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Abstract
A gap exists between nursing theory and practice when discussing medication effectiveness, new
treatments, and nursing policies. Nursing education focuses on imparting specific skills,
judgment, and knowledge in the classroom. The clinical environment is where nursing students
learn how to care for patients with different disorders and implement the theory learned in the
classroom and lab into practice. The review aims to identify the gap that exists between theory
and clinical practice in healthcare facilities, which cause pre-licensure nursing students to be
unsuccessful in their programs, the National Council Licensure Examination (NCLEX), nursing
practice, and how they use of case studies for pre-licensure nursing students affects clinical
performance compared to simulation. A search was conducted on Google Scholar and PubMed
with the keywords gap between classroom theory and clinical practice. The inclusion and
exclusion criterion were based on the currency of the evidence if they were between 2016 to
2020, if they included the population of graduate nurses and clinical instructors, and if the
analysis answered the PSCOT question. The John Hopkins Evidence-Based Appraisal Tools are
used to guide the appraisal of evidence. According to the evidence, inconsistencies exist in the
pre-licensure nursing programs based on the strategies required to improve the quality of
application and integration of classroom theory into clinical practice. The appraisal supports a
change in the institutional policies is necessary to reflect an integration of simulation-based
learning experiences with increased frequency through the curriculum as a standard practice for
pre-licensure programs for adopting and addressing the theory-practice gap. Research with a
larger population that includes theory and clinical instructors to identify the exact reason for the
gap is necessary.
Keywords: theory-practice gap, simulation, pre-licensure, future nursing
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ASSIGNMENT 3: EBTP PAPER CH 1, 2, 3 and ABSTRACT
Chapter 1 Introduction
Clinical learning is an essential part of explaining the significance of nursing students’
performance in a clinical environment, providing an opportunity for practicing skills and
development of a professional identity. Nursing is based on practical learning to ensure care
based on knowledge applied in actual practice. The inconsistency existing between nursing
classroom theory and nursing practice exists as a discrepancy between acquiring theoretical
knowledge in the classroom setting and clinical setting experience. Despite the significant efforts
put in the profession, a disconnect continues in the classroom affecting clinical performance
triggering significant scrutiny amongst the students, nurse educators, and nursing practitioners.
The gap existing between classroom knowledge and actual practice arose in the absence of a
translation of the classroom theory into practice and coupled with the increasing workload.
While there is a great concern about the clinical learning experiences and the gap continues to
widen causing pre-licensure nursing students to become unsuccessful in their nursing programs,
NCLEX pass rates, and future nursing practice.
Setting
The setting is in a rural public community college classroom and the clinical environment
is in the local hospital. The students participating in the Transition to RN Associate Degree of
Nursing Option are currently practicing as Licensed Practical Nurses (LPN), emergency medical
technicians (EMT), respiratory therapist, and physical therapist that have met the prerequisites.
The Transition program is an evening/weekend option allowing the nursing students to provide
support for their families during the daytime while continuing to pursue a higher education. The
class meets on Tuesday and Thursday nights from 1730 to 2030 and every other weekend
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throughout the year long program. The faculty/student ratio is 1:15. The nurse educator working
in the Transition to RN option must have a master’s degree in nursing although the focus does
not require the degree to be in education with instruction taking place in the classroom as well as
the clinical environment. A preceptor must show leadership capabilities and knowledge of the
colleges policies and procedures. The transition to RN program is accredited by the Mississippi
Board of Trustees of State Institutions of higher learning and the Accreditation Commission for
Education in Nursing (ACEN).
