepare them to be on duty. However, despite this encouraging point, this program needs further studies to attest of its efficiency.

Ethnography in Health Services Research: Oscillation Between Theory and Practice

The well-known divergence between what policy and protocol look like on paper, and what happens in the actual practice of daily life remains a central challenge in health services provision and research. This disparity is usually referred to as the theory-practice gap and contributes to concerns that scientific evidence fails to make substantial impacts on the processes of service delivery. In this article, we present an argument for the inclusion of ethnographic methods in health services research and show that this approach enables researchers to address this divergence by working within it. We trace how ethnography, through generative processes of oscillation, can take us beyond lamenting the gap and capture the relational dynamics of people working together in complex systemic arrangements. By moving from example to methodological reflection, to principle of research, we demonstrate how the oscillation of ethnographic research between theory and practice can productively contribute to the field of health service research.

Managing the theory-practice gap in nursing education and practice: Hearing the voices of nursing students in the United Arab Emirates

AIM

The aim of this study is to explore factors contributing to the theory-practice gap in nursing education in the United Arab Emirates.

BACKGROUND

The gap between what is taught in nursing classrooms and what is practised in clinical settings creates challenges for nursing students, practitioners, managers and educators. This has important implications for the United Arab Emirates and other developing countries as their healthcare systems require a permanent nursing taskforce that is well supplied with ready to practice graduates.

METHODS

A qualitative descriptive approach was used, whereby 25 senior student nurses were interviewed about their perceptions of the theory-practice gap.

RESULTS

The major theme that emerged in this study was the 'tripod of clinical practice', with three subthemes: prepared students, aware and supportive preceptors and qualified clinical faculty. The other theme that emerged was 'real life outside the simulated lab', with two subthemes: various and unfamiliar psychomotor skills and communication with real patients.

CONCLUSION

The tripod of clinical practice must be achieved for quality clinical practice. Further, attention should be directed to development of skills (e.g., communicating with real patients) that are difficult to acquire while dealing with simulated patients.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing students need longer immersion in simulated clinical settings, coupled with experienced clinical faculty and supportive, aware and prepared preceptors.

Anticipated nursing care as perceived by nursing students: Findings from a qualitative study

AIM

To explore the perceptions of nursing students on the phenomenon of anticipated nursing care.

DESIGN

A descriptive-qualitative study was performed in 2019 according to the Consolidated Criteria for Reporting Qualitative Research principles.

METHODS

Data were collected using 16 face-to-face, audio-recorded interviews across four Italian Bachelor of Nursing degrees. Then, content analysis was performed, identifying, analysing and describing the anticipated nursing care phenomenon as perceived by nursing students.

RESULTS

Administering medications, providing fundamentals of care, managing some clinical procedures, freeing up the patient's bed and starting the shifts early emerged as the most anticipated nursing interventions. Stable, older patients who were more functionally dependent were reported to receive some fundamental nursing care before the expected time, while older, stable and more independent patients were used to receiving medications in advance. Anticipated nursing care is triggered by factors at the time management, resource, programming, professional and organizational levels.

Clinical Compass: Guiding the Relationship Between Clinical and Didactic Learning

BACKGROUND

Evidence demonstrates there is a need for innovation and further investigation on how to best prepare nursing students for practice. A consistent framework is necessary to guide students, theory faculty, and clinical instructors.

METHOD

A tool was created to transform the student learning experience. This tool, the Clinical Compass, provides opportunity to better integrate didactic knowledge within the clinical experience. The tool was evaluated by creating a questionnaire for both students and faculty.

RESULTS

Survey data were collected from both student and instructor groups via an anonymous electronic survey. Both student and instructor surveys yielded positive results reflecting improved connection between theoretical and clinical knowledge.

CONCLUSION

Data support continued use and ongoing revisions of the Clinical Compass tool. The tool will be adapted for use in the classroom, specialty areas, and virtual and simulation environments. [J Nurs Educ. 2021;60(5):286-288.].

Can an interactive case-based activity help bridge the theory-practice gap in operative dentistry?

