May 27, 2008
I am writing this letter after reading the articles in the OJIN topic, Nursing Around the World.
I became a PhD student in Iran two years ago. Since that time I have been experiencing more and more the same uncomfortable feeling that I had experienced during my Master’s level studies. This feeling relates to the gap I sense between theory and practice at all educational levels. I have shared this uncomfortable feeling with other instructors, both nursing instructors and instructors in other disciplines, and they, too, say they have experienced distress because of this gap between theory and practice.
I find that when I am talking with other instructors discussing, for example, a research project, or a disease epidemic, or an educational issue, I speak confidently and always feel proud of my up‑to‑date knowledge of the profession, of research, or of a given disease condition.
However, woe betides me once I am in the company of expert clinical nurses in a clinical setting, and am confronted with a patient and asked to perform a technical skill. I also fear the day when my relatives will expect me, as a nurse, to be able to deal with something like a nasogastric tube.
In these situations, when I am, or might be, put on the real stage of professional nursing, I am overcome with anxiety and my self‑confidence fades away. Then I ask myself, “Why, really why do I become so fearful in these clinical situations?” I wonder whether I am becoming a nurse who is losing her physical skills while she increases the pressure on her mind. In other words, have I increased my knowledge at the expense of developing my practice skills so that my practice skills are now poor? In my opinion, I have this feeling because I have been so busy with my books, the papers, and the university responsibilities for so many years that I have lost my clinical skills, gradually, due to lack of practice. Maybe my distress is resulting from the anxiety I first experienced as a baccalaureate student when I began to see this long-recognized gap between theoretical skills and clinical skills. And I am now experiencing this gap again, but in a new light.
Perhaps expressing this feeling will help me understand the current status of PhD nursing courses in my country at least to some extent. I do not know if other PhD students, especially those teaching in lower level courses than I do, share this feeling with me. So I ask others, does the community of PhD nurses always fear direct clinical activities? Would nursing doctoral preparation in a Doctor of Nursing Science (DNS) or a Doctor of Nursing Practice (DNP) program make a difference? Is it more or less necessary to provide doctoral education with a practice focus, rather than a research focus, in a country like mine where the gap between theory and clinical practice has become so large? I look forward to reading the insights of others, as they send their responses to the OJIN Editor.
Lecturer of Azad Islamic University
PhD student of Tehran Medical University