Abstract
Background: A theory-practice gap in nursing education often occurs, and the staff from the nursing education institution and the associated healthcare services should find ways to improve their collaboration to reduce the gap during the training of nursing students.
Aim: This study aimed to develop context-specific collaboration guidelines for a nursing education institution and associated healthcare services.
Setting: Private hospital in the Gauteng province of South Africa.
Methods: Guidelines were developed from the findings of an integrative literature review. Thereafter, it was contextualised in a qualitative study with focus group discussions (FGDs) involving 9 theoretical lecturers and 10 clinical facilitators.
Results: In the partnership between the nursing education institution and the associated healthcare services, bilateral communication, cooperation between the theoretical lecturers and the clinical facilitators in delivering evidence-based patient care, intensified innovation in teaching and learning practices and an environment conducive to theory-practice integration should be emphasised.
Conclusion: A set of context-specific guidelines was developed to enable the theoretical lecturers and the clinical facilitators to collaborate in supporting nursing students to apply their theoretical knowledge in the development of clinical competencies.
Contribution: The guidelines can be adjusted to suit the context of other nursing education institutions and their associated healthcare services to improve collaboration between theoretical lecturers and clinical facilitators to the benefit students’ skills development in theory-practice integration.
Keywords: nursing education institution; associated healthcare services; clinical facilitators; theoretical lecturers; theory and practice integration.
Introduction
Nursing students often face confusion when there is a mismatch between theoretical knowledge and its application in real clinical settings (Factor, Matienzo & De Guzman 2017:84; Kerthu & Nuuyoma 2019:24). The practical experience in healthcare services often differs from the idealised scenarios presented in theory classes. While simulation laboratories are well-equipped with the necessary resources, the associated healthcare services often lack such resources (Mina, Reza & Dimitrios 2019:403). As a result, students frequently struggle to implement what they have learned in theory into rendering care to patients (Greenway, Butt & Walthall 2019:5). Poor collaboration between theoretical lecturers and clinical facilitators contributes to the challenges that students experience to integrate theory in practice (Günay & Kılınç 2018:84). It is crucial for theoretical lecturers and clinical facilitators to collaborate effectively to support students in bridging theory-practice gap.
This study aimed to develop context-specific collaboration guidelines for the theoretical lecturers of a designated nursing education institution and the clinical facilitators of its associated healthcare services. To gain data for the development of the guidelines, a comprehensive literature review on collaboration between theoretical lecturers and clinical facilitators to improve theory-practice integration was conducted. The guidelines were then contextualised with the input of theoretical lecturer and clinical facilitator participants.
Research methods and design
The research was done in two phases. In the first phase, the researcher conducted a literature review using five databases: PubMed, Science Direct, Medline and EBCHOST, CINAHL and Scopus, to collect evidence on good collaboration practices between nursing education institutions and healthcare services, particularly between theoretical lecturers and clinical facilitators, to enhance theory-practice integration during clinical training. The search led to the selection of 2939 articles, which were then screened. After removing duplicates and excluding articles that were not related to collaboration in nursing education, 47 full-text articles were reviewed. Finally, 17 articles met the inclusion criteria of being published in English, having full-text availability, and being peer-reviewed publications. These articles were published between January 2016 and January 2021 (refer to Figure 1).
The first author conducted a thematic analysis of the findings. It involved a familiarisation with the content and searching for themes. She also drafted collaboration guidelines from each article (refer to Table 1). The summarised articles and themes formed the basis for the draft guidelines.
In phase two of the study, a descriptive qualitative study through focus group discussions (FGDs) was done to contextualise the drafted collaboration guidelines to fit the unique circumstances of the designated nursing education institution and associated healthcare services.
Setting
The study was conducted at one nursing education institution and its associated healthcare services in the Gauteng province in South Africa. The nursing education institution is accredited with the South African Nursing Council (SANC) for the Diploma in Nursing Science (R171 of 2013) leading to registration with the SANC as general nurses.
