Uploaded by Anna Tran


Assignment 8.1: Theory-Practice Gap
Maryville University
Course: NURS 600
Ninety-nine percent of nurses and nurse practitioners that I encountered in the last eight
years were not able to recite the names of any theorists or theory associated with their nursing
philosophy and practices, including me. Until recently when studying nursing theory as a
requirement for the nurse practitioner program at Maryville University, I guiltily realized that
theories had been habitually and unconsciously incorporating in my daily nursing practice.
Apparently, there must be substantial theory-practice gap somewhere along my academic and
nursing career journey. Otherwise, I would know at least one or two theories or theorists after
one year of community college, four years of undergraduate at Saint Louis University, one year
of an accelerated nursing program at Goldfarb School of Nursing, and seven years of working as
a nurse on medical and psychiatric units. “If this is true then we are both the authors and the
victims of the theory-practice gap; and moreover, we are equally to blame for continuing its
perpetration” (Sellman, 2010, p.85). Before this assignment, I kept reflecting on reasons leading
to my own theory-practice gap. This assignment truly satisfies my personal, educational, and
professional curiosity as it alleviates my feeling of guiltiness about my theoretical knowledge
ignorance. This paper aims to extrapolating strategies that have been proposed by many nursing
journals to close current theory-practice gap.
Theory-practice gap are wide or narrow, problematic or understandable depending on the
perceiver’s current academic and career status as well as his/her personal optimistic or
pessimistic disposition. Leonardo da Vinci once said: “All our knowledge has its origins in our
perceptions” (“Perception quotes - Quote Coyote,” n.d.). With my limited knowledge in
theoretical nursing, I propose that the first step in bridging theory-practice gap is to alter the
common perception of the word “theory-practice gap” by changing it to “theory-to-patient
roadblocks.” This symbolic term “theory-to-patient roadblocks” emerged when I discovered that
a new theoretical model of people-centered care was formally adopted by Western Pacific and
South-East Asia which are the two Asian regions of the World Health Organization (Holzemer,
2008). I noticed that the term “theoretical model of people-centered care” related well to any
professions that concern with the common interest “people care” or “patient care” since the term
didn’t specify whether it is a nursing theoretical model of people-centered care, a medical
theoretical model, or a social theoretical model. I recognized a common pattern in all nursing
theories and conceptual models, grand theories or middle range theories, the four common
concepts that influence and determine nursing practice are patient, environment, health, and
nursing. Of the four concepts, the most important is that of the patient. (“Nursing Theories: An
Overview,” n.d.). Since the focus of every nursing theories and nursing practices is the patient,
the word “theory-to-patient” visually reminds the theorists, the researchers, the clinical nurses,
and the student nurses about their same common interest (patient). With the common interest
bonding them together, it should then follow that communication between experts regarding of
removing the “theory-to-patient roadblocks” become positive, meaningful and enjoyable.
Positive communication undoubtedly leads to innovative ideas and epiphany. The “roadblocks”
instead of gap implies that a road to bring theory to patient’s bedside has already existed, and the
theorist and practitioners just need to either remove the roadblocks or find alternative ways to
bring theory closer to patient. The word “gap” almost always associates with negative meanings
such as a break, a space, an interruption in continuity, a wide divergence, differences, and
disparity in attitudes and perceptions. On the contrary, the word “road” positively describes a
direction, way, path, process and a series of events or a course of action that will lead to an
outcome. Words are powerful. When chosen well, words bring people and ideas together
(“Words are powerful. Choose them well. But how is the choice to be made?”, 2017). At first, I
was skeptical of introducing the term “theory-to-patient roadblocks.” For one, I have only been
learning and internalizing nursing theoretical knowledge in the last eight weeks. I was afraid to
be judged as “naive and ignorance.” Two, English is my second language, and American is not
my original culture. Therefore, the way I understand and internalize words is unexplainable and
usually considered “strange” or “funny” to friends and colleagues. Nevertheless, they love my
humor. I was never hesitated to invent innovative words to replace the negative connotations of a
word, and to neutralize stress in my daily nursing practice. Examples of my invented words are
“yearly compassion booster,” the “yearly anti-drama vaccine,” “attention every 15 minutes as
needed nursing care”, “knowledge booster needed,” “knowledge deficit alert,” or “hangry”
means angry when you are hungry. After extracting information from several nursing and nonnursing journals relating to closing theory-practice gap, I suggest the replacement of the classic
term “theory-practice” gap with “theory-to-patient roadblocks” as the first step in mending the
gap between theory and clinical practice. This suggestion draws upon the model of nursing
praxis which the author argues that “only by reconsidering the relation between theory and
practice can the gap be closed” (Rolfe, 1993).
Once negative perceptions of the theory-practice gap have been replaced with a positive
one, the remaining step is merely identifying, and mending the holes. The central role of nursing
clinical instructors or educators is to link theory to practice. Much qualitative research indicated
that the lack of nursing clinical educators’ qualifications, their poor communication skills and
uninteresting teaching methods focusing on grades significantly widen the theory-practice gap.
