The Theory to Practice Gap

Jeannie Couper, MSN, RN-BCSeton Hall UniversityMay 15, 2012

Phenomenon of interest in nursing

The theory to practice gap continues to be an issue for nursing students (Kalb, 2010; May et al, 1999).

Impact observed on clinical decision making and formation of clinical judgment (Galloway, 2009).

Creative and innovative teaching strategies recently incorporated into classroom (Guhde,2010).

The Big Picture

Questions facing nurse educators

How best to address this gap in the students' learning and experience?

What strategies can nursing programs adopt to impact this gap or possibly eliminate it?

What is the missing link to facilitate the utilization of theory into the novice nurses' nursing practice?

What changes in the approach to clinical instruction can be changed to facilitate a richer, deeper clinical experience for nursing students?

Research Question

What is the effect on student learning outcomes and patient care of integrating student-centered learning strategies based on intentionality into the student nurses' clinical experience?

Statement of Defense

S LO and ultimately patient care outcomes are directly impacted.

Intentionality: raise rigor, promote critical thinking, analysis, and problem solving, and foster the student's ability to forge connections between theory or knowledge and practice.

Varied clinical experience promotes:

student learning opportunities to make clinical decisions continue the development of clinical judgment (Chappy,

Jambunathan, & Marnocha, 2010; Leonard, Shuhaibar, & Chen, 2010).

What else is known?

Guidance and mentorship support the student throughout the process.

Previous studies:

this design has not been used evidence non-conclusive no comparisons studies have been

completed.

Research Approach and Design

Quantitative approach is most appropriate for this research question

Purpose drives the design The purpose of study to determine the effectiveness of an

implemented program of student-centered intentional strategies designed to increase synthesis and integration of theory and clinical practice.

The study seeks to examine a relationship and determine causality amongst the variables

Uses logistic, deductive reasoning to make a generalization

Research Approach and Design

Research Approach and Design cont.

A quasi-experimental comparison study design with repeated measures of a interrupted time series of nonequivalent comparison groups- an experimental group and control group, two sections of a nursing course.

This design affords the greatest control and meaningful results Inclusion of a control group -

ability to detect real differences between the groups strengthens the validity of the findings (Burns & Grove, 2009) Differences between groups/trends examined over the time

period of the 15 week semester.

Defense of Research Approach

Variables are clearly defined student learning outcomes patient care (outcomes) student-centered learning strategies student nurses' clinical experience clinical decision making clinical judgment. intentionality explicitly defined

Sampling: convenience sample as students enrolled in A or B sections randomly assigned to clinical groups

Defense of Research Approach cont.

Measures: Pretests (evaluation instruments, mock NCLEX)

administered to both sections at course onset Interrupted time tests given concurrently to

groups (quizzes, unit tests, case studies, mid-term evaluations)

Post tests given to all students at the conclusion of the course (final exam, HESI or similar standardized test, and final clinical evaluation instrument).

Defense of Research Approach cont.

Results of all “tests” will be statistically analyzed to identify if statistically significant differences exist

between the two approaches to clinical education in this sample

if a higher degree of learning occurred as a result of the experimental clinical education plan

Identification of a more effective clinical education teaching strategy consider program alterations

Concerns

Instruments lack reliability Internal consistency to be est. by expert panel Variability: in clinical instructors

personalities, approaches, education, enthusiasm, and experience

Orientation of all instructors involved is necessary to limit variations in approaches and expectations.

Groups: Experimental vs Control

Both groups will have equal cumulative clinical hours

Control group: students enrolled in section A of the course receive the 'standard practice' or 'usual treatment' of

clinical education

Experimental group: students in section B; receive the 'experimental clinical experience‘

Groups: Experimental vs Control cont.

Experimental clinical experience includes: variety of patient conditions and situations, unfolding case

studies, actor simulated experiences, mentored clinical situations working in tandem with an experienced nurse/maintain consistent assignment, multiple patient assignments, reflective assignments, team building exercises, 60 second situational assessment (QSEN),and journaling.

Section B clinical instructors engage in group seminar prior to course start:"Reframing Constructive Criticism Using Reflection Based on QSEN Competencies" (Altmiller, 2012)

Thank You!

References

Altmiller, G. (2010), Reframing constructive criticism using reflection based on QSEN competencies. Retrieved from http://www.qsen.org/teachingstrategy.php?id=133

Burns, N. & Grove, S. K. (2009). The practice of nursing research: Appraisal, synthesis, and generation of evidence, 6th ed. St. Louis, Missouri: Saunders Elsevier.

Chappy, S., Jambunathan, J., & Marnocha, S. (2010). Evidenced-based curricular strategies to enhance BSN graduates' transition into practice. Nurse Educator, 35(1), 20-24.

Galloway, S. J. (2009). Simulation techniques to bridge the gap between novice and competent healthcare professional. The Online Journal of Issues in Nursing, 14(2). doi:10/3912/OJIN.Vol14No02Man03

Guhde, J. (2010). Using online exercises and patient simulators to improve students' clinical decision making. Nursing Educational Perspectives, 31(6), 387-389.

Leonard, B., Shuhaibar, E., & Chen, R. (2010). Nursing students perceptions of intraprofessional team education using high-fidelity simulation. Journal of Nursing Education, 49(11), 628-631. doi10.3928/01484834-20100730-06

May, B.A. , Edell, V., Butell, S. Doughty, J. & Langford, C. (1999). Critical thinking and clinical competence: A study of their relationship in BSN seniors. Journal of Nursing Education, 38(3), 100-110.

Stanley, M.J. & Dougherty, J.P. (2010). A paradigm shift in nursing model: A new model. Nursing Education Perspectives, 31(6), 378-380.