Study population and sampling
The study population consisted of 10 theoretical lecturers who were responsible for theoretical teaching and 10 clinical facilitators for clinical training. Participants were purposively selected and invited to FGDs. Nine theoretical lecturers and 10 clinical facilitators participated in four focus groups discussing the contextualisation of the collaboration guidelines. Refer to Table 2 for the participants’ demographic information.
| TABLE 2: Participants’ demographic data and qualifications status. |
Data collection
Draft guidelines were contextualised through four FGDs at a suitable venue at the nursing education institution. The discussions were audio-recorded with the participants’ permission. The first author facilitated the discussions, and participants provided input by discussing each guideline, deleting irrelevant ones, and adapting others to their specific collaboration needs. Four FGDs were necessary before the participants agreed upon the set of contextualised guidelines. The first author made field notes of the participants’ interaction that was not audio-recorded.
Data analysis
The audio-records of the FGDs were transcribed and together with the field notes were read several times by the first author to familiarise herself with the content. Themes were identified and coded, grouped into sub-categories and categories. The categories and sub-categories informed the contextualisation of the collaboration guidelines between the nursing education institution and healthcare services.
Trustworthiness of the findings
The researcher involved theoretical lecturer and clinical facilitator participants in contextualising the draft guidelines. Their expertise and experiences were valuable to adjust the guidelines to suit the unique circumstances of the designated nursing education institution and associated healthcare services.
Ethical considerations
A study information leaflet explaining the aims and research process, with draft guidelines, was provided to the participants who voluntarily gave informed consent before participating in the FGDs. They were informed they are allowed to withdraw from the research at any time without negative consequences. Confidentiality was emphasised during the discussions. The study proposal was approved by the Faculty of Health Sciences Research Ethics Committee at the University of Pretoria (Ref 670 of 2020). Permission was obtained from the management of the healthcare services and nursing education institution where the research was conducted.
Results
The participants through their input during FGDs contextualised the collaboration guidelines. Their discussion to contextualise the draft guidelines is reflected in categories and sub-categories (see Table 3).
Maintain a healthcare service and nursing education institution partnership
Shared values and goals enhance collaboration for improved teamwork:
‘Teamwork should include academic staff and hospital management staff. They should know what values and ethics we strive for so that there is better integration between hospital management staff and us.’ (TLP4, M Cur, PhD, 40 years)
Relationships between facilitators and lecturers foster shared responsibility, commitment and connectivity in the partnership, vital for team development and expanding teamwork:
‘Relationship is the most important thing we are having.’ (CFP4, B Cur Honours PHC, 20 years)
Clinical facilitators require knowledge of the theory content taught to support and align theory-practice integration in hospitals, bridging the gap between theory taught in class rooms, and its application in the hospital environment:
‘Clinical facilitators should know the textbook content; should know the theoretical questions to facilitate better at hospital.’ (TLP6, D Litt et Phil, 43 years)
‘Clinical facilitators should know the theoretical content to improve theory-practice integration.’ (CFP6, B Cur, 17 years)
Maintain bilateral communication
Implementing an organised, goal-driven communication plan is crucial for facilitating regular sharing of relevant information among clinical facilitators and theoretical lecturers. This ensures effective collaboration and supports the integration of theory and practice:
‘Clarity of expectations of communication is required from both clinical and theory.’ (CFP2, Diploma in Nursing Education, Management, 25 years)
Maintain cooperation between theoretical lecturers and clinical facilitators in evidence-based practice
Collaborative leadership and teamwork between clinical facilitators and theoretical lecturers are essential for implementing evidence-based practice, enhancing academic staff skills, and facilitating the transfer of knowledge between hospitals and nursing education institutions. This joint effort addresses the theory-practice gap, promotes the development of evidence-based practice, and fosters a culture conducive to learning:
‘Collaboration and shared leadership that clinical facilitators and lecturers should identify the need in the clinical field for an assignment and clinical project in the research, to fill the gap.’ (TLP2, B Cur and BA of Social Science, 14 years)
Sharing evidence-based practice processes and knowledge generated in hospitals may motivate staff and students to improve their clinical practice and advance their knowledge. Utilising evidence-based practice may enhance the students’ learning environment and improve theory-practice integration:
