Integrating evidence-based practice with educational theory in clinical practice for nurse practitioners: bridging the theory practice gap.

I am delighted to introduce my colleague, Dr. Lucille Ferrara, as the author of this issue's Evidence-Based Practice (EBP) column. Having been a preceptor for Pace's family nurse practitioner (FNP) students, an adjunct clinical instructor, and now one of our esteemed full-time faculty members, she has had a wealth of experience in facilitating the learning of FNP students, especially with regard to incorporating EBP into clinical decision-making as an integral part of advanced nursing practice. The column that follows combines Dr. Ferrara's clinical teaching experience with some theoretical approaches to teaching and learning EBP concepts. Rona F. Levin, PhD, RN One of the most exciting aspects of the role of a clinical preceptor is the opportunity to guide nurse practitioner (NP) students in applying the principles of evidence-based practice (EBP), thus bridging the theory to practice gap. How do we bridge this challenging gap? One method that I find beneficial is using a constructivist approach to teaching and learning ( Merriam, Caffarella, & Baumgartner, 2007 ) during clinical experience sessions. Within the constructivist theory, the learner is able to gain meaning from past and current learning experiences. This experience assists the learner to construct new knowledge. Most advanced practice nursing students are working as registered nurses. As practicing registered nurses, they have clinical experience and knowledge of health issues, as well as specific interventions used for the care and treatment of patients with a variety of health problems. The role of the preceptor is to facilitate learning. According to the constructivist approach, this facilitation involves negotiating meaning-making with the learner ( Merriam et al., 2007 ). Learning through a constructivist approach can be achieved by using teaching strategies that are informed by viewing teaching and learning through different lenses such as experiential learning, reflective practice, problem-based learning, and transformative learning. The constructivist facilitates experiential learning by creating an environment where the learner is an active participant in the learning process; the learner learns by doing. Through reflection, the learner is able to draw from past experience and match that with the newer knowledge that has been recently introduced or presented. When learners present case studies in which they have to collect patient data, interpret this data, and then formulate a treatment or intervention based on that interpretation, the learner is using a problem-based learning strategy. As the learner takes control of the new information and begins to internalize it, a transformation and creation of new knowledge takes place. This constitutes transformative learning. Consider the following. On a typical day, a student spends time with me before the clinical session begins, giving us an opportunity to include a discussion of patient cases from the last clinical session as well as from past experience (reflective practice and problem-based learning). Often these clinical situations provide excellent learning opportunities for students in which they can present the case incorporating the latest and best evidence, which further guides their assessments and interventions. Through reflection, the student begins to appreciate the value of EBP relative to their own practice (transformative learning). For example, students often ask why I choose one antibiotic over another, or why I decide to incorporate watchful waiting (observe the patient for a day or two) for a specific illness. I explain to them that a good portion of my decision-making draws from the current evidence, discussion with expert colleagues, past experience, and intuition (experiential learning). I arrive at my clinical decisions based on the construction of knowledge that I have incorporated based on what I know with what I have experienced. I then take the new information that I have acquired, make sense out if it, and internalize it with the end result of new meaningful knowledge. …