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Nurse Education in Practice xxx (2014) 1e4

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Nurse Education in Practice

journal homepage: www.elsevier .com/nepr

Bridging the gap: Strategies to integrate classroom and clinicallearning

Lisa Sue Flood*, Kristi Robinia 1

Northern Michigan University, 1401 Presque Isle Avenue, Marquette, MI 49855-5301, USA

a r t i c l e i n f o

Article history:Accepted 3 February 2014

Keywords:Nursing educationFaculty roleClinical educationClinical coordinator

* Corresponding author. Tel.: þ1 906 227 1673, 1 90906 227 1658.

E-mail address: lflood@nmu.edu (L.S. Flood).1 Tel.: þ1 906 227 2484; fax: þ1 906 227 1658.

http://dx.doi.org/10.1016/j.nepr.2014.02.0021471-5953/� 2014 Published by Elsevier Ltd.

Please cite this article in press as: Flood, LEducation in Practice (2014), http://dx.doi.o

a b s t r a c t

Nursing students often feel their classroom (didactic) learning and clinical (practice) experiences aredisconnected which can lead to a rejection of academe and dissatisfaction with the profession. Thisclassroom/clinical divide may be exacerbated because of the increased use of part-time clinical faculty,who are often isolated from their didactic peers. If clinical faculty, either novice or experienced, aredisconnected from didactic faculty, is it any wonder students feel their learning is fragmented? Thepurpose of this paper is to discuss strategies to help bridge the gap between didactic and clinicallearning. Specific integration strategies for faculty are presented using examples from a baccalaureateadult nursing didactic course and its related clinical course. The role of a clinical coordinator in facili-tating course integration and support for part-time clinical faculty is described. Ideas for using tech-nology to enhance learning and suggestions to promote socialization to decrease faculty isolation are alsodiscussed.

� 2014 Published by Elsevier Ltd.

Nurse educators are being challenged to better integrate class-room and clinical learning to help students understand theknowledge, skills, and ethics needed for professional nursingpractice (Benner et al., 2010). Nursing students often report feelingdisconnected from the academic ideals learned in the classroomand the real life applications experienced in clinical practice(Benner et al., 2010; Meyer and Xu, 2005; Norman et al., 2005). Thisdisconnect can lead students to rejecting academe as being irrele-vant or becoming disillusioned with nursing practice (Meyer andXu, 2005; Norman et al., 2005).

Perhaps adding to the classroom-practice dissonance in theUnited States is the national shortage of nurse educators, resultingin clinical courses being frequently taught by part-time faculty orstaff nurse preceptors who are far removed from classroomteaching (Bell-Scriber and Morton, 2009). Nursing faculty may befull or part-time and may or may not have concurrent clinicalteaching assignments. Clinical instructors without classroomteaching experience may focus solely on the clinical realities ofcompleting skills in a timely fashion (Corlett, 2000). These in-structors often lack the educational preparation and experience

6 250 3704 (mobile); fax: þ1

.S., Robinia, K., Bridging therg/10.1016/j.nepr.2014.02.002

necessary for maneuvering nursing students through the quagmireof merging theoretical knowledge with clinical realities (Bell-Scriber and Morton, 2009; Benner et al., 2010; Davidson andRourke, 2012; Kelly, 2006; Kowalski et al., 2007; Krautscheidet al., 2008; Meyer and Xu, 2005). Currently, there is a scarcity ofliterature addressing the developmental needs of part-time clinicalnursing faculty who often desire more information related toconcurrent didactic courses (Davidson and Rourke, 2012; Forbeset al., 2010).

Ideally, nursing faculty should coordinate efforts to transitionstudents’ learning from the classroom, into hands-on practice insimulation laboratories, and then implementation in clinical set-tings. But, the ideal is often not realistic as faculty struggle to findpractical ways to better connect classroom learning with profes-sional practice. Crookes et al. (2013) have identified seven strate-gies/techniques used by nurse educators to bridge the gap:technology, simulation, narratives, problem/context based, reflec-tion, gaming, and art. However, while there is growing worldwideinterest in these engaging teaching techniques, more practical ap-plications for nurse educators are needed to close the chiasm(Crookes et al., 2013).