‘Manage a positive working environment by strengthening the lecturers and clinical facilitator’s skills in teaching and learning through sharing of evidence-based practices.’ (TLP8, M CUR, 33 years)
Intensify innovation in teaching, learning and assessment processes
The implementation of an operational plan by the nursing education institution management may be instrumental in supporting the integration and alignment of theory and practice. Such a plan may effectively structure the collaboration between clinical facilitators and theoretical lecturers:
‘Operational plan has a structured clinical for learning programme for the day.’ (CFP6, B Cur, 17 years)
‘Academic staff is responsible for planning, implementation and execution of operational programme.’ (TLP 7, M CUR, 34 years)
Innovative and creative teaching and learning methods that prioritise student-centred methods are crucial for accommodating diverse types of nursing students in both classroom and hospital settings. Clinical facilitators and theoretical lecturers should therefore use innovative methods to foster critical thinking, clinical judgement, and reflective thinking, effectively addressing the unique learning needs of the students:
‘We need to find ways to improve our teaching, like, seminars, journal clubs on teaching to develop us or enhance our skill in teaching.’ (TLP5, B Cur, 11 years)
‘We need to be equipped for the types of students with different learning styles, we need to be able to accommodate them in the teaching and learning environment.’ (CFP10, B Cur, 21 years)
Active participation is a core value for team success and achieving desired outcomes. To ensure competent nursing students, clinical facilitators must actively engage in the design of clinical assessments:
‘We need to be involved or participate in designing and evaluating. It’s about participation.’ (TLP4, M Cur, PhD, 40 years)
Build an environment conducive to theory-practice integration
Mentorship programmes play a vital role in fostering a sense of belonging within a group, which in turn supports theory-practice integration. It is crucial for clinical facilitators and theoretical lecturers, to possess mentorship skills. Therefore, providing mentorship training is essential to ensure adequate support for new staff and foster the development of relationships that enhance collaboration:
‘Mentoring is a skill, need to be knowledgeable on what mentoring is about. Mentoring is a connection, relationship and time.’ (TLP4, M Cur, PhD, 40 years)
The participants agreed that theoretical lecturers and clinical facilitators need to be experts in theory-practice integration, to support students with theory-practice integration:
‘Clinical facilitators and lecturers need to become specialists in a discipline for teaching and skill.’ (TLP4, M Cur, PhD, 40 years)
Discussion
Effective collaboration between nursing education institutions and healthcare services’ management is crucial. Each partner should have defined responsibilities, with coordination overseen by designated persons. A structure is needed to facilitate the creation, translation and application of knowledge, benefiting student learning and patient care (Gilliss et al. 2021:4,5). The appointment of clinical coordinators can enhance cooperation between theoretical lecturers and clinical facilitators, supporting students’ skills development (Munangatire & McInerney 2022:2).
A shift is necessary for theoretical lecturers and clinical facilitators to transition from individual ownership of students’ teaching to a partnership model of student support (Huston et al. 2018:32). Partnerships foster commitment, clarify roles and responsibilities, and facilitate the integration of theory and practice in the hospital setting. By improving the understanding of roles and responsibilities, coordination between clinical facilitators and theoretical lecturers can be enhanced, leading to better team outcomes and theory-practice integration (Munangatire & MCinerney 2022:2). Clinical facilitators play a crucial role in theory-practice integration when they apply theoretical knowledge during clinical training of students. Sharing theoretical class content with clinical facilitators promotes cooperative teaching in the hospital, facilitating theory-practice integration (Ryan & McAllister 2020:2). Open, trustful and supportive communication is imperative for improving cooperation (Bvumbwe 2016:320). When clinical facilitators and theoretical lecturers engage in collaborative thinking and reasoning, their collective output enhances students’ learning and skills development (Askari et al. 2020:2).
Evidence-based practices play a vital role in addressing patient care challenges, generating new knowledge, and improving the learning environment for students (Ramis et al. 2019:11). The implementation of evidence-based practice also encourages the professional growth of theoretical lecturers and clinical facilitators by enhancing their clinical skills. Integrating evidence-based practice into routine patient care should be a key focus of the partnership between nursing education institutions and healthcare services. This integration aims to enhance patient outcomes and improve the quality of care provided (Kleinpell et al. 2016:706).