In a qualitative research study of one hundred and forty nursing students, the concept of
“qualifications” not only includes the educators’ formal educational degrees but also means their
communication skills and teaching methods. Students were deeply disappointed that “the
instructors are not able to give attention to the students,” and “theory teachers and clinical
instructors … did not consider” students’ individual differences and their unique learning style.
The “only one teaching method” made it difficult for the students to understand and link theory
to practice. (Saifan, AbuRuz, & Masa’deh, 2015, p.23). The innovative integration of
constructivist educational framework and evidence-based practice was proposed to use during
clinical experience sessions to bridge this particular theory-practice gap. The constructivist
clinical facilitator incorporates different teaching strategies to meet individual learners’ needs.
Examples of constructivist teaching strategies are experiential learning, reflective practice,
problem-based learning, and transformative learning (Ferrara, L. R. 2010). The experiential
learning strategy enables the nursing student to actively learn by doing specific nursing skills,
researching about the latest and best evidence-based practice, interviewing, and assessing
patients. Reflective practice happens when nursing student explore how past experiences
connect or disconnect with new knowledge. For example, many critical reflective writing
assignments during nursing theory course were describing diverse types of nursing theories,
relating them to current clinical nursing practice, reflecting on what lies ahead for the future of
nursing theory and how student's definition of nursing has or has not changed from the beginning
of the course. The last constructivist approach is problem-based learning strategy. Nursing
students use a problem-based learning strategy to develop critical thinking skills by solving realworld problems in small groups. For example, in the last few weeks of my nursing theory course,
our small group came together to review and research about the role of intuition in current
nursing practice and to evaluate possible linkage of intuition to future nursing research. Another
example of a real-world problem is identifying five major challenges facing the future
advancement of nursing knowledge, and extrapolating strategies to bridge current theory-practice
gap based on all that we have learned. Problem-based learning enables nursing students to
embrace complexity and diversity, satisfy intellectual curiosity, construct new meanings from
theory, and enhance nursing student's creativity and responsibility (Ram, Ram, & Sprague, n.d.).
There are many other innovative strategies proposed to close the theory-practice gap. It
has been a compelling academic experience to see the theory-practice gap through the lenses of
“the academic …who must remain research active while the administrative load increases”, “ the
academic who finds herself required to be positive in the face of challenges of successive
institutional reorganizations”, and “ the registered practitioner…who must contend with the
unpredictable nature of clinical environments” (Sellman, 2010, p. 85). The kind of theorypractice gap identified in this paper are from the lenses of “the highly motivate nursing student
who finds his enthusiasm eroded" when the clinical experiences did not live up to his
expectations, and “the student who must negotiate their way between the varying demands of
classroom and ward instruction” (Sellman, 2010, p. 85). I envision that theory-practice gap will
never be closed for theory will generate more theories. Instead, the gap will expand or shrink in
response to political, economic, socio-cultural, environmental and other external influences. The
theory-practice gap are places where new knowledge is breed. In this context, theory is
knowledge. Knowledge is knowing of what we can do with theory. Wisdom is knowing when
not to do it (“Is knowledge more important than wisdom? | Debate.org,” n.d.).
Ferrara, L. R. (2010). Integrating evidence-based practice with educational theory in clinical
practice for nurse practitioners: Bridging the theory practice gap (PDF). Research and
Theory for Nursing Practice: An International Journal, 24(4), 213–216.
Holzemer, W. L. (2008). Nursing theory – remembering our future (PDF). Japan Journal
of Nursing Science, 5, 71.
Is knowledge more important than wisdom? | Debate.org. (n.d.). Retrieved March 13, 2018, from
Nursing Theories: An Overview. (n.d.). Retrieved March 12, 2018, from
Perception quotes - Quote Coyote. (n.d.). Retrieved March 12, 2018, from http://www.quotecoyote.com/perception-quotes/
Ram, P., Ram, A., & Sprague, C. (n.d.). From student learner to professional learner:
training for lifelong learning through on-line PBL. Retrieved March 12, 2018, from
Rolfe, G. (1993). Closing the theory-practice gap: A model of nursing praxis (PDF).
Journal of Clinical Nursing, 2, 173–177.
Saifan, A., AbuRuz, M. E., & Masa'deh, R. (2015). Theory Practice Gap in Nursing Education:
A Qualitative Perspective. Journal of Social Sciences / Sosyal Bilimler Dergisi, 11(1),
20-29. doi:10.3844/jsssp.2015.20.29
Sellman, D. (2010), Mind the gap: philosophy, theory, and practice. Nursing Philosophy, 11: 85–
87. doi:10.1111/j.1466-769X.2010.00438.x
Words are powerful. Choose them well. But how is the choice to be made? (2017, August 29).
The Telegraph. Retrieved from https://www.telegraph.co.uk/news/2017/08/29/wordspowerfulchoose-wellbut-choice-made/