Implications of the theory/practice gap for Project 2000 students

Student nurses' pain knowledge and attitudes towards pain management over the last 20 years: A systematic review

OBJECTIVE

To discover if nursing students have improved their level of pain knowledge and their attitudes towards pain management over the last 20 years.

DESIGN

Systematic review utilising the Kable, Pich, and Maslin-Prothero 12 step approach to document a search strategy.

DATA SOURCES

A search was conducted from 2000 to 2020 using CINAHL, PubMed, Embase and ProQuest.

REVIEW METHODS

Studies exploring the level of pain management knowledge and attitudes of nursing students were included. The Critical Review Form - Quantitative Studies provided the appraisal framework (Law et al., 1998). A narrative synthesis of eligible studies was undertaken.

RESULTS

Six studies with a total of 1454 participants were included. The studies demonstrated that nursing students have not improved their level of pain knowledge and attitudes towards pain management in the last 20 years. Whilst many nursing students thought they possessed adequate pain knowledge, the studies all demonstrated that their pain knowledge is lacking and that they do not have appropriate attitudes towards pain. Students did not recognise the patient who was not grimacing as being in pain despite the patient report of pain.

CONCLUSIONS

These findings support the notion that nursing education does not include sufficient focus on pain identification and management. Alignment of nursing pain education with the curriculum developed in 1993 by the International Association for the Study of Pain is needed to ensure nurses have appropriate knowledge so that patients can receive effective pain management.

To dwell within: Bridging the theory-practice gap

Nursing has a considerable history of theory development but has consistently struggled to reconcile theoretical reality and practice realities. Many authors have attempted to reconcile what has been called the "theory-practice gap," but the space where these two realities enmesh has remained problematic and contentious (Aimei, Macau Journal of Nursing, 14, 2015, 13; Factor, Matienzo, & de Guzman, Nurse Education Today, 57, 2017, 82). The idea of the theory-practice gap has a significant history in nursing, but also continues to have a significant presence within nursing literature and mythology up to the present (Aimei, Macau Journal of Nursing, 14, 2015, 13). In this paper, the space between theoretic reality and practice reality, as evidenced by the theory-practice gap, will be examined. A Heideggerian perspective of "dwelling" (Heidegger, 1971, Poetry, language, thought, New York, NY: Harper Colophon) will be used as a guiding discourse to move nursing away from this classic tension between theory and practice, towards a perspective where theory and practice are woven together as part of one reality.

How the metaphor of a gap between theory and practice has influenced nursing education

The metaphor of a gap between theory and practice is firmly established in nursing education. Furthermore, it is embedded in conventional professional wisdom to the extent that when it used in professional reports, academic writing or in the conversations amongst nurses, it often requires no further explanation. The notion of a gap between theory and practice has proven to be a most fertile and an especially helpful concept which has enabled educators, clinicians and students to devise practical strategies, intended to resolve problems associated with the gap. However, that nursing has so enthusiastically embraced the notion of a gap between theory and practice may also have inhibited creativity in the design and delivery of programmes and thereby missing other opportunities for student nurses to learn from practical contexts.

Evidence-based practice is a time of opportunity for nursing

The debate regarding evidence-based practice (EBP) continues to rage within nursing. This article reviews the existing situation regarding policy and the ability of nurses to engage with EBP. Recommendations are made regarding moving the debate away from a focus on barriers to EBP towards seizing it as an opportunity. The article suggests that a fundamental change in attitude is required by nurses in order for the nursing profession to progress. There is a need to recognize that the nature of health services are changing and that nurses need to grasp the opportunities this makes available, but in order to do this nurses need support.

Comparing evidence-based practice of nurses and physiotherapists

Evidence-based practice has become an ubiquitous concept within nursing. However, there is little comparative data of nursing with other professions on attitudes to evidence-based practice. This article reports on a survey of nurses' and physiotherapists' sources of knowledge and perceived barriers to evidence-based practice within a large teaching hospital. A total of 324 questionnaires were sent to nurses and physiotherapists. The results showed that both physiotherapists and nurses accessed a wide variety of sources of knowledge. However, nurses were more likely than physiotherapists to use policy and procedure manuals and discussions with medical staff. Both professions have problems with overcoming the barrier of time. Nurses were more likely than physiotherapists to rate themselves as having poor evidence-based practice skills.