INTRODUCTION

A theory-practice gap in pre-doctoral dental education is a common source of stress for dental students. An interactive, small-group, case-based activity was designed to bridge the gap between pre-clinical and clinical experiences. The aim of our study was to assess the effectiveness of the case-based activity by evaluating students' comfort level in operative procedures.

MATERIALS AND METHODS

Over 5 years, a total of 172 second-year students from the classes of 2017 through 2021 participated in the case-based activity delivered after the completion of the core operative dentistry course. The exercise included a pre-activity online quiz, an in-class case-based session and a laboratory exercise. Students' self-reported comfort levels in performing operative procedures were collected by surveys at three different times. They included the post-course survey distributed after the completion of the core operative dentistry course, the post-activity survey distributed after the completion of the case-based activity, and the follow-up survey distributed after students completed their first operative procedures in clinic.

RESULTS

There was a 93% response rate. The average rating of all eight statements revealed statistically significant increase in students' comfort level after completing the case-based activity and after performing their first operative procedures in the teaching practice.

CONCLUSION

This observation suggests that the case-based activity was effective in raising students' comfort levels. The activity may serve as an important tool in bridging the theory-practice gap between pre-clinical and clinical operative experiences.

Mind the gap: The relationship between liminality, learning and leaving in pre-registration nurse education

Attrition refers to students leaving programmes of study before completion. This is an important topic area; there is a current global shortage of nurses, and it is widely reported that nursing is in crisis. Nurse education in the United Kingdom has changed substantially in the past fifty years, gradually moving from work-based apprentice style training to an 'all graduate entry' profession. There is a plethora of literature reporting attrition both in the UK and worldwide. It is clear that regardless of the education model, attrition from pre-registration programmes is a long-standing problem which has attracted much attention. The educative process of learning to be a nurse can be likened to a 'rite of passage', or perhaps a series of rites of passage. Rites of passage were first articulated by anthropologists, van Gennep and Turner. Van Gennep and Turner argued that as people make 'transitions', often via 'rites of passage' they pass through an in-between phase described as 'liminal'. This paper explores aspects of liminality in nurse education and examines the potential relationship with attrition. The paper concludes by suggesting that although liminality could be considered a risk factor for attrition, exploitation of the concept may offer opportunities to enhance learning.

Anticipated nursing care: findings from a qualitative study

Background

Contrary to Missed Nursing Care, some anecdotal data and sparse evidence has documented the tendency of nurses to anticipate some nursing interventions. However, no study has been conducted to date with the purpose of understanding this phenomenon and its underlying mechanisms and consequences. The aim of this study was to describe the phenomenon of delivering anticipated nursing care, its antecedents and consequences as perceived by nurses.

Method

A descriptive qualitative study. The Consolidated Criteria for Reporting Qualitative Research guidelines were followed. A purposeful sample of 17 clinical nurses and nurse managers working in three Italian hospitals were interviewed in depth in 2019. The audio-recorded interviews were verbatim transcribed and thematically analysed.

Results

‘Anticipated Nursing Care’ is delivered significantly earlier than when expected by nurses in their care plan, by patients, by caregivers and by other members of the team. Medication administration, mobilisation of patients, hygiene care, changes of dressing, vital parameter monitoring, blood sampling and administrative activities were reported as interventions delivered before rather than when expected. Clinically stable patients have been reported to be at risk of receiving anticipated nursing care. Individual values and attitudes, group attitudes of being always ready for the “unexpected”, implicit group norms to “leave the patients and the unit in order”, high workloads, intertwined activities and work processes inside the units, have been reported as reasons for Anticipated Nursing Care. Effects of this phenomenon have been reported at the patients’ and at the nurses’ level.

Conclusion

Anticipated Nursing Care occurs when nurses perform interventions earlier than expected according to an implicit or explicit decision and not as a consequence of a request. The phenomenon requires future studies to detect its diffusion and to accumulate evidence. Its presence in daily practice, if confirmed, suggests that Missed Nursing Care studies should also consider the combined effect of these two phenomena as, on one hand, there may be the tendency to postpone and, on the other hand, the tendency to anticipate interventions.