An operational plan is crucial in facilitating the teaching and learning process both at the nursing education institution and in hospitals, aiming to align theory teaching with practical training. Such plans promote the acquisition of clinical skills while integrating theory, minimising the theory-practice gap and fostering students’ professional development (Ngozika Ugwu et al. 2023:11). Strategic clinical planning activities are essential for supporting the operational plan and ensuring effective theory-practice integration for students (Hoda Ahmari et al. 2021:265).
Innovative assessment strategies should be created by theoretical lecturers and clinical facilitators (Van Wyngaarden, Leech & Coetzee 2019:4). Joint assessment practices between them can standardise expectations and promote understanding. Collaborative decision-making in assessment can prevent inconsistencies (Dev et al. 2020:1135).
Mentorship is essential for enhancing teaching practices, skills and collaboration within the academic team (Glover et al. 2021:272). It provides support for clinical facilitators and theoretical lecturers as they transition into their roles as educators, fostering excellence (Huston et al. 2018:32). Theoretical lecturers and clinical facilitators should focus on improving their teaching and learning skills to enhance the learning environment. Sharing innovative student-centred strategies and skills such as student feedback, mentoring, engaging in research activities and embracing management diversity is essential for fostering teamwork and positive relationships (Mallek & El-Hosany 2020:379). These actions contribute to an enhanced teaching and learning experience.
Context-specific guidelines to improve collaboration and narrow the theory-practice gap in nursing education
The guidelines are the outcome of a thorough literature review to obtain published research evidence, the identification of draft guidelines from the evidence, and a contextualisation with the input of theoretical lecturers and clinical facilitators who may benefit from its implementation. The categories and subcategories as the product of the analysis of the data of the FGDs feature in the final set of collaboration guidelines. Refer to Figure 2 for description of the contextualised guidelines.
Strengths and limitations
Although the study was conducted at one nursing education institution and its associated healthcare services only, the authors described the process of the development and contextualisation of the guidelines thoroughly to enable researchers to repeat the research to benefit other nursing education institutions and associated healthcare services.
Implications for nursing education institutions and healthcare services
The guidelines can be adjusted to suit the specific context of the nursing education institution and the associated healthcare services, and can be used to improve collaboration between theoretical lecturers and clinical facilitators to benefit students’ endeavours to integrate theory and practice. Effective collaboration and relationships between clinical facilitators and theoretical lecturers can narrow the gap that often exists between nursing education institutions and healthcare services to advance optimal support of theory-practice integration.
Conclusion
The challenges faced in applying nursing theory to clinical practice necessitate evidence-based interventions derived from the research literature. In this study, the researcher, with the guidance of supervisors, conducted a literature review to gather evidence. Based on this review, guidelines were formulated and contextualised through FGDs involving clinical facilitators and theoretical lecturers. The implementation of these guidelines has the potential to support nursing students in effectively applying nursing theory in practice.
Acknowledgements
The authors acknowledge the contribution of the participants of the study.
Competing interests
The authors have declared that no competing interest exists.
Authors’ contributions
The study was conceptualised by E.B., N.C.v.W., and C.M. E.B. was involved in data collection and analysis. N.C.v.W. and C.M. supervised the study; and E.B. and N.C.v.W. drafted the manuscript.
Funding information
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Data availability
The data are available from the corresponding author, N.C.v.W. on reasonable request.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article’s results, findings, and content.
References
Akram, A.S., Akram, S. & Mohamad, A., 2019, ‘The role of clinical instructors in bridging the gap between theory and practice in nursing education’, International Journal of Caring Sciences 11(2), 876–882.
Askari, G., Asghri, N., Gordji, M.E., Asgari, H., Filipe, J.A. & Azar, A., 2020, ‘The impact of teamwork on an organization’s performance: A cooperative game’s approach’, Mathematics 8(10), 1804. https://doi.org/10.3390/math8101804
Bay, E.H. & Tschannen, D.J., 2017, ‘An academic-service partnership: A system-wide approach and case report’, The Journal of Nursing Education 56(6), 373–377. https://doi.org/10.3928/01484834-20170518-11
Berndtsson, I., Dahlborg, E. & Pennbrant, S., 2020, ‘Work-integrated learning as a pedagogical tool to integrate theory and practice in nursing education - An integrative literature review’, Nurse Education in Practice 42, 1–8.
