FACTORS AND STRATEGIES TO BRIDGE THEORY–PRACTICE GAP IN NURSING EDUCATION AT TERTIARY HEALTHCARE INSTITUTIONS OF KARACHI: A QUALITATIVE STUDY

Abstract

The theory–practice gap remains a persistent challenge in nursing education, limiting nursing students' ability to effectively translate theoretical knowledge into competent and evidence-based clinical practice. The disconnect between classroom instruction and clinical practice compromises students' clinical competence, confidence, and preparedness for professional nursing roles. Understanding the factors contributing to this gap and identifying effective educational strategies are essential for improving nursing education and ensuring high-quality patient care.This study aimed to identify the factors contributing to the theory–practice gap between classroom teaching and clinical practice and to identify effective teaching and learning strategies that facilitate the integration of theory and practice in nursing education. A qualitative descriptive research design was employed to obtain an in-depth understanding of participants' experiences and perspectives. Purposive sampling was used to recruit seven nursing educators and clinical instructors with extensive experience in nursing education and clinical supervision from tertiary healthcare institutions in Karachi, Pakistan. Data were collected through semi-structured, in-depth interviews using a researcher-developed interview guide comprising ten open-ended questions. Ethical approval was obtained from the relevant institutional review committee, and written informed consent was obtained from all participants prior to data collection. Participants' confidentiality, anonymity, and voluntary participation were ensured throughout the study. Interviews were audio-recorded, transcribed verbatim, and analyzed inductively using Braun and Clarke's six-phase thematic analysis. Two major themes emerged from the analysis. The first theme, Factors Contributing to the Theory–Practice Gap, comprised curriculum limitations, resource-constrained clinical environments, inadequate supervision, heavy workloads, weak academic–clinical collaboration, and inconsistencies between evidence-based teaching and routine clinical practice. The second theme, Teaching and Learning Strategies for Bridging the Theory–Practice Gap, included simulation-based learning, case-based and problem-based learning, bedside teaching, reflective practice, structured mentorship, competency-based assessment, enhanced clinical placements, and strengthened academic–clinical partnerships as key strategies for improving the integration of theory and practice. The findings demonstrated that minimizing the theory–practice gap requires educational and organizational reforms that strengthen the alignment between classroom instruction and clinical practice. Nursing institutions should adopt competency-based curricula, expand simulation and experiential learning opportunities, strengthen mentorship and clinical preceptorship programs, promote continuous faculty development, and establish sustainable academic–clinical partnerships to enhance students' clinical competence and readiness for professional nursing practice.