Theory Practice Nursing In Nursing Education
What Is Theory Practice Integration
Theory practice integration is the use of nursing ideas, values, and science to guide purposeful implementation of highly skilled actions that go beyond routine technical skills to prevent or resolve patient care problems (Schon, 1983; Thompson, 2000). Theory practice integration is cyclical in that each informs and builds on the other. New practice problems identify gaps in knowledge, which drive theory revision, generation, and new scientific study. Theory-practice integration overlaps with the concepts of critical thinking, evidence-based practice, and clinical decision making
Aim of Theory Practice Integration
The goal of nursing education is to prepare students to enter practice as competent, autonomous, and accountable professional nurses. Theory-practice integration in education begins with teaching basic physical and social science principles, leading to psychomotor and interview skills in controlled laboratory settings, culminating in clinical experiences with real patients. As the knowledge base grows, students integrate theory and practice in solving patient care problems. Benner, Tanner, and Chesla (2009) describe developmental stages toward expert practice.
Novice students learn theory and psychomotor skills that are context free, concrete, and rule driven. Educators then design clinical experiences where students use skills and rules in real situations to move students to the advanced beginner stage. By graduation, students become competent in theory-practice integration as they reflect on what they are doing in unique, uncertain situations as they are practicing (Schon, 1987).Educators design curricula and clinical experiences to enhance student ability to move from novice, to advanced beginner, to competent practitioner (Benner, Tanner, & Chesla, 2009).
To do this, educators must design courses and educational methods that integrate theoretical knowledge (or knowing that), and practical knowledge (or knowing how) (Benner, 1984). Professional knowledge is the blending of theoretical and experiential knowledge, enabling the nurse to solve unique practice problems.
Schon (1983) called this reflection in action, grounded in the use of theory in the here and now, where practitioners are problem solvers using meta cognitive processes as the situation unfolds Students must learn how to use meta cognitive processes to gather patient data, analyze data to identify patterns, develop a potential nursing diagnosis based on theoretical knowledge plan interventions, implement the plan, and evaluate outcomes (Thompson, 2000).
While theory is based on research that attempts to control known variables, practice situations involve uncontrolled and initially chaotic variables that need quick clinical decisions. Educators need to help students identify a framework to guide them through the problem-solving process.Students in clinical practice can be frightened by the need to accept risk and responsibility for decisions and action in practice (Benner et al., 2009).
Educators must be attuned to this and assist students to work through this uncomfortable process. If the student resists accepting responsibility for actions, then stagnation, boredom, or withdrawal from learning can occur. As students gain experience, integration of theory into practice becomes more intuitive and less emotional.
Impact of Theory Practice Nursing
Nursing has evolved from a technical practice that uses trial and error to a professional practice that uses theory based scientific evidence, clinical reasoning, and critical thinking to guide actions. Thompson (2000) identified the fallacy that professional practice is theory-less failure to draw on theoretical knowledge leads to inappropriate interventions that are inefficient and fail to solve patient problems (Meleis, 1997; Thompson, 2000). Theory helps direct care away from ineffective interventions and assists to prioritize actions in unique individual patient situations.
Therefore, nursing education must move students from simple memorization of facts and procedural skills to reflection in action; thus, using meta cognitive processes as professional practice is based on thought and reflection rather than routine assumptions (Thompson, 2000). This can be difficult as students use memorization in beginning courses of basic physical and social sciences and then move to theory-practice integration. When students become competent in theory-practice integration, they become skilled, autonomous, and accountable for their practice.
Curriculum and Teaching Impact of Theory Practice
Curriculum design and teaching methods emphasize coaching and learning by doing enhanced theory-practice integration (Schon, 1987). Coaching in the art of reflection and clinical practicum courses where dialogue between student and teacher includes: advice, criticism, explanations, and descriptions regarding patient care enhance theory-practice integration. High-fidelity simulation and debriefing methods commonly used in nursing education also support reflection in action.
Nursing education must teach students to become information literate. To use scientific evidence, students need to know how to access it, analyze it, and apply it to practical problems (Cannon & Boswell, 2012). While students grow up using personal information sources such as Google, Yahoo, Wikipedia, and other nonprofessional Internet search engines to find information, educators need to move them to professional information sources. It is essential to teach students how to use computerized search engines to find evidence for practice.
Educators need to direct students to use professional peer-reviewed sources such as Cochrane Reviews, CINAHL, PubMed, and government and professional practice websites for practice recommendations, research, and practice standards. Requiring the use of professional resources supports thinking and decision making using theory practice integration Investigation of how to support student transition from the use of personal information resources to professional resources is needed.
Further development of teaching strategies that improve student rational learning and critical thinking is needed (Cannon & Boswell, 2012). Formative evaluation implements a constructionist model of learning where the teacher coaches the student into reframing problems that are goal oriented for both patient and student (Schon, 1987). Formative evaluation provides feedback on incorrect thinking, redirects problem solving, and can provide opportunities for modeling clinical decision making and coaching reflection in action (Oermann & Gaberson, 2013).
The Socratic method of asking students to examine the logic behind selected tasks and judgments can support rational learning Syntactic learning methods support understanding of the relationships and patterns in patient care. Faculty should talk students through their decision-making process and clarify the intuitive process that meshes theory with practice. Inquiry learning methods that engage students in questioning, exploring, and categorizing challenges in nursing care help to close the loop in theory-practice integration and further advance nursing science, theory, and practice (Ironside, 2007).
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