Bester, E., Van Wyk, N.C. & Maree, C.M., 2023, ‘Collaboration guidelines for a designated nursing education institution and associated healthcare services’, Masters dissertation, University of Pretoria repository, Pretoria.
Bvumbwe, T., 2016, ‘Enhancing nursing education via academic–clinical partnership: An integrative review’, International Journal of Nursing Sciences 3(3), 314–322. https://doi.org/10.1016/j.ijnss.2016.07.002
Clevenger, C.K. & Cellar, J., 2018, ‘Creating new models of care through an academic-clinical partnership’, Georgia New Administration Quarterly 42(4), 30–31.
Dev, M.D.B., Rusli, K.D.B., Mckenna, L., Lau, S.T. & Liaw, S.Y., 2020, ‘Academic-practice collaboration in clinical education: A qualitative study of academic educator and clinical preceptor views’, Nursing & Health Sciences 22(4), 1131–1138. https://doi.org/10.1111/nhs.12782
Drayton-Brooks, S.M., Gray, P.A., Turner, N.P. & Newland, J.A., 2017, ‘Building clinical education training capacity in nurse practitioner programmes’, Journal of Professional Nursing 33(6), 422–428.
Factor, E.M.R., Matienzo, E.T. & De Guzman, A.B., 2017, ‘A square peg in a round hole: Theory-practice gap from the lens of Filipino student nurses’, Nurse Education Today 57, 82–87. https://doi.org/10.1016/j.nedt.2017.07.004
Gierach, M., Knuppe, M., Winterboer, V. & Randall, R., 2019, ‘Creating a culture of caring: A collaborative academic-practice approach to clinical education’, Nursing Forum 54(3), 386–391.
Gilliss, C.L.P.R.N.F., Poe, T.D.N.P.R.N., Hogan, T.H.P., Intinarelli, G.P.R.N. & Harper, D.C.P.R.N.F., 2021, ‘Academic/clinical nursing integration in academic health systems’, Nursing Outlook 69(2), 234–242. https://doi.org/10.1016/j.outlook.2020.09.002
Glover, H.A., Hitt, A., Zills, G., Darby, W., Hall, C. & Kirkman, T., 2021, ‘Nurturing novice faculty: Successful mentorship of nurse practitioners’, The Journal for Nurse Practitioners 17(10), 1271–1275. https://doi.org/10.1016/j.nurpra.2021.07.015
Greenway, K., Butt, G. & Walthall, H., 2019, ‘What is a theory-practice gap? An exploration of the concept’, Nurse Education in Practice 34, 1–6. https://doi.org/10.1016/j.nepr.2018.10.005
Günay, U. & Kılınç, G., 2018, ‘The transfer of theoretical knowledge to clinical practice by nursing students and the difficulties they experience: A qualitative study’, Nurse Education Today, 65, 81–86. https://doi.org/10.1016/j.nedt.2018.02.031
Gursoy, E., 2020, ‘The partnership between academic nursing and clinical practice: A qualitative study’, Journal of the Pakistan Medical Association 70(4), 597–601.
Hoda Ahmari, T., Gaeeni, M., Rezaei, M., Khoramirad, A. & Ahmad, P., 2021, ‘The challenges of clinical education in nursing: A qualitative analysis of nursing students and clinical instructors’ perspectives’, Journal of Nursing and Midwifery Sciences 8(4), 260–267. https://doi.org/10.4103/jnms.jnms_151_20
Huston, C.L., Phillips, B., Jeffries, P., Todero, C., Rich, J., Knecht, P. et al., 2017, ‘The academic-practice gap: Strategies for an enduring problem’, Nurse Forum 53(1), 27–34.
Huston, C.L., Phillips, B., Jeffries, P., Todero, C., Rich, J., Knecht, P. et al., 2018, ‘The academic-practice gap: Strategies for an enduring problem’, Nursing Forum 53(1), 27–34. https://doi.org/10.1111/nuf.12216
Hussein, M.T.E.L. & Osuji, J., 2017, ‘Bridging the theory-practice dichotomy in nursing: The role of nurse educators’, Journal of Nursing Education and Practice 7(3), 20–25.