Issue
The nursing education issue is the existence of a gap between knowledge gained in the
classroom setting and clinical practice. Contributing factors to the expanding gap is the amount
of time available for lecture, lack of nursing faculty to bring connections between theory and the
clinical environment due to a decrease in the available clinical sites. Nursing involves caring for
an individual’s health-related concerns, prevention of illness, and education. Maintaining a
proper balance between theory and practice in nursing by implementing evidence-based research
teaching and practice is essential to bridge the gap. According to Akram et al. 2018, the clinical
environment, an essential component, is where the student learns how to care for patients thereby
making judgments and decisions based on critical thinking. In a qualitative study by Irajpour et
al. 2018, the gap between nursing and what students learn in the classroom impacts the care
given in the emergency department. For some nursing students, the reality and views of real
clinical practice versus classroom theory places them at risk for failure to rescue due to a lack of
knowledge. A 2009 report from the Carnegie Foundation calls for “radical transformation” of
nursing education (Benner et al., 2009). According to Benner et al., 2009, strengths and
weaknesses exist in nursing education and external challenges that the profession faces. Nursing
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education requires to be remade and radical advances are necessary in the pathway to nursing
licensure and an understanding of the curriculum (Benner et al., 2009).
According to research by Brown 2019, graduate nurses experience deficits integrating
classroom theory and the clinical practice setting. Besides, the theory-practice gap could be
minimized based on the utilization of high-fidelity simulation using scenario-based learning
before entry into practice. Nursing students lack critical thinking skills and knowledge of how to
incorporate classroom theory with total patient care (Brown, 2019).
Issue in Relation to Organization Mission/Strategic Plan
Classroom theory and clinical practice align with the strategic plan to protect public
health, safety, and welfare. Clinical learning is essential in providing the best opportunities for
integrating theory and practice to ensure the provision of better patient care (Brown, 2019). The
strategy of generic RN is aimed at preparing graduates in the area of professional behavior,
clinical decision making, care management, assessment, and collaboration (Associate Degree in
Nursing-Generic Option, 2020). The strategy aligns with the issue to bring a connection between
theory and clinical practice.
PSCOT Question
In _pre-licensure nursing students_ (P), how does using case studies__ (S) compared to
simulation__(C) affect _clinical performance?
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Chapter 2: Method
Search Protocol
A search was conducted on Google scholar and PubMed using the keywords gap between
classroom theory and clinical practice. The years searched are from 2016 to 2020. The inclusion
and exclusion criterion was based on an analysis of the evidence to answer the PSCOT question
and if the evidence applied to the population under study. Besides, the currency of the articles
also mattered in the selection of the sources. The number of articles located was ten, while those
that were included in the review were eight. The John Hopkins Evidence-Based Appraisal Tools
are used to guide the appraisal of evidence. The title of each article returned was reviewed based
on relevance to the PSCOT question and the relevance of the abstracts' information to align with
the health education issue for consideration for inclusion.
Evidence Table
See Appendix A: JHEBP Individual Evidence Tool
Evidence Synthesis
See Appendix B: JHEBP Evidence Synthesis and Recommendation Tool
Narrative of Evidence Synthesis
One of the articles found was level I evidence and recommended that the orientation
process to the training place, availability of simulation labs and the students in the groups
undergoing training in the clinical setting contributes to closing the classroom gap existing
between classroom knowledge and actual practice in the hospital facility (Akram et al., 2018).
Three articles were level II evidence, which recommends that adopting strategies from a threedimension perspective, including the instructor, students, and educational planning, help close
the gap between classroom theory and clinical practice (Oducado et al., 2019). Besides, clinical
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instructors should seek to ensure the sufficiency of clinical equipment in teaching and integrate
theory and practice (Akram et al., 2018). On the other hand, five articles were level III evidence
suggesting a parallel connection between classroom theory and clinical practice (Brown, 2019).
The evidence recommends that the utilization of strategies aligning with active learning is
essential for promoting learner development in the clinical setting (Johnston, 2018). Utilizing
simulation technology properly supports the integration of theoretical knowledge into practice
(Brown, 2019). Simulated clinical environments occupy minimal spaces between the classroom
and clinical healthcare practice (Weeks, 2019).
The populations represented are graduate nurses, and the instructors are meant to identify
where the disconnect exists between concepts learned in the classroom and the clinical
environment (Brown, 2019). The population of graduate nurses, and instructors represented are
appropriate as they help in obtaining strategies that will help in closing the inconsistency
between classroom theory and practice other than case studies in class.