The purpose of this paper is to discuss specific teaching rec-ommendations for bridging the gap between didactic (classroom)and clinical (practice) gleaned from deliberate, coordinated effortsin an undergraduate adult nursing didactic course and its

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concurrent clinical course. The use of a Clinical Coordinator infacilitating integration and support for part-time faculty isdescribed. Finally, the importance of promoting socialization be-tween clinical staff and didactic faculty is emphasized.

Strategies for didactic faculty

Logically, classroom and clinical learning is best integratedwhen didactic faculty also teach related clinical courses, but theacute shortage of nurse educators often limits the supply of facultyavailable to teach in both settings (Benner et al., 2010). Didacticfaculty, who teach clinical courses, are well positioned to enhanceclassroom learning with recent exemplars from students’ experi-ences. These types of illustrations help students to contextualizetheoretical concepts by providing relevant patient-centered ex-amples (DiLeonardi, 2007) and also serve to enforce the credibilitythat the instructor’s knowledge and course materials are related tocurrent practice. Didactic faculty should strive to maintain clinicalexpertise by regularly teaching clinic/lab courses, holding joint/contingent practice positions, and/or participating in clinicalshadowing experiences. Attendance at hospital in-services, uni-versal skills days, or practice related continuing education such asthe Trauma Nursing Core Course or Advanced Cardiac Life SupportCertification also helps to ensure currency with standards, policies,and procedures. Ultimately, a commitment to clinical relevancyrequires administrative support and its importance needs to beoutlined in criteria for annual faculty evaluations and promotion.

Didactic faculty, who are not teaching in the clinical environ-ment, need to develop course materials that explicitly connect thetheory-practice dots for students. Didactic faculty should have ac-cess to clinical books and assigned skill videos in order to weavepractice content into theoretical lectures and case studies. Skilltextbooks are particularly helpful in providing concrete steps,application examples, and evidence-based practice references, inorder to illustrate theoretical concepts. For instance, when teachingabout patient transitions, skill textbooks often have content relatedto discharge planning, patient education, and home care.

Along a similar note, didactic faculty can support clinical facultyby providing access to lecture notes, course materials, and currentresearch articles. This enables busy clinical faculty to mine appro-priate patient experiences and plan clinical discussions thatcorrelate with current didactic concepts. Milner et al. (2005) pointto the importance of clinical educators as being a credible andvisible links between academe and practice settings. Mindfulmentoring and support of clinical faculty creates more opportu-nities for the transfer of current evidence-based practice into healthcare settings (Milner et al., 2005). Positive and collaborative in-teractions between didactic and clinical faculty also serve to rolemodel professional civility for students.

Classroom technology is an important tool for didactic faculty toengage students in meaningful learning and has the potential toimprove practice (Crookes et al., 2013). For example, use of audi-ence response technology such as I-clickers, is beneficial for bothfaculty and students. Faculty can select or create questions to pro-mote synthesis and application of complex concepts which helpsstudents to develop advanced reasoning skills (DeBourgh, 2008).Using this technology, faculty are able to immediately clarify anymisconceptions which enhances comprehension (Broussard, 2012).

Video clips and photographs can be useful for portraying ap-plications of theoretical concepts. For example, during a class onpostoperative care, showing a short video on patient controlledanalgesic devices can provide a pertinent link between conceptualknowledge, clinical skills, and bedside technology. Another class-room strategy is to use samples of electronic medical records tohighlight practice relevant to a specific topic such as documenting

Please cite this article in press as: Flood, L.S., Robinia, K., Bridging theEducation in Practice (2014), http://dx.doi.org/10.1016/j.nepr.2014.02.002

assessment data, analyzing vital sign trends, or reviewing pre-scribed medication orders.

The importance of reflective activities for student comprehen-sion has also been noted in the literature (Crookes et al., 2013).Although content dense didactic courses may have limited time forreflective activities, using short video clips from websites such asTED Conferences, LLC (2013) can be helpful in engaging students tocontemplate holistic nursing interventions. Didactic faculty shouldshare relevant websites used in theory with clinical faculty topromote further reflection during clinical discussions withstudents.

