Author Affiliations
Abstract
Background: The theory-practice gap in nursing refers to the discrepancy between knowledge acquired in classrooms and its application in clinical settings. This gap affects clinical competence and quality of care.
Aim: To identify factors contributing to the theory-practice gap among nursing students at the College of Nursing, Rawalpindi.
Methodology: A descriptive cross-sectional study was conducted over three months (October-December 2020). A convenience sample of 126 nursing students from 2nd, 3rd, and 4th year was included. Data were collected using a validated structured questionnaire (Cronbach’s alpha = 0.81). Descriptive statistics and inferential tests (chi-square and Fisher’s exact test) were applied using the Statistical Package for the Social Sciences (SPSS) version 23.
Results: A total of 126 students participated; 60.8% perceived the existence of a theory-practice gap. A statistically significant association was found between academic year and extent of gap (p < 0.001), while no significant association was observed between academic year and perception of the gap (p = 0.15). Major contributing factors included ineffective clinical supervision, lack of objective assessment, inadequate clinical support, student-related knowledge deficits, and unsupportive clinical environments.
Conclusion: The theory-practice gap remains a significant issue in nursing education. Strengthening clinical supervision, improving collaboration between academic and clinical settings, and enhancing student preparedness can help reduce this gap.
Keywords
Theory-practice gap, Nursing students, Clinical instructors, Clinical learning environment, Nursing education.
Introduction
Theoretical and practical experience are equally important ingredients of an integrated mixture of nursing degrees to enrich the capability of nursing students.[1] Clinical experience is considered to be the most widespread source regarding anxiety and stress-producing factors throughout the nursing degree program, and it is an important part of curriculum of nursing.[2,3] The term “theory-practice gap” is most often used without understanding its underlying concepts and description; hence, a few words widely used for “gap” are “bridged,” “breached,” or “avoided.” [4] The complexity of integrating theoretical knowledge into practice has been widely debated in nursing education literature, emphasizing the persistent disconnect between knowledge and application.[5,6]
The researchers examined that the transition of theoretical knowledge into practical work is the most difficult transition for the students and freshly graduated nurses.[2] Around the globe, the gap between practice and theory is reported, documented, and dialogued in the literature.[7] The theory-practice gap can be defined as the discrepancy and contradiction between what students attain in the classroom versus what they exhibit and produce in the clinical environment.[8] Similar findings have been reported among nursing students in different contexts, including studies from Africa and other developing regions, where students experience difficulty applying classroom knowledge in clinical settings.[9] Clinical nurse teachers and mentors play a vital role in reducing the gap of theory and practice by creating a helping and enhancing working environment and letting students participate in practical work as a responsible partner.[10] Effective transition programs and structured clinical support systems have also been identified as essential strategies to bridge this gap.[11]
The study is intended to explore and rectify the shortcomings that are widening the theory-practice gap among student nurses at the College of Nursing, Rawalpindi. A study related to the transition from student to ward nurse was published in the Association of Black Nurses Federation Journal. The researcher revealed that most newly graduated nurses suffer from stress due to expectations from them while they face a huge difficulty in converting their theoretical knowledge into practice, hence causing compromise in effective patient care.[12] In addition, gaps in knowledge and clinical practice have also been identified in local contexts such as Pakistan, particularly among pediatric nurses working in tertiary care hospitals.[13] The theoretical and practical dimensions of nursing, often described as both an art and a science, further complicate the integration process in clinical learning environments.[14]
Methodology
Design: A descriptive cross-sectional study design was used.
Setting and sample: The study was conducted at the College of Nursing, Rawalpindi. A convenience sample of 126 nursing students from 2nd, 3rd, and 4th year was recruited. First-year students were excluded due to limited clinical exposure.
Data collection and instrumentation: A validated, self-administered questionnaire was used, consisting of three sections: instructor-related factors, student-related factors, and environmental factors. The reliability of the instrument was confirmed with Cronbach’s alpha of 0.81.
Operational definition: The theory-practice gap was defined as the perceived discrepancy between theoretical knowledge and its clinical application, measured using Likert-scale responses.
Scoring system: A 3-point Likert scale was used (Agree = 1, Disagree = 2, Don’t Know = 3), where lower scores indicated stronger agreement.
Ethical considerations: Ethical approval was obtained from the Institutional Review Board. Informed consent was obtained from all participants. Confidentiality and anonymity were maintained.
Data analysis: Data were analyzed using SPSS version 23. Descriptive statistics (frequencies and percentages) and inferential statistics (chi-square and Fisher’s exact test) were applied. A p-value < 0.05 was considered statistically significant.
Results
Descriptive statistics:
Sociodemographic characteristics: The mean age of participants was 21.21 ± 1.45 years. All participants were female. Most students were from the second year (46.8%). A total of 60.8% of students perceived the presence of a theory-practice gap. Regarding the extent of the gap, 45.5% reported it as large, 37.3% as moderate, and 18.2% as small.
| Sr. no | Characteristics | No of representatives | %age |
| 1 | 1st year | 0 | 0% |
| 2 | 2nd year | 59 | 46.8% |
| 3 | 3rd year | 29 | 23% |
| 4 | 4th year | 38 | 30.2 |
| 5 | Perception of gap
Yes No
|
73 53 |
60.8% 39.2% |
| 6 | Extent of gap
Big Moderate Low |
57 47 22 |
45.5% 37.3% 18.2% |
Table 1: Sociodemographic characteristics of participants
Variables related to the instructor during the practice period: Instructor-related factors such as lack of supervision, ineffective teaching methods, and insufficient feedback were highly reported contributors.
| Sr. no | Item | Agree | Disagree | Don’t know |
| 1 | The inefficiency of instructors at the clinical training site contributed to the gap between theoretical knowledge and practical application. | 101 (80.2%) | 19 (15.1%) | 6 (4.8%) |
| 2 | The lack of commitment of the instructor in the training place contributed to creating this gap. | 84 (66.7%) | 27 (21.4%) | 15 (11.9%) |
| 3 | The instructor’s supervision and evaluation of our performance during training contributed to identifying the gap between theory and practice. | 82 (64.8%) | 34 (27.2%) | 10 (8%) |
| 4 | Lack of supervision for us as students by the trainers in the training place contributes to the existence of this gap. | 84 (66.7%) | 35 (27.8%) | 7 (5.6%) |
| 5 | The lack of support provided by the instructor during the training period contributed to the gap between theory and practice. | 81 (64.3%) | 36 (28.6%) | 9 (7.1%) |
| 6 | The teaching and training methods used during the period were characterized by neglect and insufficient guidance, which contributed to the emergence of the gap between theory and practice. | 71 (56%) | 43 (34.4%) | 12 (9.6%) |
| 7 | The absence of the instructor during the training period contributed to the development of the gap between theory and practice. | 78 (61.9%) | 31 (24.6%) | 17 (13.5%) |
| 8 | The lack of interest in the objectives of course outlines, which were expected from the training site, was a main reason to create a gap between what we have learned in college and what we found actually. | 81 (64.3%) | 39 (31%) | 6 (4.8%) |
| 9 | Feedback and evaluation by the instructor are not enough. | 76 (60.3%) | 41 (32.5%) | 9 (7.1%) |
| 10 | I am often unable to locate my clinical instructor for one-on-one practice and guidance. | 81 (64.3%) | 31(24.6%) | 14 (11.1%) |
| 11 | Clinical instructors do not assess students objectively. | 93 (73.8%) | 29 (23%) | 4 (3.2%) |
| 12 | Clinical instructors are unable to ensure effective cooperation with ward personnel. | 78 (61.9%) | 36 (28.6%) | 12 (9.5%) |
Table 2: Description of variables associated with the instructor during the practice period
Variables related to students: Student-related factors included lack of knowledge, low confidence, and fear of clinical settings.
| Sr. no | Items | Agree
|
Disagree
|
I don’t know |
| 1 | The lack of information that I have as a student was a direct cause of the existence of a gap between theory and practice. | 92 (73%) | 29 (23%) | 5 (4%) |
| 2 | My lack of knowledge contributed to low self-confidence as a new student, which in turn led to a gap between theory and practice. | 74 (58.7%) | 41 (32.5%) | 11 (8.7%) |
| 3 | Fear of the new clinical training environment also contributed to the development of this gap. | 63 (50%) | 53 (42.1%) | 10 (7.9%) |
| 4 | Additionally, fear of applying theoretical knowledge to real patients during clinical practice further widened the gap between theory and practice. | 55 (43.7%) | 65 (51.6%) | 6 (4.8%) |
| 5 | The lack of my commitment as a student during the period of my study, and my academic carelessness in both college and training, contributed to the creation of a gap between the theoretical and practical side. | 47 (37.3%) | 69 (54.8%) | 10 (7.9%) |
| 6 | The difference between the educational programs in educational institutes, contributed to the creation of gap between theory and practice. | 70 (55.6%) | 40 (31.7%) | 16 (12.7%) |
| 7 | The weakness of my academic achievement during the study was the reason of creating this gap that I have. | 43 (34.1%) | 66 (52.4%) | 17 (13.5%) |
| 8 | I did not train in my workplace previously. | 55 (43.7%) | 62 (49.2%) | 9 (7.1%) |
| 9 | My lack of initiative contributed to the emergence of the gap between theory and practice. | 57 (45.2%) | 58 (46%) | 11 (8.7%) |
| 10 | Fully depending on the teacher to explain the material and lack of early preparations, contributed to the emergence of this gap | 43 (34.1%) | 68 (54%) | 15 (11.9%) |
| 11 | I cannot transfer theoretical knowledge into practice | 50 (39.7%) | 70 (55.6%) | 6 (4.8%) |
Table 3: Descriptives of variables related to students
Variables related to ward personnel and environment: Environmental factors included lack of resources, limited cooperation from staff, and inadequate learning facilities.
| Sr. no | Item | Agree | Disagree | Don’t know |
| 1 | The limited availability and at times absence of medical equipment in the hospital prevented me from performing procedures effectively. | 79 (62.7%) | 41 (32.5%) | 6 (4.8%) |
| 2 | Lack of adequate educational opportunities in training place is the cause of creating this gap. | 78 (61.9%) | 42 (33.3%) | 6 (4.8%) |
| 3 | Fear of applying what we have learned to real patients contributed to the development of the theory-practice gap. | 62 (49.2%) | 53 (42.1%) | 11 (8.7%) |
| 4 | The lack of cooperation from nursing staff during training also played a role in creating this gap. | 80 (63.5%) | 42 (33.3%) | 4 (3.2%) |
| 5 | Being assigned tasks unrelated to patient care further widened the gap between theory and practice. | 92 (72.8%) | 29 (23.2%) | 5 (4%) |
| 6 | The absence of a supportive environment where classroom-learned procedures could be practiced contributed to the existence of this gap. | 84 (66.7%) | 30 (23.8%) | 12 (9.5%) |
| 7 | Being excluded by ward personnel. | 76 (60.3%) | 42 (33.3%) | 8 (6.3%) |
| 8 | Not having a room and lockers for students. | 86 (68.3%) | 35 (27.8%) | 5 (4%) |
| 9 | The absence of opportunities for joint meetings between teaching faculty and students contributed to the gap between theory and practice. | 91 (72.2%) | 30 (23.8%) | 5 (4%) |
Table 4: Descriptives of variables related to ward personnel and environment
Inferential statistics: Fisher’s exact test showed a statistically significant association between academic year and extent of the gap (p < 0.001). However, no significant association was found between academic year and perception of the gap (p = 0.15). Chi square and Fisher exact test of significance was applied between academic year of respondents and perceptions of respondents about existence of the theoretical and practical gap and extent of gap according to the respondents, respectively. Fisher exact test shows that a statistically strong association exists between academic year of respondents and extent of gap that exists according to these respondents (small, moderate, big) (p= 0.000), whereas Chi square test of significance between academic year and perceptions of respondents about existence of the theoretical and practical gap shows no association (p=0.15). Cross tabulation of the variables is presented below in table 5.
| 1. | Academic rear | Perceptions of respondents
Yes No |
| 2nd | 23 14 | |
| 3rd | 19 24 | |
| 4th | 31 15 |
| 2. | Academic rear | Extent of gap that exists | ||
| Small | Moderate | Big | ||
| 2nd | 0 | 22 | 25 | |
| 3rd | 4 | 19 | 18 | |
| 4th | 18 | 6 | 14 | |
Table 5: Cross tabulation of variables
Discussion
The findings indicate that the theory-practice gap remains a significant issue among nursing students. The majority of students reported difficulty in applying theoretical knowledge in clinical settings, reflecting a disconnect between academic preparation and practical experience. Instructor-related factors emerged as key contributors. Ineffective supervision, lack of feedback, and inadequate evaluation hinder students’ ability to integrate theory into practice. This highlights the importance of active instructor engagement in clinical teaching.
Student-related factors such as insufficient knowledge, lack of confidence, and fear of clinical environments further exacerbate the gap. These findings suggest the need for enhanced academic preparation and supportive learning strategies. Environmental factors, including lack of resources, limited staff cooperation, and non-supportive clinical environments, also play a significant role. A collaborative and resource-rich clinical setting is essential for effective learning.
Recommendations
- Strengthen the role of clinical instructors in supervision and mentoring
- Improve collaboration between academic institutions and healthcare facilities
- Provide simulation-based training for students
- Ensure availability of adequate clinical resources
- Conduct further large-scale and mixed-method research studies
Conclusion
The findings of this study demonstrate that the theory-practice gap remains a significant and persistent challenge among nursing students. A considerable proportion of participants reported difficulty in translating theoretical knowledge into clinical practice, reflecting a clear disconnect between classroom learning and real-world application. This finding is consistent with previous studies conducted in diverse contexts, which highlight that nursing students frequently struggle to integrate knowledge due to differences between idealized teaching and practical realities in clinical environments.[7,9]
Instructor-related factors emerged as one of the most influential contributors to the theory-practice gap. Students reported issues such as ineffective supervision, lack of timely feedback, and inadequate objective evaluation. These findings align with earlier research emphasizing that clinical instructors play a pivotal role in facilitating the integration of theory into practice through guidance, mentorship, and constructive evaluation.[10,15] Poor instructional strategies and weak coordination between academic and clinical educators further widen this gap, as also discussed in studies exploring inconsistencies in teaching methodologies among nurse educators.[15]
Student-related factors also significantly contributed to the gap. Participants identified lack of knowledge, low self-confidence, and fear of engaging in clinical practice as major barriers. These findings are supported by existing literature, which indicates that students often feel unprepared and anxious when transitioning into clinical settings, ultimately affecting their performance and learning outcomes.[2,9] Additionally, reliance on passive learning approaches and limited self-directed preparation further exacerbate the inability to apply theoretical concepts in practice. This reflects the broader issue of inadequate preparation strategies and insufficient emphasis on critical thinking in nursing education.[11]
Environmental and organizational factors were also found to play a critical role. The lack of resources, limited cooperation from ward staff, and non-supportive clinical environments were frequently reported by students. These findings are consistent with studies conducted in both developed and resource-constrained settings, where insufficient infrastructure and lack of collaboration between academic institutions and healthcare facilities hinder effective clinical learning.[7,13] In particular, studies in local and regional contexts have highlighted how resource limitations and workplace dynamics negatively impact the practical training of nursing students.[13]
Furthermore, the findings of this study reinforce the notion that the theory-practice gap is a multifaceted issue influenced by the interplay of educational, personal, and systemic factors. Nursing, being both an art and a science, requires a balance between theoretical knowledge and practical competence, which is often difficult to achieve in traditional educational models.[6,11] The persistence of this gap suggests the need for innovative teaching approaches, including simulation-based learning, competency-based education, and stronger integration of clinical experiences within the curriculum.
The significant association found between academic year and the extent of the theory-practice gap indicates that students’ perceptions evolve with increased clinical exposure. Senior students reported a greater awareness of the gap, possibly due to their deeper engagement in clinical settings and increased responsibility. Similar trends have been observed in previous studies, where advanced students demonstrate a more critical understanding of discrepancies between theory and practice.[9]
Overall, the findings of this study are in agreement with global literature, confirming that the theory-practice gap is a widespread issue in nursing education. Addressing this challenge requires a collaborative effort involving educators, clinical instructors, and healthcare institutions. Strengthening clinical supervision, enhancing communication between academic and practice settings, and fostering active student engagement are essential steps toward minimizing this gap. Additionally, structured transition programs and continuous professional development for educators can further support the effective integration of theory into practice.[11]
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Exploring the potential theory-practice gap in the teaching methods of nurse educators
Acknowledgments
The author would like to acknowledge the support of the College of Nursing, Rawalpindi, and all participating students for their valuable contribution to this study.
Funding
This research received no external funding.
Author Information
Corresponding Author:
Nadira Nasim
Department of Nursing
College of Nursing, Rawalpindi, Pakistan
Email: [email protected]
Co-Author:
Tahseen Raana
Department of Nursing
College of Nursing, Rawalpindi, Pakistan
Authors Contributions
Nadira Nasim (Corresponding Author) made the primary contribution to this study, including conceptualization and design of the research, data collection, data analysis and interpretation, and drafting of the manuscript. She also took the lead in revising and finalizing the article for publication. Tehseen Raana contributed to the study by supporting the research design, assisting in data interpretation, and critically reviewing and editing the manuscript for important intellectual content. Both authors read and approved the final version of the manuscript and agree to be accountable for all aspects of the work.
Ethical Approval
Ethical approval for this study was obtained from the Institutional Review Board (IRB) of Armed Forces Postgraduate Medical Institute (AFPGMI), Rawalpindi, Pakistan. The study was conducted in accordance with ethical principles outlined in the Declaration of Helsinki.
Conflict of Interest Statement
The author declares no conflict of interest.
Guarantor
None
DOI
Cite this Article
Nasim N, Raana T. Factors Contributing to the Theory-Practice Gap Among Nursing Students: A Cross-Sectional Study in Rawalpindi. medtigo J Med. 2026;4(2):e3062426. doi:10.63096/medtigo3062426 Crossref