Based on the evidence reviewed, simulation increases the effectiveness in clinical
practice than case studies. The results of the various studies varied significantly but were pulled
together to a common goal of addressing the gap that exists between classroom knowledge and
actual practice. Nursing educators ought to continually observe clinical practice and ensure the
reevaluation of the clinical program and develop strategies that ensure acquiring of necessary
knowledge and skills for practice (Johnston, 2018). According to Brown (2019), the use of highfidelity simulation utilizing scenario-based learning exercises helps in the integration of
integration of theoretical knowledge into practice. The strategies are applied in three dimensions
to involve instructors, students, and planning to eliminate the theory-practice gap (Khodaei et al.,
2016).
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Student nurses supported that insufficiency of clinical equipment existed in the clinical
practice section, showing that a theory-practice gap exists. (Peters et al., 2017). On the other
hand, some authors supported that graduate nurses faced difficulties in their transition, indicating
the gap that exists between nursing theory and actual clinical practice (Akram et al., 2018). The
authors also supported that the utilization of simulation strategies helped transition from nursing
theory to clinical practice within the setting. There are difficulties in integrating theoretical
knowledge to practice during the clinical setting (Brown, 2019).
The limitations to the studies include lack of explorative use of nursing and health care
professionals. Akram et al., 2018 included nurse students available at target hospitals. Graduate
nurses were also included in the study (Bennett, 2017). Clinical instructors, nursing lecturers
and matrons are key personnel in offering sufficient equipment within the clinical facilities to
enable learning and teaching (Akram et al., 2018). Besides, the exploration of healthcare
professionals was minimal. As a result, exploring the strategies to close the gap in three
dimensions is not fully handled.
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Chapter 3 Results/Discussion
Akram (2019) used the Likert scale questionnaire to collect data and showed a significant
role of clinical instructors in bridging the gap between theory and practice. Although the study
did not explore clinical instructors, theory instructors, and supervision as part of the teaching
function and quality improvement, instructors play a critical role in reducing the gap between
classroom theory and practice (Akram, 2018). The instructors' communication skills, effective
time utilization, the use of a case-study approach, and nursing procedures, as in theory, help
reduce the gap (Akram, 2018). The instructor plans to reflect the harmonization of theory and
clinical practice for the quality functioning and competence in the clinical setting. While Brown
(2019) used a small sample size of 13 participants, the study showed the graduate nurse
experience was overwhelming, with knowledge overload, and challenging. Role transition from
student to nurse was reported with difficulties in communication with care providers and
prioritization of care (Brown, 2019). According to Bennett 2017, nurses' education did not
prepare them for different areas in the clinical setting as the nursing students do not select areas
of placement and thus do not have skills for dealing with varying patient issues. Theory
instructors and clinical instructors do not teach similar skills resulting in confusion between them
(Bennett, 2017). Although Khodaei et al., (2019) did not explore clinical and theory instructors,
the mean scores indicated low performance in integrating classroom knowledge into practice.
The results showed that incorporating a three-dimension plan, including instructors, students, and
educational planning, is necessary to improve performance (Khodaei et al., 2019). Johnston 2018
indicated that the utilization of strategies aligning with active learning principles to promote
active learner development contributes positively to reducing the theory-practice gap. As a result,
the learners will acquire the skills and knowledge they incorporate into the clinical setting.
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Implications
Education
The theory instructors and clinical practice instructors play a role in the preparation of
graduate nurses. More research is required on the need for the preceptorship program in the last
year in nursing school to decrease the challenges in the transition from classroom theory and
practice (Bennett, 2017). The skill acquisition model to incorporate classroom theory in practice
should be included to ensure the learners are prepared effectively to handle different clinical
practice situations. Besides, the instructor plans and training activities used upon arrival in the
clinical setting reflect the need for harmonization and keeping instructors up-to-date in classroom
theory (Akram, 2018). A change in the institutional policies must reflect an integration of
simulation-based learning experiences with increased frequency through the curriculum as a
standard practice for pre-licensure programs for adopting and addressing the theory-practice gap.
