Theoretical environment

The topic of determining whether the theory-practice problem originates in the classroom has been extensively studied over years. Researchers like McCaugherty (1991a:1056), Ferguson and Jinks (1994: 688), Hewison and Wildmam (1996:755) and Fealy (1999:76) identified various factors that may play a prominent part in facilitating the theory-practice gap. These factors include textbooks and lectures, the curriculum, study block contents, teaching methodologies and the nurse educators and are discussed next.

(a) Textbooks and lectures

Symbol-object dichotomy refers to textbooks (words and symbols) that are different to real life situations. McCaugherty (1991a:1056) opines that the overuse of textbooks may be the root of the theory-practice problem as it represents an incomplete picture of the nursing ‘practice’ because the

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latter is more complex than how it is portrayed in theoretical descriptions. Hence, textbooks can never present the real situation as it is experienced in nursing practice; the practical hands-on environment is far more challenging and complicated than any theoretical description thereof. Obviously, the contrast between having textbook knowledge and the reality of what the nurse student experiences in the demanding real life situation is a problem. Knowledge generated in the classroom from textbooks bear little relationship to what the student nurse experiences in practice. Russell (1967) as mentioned by McCaugherty (1991a:1056) referred to it as “knowledge by description”. It is very different to the knowledge the student gains by experience while working in the clinical (or practical) environment. The textbook descriptions can never be the same as the real life situation or experience. Therefore, a full understanding of the theory (knowledge) does not guarantee that the student nurse has the ability to apply the knowledge in the clinical (or practical) environment.

Furthermore, lectures and textbooks have shortcomings when used to teach holistic patient care. It does not capture the psychological and social dimensions unique to each patient. It is a rather difficult and abstract way to communicate some of the problems patients experience whereas experiencing something in practice results in a better understanding of it. This may be the reason why the student nurses may find it difficult to apply their acquired textbook knowledge to nursing practice. According to McCaugherty (1991a:1057), a potential gap between the theory and the practice lies therein that, from a student nurse’s viewpoint, practice (the patient) can appear very different from theory (books and lectures).

McCaugherty (1991a:1056) emphasises that although it may seem as if the use of textbooks and lectures do not have any value when learning nursing, this is only true when they are relied on too heavily. It is only the overuse of textbooks and lectures that leads to theory being an imperfect representation of nursing practice. Textbooks and lectures do indeed have value in the sense that it is an excellent transmitter of knowledge and gives guidance to student nurses; it is only when over-relied on that it can foster a theory-practice gap (McCaugherty, 1991a:1056).

(b) Curriculum

The way in which a curriculum is structured can either narrow the theory-practice gap or widen it. If the theory and practice is captured as separate entities in the curriculum and assessed as such, it may cause the assumption that they are separate and integration is not a primary consideration

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(McCaugherty, 1991a:1058). This may widen the gap instead of enhancing theory/practice integration.

(c) Study block contents

Poor sequencing of theoretical (study) blocks and practice with theoretical input preceding the placement of the student has been identified as a cause for the theory-practice gap. The sequencing of study blocks and planning of content can also be a problem according to some authors (McCaugherty, 1991a:1059; Ferguson & Jinks, 1994:691) but Corlett et al. (2003:189) disagree. An empirical study conducted by these authors revealed surprising results which indicated that there was no difference between the theoretical knowledge of student nurses who went straight to the clinical (or practical) environment and those who had a delayed clinical placement. On the contrary, the former study revealed that student nurses who had a delayed clinical placement had a more in-depth theoretical knowledge basis than those who were immediately placed in the relevant clinical (or practical) environment.

(d) Teaching methods

The use of teacher-centred teaching methods such as formal lectures and heavily structured days facilitates the theory-practice gap. This was described by Treacy (1987) in Ferguson and Jinks (1994:689) as “teaching that fails to touch the students’ reality”. When students are passive receivers of the information provided by the educator they do not actively participate in the teaching session and give little or no feedback. Instead, it enhances the competencies of listening, note-taking and rapid reading (Frost, 1996:1048) and does not foster application of knowledge to practice and critical thinking (CT) which is very important in the nursing profession (see discussion under section 2.4) (Kumar, 2003: 20; Meyer & Van Niekerk, 2008:63; Applin, Williams, Day & Buro, 2011:130). Formal lectures tend to encourage the memorising of facts and have a negative effect on the student’s ability to correlate theory and practice. Moreover, textbooks are synonymous with lectures but if over-used it unwittingly provides the starting point for the theory practice gap. The reason being that it paints a generalised and incomplete picture of patient care which is usually far removed from the reality of the clinical (or practical) environment (McCaugherty, 1991a:1057).

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(e) Nurse educators

McCaugherty (1991a:1058) supports the notion that the title ‘nurse educator’ indicates a dual role, that of educator (time spent on classroom teaching) and that of nurse (the accompaniment of the student nurse in the clinical environment [practice]). According to MacNeil (1997:641), these are two demanding and diverse roles. As nurse educators, they must have the appropriate range of knowledge and skills to function in the classroom as well as in the clinical (or practical) environment. Thus, they must have expert knowledge of the general nursing principles, knowledge of specific branches of nursing and educational principles while they are at the same time expected to be competent nurse practitioners and role models to the student nurses. This implies that nurse educators indeed have a dual responsibility.

Although the title ‘nurse educator’ indicates a dual role as explained by McCaugherty (1991a:1058), the average nurse educator is predominantly based in the nursing education institution and busy with lecture preparations (textbooks), facilitating learning and assessments, and performing associated administrative tasks. This may result in the nurse educator lacking enough time, or no time at all, to spend with the student nurse in the clinical (or practical) environment. Consequently, it causes a lack of clinical supervision of student nurses in the clinical environment. This means that the clinical teaching is delegated to the unit staff members who are already struggling under the burden of the clinical environment workload (Ferguson & Jinks, 1994:688).

Another implication of the lack of clinical supervision is that the nurse educator is separated from the practice. This questions the clinical credibility of the educator as she or he is perceived as a ‘visitor’ to the clinical environment with limited knowledge of the patient. Ferguson and Jinks (1994:692) identified this lack of clinical supervision and clinical credibility as two causes of the theory-practice gap.