DISCUSSION AND CONCLUSIONS REGARDING THE SECOND SUB-QUESTION

The literature review in this study indicated that the following teaching methods are regarded as essential to enhance theory-practice integration: demonstrations, group discussions, small group activities, projects, reflection on learning / experience, role-play, problem-based/ -solving activities, concept / brain / mind mapping, scenarios, case studies, simulation, the nursing process, brainstorming, evidence-based teaching and self-directed learning.

It was revealed in literature that an overuse of formal lectures fosters and widens the theory- practice gap. Formal lectures are not conducive to enhance theory and practice integration. Furthermore, textbooks are synonymous with lectures and, according to McCaugherty (1991a:1057), it unwittingly provides the starting point for the theory practice gap. The results (validated by data triangulation) showed that formal lectures are primarily used in the classrooms as illustrated by the findings captured in Table 4.21. This clearly demonstrates an over-reliance on formal lectures that may lead to dependence on the part of the students. It is possible that the students can expect all information must simply be handed to them which will prevent or lessen their initiative to find the information themselves. Formal lectures do not comply with the teaching methods identified by literature as essential methods to enhance theory-practice integration. It also limits the students’ ability to develop CT and may occasion the starting point of the theory-practice gap. The structured observation data showed that a data projector with PowerPoint slides were used more than 60% of the time. This correlates with the data obtained from the completed questionnaires of both the nurse educators and student nurses.

The data validated by means of person and method triangulation revealed that only the eight (8) teaching methods that comply with the teaching methods identified by literature as essential methods to enhance theory-practice integration were used. These methods are group discussion,

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small group activities, reflection on learning / experience, self-directed learning, scenarios, problem based / -solving activities, the nursing process and evidence-based teaching.

Although not a teaching method, literature identified the independent use of multimedia by students (when given assignment) as most effective; it not only promotes the students’ learning experience but also narrows the theory-practice gap (Meyer & Van Niekerk, 2008:142). Both groups responded that the student nurses are encouraged to use multimedia when they were given assignments with more than 90% of each group answering “Yes” to the following question: ‘Do you encourage the utilisation of multimedia when giving assignments to students?’ Conversely, only a third of the nurse educators referred the students to the internet. This concurred with the student nurses’ responses which indicated approximately a third of them were referred to the internet by the nurse educators. As illustrated in the findings the reason for this poor referral may be that the student nurses had limited access to internet facilities at the learning centres.

In summary, the teaching methods identified by literature as methods essential to enhance theory and practice integration were discussed. From the literature research learning contracts, the use of multimedia and inclusion of clinical scenarios in assignments were identified as additional strategies to enhance theory and practice integration. The study findings showed that learning contracts, which are used in the theoretical and / or clinical environment to enhance theory and practice integration and CT skills (Quinn & Hughes, 2007:33; Jones, 2010:252), are used frequently. Networking with peers, also indicated to be used frequently, is another important strategy that enhances theory and practice integration thereby bridging the theory-practice gap (Wilson, 2008:2-3). Including scenarios of clinical problems in assignments also complies with strategies essential to enhancing theory and practice. It stimulates a student to seek and analyse information and apply the knowledge to real life situations, thus enhancing the student’s ability to correlate theory and practice (Distler, 2007:56; Meyer & Van Niekerk, 2008:84; Van der Horst & McDonald, 2008:138). The validated response of nurse educators that student nurses are encouraged to use multimedia when given assignments complies with the strategies identified by literature as essential methods to enhance theory-practice integration.

Finally, it is evident from this study that the traditional teacher-centred lecture format still maintains a strong influence in the DGNS programme as it was indicated and validated as the teaching method mainly used. It raises concern as this method does not comply with teaching methods identified by literature as essential to enhance theory-practice integration. However, a positive factor is that the study findings showed that the nurse educators utilise approximately 53% of the

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teaching methods essential to enhance theory and practice integration. If learning contracts, assignments related to clinical problem scenarios, networking with peers and students’ use of multimedia use were also taken into account, then 63% of the teaching methods and strategies that comply with methods and strategies identified by literature as essential to enhance theory and practice are currently used in the study settings.