The provision of simulation technology, when appropriately used, supports the integration of
theoretical knowledge into practice by engaging students in opportunities to improve their
confidence, knowledge retention, and competence in their skills (Brown, 2019).
Future Research
Further research is necessary with a larger population that includes theory and clinical
instructors to identify the exact reason for the gap between classroom theory and practice
(Bennett, 2017). The research should be conducted to obtain a larger population to identify the
problems that result in the theory-practice gap as it is a generalized problem within nursing.
Despite the population a number of baccalaureate programs have introduced seminars to help
students in the formation of a new nursing identity and an understanding of the requirements
used in nursing practice in the first two years of college (Benner, 2012). The clinical information
EBTP PAPER
is aimed at helping develop skills and understanding of clinical practice. However, there is a
potential for exploring other options to support the integration of pre-licensure programs other
than the use of simulation technology and research should involve a larger population.
10
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Chapter 4: Implementation Plan
Goal of the Project
The primary goal of the project is to bridge the gap existing between classroom theory
and practice causing pre-licensure nursing students to become unsuccessful in their nursing
programs, NCLEX pass rates, and future nursing practice. An additional goal is to communicate
recommendations for curriculum improvement to major stakeholders in nursing for preparation
of graduate nurses. The overall goal is to bridge the gap between classroom theory and practice
by incorporation of curriculum changes to include simulation practices in education for nursing
pre-licensure programs and provide recommendations for effecting the change in two months.
Change Theory
The Plan-Do-Study and Act (PDSA) Model is a way for the implementer to evaluate
whether a change is effective or if it should follow a different direction (Katowa-Mukwat et al.,
2020). The PDSA Model is similar to following the nursing process using evidence-based
interventions. According to Katowa-Mukwat et al. there are barriers to models such as the John
Hopkins Nursing Evidence Based Practice (JHNEBP) that interferes with its use in all healthcare
facilities. The PDSA model can be used to track changes in nursing education and is versatile in
small or large projects. This writer used the PDSA model in a bachelor’s degree in nursing
course with mentoring as a topic during the first eight weeks at the college. Dresang’s Radical
Change Theory provides guidance in the evidence-based practice project. Dresang’s theory can
be applied in nursing education a most educators come from bedside nursing to academia with
no prior experience. Radical change theory fosters the digital youth’s skills including the digital
information literacy in taking advantage of opportunities through the interactive and connected
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digital environment. As the students gain knowledge and skills the preparation for clinical and
theory is a smoother transition. The expert nurse educator learns what may work in the classroom
and what may not work. To advocate for change the educator can utilize the PDSA model by
researching the impact of case studies and simulations on the students test scores, clinical skills,
program outcomes, and first-time pass rates for NCLEX. The process of professional
developmental and implementation of theory takes time and practice in the field of education.
Application of Change Theory to Implementation and Evaluation Plan
The core principles of Drerang’s Radical Change Theory include connectivity which
creates a sense of community in a world of changing perspectives, interactivity, and access
involving breaking the long-standing barriers. The radical change theory is used in information
seeking as a way of learning that makes the students’ learning meaningful. Communication of
the change theory is necessary to ensure it is done within the required timeline. Besides,
incorporation of what the change covers and its intended purpose to close the disconnect between
classroom theory and clinical practice necessary. According to Bennet (2017), education of
nurses does not prepare them for diverse areas in the clinical setting and nursing students do not
select areas of placement during nursing school thus they do not acquire skills of dealing with
different patient issues at the same time. According to Akram (2018), the orientation process
during training, availability of simulation laboratories, the number of students in the training
groups in the clinical setting contributes to bridging the gap. The radical change theory can be
used to observe how the application of the change affects the performance of pre-licensure
students.
See Appendix X: JHEBP Stakeholder Analysis Tool
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Inhibitors and Facilitators
Implementation of the project in nursing education is a complex process, requiring
support from the nursing instructors and faculties, education policy makers, clinical educators or
nurses, and students. Nursing instructors deliver clinical training necessary in bridging the gap
between classroom theory and clinical practice thus will facilitate the success of the project. Prelicensure students require mutual and coordinated training from clinical nurses and faculty
instructors. The education policy makers are to effect the change in the curriculum which is
linked to nursing educators and students for positive translation of theory into practice. Financing
for curriculum change could be facilitated by government grants and the schools as well as it
affects the students and nursing instructors. Financing may inhibit the success of the project.
