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Introduction
Nursing is a discipline of applied nature. Unlike other
sciences, Nursing first started as a practice and then
got organised as a scientific study, The ‘Learning from
Practice’ era changed to ‘Learning to Practice’ now.
With this drastic change comes the serious problem of
a long gap between Nursing Education and Practice.
With the advent of numerous nursing institutions, it
becomes mandatory for us to see whether they provide
‘Quality Education’, which is this year’s SNA theme.
One way of ensuring this is to bridge the existing gaps
between theory and practice. A study was therefore undertaken
wiht the objective to:
1. assess the extent ot gap in nursing education and
practice.
2. find the possible causes for gaps in nursing education
& practice,
3. formulate strategies and measures to bridge the gap
in nursing education and practice.
Review of Literature
Benner (1984) described the knowledge
that is embedded in Nursing Practice. Benner identified
four stages of skill acquisition (Self affirmation,
engaging patient, experiencing setbacks and refining
the repertoire) following a study involving baccalaureate
nursing students.
Eraser et al (1986) indicated that class room environment
instruments would be useful for research involving the
effects of the class room psychosocial en-
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vironment on student’s cognitive and affective outcomes.
Dominic Chan (2002) developed a clinical
learning environment inventory to gauge the insight
gained by students in their clinical placement. It includes
the following categories: Individualisation, innovation,
satisfaction, involvement, personalisation, and task
orientation.
Ajzen & Fishbein (1980) developed a
students clinical intention questionnaire to study the
behavioural intentions of students. It tested the intention,
attitude, subjective norm, perceived behavioural control,
behavioural belief, normative belief and control belief.
Neistadt & Smith (1994) insisted that
if faculty show novice nurses how key signs and symptoms
link to recognition of health pattern through example
development, students may gain more in clinical situations.
Methods and Procedures
The investigator used a Descriptive Design. Three Schools
of Nursing and 2 Colleges of Nursing located at Urban,
Semi - Urban and Rural Areas of Tamil Nadu were selected
for this study. The study samples included 200 Pre-final
and Final year Basic B.Sc (Nursing) students and Final
Year GNM students using Non-Probability convenient sampling.
Criteria for Sample Selection
Inclusion Criteria |
1. Nursing Students of pre-final and final year [Basic
B.Sc(N)] and Final year (G.N.M.)
2. Willingness of the subjects to participate in the
study.
With respect to supervision during procedures only a
meagre 15.5 percent students were supervised. 76 percent
of the students were motivated to follow staff nurse’s
clinical experience rather than text book methods.
With regard to the confidence level of the students,
71 percent of the students were confident but unsatisfied
at the end of the procedure and 9.5 percent of the students
felt anxious to do anything.
Considering the laboratory facilities only 17 percent
students had access to well - equipped labs and only
10 percent students felt that they had student friendly
labs. Majority of students (63.5%) did not practice
the procedures in the lab before doing it in the ward.
Description of Tool
Part-I : Demographic Data
Part-II : Structured Questionnaire
on Nursing Education and Nursing Practice including:
a. Hospital facilities
b. Scope for clinical practice
c. Clinical learning environment
d. Class room environment
e. Laboratory practice
Part-III : Suggestion by students.
Data Collection Procedure
The study was conducted after obtaining formal permission
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Table 1. Clinical Learning Environment
| SNo |
Variables |
N |
% |
| 1. |
Observing doctor / Nurse
a. Always
b. Sometimes
c. Only if they call
|
70
113
17
|
35
56.5
8.5
|
| 2. |
Doctor’s rounds attending
a. Routine
b. Only when free
c. Hesitate
|
34
149
17
|
17
74.5
8.5
|
| 3. |
CNE
a.Regularly
b.Sometimes
c.Not conducted |
-
80
120
|
-
40
60
|
| 4. |
Supervision by clinical instructor
a.Often
b.Sometimes
c.Unsupervised
|
34
157
9
|
17
78.5
4.5
|
| 5. |
At the end of a posting feel
a.Satisfied
b.Unsatisfied
c.Confused
|
96
73
11
|
48
46.5
5.5
|
| 6. |
Staff nurses treating uniquely
a.All nurses
b.Some nurses
c.Not treated uniquely
|
99
84
17
|
49.5
42
8.5
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from the Dean/Principal of the
Nursing Institution.
The students were assembled
in auditorium or conference
hall and arranged spaciously
to discourage discussion.
