Closing the Theory-Practice Gap: Is it Possible?

Moving to different clinical environments and embracing new responsibilities can be stressful and challenging for even the most experienced practitioners.

But, for newly qualified staff managing the gap between theory and practice can seem overwhelming.

The theory-practice gap or research-practice gap, as it’s sometimes called, occurs when practitioners struggle to integrate knowledge learnt in an academic environment with real-world clinical practice.

As standards of care continue to evolve from practices rooted in custom and tradition, to an evidence-based profession, there can often seem to be a disconnect between what is considered best practice and actual practice.

This is a problem because as Matthew and Tucker (2018) note when clinical practice no longer reflects the best available scientific evidence the result can be sub-standard patient care.

The theory-practice gap is nothing new and even though the challenge of bringing research evidence and clinical practice closer together has been recognised for years, it still remains a problem, especially for newly qualified staff.

Of course, as Chapman (2017) says, nurses shouldn’t expect to know everything. Yet it’s only by understanding practice in relation to theory that skills and knowledge can be kept relevant and up to date.

What Does the Theory-Practice Gap Really Mean?

In the view of Chapman (2017) the theory-practice gap can be viewed in the following ways:

• The difference between idealised practice and common practice.
• The difference between taught general principles and the difficulty in interpreting them for application to a specific situation.
• The gap between taught abstract nursing theory and its use in practice.
• The gap between scientific knowledge and theory used as common practice.
• The gap between our individual mental representations of nursing and the published theories of nursing.
• The gap between the theories practitioners claim underlie their practice, and the implicit theories embedded within their practice, of which they may not be aware.

For nurse educators, the dichotomy between the theoretical input taught in the classroom and what is practised or experienced on the wards remains a perennial problem (Landers 2000), and nowhere is this gap so large as for newly qualified students.

It’s a gap that is inevitably encountered by all nurses at various times in their careers, but it is student nurses, given their novice status and limited experience, who perhaps struggle most to manage the theory-practice void (Scully 2011).

There have been many initiatives introduced over the years in an effort to bridge the theory-practice gap and most of these have focused on the role of the nurse teacher, preceptor or mentor. Yet despite a high level of awareness of the problem and a willingness to find creative solutions, barriers still remain to integrate research-based theories into clinical practice.

Armstong (2009), makes the following suggestions about why this problem remains so difficult to tackle.

Barriers to Implementing Research

• Nurses did not feel they had authority to implement research findings.
• There was insufficient time on the job to implement new ideas and/or to read research articles.
• Management and/or doctors would not allow and/or cooperate with implementations.
• Statistical analyses were not understandable.
• Facilities were inadequate for implementation.
• Other staff were not supportive of implementation.

(Armstrong 2009)

Can the Gap Ever Be Closed?

The all-important question is, ‘can the theory-practice gap ever be closed’?

Cook (1991) argues that it can’t and that while the narrowing of the theory/practice gap may be a realistic goal, attempts to close it completely are doomed to failure.

Making Use of Clinical Mentorship

Whilst questions about how to completely close the theory-practice gap remain unanswered, the role of the mentor is gaining increasing recognition as the best way for novice practitioners to make sure that their knowledge is both up to date and relevant to their practice.

It’s long been understood that the best learning comes through experience and that practitioners prefer to use the knowledge they gain from their colleagues.

But, this preference can be a double-edged sword as knowledge picked up ‘on the go’ could be flawed or even misinterpreted (El Hussein & Osuji 2017).

This is why nurse educators and competent mentors have such an important part to play in encouraging reflection and critical thinking to help minimize the gap between research and practice. By sharing their experiential knowledge validated by real experience they can assist learners to keep their knowledge up to date in a way that is both consistent and valid for real patient care.

As Rolfe (1998) simply points out the aim of nursing research is the generation of knowledge, and whilst this is a relevant aim in theory-based disciplines, such as sociology, the primary concern of nursing is with practice.

In other words, if clinical research is actually to make a difference to practice it must be practitioner based.

Closing the Gap is a Shared Responsibility

To date, all attempts to bring research and practice closer together have been at best only partially successful.

So, given that expectations of completely closing the research-practice gap are unrealistic, how can nurse academics and educators help to support a closer relationship between research and clinical practice?

Based on extensive research Matthew and Tucker (2018) suggest the following.

1. The primary focus of attention should be in supporting academic-clinician collaboration.
2. Building a research culture within the clinical environment.
3. Improving research access.

To do this of course practitioners need to have access to updated information, learning resources, and continuing educational opportunities. Resources that are not always readily available in busy and potentially under-resourced clinical environments.

In an ideal situation, research is informed by clinical practice and practice informed by research. But, finding creative and meaningful ways to merge, both in ways that deliver safe and up to date care, can be a struggle in a clinical environment that is itself ever changing and evolving.

Bridging the gap between research and the realities of everyday practice is a challenge that isn’t going away soon.

Nor is it the sole responsibility of academics but a challenge shared by educators and practitioners too.

After all, the students of today are the leaders of tomorrow and that means that all nurses and midwives, wherever they work, have a responsibility to forward their profession in some way.

References

• Armstrong, N 2009, ‘Are student midwives influenced by the ‘traditional’ (non-evidence-based) practices of their clinical mentors?’, in Evidence Based Midwifery, 11 March, viewed 4 June 2018, https://www.rcm.org.uk/learning-and-career/learning-and-research/ebm-articles/are-student-midwives-influenced-by-the–0
• Chapman, H 2017, ‘Nurses should understand practice in relation to theory’, in Nursing Times, 6 November, viewed 4 June 2018, https://www.nursingtimes.net/opinion/practice-comment/comment-nurses-should-understand-practice-in-relation-to-theory/7021934.article
• Cook, SH 1991, ‘Mind the theory/practice gap in nursing’, Journal of Advanced Nursing, vol. 16, no. 12, pp. 1462-9, viewed 4 June 2018, https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2648.1991.tb01594.x
• El Hussein, M & Osuji, J 2017, ‘Bridging the theory-practice dichotomy in nursing: The role of nurse educators’, Journal of Nursing Education and Practice, vol. 7, no. 3, pp. 20-5, viewed 4 June 2018, http://www.sciedu.ca/journal/index.php/jnep/article/view/9744
• Landers, MG 2000, ‘The theory-practice gap in nursing: the role of the nurse teacher’, Journal of Advanced Nursing, vol. 32, no. 6, pp. 1550-6, viewd 6 June 2018, https://www.ncbi.nlm.nih.gov/pubmed/11136425
• Matthew, J & Tucker, B 2018, ‘Current understandings of the research-practice gap in nursing: A mixed-methods study’, The Australian Journal of Nursing Practice, vol. 25, no. 2, pp. 171–9, viewed 4 June 2018, https://www.collegianjournal.com/article/S1322-7696(17)30093-8/fulltext
• Rolfe, G 1998, ‘The theory-practice gap in nursing: From research-based practice to practitioner-based research’, Journal of Advanced Nursing, vol.  28, no. 3, pp. 672-9, viewed 4 June 2018, https://www.researchgate.net/publication/13530235_The_theory-practice_gap_in_nursing_From_research-based_practice_to_practitioner-based_research
• Scully, NJ 2011, ‘The theory-practice gap and skill acquisition: an issue for nursing education.’, Collegian, vol. 18, no. 2, pp. 93-9, viewed 4 June 2018, https://www.ncbi.nlm.nih.gov/pubmed/21706997?report=abstract