However, early communication of the project is likely to help get the necessary finance from the
government and get the institutions prepared for any shifts.
Chapter 5: Evaluation Plan
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Evaluation Method
The tool for measuring academic success is based on evaluation of the scores on nursing
program tests for identification if the development of the tests should base on simulation rather
than case studies. The NCLEX pass rates for pre-licensure students will also address academic
success and indicate the reliability of the scores. Initially, the scores were low indicating
compared to after the implementation of evidence-based teaching practices. The improvement
indicate that the change had an impact in improving the pass rates for the pre-licensure nursing
students thus helping bridge the gap between theory and practice.
Timeline to Implement and Evaluate the Project
See Appendix X: JHEBP PET Management Tool
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Chapter 6: Education Plan
Teaching Plan
The intended audience is first year Nursing students enrolled in a Fundamentals of
Nursing Course. The course requires a time length of 4 hours for the lesson. The course is an
initial core course that is based on caring and application of the knowledge in patient care. The
course aims at providing students with the necessary skills and attitudes based on theoretical
knowledge for demonstration of nursing care procedures for patient care. The students apply
basic practices accurately through simulation demonstrations. The practices including proper
hygiene while handling patients are reflected by incorporation of concepts of care and
professional commitment. The students should also identify the challenges faced in ensuring
control of infections and how to address them. Besides, as the students should recognize the
effects of antimicrobial resistance and the role nurses play in antimicrobial advocacy. The course
also aims at ensuring students understand the knowledge and competence required by nurses for
safe practice to prevent and control the spread of infections based on simulations.
Conclusion
The clinical environment evolves continually and is based on theoretical knowledge
applied in practice. The disconnect exists when health care professionals struggle in the
integration of knowledge gained in the classroom to clinical practice. The disconnect results prelicensure students being unsuccessful in their nursing programs including NCLEX PASS rates
and transition into practice. According to Akram et al. (2019), the use of simulation and training
in the clinical setting during transition helps improve the integration of theory in actual practice.
The utilization of a model in the nursing education system that uses technology supporting the
transition to practice is essential to help bridge the dichotomy between classroom theoretical
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input and practice (Weeks, 2019). Simulation programs give an opportunity to obtain skills and
continuous practice to help increase confidence and improve the performance of the nurses in
actual practice.
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References
Akram, A. S., Mohamad, A., & Akram, S. (2018). The role of clinical instructor in bridging the
gap between theory and practice in nursing education. International Journal of Caring
Sciences, 11(2), 876–882. https://eds-a-ebscohostcom.sacredheart.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=9&sid=38bc25c8-45d548de-8f79-f042afd443a1%40sdc-v-sessmgr01
Akram, A., Aljerjawy, M., & Salama, A. (2018). Gap between theory and practice in the nursing
education: The role of clinical setting. JOJ Nursing & Health Care, 7(2), 001–006.
https://doi.org/10.19080/jojnhc.2018.07.555707
Associate Degree in Nursing- Generic Option . (2020). Retrieved October 17, 2020, from
Hindscc.edu: https://www.hindcc.edu/programs-of-study/nursing-allied-health/associatedegree-nursing/adn-generic-option
Benner, P., Surphen, M., & Dey, L. (2009). Educating Nurses: A Call for Radical
Transformation. San Franscisco: Jossey-Bass.
