CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents the related literature and studies after the in-depth research of the

researchers including the local, national, and foreign journals and articles which have

contributed to studies. This literature or article is gathered on the internet, websites, journals,

and recent research from different resources.

Theory – Practice Gap

The theory-practice gap (TPG), is seen from an international viewpoint as a decade-long

competency crisis that still affects the nursing profession until today (Gamblin, 2019).

Bouchlaghem and Mansouri (2018), added that TPG has been identified as one of the primary

obstacles hindering the progress of nursing students and prevent them from meeting their

learning objectives.

According to Abusalah and Salama (2018), the gap between nursing theory and clinical

practice can be defined as the difference between what the nursing students acquire through

theoretical classroom lectures and what they experience practically in the clinical setting. Many

studies have shown that the growing disparity between nursing theory and practice creates an

alarming concern especially to the educators, practitioners, and specifically to the nursing

students who are affected by the gap which threatens their future profession. In addition, Wasini

et al., (2019) also declared that the TPG emerges when the classroom knowledge is not being

transferred into practice at the same time Mahmoud (2014), confirmed that when TPG is

present it will serve as a barrier to the nursing student’s clinical learning process.
 In the present study of Santa De (2023), found that the transition from student to a

registered nurse leads to a stressful period in their lives. Some of them experienced transition

shock due to the gap between theory and practice wherein they ended up thinking that their

education was useless because traditional practice was still being followed in the clinical setting.

One of the identified reasons for TPG was training related factors wherein due to the increasing

number of nursing students, practical examinations conducted in clinical area, and focusing

more on the completion of clinical assignments some are unable to apply the procedure which

resulted for them to have enough theoretical knowledge but they lack mastery of the actual

practice. Also, instructor related factors contributed to the TPG such as lack of experience,

failure to supervise students, and poor communication between teacher and students. Further,

factors related to the clinical learning environment which includes unavailability of equipment,

unsupportive staff, poor teamwork, student’s unwillingness, and mistreatment of the instructor

lead to widen the gap.

O'Brien et al. (2017) conducted a mixed-methods investigation in order to evaluate

nursing students' perspectives of the gap between theory and practice. Students cited a number

of issues contributing to the gap, including minimal clinical exposure, unreasonable

expectations, and a lack of assistance from clinical instructors. The researchers suggested that

nurse educators work together to solve these issues and increase the quality of clinical learning

experiences.

According to the study published by Ugwu, et.al (2022) it reveals the different causes of

TPG during clinical practice are resource constraints, environmental system challenges, and

unhealthy human attitudinal and behavioral factors. It was confirmed in the studies of Salifu, et

al. (2018) and Wasini, et al. (2019) that the main contributor to TPG was inadequate materials

and equipment during classroom procedure. Using improvised materials as an alternative are

not appropriate which resulted in delayed care and caused confusion to the nursing students
since they were not able to experience handling the ideal instrument. In connection with this,

environmental factors affect TPG, specifically unconducive classrooms due to overpopulation,

foul smell, no proper lighting, inappropriate ambience, and unstructured ward.

Furthermore, student’s behavior and attitude were identified as a predisposing factor which

includes skipping classes, browsing the internet during lectures, poor dedication, tardiness, and

unwillingness to assign duty imparting to poor theoretical and practical knowledge. On the other

hand, lecturers contribute to the gap due to unpreparedness, not adhering to teaching time

tables, rushing to finish the lesson, and not providing materials to the students.

Both Kertu (2019) and Odetola (2018) emphasize the challenges that nursing students

experience when incorporating theory into practice, such as inadequate resources,

discriminatory attitudes, and disputes among clinical personnel. These difficulties are increased

further by infrastructural constraints in nations that are developing (Odetola, 2018). Mahmoud

(2014) and Saifan (2015) highlight the importance of clinical preceptors and instructors in

bridging this disparity, with a specific emphasis on the need for improved supervision,

preparation, and communication.

A major problem affecting students in Filipino nursing schools is the lack of theoretical

practice, which has been caused by structure, pedagogical and Relational Deficits (Factor,

2017). The lack of resources, discriminatory attitudes and communication barriers in clinical

settings are exacerbated by these gaps (Kertu, 2019). This gap is further exacerbated by

inadequate supervision, ill-prepared simulation laboratories, and a dearth of opportunities for

skill practice (Mahmoud, 2014). These results highlight the need for nursing education to be

realigned in order to better prepare students for the difficulties they will encounter in clinical

settings.
 Gamblin (2019), stated that the effects of TPG in nursing can put the patient at risk and

creates a huge burden on training the future nurses especially in providing advanced patient

care. Also, Jones & Johnstoneb (2019), added that when the gap is continuously occurring the

expected and planned sequence of care will be obstructed. Moreover, the reality shock brought

about by the wide TPG is thought to be a primary factor in low job satisfaction and high rates of

job attrition among recently qualified nurses. (Al-Awaisi et al., 2015; Monaghem, 2015).

According to Cabalsa (2018), the knowledge gained from the classes should be well

interpreted in the clinical learning environment in which the instructor teaching in the classroom

and in the clinical area should be carefully chosen and qualified to train the nursing students.

Nursing students receive guidance from the clinical instructor during each clinical session,

giving them the chance to put their classroom knowledge into practice. Through exposing them,

students will develop skills and confidence in handling a variety of nursing situations.

Rhikhotso, Williams, and De Wet (2014) suggest that in order to reinforce theory integration

in the clinical placements, the maximum amount of time should be spent as accompaniment

with the student. According to Siganga and Jeggels (2014), this accompaniment will help

nursing students get ready for a variety of obstacles they may face in the workplace.