There is much written about the theory – practice gap in nursing (and in other professions – e.g. teaching). In my reading of the issues, writers seem to be coming from an ideological position of either making practice more closely linked with theory or making theory more relevant to practice. People writing about this seem to me to be saying one of two things. Either clinicians need to be more aware of the theoretical underpinnings of practice in order to be more responsive to a changing world or that academics need to acknowledge the real world of practice where the theoretic ideals are almost impossible to implement. These arguments may underpin the expectations placed on new graduates that I’ve discussed here earlier. University tries to prepare students to be able to think critically, use research and solve problems, while health care organisations are interested in skilful practitioners who can function well in busy, changing environments. Theory v. Practice.
I am increasingly of the opinion that the two points of view are not really so different but that there are difficulties in articulating the perspectives. I’ve been reading some work by Gary Rolfe that explores this.
Maybe one of the problems is that the empirical, scientific, testable, theory-type-things that are taught at university are seen to exist in isolation from practice. The same doesn’t seem to be true of practice existing in isolation from theory though. So, we have students learning quite definite theory at university that is sometimes difficult to see in practice. One example off the top of my head is in communication theory, where students are taught to use open ended questions and non-verbal cues to encourage effective communication with clients. In my experience, in practice, this approach sometimes makes it difficult to fill in the admission paper work (for example) as your patients may give very expansive answers to questions, encouraged by your active listening, which has implications for how much time you really have allocated for the task. The approach can also make some people cranky.
This isn’t to say that the theory doesn’t apply to practice though. As I understand it so far, one of the most important things that Rolfe describes is a kind of an extra layer of theory. He suggests that the more formal, empirical, perhaps scientific theories learnt at university inform a suite of personal theories that are interconnected and are able to be drawn on quickly in practice. When combined with Schön’s ideas of artistry in practice – practice that practitioners agree is good practice without necessarily being able to describe it – it makes sense.
So as students collect the formal theory, practice them in authentic situations at university and in clinical practice, they are developing this internal theory. It doesn’t make the formal theory useless or disconnected; it reframes it as a foundation on which good decision making and good practice exist.
I think this reframing of theory into the personal context would be helpful in explaining what students learn and how they are able to apply it in practice. It has implications for the education of students, and the support of new graduates and in how the profession understands itself.