Bennett, L. (2017). The gap between. ABNF, 28(4), 96–102. https://eds-a-ebscohostcom.sacredheart.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=1&sid=38bc25c8-45d548de-8f79-f042afd443a1%40sdc-v-sessmgr01
Brown, J. E. (2019). Graduate nurses’ perception of the effect of simulation on reducing the
theory-practice gap. SAGE Open Nursing, 5, 1–11.
https://doi.org/10.1177/2377960819896963
Johnston, L., Williams, S. B., & Ades, A. (2018). Education for ecmo providers: Using education
science to bridge the gap between clinical and educational expertise. Seminars in
Perinatology, 42(2), 138–146. https://doi.org/10.1053/j.semperi.2017.12.010
EBTP PAPER
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Katowa-Mukwat, P., Mwiinga-Kalusopa, V., Chitundu, K., Kanyanta, M., Chanda, D., Mbewe,
M. M., Wahila, R., Petronella, M., & Carrier, J. (2020). Implementing evidence based
practice nursing using the pdsa model: Process, lessons and implications. International
Journal of Africa Nursing Sciences, 1–25. https://doi.org/10.1016/j.ijans.2020.100261
Khodaei, A., Mansourain, M., Ganjei, S., & Asgari, H. (2016). Strategies for decreasing gap
between theory & clinical performance from the viewpoints of nursing students in Tabriz
University of medical sciences. Research in Medical Education, 8(2), 49–59.
https://doi.org/10.18869/acadpub.rme.8.2.49
Oducado, R. M., Amboy, M. K., Penuela, A., & Belo-Delariarte, R. G. (2019). Correlation
between theoretical classroom instruction and related learning experiences: Evidence
from a Philippine nursing university. International Journal of Scientific & Technology
Research, 8(12), 3666–3670.
https://eric.ed.gov/contentdelivery/servlet/ERICServlet?accno=ED603042
Peters, S., Clarebout, G., Diemers, A., Delvaux, N., Verburgh, A., Aertgeerts, B., & Roex, A.
(2017). Enhancing the connection between the classroom and the clinical workplace:
A systematic review. Perspectives on Medical Education, 6(3), 148–157.
https://doi.org/10.1007/s40037-017-0338-0
Weeks, K., Coben, D., O'neil, D., & Jones, A. (2019). Developing and integrating nursing
competence through authentic technology-enhanced clinical simulation education:
Pedagogies for reconceptualising the theory-practice gap. Nurse Education Practice, 2938. https://doi.org/10.1016/j.nepr.2019.04.010
Johns Hopkins Nursing Evidence-Based Practice
Appendix A
Individual Evidence Summary Tool
Date:
Article
Number
1
2
EBP Question:
Author and Date
Akram, 2018
Bennet, 2017
Evidence Type
Experimental
(quantitative)
Assessing the
present role
clinical nurse
instructor in
bridging the gap
between theory
and practice
Nonexperimental
(crosssectional
survey)
Investigate
whether new
graduate nurses
were ready for
workplace or if
there is a gap
between nursing
education and
clinical practice
Sample, Sample
Size, Setting
135 3rd and 4th
level students
in the BSN
program
33 new
graduates with
less than one
year experience
Findings That
Help Answer the
EBP Question
A gap between theory
and nursing exists and
is related to the
nursing setting
The process of
orientation to the
place of training,
availability of
simulation labs, the
number of students in
the training groups in
the clinical setting
contributes to bridging
the gap
Observabl
Evidence Level,
e
Quality
Limitations
Measures
The Likert’s
No exploration of I/A
scale
the clinical
questionnaire
instructors was
was used for data done
measurement
Supportive
clinical training
environment
Influences the
integration of
theory and
practice
Quantitative
Education of nurses
No clinical
did not always prepare descriptive study instructors
them for different
was used to
were
areas in the clinical
collect data and involved
setting
measure data
Nursing students do not
Skill acquisition
select areas of
model aimed at
placement during
nursing school thus they incorporating
do not acquire skills of classroom theory
dealing with different in practice
patient issues at the
same time
III/ B
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
1
Johns Hopkins Nursing Evidence-Based Practice
Appendix A
Individual Evidence Summary Tool
3
4
5
Brown, 2019
Khodaei, 2016
Johnston, 2018
NonExperimenta
l
(qualitative,
interviews)
Exploring the
theory-practice
gap and the
benefit of
simulation from a
faculty
perspective
QuasiExperimenta
l
Strategies for
decreasing gaps
between
knowledge and
practice
NonExperimenta
l
To incorporate
traditional and
instructorcentered methods
to bridge the
theory-practice
13 graduates
with 2 years or
less of clinical
experience
200 nursing
students
ECMO