Iseler, J., Wehrwein, T. & Jensen, C., 2019, ‘A Model of academic and service partnership focused on the clinical nurse specialist’, Journal of Nursing Administration 49(6), 294–296.
Kerthu, H.S. & Nuuyoma, V., 2019, ‘Theory-practice gap: Challenges experienced by nursing students at the satellite campus of a higher education institution in Namibia’, International Journal of Higher Education 8(5), 21–28. https://doi.org/10.5430/ijhe.v8n5p21
Kleinpell, R.M., Faut-Callahan, M., Carlson, E., Llewellyn, J. & Dreher, M., 2015, ‘Evolving the practitioner-teacher role to enhance practice-academic partnerships: A literature review’, Journal of Clinical Nursing 25(5–6), 708–718.
Kleinpell, R.M., Faut-Callahan, M., Carlson, E., Llewellyn, J. & Dreher, M., 2016, ‘Evolving the practitioner-teacher role to enhance practice-academic partnerships: A literature review’, Journal of Clinical Nursing 25(5–6), 708–714. https://doi.org/10.1111/jocn.13017
Mallek, S.S. & El-Hosany, W., 2020, ‘Training program for improving clinical teaching knowledge as a competence of clinical instructors’, American Journal of Nursing 8(3), 379–391.
Mina, H., Reza, N. & Dimitrios, T., 2019, ‘Exploring the barriers of utilizing theoretical knowledge in clinical settings: A qualitative study’, International Journal of Nursing Sciences 6(4), 399–405. https://doi.org/10.1016/j.ijnss.2019.09.008
Munangatire, T. & Mcinerney, P., 2022, ‘A phenomenographic study exploring the conceptions of stakeholders on their teaching and learning roles in nursing education’, BMC Medical Education 22, 404. https://doi.org/10.1186/s12909-022-03392-w
Ngozika Ugwu, S., Ogbonnaya, N.P., Chijioke, V.C. & Esievo, J.N., 2023, ‘Causes and effects of theory-practice gap during clinical practice: The lived experiences of baccalaureate nursing students’, International Journal of Qualitative Studies on Health and Well-Being 18(1), 2164949. https://doi.org/10.1080/17482631.2023.2164949
O’Neal, P.V., McClellan, L.C. & Jarosinski, J.M., 2016, ‘A new model in teaching undergraduate research: A collaborative approach and learning cooperatives’, Nurse Education in Practice 18, 80–84.
Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., et al., 2021, ‘Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement’, Journal of clinical epidemiology 134, 103–112. https://doi.org/10.1016/j.jclinepi.2021.02.003
Ramis, M.-A., Chang, A., Conway, A., Lim, D., Munday, J. & Nissen, L., 2019, ‘Theory-based strategies for teaching evidence-based practice to undergraduate health students: A systematic review’, BMC Medical Education 19(1), 267. https://doi.org/10.1186/s12909-019-1698-4
Ryan, C.W. & Mcallister, M.M., 2020, ‘Australian clinical facilitator professional development needs: A cross-sectional study’, Nurse Education Today 94, 104590. https://doi.org/10.1016/j.nedt.2020.104590
Sadeghnezhad, M., Nabavi, F.H., Najafi, F., Kareshki, H. & Esmaily, H., 2018, ‘Mutual benefits in academic-service partnership: An integrative review’, Nurse Education Today 68, 78–85.
Shoghi, M., Sajadi, M., Oskuie, F., Dehnad, A. & Borimnejad, L., 2019, ‘Strategies for bridging the theory-practice gap from the perspective of nursing experts’, Heliyon Science Direct 5(9), 1–6.
Van Wyngaarden, A., Leech, R. & Coetzee, I., 2019, ‘Challenges nurse educators experience with development of student nurses’ clinical reasoning skills’, Nurse Education in Practice, 40, 102623. https://doi.org/10.1016/j.nepr.2019.102623
Yi, Y.J., Lee, H. & Park, K., 2020, ‘The role of academic-practice partnerships from perspectives of nursing students: A cross-sectional study’, Nursing Education Today 89, 1–8.
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