Abstract
This paper by Morrell-Scott (2022) discusses entrenched problems in nursing. Although the study reported is a small, single-site study, the author’s findings come as no surprise to any of us working either in nursing practice or in education. It is important to place their findings in context to critically appraise the state of nursing.
The findings suggest that ‘whilst students may be undertaking care holistically, they are separating the tasks as part of their proficiencies,’ (page 769). Let’s unpick this description of student nurses’ learning.
Menzies Lyth (1960) observed that nurses unconsciously organised their work into routinised even ritualistic nursing behaviours or tasks to construct an emotional distance from their patients. This emotional distance protected nurses from emotional involvement and distress (Menzies Lyth, 1960). This way of organising nursing work into routinised tasks has been noted repeatedly over the years by De Board (1978), Allan (2001) and the Francis Report (2013) among others. Francis argued that conformity induced by task-based care in nursing resulted in lack of personal authenticity (or sense of self) and compassion. These routinised barriers to person-centred care can be broken down through reorganisation of nursing work and the introduction of therapeutic care (Manley et al, 2011; Tutton et al, 2008). However, it should not be underestimated how entrenched these organised forms of care are and how difficult it is to reorganise nursing work to provide holistic care (Johnson et al., 2015), largely because of the organisation of acute care and the lack of staffing (O’Driscoll et al., 2019). Given this evidence, it is unsurprising that students do not ‘see[ing] how this [the care they give] all fits together to form the holistic care of the patient’ (page 769).
Even if we would all agree that ‘nursing is so much more than simply completing tasks and is fundamentally about providing holistic care to patients and their families’ (page 774), do the social, economic and political systems provide support (including but not restricted to funding) to deliver person-centred care? As Morrell-Scott (2022) shows, students experience a disconnect between what they learn at university and what they observe and learn from in practice, which explains why ‘some participants still demonstrate how they have a restricted view of the role of the nurse’ (page 774). Allan and Evans (2022), Evans et al., (2010) argue that learning models in nursing education are at fault because they reify the theory–practice gap. Rather than understand student nurses’ disconnected learning as a theory–practice gap, Allan and Evans (2022) argue that this disconnectedness is constructed by practice and education in a theory–practice split. We argue that understanding the relationship between theory and practice as a gap creates a false dichotomy and ignores the thinking in doing. Using the word ‘split’ instead of gap requires us to consciously think of splitting theory from practice. It reminds us that we all split theory and practice artificially. We explain our discomfort over the tension between doing and thinking by blaming or projecting the blame onto or into someone or something else – it’s the lecturers’ fault, they’ve lost contact with practice; it’s my mentor’s fault, she doesn’t nurse according to what I’ve been taught in college. We continue to believe in something which actually doesn’t exist (the theory–practice gap) and we reproduce the gap through our thought as if it exists without thinking about it (the gap) critically. In sociology, we would call this a reification.
To survive, as Morrell-Scott (2022) shows us, student nurses are required to act, ‘acting in the role of the nurse is essential’. I would argue that as well as acting in both learning settings (university and practice), student nurses have to negotiate the world of practice and the world of the university to survive until they graduate (Allan, 2009; Allan et al., 2011). The theory–practice split affects lecturers as well as they feel increasingly disconnected from practice (Smith and Allan, 2010). Allan and Evans argue that the 50:50 learning curriculum where responsibility for learning support lies equally with practice and the university needs to be rethought (Allan and Evans, 2019).