Another concern is that although literature indicates that the use of multimedia is necessary for student engagement and successful integration of theory and practice, only three teaching aids are used frequently. Two of these teaching aids, namely data projectors with PowerPoint slides and textbooks, are also synonymous with formal lectures which are a teacher-centred method. This method, when overused, is seen as closely related to the causes of the theory-practice gap. Additionally, the over-reliance on textbooks is perceived to be the root of the theory-practice problem and a possible starting point for the theory-practice gap (McCaugherty, 1991a:1056).

Although the study showed that teaching methods essential to enhance theory-practice integration are used to some extent, it is a significant concern that the data generated by the literature research indicated some important factors that have to be considered to ensure successful implementation of teaching methods essential to theory and practice integration. These are the theoretical grounding, competency and skills of nurse educators as well as the availability of educational and information technology resources. One key skill which enables nurse practitioners and student nurses to successfully integrate theory and practice is CT. Teaching students CT starts in the classroom; therefore nurse educators must be able to use and demonstrate CT skills to role model and teach students this skill. The findings of the study indicated that the perception of the majority of nurse educators was that they did utilise strategies to enhance nurse students’ CT skills. Yet, only two nurse educators hold a master’s degree in nursing and one a master’s degree in nursing education. This is a concern as Chang et al. (2011:3224) state the CT skills of a nurse practitioner with a master’s degree are significantly better than one who holds a bachelor’s degree or a diploma. Secondly, there must be suitable educational and information technology resources available; this is not the case as pointed out in this study. The study results indicated that student nurses have limited internet access at the four learning centres. Research forms the basis of many of the teaching methods such as problem-based / -solving activities, self-directed learning and project work – all activities essential for enhancing theory and practice integration.

Lastly, the knowledge about the different teaching methods and facilitation skills of the educators were also mentioned as important factors in the successful implementation of active student-

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centred teaching methods. In effect, the minority of nurse educators (less than a third) indicated they had not received training regarding facilitation of learning, problem-based learning, reflective learning, multimedia and methods essential to correlate theory and practice. Conversely, the comments made by the non-research observer in her notes raised the question whether the correct criteria and principles are used when the teaching methods essential to enhance the integration of theory-practice are utilised.

The comments made by the non-research observer have implications for the nurse educators. It also warrants an in-depth study because this study did not indicate whether the current teaching methods are used according to the principles and criteria of the specific teaching method.

5.6 IMPLICATIONS OF THE STUDY

The findings and conclusions drawn in this study have implications in three domains. The first is for nurse educators at the HEI, the second for nursing education at the HEI and finally for future research.

5.6.1 Implication for nurse educators

For nurse educators at the HEI the findings of this study may have a number of important implications. These implications are listed below.

i The nurse educators should be encouraged to attend workshops regarding theory-practice integration, the teaching methods that are essential to enhance theory-practice integration, the use of multimedia and facilitation skills.

ii All nurse educators, whether they have their diploma in nursing education or not, should be encouraged to obtain a master’s degree in nursing. This is viewed as essential since it was evident from the literature research that nurse educators need strong theoretical grounding and CT skills to enhance theory and practice integration.

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iii Nurse educators should do more regular and longer clinical accompaniment of student nurses in the clinical environment. This will enhance the change of being more involved in the clinical supervision of students. It may also maximise the students’ opportunity to integrate theoretical learning with practice.

5.6.2 Implications for nursing education

For nursing education in general at the HEI the findings may also have a number of important implications.

i Nurse educators and student nurses should be encouraged towards an increase in the use of active student-centred teaching and learning methods. The implementation thereof has to be supported at the HEI by the availability of internet access for student nurses at all the learning centres.

ii The curriculum team of the HEI, currently consisting of managers and some of the nurse educators, may have to consider a hybrid curriculum that combines problem-based learning, experiential learning, reflective learning and self-directed learning teaching and learning approaches when developing a curriculum for the new nursing qualifications.

5.6.3 Implications for future research

This study raised a number of questions which merit further investigation. The findings of the present study warrant a need for more in-depth studies regarding the following themes:

i. The way in which teaching methods, essential to theory and practice integration, are used at the HEI.

ii. Constraints and challenges for nurse educators and student nurses that are currently preventing the use of teaching methods that enhance theory-practice integration at the HEI.

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iii. Factors that currently may hinder theory-practice integration in the clinical teaching environment at the HEI.

It is evident that this study should be seen as a forerunner or baseline study for further investigations into the theory-practice problem in nursing education and quality nursing education in general at the HEI.