Research Review
Nursing workforce to explore the gap between learning and reality
The nursing profession should be deeply concerned that the reality gap between education and practice identified three decades ago still remains today, according to a commentary in the latest Journal of Advanced Nursing.
Professor Jill Macleod Clark from Southampton University (UK) says that despite considerable efforts by the profession to bring about the change, the basic problems identified in a 1976 paper by Eve Blendall continue to cause concern.
In 1976 Eve Blendell, then Registrar of the General Nursing Council for England and Wales (UK), conducted a multi-site study of 321 student and pupil nurses which revealed a gap between what nurses learn and what they put into practice. She called for radical changes to ensure that nurses did not become “increasingly proficient on paper and decreasingly proficient in practice.”
Blendell’s study included a brief description of her research to test the assumption that there is a relationship between a student nurse’s description, on paper, of how she would care for a patient, and the actual observed behaviour. No relationship was found in more than two-thirds of subjects in 19 hospitals. She then explored possible reasons for this phenomenon and suggested alterations in the training programs for nurses in England and Wales in order to create a greater correlation between the theory and practice of nursing.
The 30th anniversary issue of the Journal of Advanced Nursing has reprinted an article of Blendall with commentary from Professor Jill Macleod Clark from Southampton University (UK) in which Macleod Clark agrees that Blendall's paper remains “contemporary and provocative” and that the key problem identified in her research “is still disconcertingly prevalent” particularly in this new era of nursing shortages.
Blendall acknowledges that much has changed in the last 30 years but still maintains that “the conflict between the ideal and the real inevitably remains … I suspect that if my research study was replicated today, the result would be similar.” Macleod Clark, who is also Chair of the Council of Deans and Heads of UK Faculties for Nursing and Health Professions and Head of the University's School of Nursing and Midwifery, agrees.
In an up-to-date commentary for the 30th anniversary issue of the journal, Macleod Clark states that the profession has made considerable efforts to bring about change, but the pressures on today's nurses are a key factor in the continuing "reality gap" identified by Eve Blendall. In this connection, Macleod Clark adds:
“A total review of the nursing education system is called for and tough policy measures need to be introduced … there is a need to provide good role models and fewer, but higher quality, practice placements supported with adequate resources to radically modernise the practice learning requirements and outcomes of nursing students in the 21st century. Until the fundamental issue of an over-stretched nursing workforce is resolved, the gap between theoretically sound practice and actual care delivery will remain.
"As a profession we should be deeply concerned, indeed embarrassed, that the problems identified by Eve Blendall 30 years ago still persist in today's nurse education system in spite of everyone's best efforts to change.”
References:
Blendall E. Learning for reality. Journal of Advanced Nursing, 1976 (1) pp. 3–9.
Blendall E & Macleod Clark J, 2006. Learning for reality. Journal of Advanced Nursing, 30th Anniversary Issue, Volume 53.1, pp. 14-20.
The Blendall paper and commentaries are available on-line at
www.journalofadvancednursing.com
NOTE:
The Journal of Advanced Nursing is celebrating its 30th anniversary in 2006. The special issue also features another 11 papers from the last three decades, together with commentaries from 2006. The Journal of Advanced Nursing is read by experienced nurses, midwives, health visitors and advanced nursing students in over 80 countries. It informs, educates,explores, debates and challenges the foundations of nursing health care knowledge and practice worldwide. Edited by Professor Alison Tierney, it is published 24 times a year by Blackwell Publishing Ltd, part of the international Blackwell Publishing group, www.blackwellpublishing.com
