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T he Theory to Practice Gap J eannie Couper, MSN, RN-BC Seton Hall University May 15, 2012. Phenomenon of interest in nursing. The theory to practice gap continues to be an issue for nursing students (Kalb, 2010; May et al, 1999).
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The Theory to Practice GapJeannie Couper, MSN, RN-BC Seton Hall University May 15, 2012
Phenomenon of interest in nursing • The theory to practice gap continues to be an issue for nursing students (Kalb, 2010; May et al, 1999). • Impact observed on clinical decision making and formation of clinical judgment (Galloway, 2009). • Creative and innovative teaching strategies recently incorporated into classroom (Guhde,2010).
Questions facing nurse educators • How best to address this gap in the students' learning and experience? • What strategies can nursing programs adopt to impact this gap or possibly eliminate it? • What is the missing link to facilitate the utilization of theory into the novice nurses' nursing practice? • What changes in the approach to clinical instruction can be changed to facilitate a richer, deeper clinical experience for nursing students?
Research Question • What is the effect on student learning outcomes and patient care of integrating student-centered learning strategies based on intentionality into the student nurses' clinical experience?
Statement of Defense • S LO and ultimately patient care outcomes are directly impacted. • Intentionality: raise rigor, promote critical thinking, analysis, and problem solving, and foster the student's ability to forge connections between theory or knowledge and practice. • Varied clinical experience promotes: • student learning • opportunities to make clinical decisions • continue the development of clinical judgment (Chappy, Jambunathan, & Marnocha, 2010; Leonard, Shuhaibar, & Chen, 2010).
What else is known? • Guidance and mentorship support the student throughout the process. • Previous studies: • this design has not been used • evidence non-conclusive • no comparisons studies have been completed.
Research Approach and Design Research Approach and Design • Quantitative approach is most appropriate for this research question • Purpose drives the design • The purpose of study to determine the effectiveness of an implemented program of student-centered intentional strategies designed to increase synthesis and integration of theory and clinical practice. • The study seeks to examine a relationship and determine causality amongst the variables • Uses logistic, deductive reasoning to make a generalization
Research Approach and Design cont. • A quasi-experimental comparison study design with repeated measures of a interrupted time series of nonequivalent comparison groups- an experimental group and control group, two sections of a nursing course. • This design affords the greatest control and meaningful results • Inclusion of a control group - • ability to detect real differences between the groups • strengthens the validity of the findings (Burns & Grove, 2009) • Differences between groups/trends examined over the time period of the 15 week semester.
Defense of Research Approach • Variables are clearly defined • student learning outcomes • patient care (outcomes) • student-centered learning strategies • student nurses' clinical experience • clinical decision making • clinical judgment. • intentionality explicitly defined • Sampling: • convenience sample as students enrolled in A or B sections • randomly assigned to clinical groups
Defense of Research Approach cont. • Measures: • Pretests (evaluation instruments, mock NCLEX) administered to both sections at course onset • Interrupted time tests given concurrently to groups (quizzes, unit tests, case studies, mid-term evaluations) • Post tests given to all students at the conclusion of the course (final exam, HESI or similar standardized test, and final clinical evaluation instrument).
Defense of Research Approach cont. • Results of all “tests” will be statistically analyzed • to identify if statistically significant differences exist between the two approaches to clinical education in this sample • if a higher degree of learning occurred as a result of the experimental clinical education plan • Identification of a more effective clinical education teaching strategy • consider program alterations
Concerns • Instruments lack reliability • Internal consistency to be est. by expert panel • Variability: in clinical instructors • personalities, approaches, education, enthusiasm, and experience • Orientation of all instructors involved is necessary to limit variations in approaches and expectations.
Groups: Experimental vs Control • Both groups will have equal cumulative clinical hours • Control group: • students enrolled in section A of the course • receive the 'standard practice' or 'usual treatment' of clinical education • Experimental group: • students in section B; • receive the 'experimental clinical experience‘
Groups: Experimental vs Control cont. • Experimental clinical experience includes: • variety of patient conditions and situations, unfolding case studies, actor simulated experiences, mentored clinical situations working in tandem with an experienced nurse/maintain consistent assignment, multiple patient assignments, reflective assignments, team building exercises, 60 second situational assessment (QSEN),and journaling. • Section B clinical instructors engage in group seminar prior to course start:"Reframing Constructive Criticism Using Reflection Based on QSEN Competencies" (Altmiller, 2012)
References Altmiller, G. (2010), Reframing constructive criticism using reflection based on QSEN competencies. Retrieved from http://www.qsen.org/teachingstrategy.php?id=133 Burns, N. & Grove, S. K. (2009). The practice of nursing research: Appraisal, synthesis, and generation of evidence, 6th ed. St. Louis, Missouri: Saunders Elsevier. Chappy, S., Jambunathan, J., & Marnocha, S. (2010). Evidenced-based curricular strategies to enhance BSN graduates' transition into practice. Nurse Educator, 35(1), 20-24. Galloway, S. J. (2009). Simulation techniques to bridge the gap between novice and competent healthcare professional. The Online Journal of Issues in Nursing, 14(2). doi:10/3912/OJIN.Vol14No02Man03 Guhde, J. (2010). Using online exercises and patient simulators to improve students' clinical decision making. Nursing Educational Perspectives, 31(6), 387-389. Leonard, B., Shuhaibar, E., & Chen, R. (2010). Nursing students perceptions of intraprofessional team education using high-fidelity simulation. Journal of Nursing Education, 49(11), 628-631. doi10.3928/01484834-20100730-06 May, B.A. , Edell, V., Butell, S. Doughty, J. & Langford, C. (1999). Critical thinking and clinical competence: A study of their relationship in BSN seniors. Journal of Nursing Education, 38(3), 100-110. Stanley, M.J. & Dougherty, J.P. (2010). A paradigm shift in nursing model: A new model. Nursing Education Perspectives, 31(6), 378-380.