Joint appointments: another dimension to building bridges

For many years nurse education has been under close scrutiny, with particular focus on the links between what is taught in the classroom and what is practised. Since the onset of the United Kingdom Central Council for Nursing and Midwifery's Project 2000: A new preparation for practice, concerns have been raised over the potential for an even greater gap between theory and practice. Within this concept, the development of joint appointments between education and service providers has been an issue of much debate within the nursing profession in recent years. This paper explores the complexity of the role and shares the writer's personal experiences as a joint appointee between University College Worcester and Worcester Royal Infirmary NHS Trust. The issues discussed demonstrate how by supporting nurses in their development of practice, research, policy and teaching, joint appointments can contribute directly and indirectly to providing a first class nursing service for patients.

Teaching sociology to nurses: exploring the debate

This article reviews literature on the current debate concerning teaching sociology to nurses. The debate is limited because it does not take into account the work of Donald Schön, or Anthony Giddens. The article also discusses theories of adult education which support teaching sociology in nurse education. Sociology is essential for nurses, because it can help to develop an understanding and analysis of the context and substance of nursing practice.

The clinical skills resource: a review of current practice

This review is based on the findings of the Southampton Clinical Skills Project, which was a needs assessment and feasibility study to consider the development of a multiprofessional Clinical Skills Resource at Southampton. The project spanned a period of 18 months and used a range of methods of data collection, including visits to 12 clinical skills facilities in the UK. Most existing clinical skills centres have developed in response to changing healthcare policy, curricular initiatives and increasing emphasis on the quality of assessments and competencies. There is also increasing recognition that clinicians are no longer able to teach effectively all skills to students in the traditional ways, and that clinical skills training and assessment, particularly for undergraduates, is an area of deficiency. The potential scope of clinical skills centres is broad and encompasses not only clinical and communication skills but medical informatics, computer assisted learning, multiprofessional learning and assessment. Skills centres can also promote self directed and lifelong learning methods. The planning of skills centres involves a variety of stakeholders and users, including undergraduates, postgraduates, acute and community Trusts, Postgraduate Deans and medical schools. A successful skills centre needs to be flexible in its design, integral to the curriculum and relevant to educational and training requirements. This requires planning, organization and resources. Different organizational models can be used, depending on local factors. The management of skills centres involves consideration of issues such as security, safety, supervision of learners and staff development, informed by a network of experts and everyday users. The development of skills centres should include ongoing educational evaluation of outcomes and educational research. The use of a clinical skills centre has potential benefits for staff and students, including the provision of a safe environment in which to learn and practise skills before using them in the real clinical setting. This can reduce anxiety in students and protect patients from novice practice. Clinical skills centres provide a setting for structured learning with feedback as well as assessment of competence. The limitations of a skills centre are that it can only provide simulated experiences which are an adjunct to, but can never replace real clinical experience.

An examination of the use of reflection in the assessment of practice for undergraduate nursing students

Reflection-on-practice by second year undergraduate nursing students was examined both during clinical placements and soon after. Students identified incidents which had occurred during their practice and discussed them with the researcher individually, in pairs and in a larger group. Data relating to both students' and the researcher's perceptions of these sessions were collected by questionnaire and from diary entries. It was concluded that the purpose of reflection as part of the assessment of practice needs to be clearly defined. Helping students to develop reflective skills is different to assessing their skills and the level of reflection demonstrated.

Situating theory in practice: student views of theory-practice in Project 2000 nursing programmes

In this paper the views of student nurses taking Project 2000 at a Scottish College of Nursing are reported. A random sample of 19 students were interviewed. The interviews focused on the relationship between the college course and the students' experiences on placement. The majority had difficulty in relating the college course to their practice, except when it came to very specific parts of the programme, for example basic medical procedures. Only a minority could integrate the broader aspects of the course to their practice, largely because there was such a long period of time between studying a topic in college and the related placement. It is tempting to see the results as supporting the situated cognition hypothesis that theory loses meaning out of context, and it is evident, even from this limited study, that the success of Project 2000, with its emphasis on the 'knowledgeable doer', could depend, to a great extent, on the careful phasing of college coursework and placement to enable students to integrate theory and practice more effectively.