Involving didactic faculty in simulations is another way forstudents to visualize the connections between the classroom andclinic setting. Didactic faculty canworkwith simulation staff to planrelated classroom activities to precede a simulation experience.Burns et al. (2010) found significant knowledge gains in studentstaught with human patient simulators preceded by a related di-dactic lecture. In turn, transfer of lessons learned in simulations canshift back into the classroom by involving didactic faculty insimulation design, implementation, and debriefing sessions.

Didactic faculty have long understood the importance ofthreading narrative stories into their courses. Inviting clinical in-structors to share their stories in the classroom, or through elec-tronic communication, allows students to benefit from multiplefaculty experiences and perspectives. For example, via email clin-ical instructors could submit ‘a story of the week’ to share in theclassroom providing real life relevance. Use of case studies in theclassroom also provides realistic problems to promote criticalthinking and develop clinical reasoning (Delpier, 2006). Havingstudents work through a scenario or online case study enablesstudents to apply classroom concepts to practice situations. Sharingthese cases with clinical faculty helps to thread the learning backinto the clinical setting.

Strategies for clinical faculty

Clinical faculty must constantly strive to maximize teachingopportunities and balance multiple students’ learning needs whileproviding safe, high quality patient-centered care in complex,chaotic environments. Although many clinical faculty are expertstaff nurses who are thrust into the teaching role, they may not bewell prepared for the transition into an educator role (Anderson,2009; Forbes et al., 2010; Schriner, 2007) and need help to under-stand how practice experiences correlate with concurrent didacticcourses (Davidson and Rourke, 2012; Forbes et al., 2010). To helpfacilitate understanding, clinical faculty should be given copies ofthe didactic syllabi and textbooks and be invited to attend class-room lectures to learn firsthand about key concepts, observe how aclass is conducted, and discern management of student issues(Anderson, 2009; Flood and Powers, 2012).

Clinical faculty, especially those new to the role or in part-timepositions, often need help to prepare for pre/post clinical confer-ences (Hewitt and Lewallen, 2010). These clinical meetings providefaculty and students with rich opportunities for dialog and reflec-tive learning which facilitates linking didactic concepts to practice.Ideas for clinical conferences include: 1) Challenging students tolook for patient medications that correlate with the week’s didactictopics; 2) Reviewing NCLEX style questions and then discussingconnections to clinical experiences (Yehle and Royal, 2010); 3)Analyzing short case studies derived from lecture topics andidentifying links between textbook knowledge and clinical obser-vations (Oermann, 2008; Yehle and Royal, 2010); 4) Sharingevidence-based practice articles that directly relate to didactictopics and discussing ways to integrate research into practice

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settings; and 5) Inviting interdisciplinary professionals and nurseswith specialty certifications to speak on related didactic topics.

Role of the clinical course coordinator

Identifying a faculty member as the Clinical Coordinator ishelpful to bridge the classroom-clinic gap (Bell-Scriber andMorton,2009). An essential responsibility of the Coordinator’s role relatedto integration is to cultivate effective communication between di-dactic and numerous clinic faculty. Part-time faculty new to clinicalteaching, report needing more orientation to clinical policies, pro-cedures, performance expectations, technology including simula-tions, and access to didactic resources such as textbooks andexaminations (Davidson and Rourke, 2012; Forbes et al., 2010). TheCoordinator provides course orientation for new clinical in-structors, which includes reviewing policies, procedures, andevaluation tools and providing access to didactic and clinic courseresources such as syllabi, textbooks, and online videos. A helpfulsuggestion is to use a combined course website to house clinicalforms, assignments, simulation materials, care plans, and discus-sion boards to ensure that clinical faculty and students in varioussections have equal access to resources. The Coordinator shouldassume responsibility for management of this online course as thetechnical skills required may be too time consuming or foreign forpart-time faculty. Use of the combined course website is a non-intimidating way to orientate novice clinical instructors toinstructional technology while role modeling effective onlineteaching. Examples of online teaching ideas include using wiki careplans after simulations to connect lab experiences with textbookreadings and didactic learning (Flood, 2012) and using on-linediscussion boards for post clinical reflections (Cooper et al., 2004;Hermann, 2006). Faculty can use these online resources to incor-porate relevant student experiences into the clinical and classroomsettings.