providers ,
specialists,
physicians, and
staff
Semi-structured
The nursing
graduates
interviews
were The study did not III/A
experience the
used for
include student
theory-practice gap
There are
collecting data nurses and clinical
difficulties in
and analysis
instructors to
integrating
theoretical
Use of highexplore the topic
knowledge to
fidelity
widely
practice during the
period of transition
simulation
Simulation technology utilizing
when used properly
scenario-based
supports the integration
learning
of theoretical
knowledge into practice exercises
Survey was used
A gap exists
for data
No instructor was II/A
between theory and
clinical
collection
involved in the
performance
Adoption of
study
Adoption of strategies in strategies in three
three dimensions, the
dimension
instructor, student, and
involving
educational planning
instructors,
students, and
planning to
eliminate the
theory-practice
gap
Utilization of strategies Survey was used
aligning with the
for collecting
Student nurses
principles of active
data. Utilization are not involved
learning for promotion of strategies
in the study
of active learner
aligning adult
development
learning to
promote active
learner
involvement
III/A
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
2
Johns Hopkins Nursing Evidence-Based Practice
Appendix A
Individual Evidence Summary Tool
gap
A descriptive
Partial data on
correlational
the study was
II/A
research was
given as the
653 nursing
used to obtain
student’s
graduates
data. Transfer of performance is
learning from
not explained
classroom to the
actual care
setting to bridge
the theorypractice gap
No extensive
QuasiThere is statistically a Data was
7
Akram, 2018
obtained by a
clarification of
II/A
experimental
difference between
Evidence of the
nursing colleges and quantitative and instructors,
demonstration of the qualitative
existence of the
lecturers, and
theory-practice gap
theory-practice 140 student
review of
nursing matrons
nurses
gap
Clinical instructors
electronic
on how to bridge
available in
make a valuable
sources.
the gap between
four main
contribution to the
Instructors
play
a
theory and
hospitals
learning process
practice
Ensuring sufficiency of crucial role in
reducing
the
clinical equipment in the
theory-practice
clinical setting for
gap
teaching
Attach a reference list w ith full citations of articles review ed for this EBP question.
6
Oducado, 2019
QuasiExperimenta
l
Determining the
relationship
between
theoretical
classroom
instruction and
learning
experience
Good theoretical
classroom
instructions is
important in better
performance in the
clinical setting
The study affirms that
theory influences
practice
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
3
Johns Hopkins Nursing Evidence-Based
Practice
Appendix B
Synthesis Process and Recommendations Tool
Date:
Article
Number
8
9.
EBP Question:
Author and Date
Peters, 2017
Benner, 2009
Evidence
Type
Sample, Sample
Size, Setting
NonExperiment
al
Enhancing the Third year
medical
connection
undergraduat
between
e
classroom
theory and the
clinical setting
Case report
Student Nurses
Findings That
Help Answer the
EBP Question
Classroom based
learning experiences
are not connected to
the clinical practice
There is a parallel
connection between
classroom theory and
clinical practice
Strengths and
weaknesses exist in
nursing education
and external
challenges that the
profession faces.
Observabl
Evidence Level,
Limitations
e
Quality
Measures
A systematic
No small-scale
review used for interventions
III/B
data collection parallel to
and
workplace and
measurement.
classroom
Incorporation of experiences were
specific
included in the
processes that
study
link patient with
classroom cases
through
intervention tools
such as flow
charts
Nursing
education
requires to be
remade and
radical
advances are
necessary in
the pathway to
nursing
licensure and
No exploration
of nursing
instructors
V/A
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
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Johns Hopkins Nursing Evidence-Based
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Appendix B
Synthesis Process and Recommendations Tool
an
understanding
of the
curriculum
10
Weeks, 2019
NonExperim
ental
Advancing
the debate on
competence
in nursing,
simulation
education and
literacy in
education
pedagogy
Nursing
students and
early stage
educators
There is a gap
between classroom
theory and clinical
practice. A
relationship exists
between
competence in the
clinical setting,
learning, and
diagnostic
environment design.