The purpose of the study was explained
and the questionnaire
was distributed to the subjects
individually. A5-minute explanation
was given about the questionnaire
and then the students
were allowed to fill it.
Findings & interpretation
As for the hospital facility 60 percent
of the institutions had their
own hospital out of which 40 percent
were multi-specialty hospitals.
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Only 40 percent of the hospitals
had 100 percent bed occupancy.
With regards to availability of
adequate resources to perform
procedures, only 10 percent students
had an access. Only 23.5
percent of the students were
given ward assignments by the
clinical instructor. From the
Table it was observed that only
35 percent of the students observe
a doctor / nurse performing
a procedure and only 17 percent
of them attend the Doctor’s
rounds. In 60 percent of hospitals,
Continuing Nursing education
programmes were not conducted.
At the end of every speciality
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speciality
postings 46.5 percent of
the students were not satisfied
and 5.5 percent were confused
about it.
With regard to class room environment
& learning, 67 percent
of the nursing educators explains
the subject fully to the students.
Majority of the students (79.5%)
were not taught about evidence
- based practice. Only 38.5 percent
students find their assignments
to be useful for clinical practice.
Nearly half of the students (54%)
find the co-relationship between
their textbook and clinical settings
to be only moderate
whereas 20 percent feel it to be
extremely low.
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Higher proportion (97.5%) of
students felt that a moderate gap
exists between nursing education
and practice.
Interpretation
 While most colleges excel in
Nursing education the practice
levels of their students
tends to be very low.
Institutions with own hospitals
were able to provide the
proper practice for their students.
Improper supervision in
clinical areas affects quality
practice.
Majority of the hospitals
never care to conduct CNE.
Majority of the staff rely
more on their clinical experience
and not on theoretical
methods.
The labs of majority of colleges
are not adequately
equipped.
Conclusion
The gap between Nursing education
& practice is moderate
and it could be easily bridged by
adopting simple measures like
ensuring proper clinical postings
under continuous supervision,
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well-experienced faculties, conducting
regular CNEs etc.
Recommendations
1. It should be mandatory for
all the Nursing Educational
Institution to have their own
hospital. Institutions without
own hospitals must
maintain a very good relationship
with their affiliated
hospitals at all levels (from
Dean to staff nurse) so that
their students can get good
attention and better allowance
in those hospitals.
2. Nurse Educators must perform
dual role both in service
and education.
3. Nurse educators with adequate
clinical experience
and other criteria cited by
INC, to be allowed to handle
the subjects.
4. More investment to be made
in furnishing the clinical
skills lab e.g. simulators.
5. Nursing Institutions must take initiative and collaborate
with the hospitals to
conduct CNE programmes
for staff Nurses.
6. Nurse Educators should provide
periodical guidance and
counselling to the students.
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7. Periodic appraisal from the
students must be considered.
8. Standardised practice
manuals must be prepared
by the concerned institutions
for the students.
9. Use of innovative clinical
teaching methods, e.g.
Decker’s Clinical database,
Pattern recognition model.
References
1. Benner, P (1984). “From Novice
to Expert: Excellence & Power in
Clinical Nursing Practice”, Menlo
Park, CA; Addison - Wesley.
2. Catherine Nuss Kotecki (2002).
Baccalaureate Nursing student’s
communication process in the
clinical setting. Journal of Nursing
education 41(2), 61-67.
3. Fraser & Fisher (1981). Validity &
use of my class - room inventory.
Science Education, 65, 145-156.
4. Dominic Chan (2002). Development
of the clinical learning environment
inventory using the theoretical
framework of learning environment
studies to assess nursing
student’s perceptions of the
hospital as a learning environment.
Journal of Nursing education,
41(2): 69-75
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5. Ajzen I & Fishbein M (1980). Understanding
attitudes & predicting
social behavior, Englewood Cliffs,
NJ; Prentice - Hall
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6. Linda Meyer (2002). Applying the
theory of planned behavior Nursing
students’ intention to seek clinical
experiences using the essential
clinical behaviour database,
Journal of Nursing Education,
41 (3) 107-115
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7. Ruth - Sahd, LA (2003). Intuition: a
critical way of knowing in a
multicultural Nursing curriculum,
Nursing Education Perspectives,
24: 129-134.
8. Argyris L & Schon D (1974).
Theory in practice: Increasing
Professional Effectiveness, Jossey
- Bass, London.
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