Bridge over the Theory-Practice Divide A study by Judith Wilson

Aim of this Presentation To share The process The findings To explore Implementing change Constraints

Purpose of the Study Explore WA student midwives’ understanding of the theory practice gap To investigate their coping strategies Explore the impact of student seniority on TPG These students were all working and obtaining clinical experience in the same private midwifery hospital

Background In nursing and midwifery the TPG has long been seen as a problem. TPG exists and most view it as a problem Some assert the gap is necessary for change to occur

TPG in Midwifery Midwifery model of care Medicalized model Students learn the ideal and struggle to cope with the clinical reality

The study Qualitative descriptive study Phenomenological study using Hermeneutics Humans experience the world through language This language provides understanding & knowledge –Embeddedness of language in understanding of the world –Indissoluble unity between person and the world

The Sample 6 students Senior midwifery students (PG Dip) All working in a private tertiary midwifery hospital 5 participants interviewed

Methodology Outline of study before interview No questions prior to interview All students asked the same questions Interviews tape recorded Interviews conducted neutral environment Interviews transcribed verbatim

Data Analysis Transcribed interviews were studied Repeated significant statements extracted Meanings formulated & organised into clusters Sub themes (16) and then Themes (4) were identified

Findings – theme 1 Practice based on tradition contributes to the TPG “You get to work…not really evidence based practice” (P4) “Our lectures and how things in the ideal world…not like that at all” (P5) “In a private institution anything is what the obstetrician says/does/wants” (P3)

Findings – theme 2 Acceptance in the face of powerlessness is a coping mechanism “As a student midwife you don’t actually have a lot of power…go with the flow” (P4) “Have to accept…playing the student role…if I accept…I have greater learning opportunities” (P4) “Feel frustrated but yes…I’m not very good at confrontation…keep it to myself” (P5)

Findings – theme 3 Having peers and others to identify with helps to bridge the TPG “Talking with a lot of girls at uni…different view from everybody…what they have been up to…how they coped with it…all in the same situation…all learning at the same time” (P3) “We probably whinge a lot with each other every week. We meet at uni…it’s a huge debrief session…the biggest way to off load. The six of us at work, we bounce things off each other a lot when we’re frustrated. Feel frustrated…not very good at confrontation” (P5)

Findings – theme 4 Seniority and increased autonomy (though daunting) allows some freedom to implement practice preferences based on evidence and this helps to bridge the theory practice gap “Lessens the gap a little…you’re left to it” (P4) “I can cope better because I’ve learnt…before we were learning as we went along…I can cope better now” (P2) “I have to think about [it] and then go away and read up and say Okay, is this evidence based or …isn’t it? Looking in your manuals, seeing if it’s evidence based…keeps what you are supposed to do at the back of your mind. Look that up to see, is that a valid, is that evidence based. Reading…a lot of reading and other peoples opinions” (P4)

Change? Implementation –Networking Constraints –Time –Money