Nursing is a scholarly discipline that is founded on theory and the skill of caring. However, the theory-practice divide has become the profession’s most difficult obstacle, lowering the quality of the service in both education and clinical practice (Irajpour et al., 2018). The theory-practice gap develops when practitioners fail to combine subject knowledge with clinical setting practice. As medical standards of care improve, there may appear to be a gap between what is recognized as recommended practice and practical reality (Irajpour et al., 2018). In general, the gaps between theory and application of scientific activity can be bridged by conducting action compatible with the procedural rules inherent in the conceptual framework driving the activity on the issue.
In the assigned case study, the issue of the theory-practice gap is present. Namely, the nurse in the situation under discussion was instilling saline into the endotracheal tube of the patient after an operation related to coronary artery bypass. It can be assumed that she had done this activity to loosen the secretions. As a matter of fact, during suctioning, nurses encounter thick, sticky discharge. There are numerous methods for diluting this discharge, one of which is to instill normal saline into the airway (Chai et al., 2022). However, research suggests that the use of various tracheal suctioning solutions correlates with the prevalence of pneumonia in ventilator patients (Chai et al., 2022). Although normal saline is commonly used in tracheostomy, multiple studies have revealed conflicting results on whether or not to utilize it. One study found that using normal saline before suction did not produce significant hemodynamic changes. Nevertheless, it increased the quantity of ventilator-associated pneumonia (Chai et al., 2022). Therefore, the nurse has used a widely-applied medical method, relying on her experience, although academic knowledge disputes it.
As a result of the theory-practice gap, graduated and even experienced nurses would undergo transition shock. It leads them to decide that their training was useless and that sticking to established routines is preferable (Irajpour et al., 2018). The experienced discrepancy causes nurses’ incapacity and lowers the nursing care they provide. A lack of rules, nurses’ emphasis on conventional hospital care, and routine-based behavior would prevent nursing students from using their theoretical concepts in the emergency room. Thus, one fundamental difficulty encountered is the routine-oriented approach to giving nursing care, which should be substituted with judgments based on their academic knowledge and abilities.
In the particular case study mentioned earlier, the theory-practice gap demonstrated by the nurse has several implications for nursing practice and patient care. First of all, the confidence of the nurse concerning her clinical activity might influence the practice of newly-admitted practitioners. Namely, the nurse might try to guide others in the process of diluting the discharge during suctioning with saline instilling. Although the new health care providers might be aware of the hazardous effect of such a practice, the claimed expertise of the nurse might reassure them. Hence, a system of inappropriate nursing practices would be exchanged in the facility, further affecting the clinical expertise. As for patient care, it could be observed that the customer experience discomfort because of the procedure, which reduces the positivity of the patient experience. Moreover, the practice is useless and might cause morbidity in the nearest future. Thus, the patient is at risk of ineffective care, which leads to readmissions.
The positive patient outcomes in this scenario could be created through the interaction of theory, research, and practice. To transcend the gap between theory and practice, it appears that a strong desire to change and active engagement from professors and clinical nurses is required. According to the findings of a study, developing an appropriate atmosphere for nurses and nursing instructors encourages mutual learning (Shoghi et al., 2019). Moreover, using a common shared practical language as a way of clinical guidelines may assist in closing this gap (Shoghi et al., 2019). Furthermore, critical thinking is essential to use as expertise and experience to recognize patients’ needs and to guide clinical judgments and activities that result in favorable patient outcomes. In turn, clinical decision-making balances the established best practice, awareness of the present situation and surroundings, and patient understanding (Ludin, 2018). Thus, the practice is guided by the theory and medical research while evaluated through the lens of clinical decision-making.
Finally, a plan for closing the gap in the pertinent situation could be made in accordance with the mentioned approaches. First of all, the clinic should invest in fostering an inquisitive attitude in nurses. For example, the facility might begin to use the PICOT framework to ask clinical questions. As for the particular nurse, it is necessary to find the best evidence by reading abstracts or entire publications to establish the quality of evidence about the effect of saline for suctioning. Examining the evidence critically and combining evidence with clinical competence as well as patient preferences and values would be an essential step. Based on the evidence, one should evaluate the effects of practice decisions or modifications. Finally, it is necessary to communicate the findings about saline instillation to the nurse that was using this method, as well as to inform their colleagues. Thus, the application of inappropriate methods would be reduced, closing the gap between theory and practice and improving quality care.
References
Chai, C., Liu, X., & Zhao, Y. (2022). The effect of different solutions in tracheal suctioning on the incidence of pneumoniain patients on the ventilator. Cellular and Molecular Biology, 68(2), 197–202.
Irajpour, A., Safazadeh, S., Alimohammadi, N., & Haghani, F. (2018). Exploring the reasons for theory-practice gap in emergency nursing education: A qualitative research.Journal of Education and Health Promotion, 7(1), 132.
Ludin, S. M. (2018). Does good critical thinking equal effective decision-making among critical care nurses? A cross-sectional survey.Intensive and Critical Care Nursing, 44, 1–10.
Shoghi, M., Sajadi, M., Oskuie, F., Dehnad, A., & Borimnejad, L. (2019). Strategies for bridging the theory-practice gap from the perspective of nursing experts. Heliyon, 5(9).