The Coordinator also schedules simulations to coincide withdidactic learning. For example, the coordinator ensures that a“Surgical Concepts” lecture immediately precedes a high fidelitypostoperative simulation experience by facilitating communicationbetween didactic, clinical, and simulation staff. To prepare, theCoordinator submits lab room requests along with equipment/supply lists and maintains the faculty simulation folder withupdated scenarios and teaching instructions. Also, the Coordinatorworks with the simulation staff to assist with orientation of clinicaladjuncts and often role models how to lead simulations anddebriefing experiences for novice clinical faculty.

Another important Coordinator responsibility is to organize andlead didactic-clinic team meetings. These face to face coursemeetings help to foster faculty socialization and being part of ateaching team (Hessler and Richie, 2006; Kelly, 2006). At the se-mester start-up meeting, the Coordinator matches new clinicalfaculty with experienced mentors to provide support in the clinicalsetting. Some meeting time is reserved for brain storming pre/postclinical conference ideas. As this is a standing agenda item, clinicalfaculty are encouraged to bring new ideas and materials forconsideration. Finally, the importance of didactic versus clinicalcourse objectives is discussed in order to remind returning facultyabout integration links and assist new instructors in understandingthe curriculum.

At the end-of- semester course meeting, the Coordinator sharesthe results of students’ course evaluations (didactic and clinical)and decisions are made to either maintain or revise the courses.Collegial dialog often occurs related to critical incidents and ‘chal-lenging students’ which is helpful for problem solving anddebriefing (Kelly, 2006). Novice clinical faculty are encouraged to

Please cite this article in press as: Flood, L.S., Robinia, K., Bridging theEducation in Practice (2014), http://dx.doi.org/10.1016/j.nepr.2014.02.002

share input about their first teaching experiences so that futureorientations can be improved.

Throughout the semester, the Coordinator is responsible forongoing contact with clinical instructors via emails, phone calls,and site visits acting as the go-to-person to ensure that specificconcerns are addressed (Forbes et al., 2010). Because the Co-ordinator’s role involves responsibilities outside of teaching,release time and/or evaluation recognition is important to securesustainability of the position (Forbes et al., 2010). Likewise, part-time faculty should be reimbursed for their time related to orien-tation and attending course meetings (Benner et al., 2010).

Socialization strategies and benefits

In addition to the strategies previously described, other oppor-tunities should be planned to decrease the isolation often experi-enced by part-time faculty (Davidson and Rourke, 2012; Forbeset al., 2010; Hessler and Richie, 2006; Kelly, 2006). Some sugges-tions include: formal invitations to attend departmental meetings,lectures, and workshops, as well as graduation ceremonies (Forbeset al., 2010) and inclusion in social events such as departmentallunches or parties. These social activities can provide opportunitiesfor important dialog between didactic and clinical faculty;increased social interactions may translate into more connectedteaching between classroom and clinical courses.

The benefits from didactic faculty attuned to clinical teachingand visa versa translate beyond student learning and may posi-tively impact faculty retention and patient care. Providing appro-priate support makes a difference in recruitment/retention andfacilitates the transfer of evidence-based practice information andresearch findings from academe to clinical settings (Clark, 2013;Evans, 2013; Kelly, 2006; Milner et al., 2005). Evans (2013) founda majority of nurse educators cited faculty role models as theirinspiration for pursing teaching careers, and Clark (2013) notedthat direct communication between faculty was associated withfostering more positive work environments and encouragedretention.

Summary

Nursing faculty are challenged to purposefully integrate class-room learning and clinical practice to better prepare students tofunction in complex health care environments (Benner et al., 2010;Crookes et al., 2013). In the United States, the use of separate di-dactic and clinical faculty without careful integration could result infragmented learning for students. Nursing faculty in other coun-tries may face similar clinic-practice dissonance and may find thesuggested strategies helpful. No matter where the program islocated, students, who are enrolled in didactic and clinical coursesbeing taught by different faculty, may need assistance to connectthe learning between their classroom and varied clinical experi-ences. Strengthening the connections between classroom andclinical faculty may help to improve student learning outcomes,promote collegial relationships between academe and practice, andenhance faculty recruitment and retention. Successfully bridgingthe classroom-clinic gap has the potential to positively impactfuture nursing practice and ultimately patient care.

Conflict of interest statement

The authors have no personal, professional, or financial conflictsof interest to disclose related to this article.

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