Strategies to Close Theory Practice Gap

This article discusses Strategies to close theory practice gap in nursing.

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Sample Question

Using the articles from Ferrara ,Rolfe and Sellman plus two more of your choosing, extrapolate strategies you propose are useful to close the theory-practice gap.

Sample Answer

Strategies to Close Theory Practice Gap

In nursing, theory-practice gap has been a subject to numerous research studies. Various factors have been attributed to the wide theory-practice gap in nursing. One factor is theories being too idealistic, hindering their application in the nursing practice. Another factor is failure of nurses to apply nurse theories, even in situations where they have been proven to be effective and beneficial in enhancing patient’s outcomes (Brake, 2005). In spite of the limited application of theories in nursing practice, their application in practice has been found to enhance delivery of quality healthcare services to patients. This paper explores various strategies that could help in bridging the theory-practice gap in nursing.

Researchers have explored diverse approaches of closing theory practice gap. Levin (2010) suggested the application of constructivist approach to teaching and learning in nurse education, to enable nurses adopt evidence based practice, which is a major element of bridging the existing theory-practice gap.  Application of constructivist strategy enables nurse learners to obtain meaning from the past and the current learning experiences, which facilitates construction of new knowledge.  In this regard, Levin (2010) argued constructivist approach could close the theory- practice gap by promoting experimental learning, which encourages nurses become active participants by applying the knowledge acquired into real practice.

Rolfe (1993) attributed the existing theory-practice gap to the failure of the nursing theories to sufficiently address the events in real-life nursing experiences. The failure is caused by the fact that nursing as a profession is founded within the conventional scientific paradigm, whereby theory determines and influences the practice. In this regard,  Rolfe (1997, p.176) argues that closing the theory-practice gap in nursing would require the theory to “relinquish its hierarchical position and develop from practice”, thereby enabling development of an approach that is sensitive to the needs of individual nurse practitioners in diverse settings. Rolfe’s approach is drawn from pedagogical and other practice based disciplines, resulting to a nursing praxis model that encourages future nursing practice (1993).

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Sellman (2010) has also acknowledged the existent of theory practice gap in nursing and put forward various approaches of addressing the issue in healthcare.  Sellman argues that the existing theory-practice gap and the nursing philosophy play an important role in the advancement of the profession, and hence should not be examined from a negative perspective (2010). The theory-practice gap provides a creative space in which nurses could engage in self-reflection activity, regarding the nursing practice. This enables nurses develop into a nursing practice, which is responsive to the changing dynamics health dynamics and conflicting demands in healthcare system. In this regard, Sellman contends that the existing theory-practice gap is not problematic, but an issue that is brought about by different understanding of nurse theory, philosophy and practice in different healthcare processes, including nurse education  and in real life practice(2010).

The existence of the theory-practice gap in nursing has been demonstrated by the varying levels of success following the implementation of clinical practice guidelines (CPGs) in the healthcare system.  Clinical findings indicate that implementation of CPGs has not resulted to optimal benefits, in regards to enhancing patient outcomes. CPGs play a critical role in the adoption of evidence based clinical practices and in the transformation of solid evidence into tangible and beneficial patient care practices.  Moreover, CPGs provide support to quality measures, including performance metrics which are applied in accounting patient care. Empirical evidence indicates that adherence to clinical practice guidelines by healthcare practitioners could drastically reduce patient morbidity and mortality in the healthcare system (Hoesing, 2016).

To address the existing practice theory gap, a holistic approach that examines the factors hindering the implementation of clinical practice guidelines is essential. Brake (2005) suggested strengthening of the role of lecturers in nurse education and application of reflective practice in pre and post registration education of nurses. Additionally, Brake (2005) underlined the importance of implementing policies aimed at creating a favorable environment that encourages nurses to reflect on the theories and develop alternatives in their own practices. In view of the various suggestions of closing the existing theory-practice gap, it is important to examine the various impediments to implementing clinical practice guidelines at both global and local levels.

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Various impediments that hinder implementation of clinical practice guidelines at global levels are normally institutional based.   In this case, the existing practice guidelines developed   by experts and professional bodies at national and global level though inspirational are not applicable in real clinical setting. This is attributed to lack of experience in developing, appraising and implementing the clinical practice guidelines at various levels, to ensure that they improve the quality of healthcare services delivered. Although various bodies are involved in development and appraisal of the clinical guidelines in different countries, the lack of a common forum to facilitate critical appraisal and discussion among professionals involved hinders effective implementation in other regions and healthcare systems (Hoesing, 2016).

At the local level, theory-practice gap is demonstrated by healthcare practitioner’s failure to adhere to clinical practice guidelines at the workplace. This is attributed to various factors, including lack of awareness about the existence of the guidelines and lack of familiarity with guidelines. Other local factors include lack of consensus among the healthcare practitioners about the effectiveness of the guidelines in promoting patients’ health outcomes, lack of auto effectiveness and lack of motivation to implement the clinical practice guidelines among healthcare practitioners in the healthcare setting (Hoesing, 2016).

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Strategies to close theory practice gap
Strategies to Close Theory Practice Gap

To close the theory-practice gap at the global level, there is need to promote international collaboration among the various professionals bodies involved in the development, appraisal and implementation of clinical practice guidelines (Hoesing, 2016). This would facilitate harmonization of diverse methodologies and other practice guidelines applied across the world, which would enhance their application in different healthcare settings. At local level, theory-practice gap could be addressed by application of available technology and clinical decision support systems. These applications have been proven to accelerate the transformation of theory into practice, because they are clinically accredited best practice guidelines and customized to address the needs of individual patient. 

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The second approach of closing the theory-practice gap at local level entails providing incentives, which would motivate healthcare practitioners adopt the clinical practice guidelines in the respective healthcare settings (Brake, 2005). This could be achieved by promoting collaboration among the various health leaders in identifying clinical practice guidelines applicable to their patients and respective healthcare institutions and evaluating their relevance to selected patient populations. Moreover, healthcare practitioners should be encouraged to evaluate and critique the clinical practice guidelines for their scientific validity and approval by the authorized professional bodies.

Conclusion

Closing the existing theory-practice gap requires concerted effort among all stakeholders involved at the local and global level. The stakeholders include healthcare practitioners and professionals involved in the development, appraisal and implementation of clinical practice guidelines. To achieve this, the various barriers that hinder application of the guidelines at local and global level should be identified and addressed. This would facilitate transformation of theory into practice in diverse settings, thereby promoting the quality of care delivered and the anticipated patient outcomes.

References

Brake, J. (2005). Bridging the gap between knowledge and practice. Journal of Diabetes Nursing 9(3): 92-96.

Hoesing, H.(2016). Clinical practice guidelines: closing the gap between theory and practice.   Joint Commission International. Available at https://www.elsevier.com/__data/assets/pdf_file/0007/190177/JCI-Whitepaper_cpgs-closing-the-gap.pdf

Levin, R.(2010). Integrating Evidence-Based Practice with Educational Theory in Clinical Practice for Nurse Practitioners: Bridging the Theory Practice Gap. Research and Theory  for Nursing Practice: An International Journal, 24(4): 211-216.

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

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

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