Simulated clinical
environments
occupy liminal
spaces between the
classroom and
clinical healthcare
practice
Systematic
review used to
obtain data.
Incorporation
of clinical
simulation
education
model for the
integration of a
framework for
application of
technology
enhanced
objects for
supporting
student
transition the
boundaries
between
classroom and
theory
The use of
technology and
computer
animations use
complex ideas
that require
experienced
educators and
clinicians
III/B
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
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Johns Hopkins Nursing Evidence-Based
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Appendix B
Synthesis Process and Recommendations Tool
EBP Question:
In pre-licensure nursing students how does using case studies compared to simulation affect clinical performance?
Category (Level Type)




Level I
Experimental study
Randomized controlled trial (RCT)
Systematic review of RCTs with or without
meta-analysis
Explanatory mixed method design that
includes only a Level I quantitative study
Level II
 Quasi-experimental studies
 Systematic review of a combination of RCTs
and quasi-experimental studies, or quasiexperimental studies only, with or without
meta-analysis
 Explanatory mixed method design that
includes only a Level II quantitative study
Total Number of
Sources/Level
One
Overall Quality
Rating
I/A
Three
II/A
Synthesis of Findings
Evidence That Answers the EBP Question
Nurses are confronted to provide quality health care
service. However, there is evidence of the existence of the
theory-practice gap and it has its strengths and areas that
require improvement based on clinical instructor’s
approach based on the learning environment integration
with trends in clinical practice (Akram, 2018)
A gap exists between theory and clinical performance.
The adoption of strategies in three dimensions, the
instructor, student, and educational planning. Besides,
good theoretical classroom instructions are important in
better performance in the clinical setting (Khodaei,2016).
There is statistically a difference between nursing colleges
and demonstration of the theory-practice gap and clinical
instructors make a valuable contribution to the learning
process. Besides, ensuring sufficiency of clinical
equipment in the clinical setting for teaching is essential
for bridging the gap to improve performance in the clinical
setting (Akram et al., 2018).
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
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Johns Hopkins Nursing Evidence-Based
Practice
Appendix B
Synthesis Process and Recommendations Tool





Level III
Nonexperimental study
Systematic review of a combination of RCTs,
quasi-experimental and nonexperimental
studies, or nonexperimental studies only,
with or without meta- analysis
QuaLitative study or meta- synthesis
Exploratory, convergent, or multiphasic
mixed-methods studies
Explanatory mixed method design that
includes only a level III QuaNtitative study
Five
III/B
There is a parallel connection between classroom theory
and clinical practice. Nursing graduates experience the
theory practice gap (Brown, 2019). There are difficulties
in the integration of theoretical knowledge to practice
during transition but the utilization of strategies aligning
with the principles of adult learning for promotion of
active learner development (Johnston, 2018). Besides,
simulation technology when used properly supports the
integrating theoretical knowledge into practice. Simulated
clinical environments occupy liminal spaces between the
classroom and clinical healthcare practice (Weeks, 2019).
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
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Johns Hopkins Nursing Evidence-Based
Practice
Appendix B
Synthesis Process and Recommendations Tool
Total Number of
Sources/Level
Category (Level Type)
Overall Quality
Rating
Synthesis of Findings
Evidence That Answers the EBP Question
Level IV
 Opinions of respected authorities and/or
reports of nationally recognized expert
committees or consensus panels based on
scientific evidence
Level V
 Evidence obtained from literature or
integrative reviews, quality improvement,
program evaluation, financial evaluation, or
case reports
 Opinion of nationally recognized expert(s)
based on experiential evidence
One
V/A
Strengths and weaknesses exist in nursing education
and external challenges that the profession faces.
Nursing education requires to be remade and radical
advances are necessary in the pathway to nursing
licensure and an understanding of the curriculum
(Benner, 2009)
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
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Johns Hopkins Nursing Evidence-Based
Practice
Appendix G
Individual Evidence Summary Tools and
Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing