Nursing Gaps

Nursing Gaps




Thenursing profession is a critical part of healthcare. It is crucialthat the health care professional specialists be well aware andcompetent enough to deal with the medical situations that arise inthe units where they work. The special nature of the professionrequires integrating theory and practice among the nursingprofessionals (Launders, 2001).

Despitethe dire requirement for technical skills in healthcare, there existslittle information regarding the learning of technical skills in thecurriculum for the pediatric field. The following paper qualitativelyevaluates the possible gaps between theory and practice of nursing.It categorizes the gaps into various critical areas such asmedication, skills/ practice, knowledge and emergency handling asthey apply in the nursing theory. It further relates to the practiceof pediatric nurses in a hospital setting to identify gaps (Cheek, &ampJones, 2003).

Finally,the paper provides the various problems caused by the gaps in theprovision of adequate health care. It also provides the suggestedsolutions to the nursing curriculum. The recommendations serve asthe solutions to aid in bridging the identified gaps (Launders,2001).

Accordingto Ferguson, &amp Jinks (1994), the field of Medicare is non-staticand keeps on evolving. Consequently, the constant changes create theneed for competent health care professionals. The competence is toprovide care and handle critically ill children. Pediatric nurses getinvolved in complicated activities that require vigilance inhealthcare provision. The nurses are busy and fail to get enough timeto improve their skills to match the new technological improvement. Consequently, there exists a possible gap between practice and thetheoretical knowledge possessed by the nurses.

Thereexist works of literature supporting the existence of gaps as one ofthe major challenges. The gaps involve the discrepancy betweenclinical theory and the teaching practice. The literature calls forthe integration of theory into practice to bridge the gaps. Thefurther literature recommends for nursing education to be counterpartwith the contemporary practices. Nursing students should acquireenough learning and experience clinical and theoretical perspectives.The nurse teachers are required to have both expertises in practiceand in theory (Morgan, 2006).

Additionalliterature supports the existence of gaps. They exist among thenursing profession administrators and the tutors. The gap requires tobe addressed to improve quality care through the undertaking ofconsequent actions towards patients care. Various research findingsfrom assignments conducted on registered nurses with three to fouryears of practice provide consistent results. They support theexistence of the gaps and aim to identify the specific gaps in termsof knowledge and practice. Specifically, they include nurses,educators and nursing service administrators and seek recommendationsto improve the quality of service offered by pediatric nurses. Theresearchers categorized the various gaps into medication, skills/practice knowledge, and code blue/ crash handling (Cheek, &ampJones, 2003).

Medicationevaluated the nurse’s skills in handling drugs, drug calculation,dilution, compatibility, and pharmacology. They were categorized intocatheterization, nasogastric/oral tube insertion cannulation andsuctioning. Knowledge tested on the nurse’s ability to conducthealth assessments, management and interpretation of lab results anddiagnostic tests and the knowledge of the disease process. The codeblue/ crash handling involved the level of knowledge in tacklingintubation and respiratory emergencies (Ferguson, &amp Jinks, 1994).

Theresults indicated that pediatric nurses were missing practical skillsin medication. They include dilution, dosage calculation liken cc/kg/hr, and information regarding the compatibility of drugs. Nursesaccepted to have had heard some names and calculations like cc/kg/hour for the first time in the pediatric wards. They did not learnthe terms during their course at school. They felt inadequate inareas where they found new information and in the use of intravenousdrugs that require the direct push, drugs used in emergencies anddilutions. The nurses admitted to feeling incompatible with thepatients.The skills gaps pose a big problem to the provision ofquality health care by nurses (Suleiman, 2005). The lack of practicalskills can result to stress among the nurses that inhibit theirperformance by creating stress, depression, pressure and the burdenof lacking information. The deficiency of skills has led the doctorsto mistreat them as handmaidens as opposed to their colleagues. Thesolution to such a problem is a great effort to self-improvementamong the nurses. It would create self-confidence, respect andenhance the nurses prove of self-worth (Morgan, 2006).

Gapsrelated to medication were frequent since the participants had apractical experience of one to two years in a pediatric department.The gaps emerged since medication such as dilution is taken in basicnursing education. They only have four credit hours for Pharmacologyand two credit hours for mathematics in a three-year diploma course.The understanding of pharmacology is an integral part ofpost-integration nursing that enables the nurse’s prescriptionabilities. The results conform to literature that reveals highermedication errors in the pediatric department compared to adult units(Prot, Fontan, &amp Alberti, 2005).

Interms of skills, the necessary psychomotor skills for a nurse toprovide quality service were tested. The findings indicated gaps incatheterization, cannulation, suctioning, oral gastric tube insertionand nasogastric. The skills gaps pose a problem given the importanceof psychomotor skills in ensuring the provision of efficient healthcare to patients.

Knowledgegaps got identified in health assessment, signs and symptomsidentification and management, disease processes, interpretation oflab results and in care education among the pediatric nurses. Thenurses indicated that the pediatric rotations only lasted for sixweeks, and the patients are not covered. The knowledge gaps pose aproblem given the current importance of nurse’s knowledge inplanning the patient`s care (Stratton, Blegen, Pepper, &amp Vaughn,2004).

Thenurses indicated their inability to handle the cardiac arrest. Itposes a problem since the nurses are the first responders towards acardiac arrest. They are responsible for initiating the requiredbasic life support as the patient waits for the arrival of thecardiac support team. Their skills may inhibit efficiency and speedof response to an emergency (King, 2004).

Inconclusion, it is evident that there exist theory and practice gapsin the nursing profession. They reduce the quality of health careprovided by the nursing professionals. The skills gap can be solvedby increasing the number of clinical hours to increase the expertise.The credit hours need to be supplemented with additional experiencethrough increased rotation durations to brighten the nurse’s skillson the pediatric population. The tutors are required to demonstratethe required skills during the theoretical classes to enhance theirperformance (Tronce, 2000).

Itis important to equate the theoretical background with the practicalclinical experience. The curriculum needs to increase the duration ofthe rotational program from six months to one year. The solution tomedication problems requires the increase of pharmacology credithours in the nurse’s theoretical curriculum. The cardiac arrestproblem can be solved by increasing resuscitation credits in thecurriculum and more clinical experience to enhance the development ofappropriate skills and confidence among the nurses (Launders, 2001).


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Stratton,K. M., Blegen, M. A. Pepper, G and. Vaughn, T. (2004).Reporting of medication errors by pediatric nurses. Journalof Pediatric Nursing, 19(6),385–392.

Prot,S., Fontan, J.E. Alberti, C. (2005). Drug administration errors andtheir determinants in pediatric in-patients. InternationalJournal for Quality in Health Care, 17(5),381–389.

Suleiman,N.(2005). Theprocess of role transition from student to staff among the nurses ofa university teaching hospital. Karachi,Pakistan: The Aga Khan University.

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Cheek,J. and Jones, J. (2003). What nurses say they do and need:Implications for the educational preparation of nurses. NurseEducation Today, 23(1),40–50.

Ferguson,K. E. and Jinks, A. M. (1994).Integratingwhat is taught with what is practised in the nursing curriculum: amulti-dimensional model.Journal of Advanced Nursing, 20(4),687–695.