Theory-Practice Integration for Clinical Skills Competence among Undergraduate Nursing Students in Ireland: A Mixed Methods Study

The nursing literature identifies an ongoing concern regarding undergraduate nursing students’ competency in clinical skills and implies that current methods do not sufficiently enable undergraduate nursing students to effectively transfer and develop clinical skills competency learned in the classroom to the practice setting. The research question for this study was, ‘does a practice based learning aid influence theory practice integration for clinical skills competence among undergraduate nursing students’? The educational approach incorporated a number of components including theoretical learning in the classroom, Simulated Learning (SL) in the Clinical Skills Laboratory (CSL), an Objective Structured Clinical Examination (OSCE) and finally, the use of a practice based learning aid, entitled the Reflective Checklist for Clinical Skills Competence (RCCSC). The practice based learning aid conceptually synthesises reflective theory with a self-grading approach, using a competency scale and a criterion-based clinical skills checklist. A mixed-methods approach incorporating an explanatory sequential design was used for the study. Data was collated at four stages over an eight-month period and included clinical skills competency level data generated from the OSCE, the practice based learning aid and from the researcher’s observations of students at the end of their clinical placement. Qualitative data was generated from the practice based learning aid in the form of written reflective comments. Further data was collated on completion of the clinical placement and included an evaluative questionnaire, the findings of which were further explored using qualitative data from a focus group. The findings included an improvement in clinical skills competency levels recorded at the end of clinical placement when compared to competency levels recorded at the beginning of clinical placement (p≤0.05). The educational approach used and specifically the integration of a practice based learning aid, was identified by students as a key factor in developing and improving their clinical skills competency levels during clinical placement. Three key themes emerged from the qualitative analysis and included factors identified as pre-requisites for learning, factors that were conducive to learning and factors that were unconducive. These themes provided a deeper understanding of the students’ learning experience and support the use of the educational approach employed in the study. Whilst the study is limited in context to one cohort of students the findings from both data sets increase our understanding of how students develop competency in clinical skills. The study concludes that the educational approach employed benefited theory-practice integration by enabling students to transfer learning from the simulated setting to clinical practice and improve their clinical skills competency. The study has particular relevance and implications for nurse educators and practitioners seeking teaching and learning methods to enhance clinical skills competency transfer and transition among undergraduate nursing students. This educational approach could also be adapted by other health care professionals to enhance theory practice integration and skills competency.