Perceptions of students and nurse educators on the integration of theory and practice in nursing education in Swaziland : an exploratory-descriptive study.
Background: The gap between theory and practice in nursing has long been regarded as controversial and has been a much debated subject in literature. The disparity between theory and practice in nursing education has been attributed to, among other factors, the move of nursing education from hospital-based training to higher education. Attempts to bridge the gap have been recorded in literature, including the introduction and use of problem-solving learning approaches that are regarded as reflective; learner-centred and promote lifelong learning. With this transition, there is confusion concerning the role of the nurse educator in clinical teaching which further compounds the problem of integrating theory and practice in nursing education. Nursing education in Swaziland has also experienced the transition from the hospital-based model to higher education in the late nineties. Issues regarding the competence of nurses have emerged with complaints from the local media and the general public about nursing services declining in quality. Purpose: This study was aimed at exploring and describing the perceptions of students and nurse educators regarding the integration of theory and practice in nursing education in a Higher Education Institution in Swaziland. The ways in which theory and practice integration is facilitated in this university were explored with the perceived barriers that are thought to deter the integration. Methodology: A quantitative approach was employed in this study with a total of 167 participants. Of these, 151 were students and 16 were nurse educators. Two self-administered questionnaires were developed for each group. Reliability and validity of these instruments was measured and the α-coeffient of 0.74 and 0.83 were achieved for the students' and educators' instruments respectively. Data were collected and then analysed using the SSPS package, Version 15.0. Findings: Results of this study revealed the existence of the gap between theory and practice in nursing education in Swaziland. Clinical nursing education was found to be an essential component in the training of nurses, however the role of the nurse educator in the integration of theory and practice remained contentious. It was also discovered that no clear guidelines or protocol regarding clinical supervision were available in the country, hence nurse educators conducted clinical supervision as they saw fit. Barriers to the integration of theory and practice were explored, and it was established that the lack of resources and supplies, more particularly in the practice setting stood out as the primary obstacle. It emerged from the study that problem-solving pedagogic approaches are essential in the integration of theory and practice. Furthermore, inadequate student support structures in the clinical setting also emerged as barriers coupled with poor communication and professional relations between the university and the practice settings. Recommendations: The establishment of a university hospital or a partnership with a health care institution where the value of clinical practicum for students would be enforced was one of the recommendations. Furthermore, it was suggested that the nursing department use process-based curricular approaches to teaching and learning which may enable students to be more reflective and more self-directed in their learning process. It was also suggested that the clinical skills laboratory be more self-directed, with students learning how to conduct clinical skills with minimum guidance from the facilitator.