The grid that bridges the gap

Since the introduction of the Diploma in Higher Education in Nursing Studies (Dip HE NS) at this Faculty, course evaluations have consistently reported students' fears and apprehensions which result from their perceived lack of practical ability. Their experiences are supported by accounts from other nursing faculty (Elkan et al. 1993, Jowett & Walton 1994). In 1994, following analysis of course evaluations and a review of the literature on skill acquisition, experiential skills teaching was resumed within the faculty setting. This was after a period in the late 1980s when the cultural thinking was that 'practice suites' were to be frowned upon, and that skills were best taught in practice placements. Despite rigorous literature reviews (Love et al. 1989, Knight 1996) there appears to be no research to support the dismantling of practice suites. A structured approach to teaching skills now takes place in a purpose built Skills Centre. The approach used is based on a model by Gentile (1972), which is founded upon the theoretical principles of skill acquisition. It provides a blueprint for the teaching and transference of skills, and implicit in the model is the use of skill analysis. This involves demonstration of a skill by the facilitator, followed by analysis of it by the student into its component parts; this is followed by practise. The authors were concerned, however, that the use of skill analysis to teach skills should not be reduced to a presentation of a succession of isolated tasks. The authors were also aware that a nursing skill often has a tendency to be viewed purely within the psychomotor domain, with little attention paid to the knowledge base which underpins the skill. This viewpoint may contribute to the notion of a theory-practice gap. In response to these concerns, the authors have developed the Skill Grid. The grid incorporates skill analysis with Carper's theoretical framework: Fundamental Ways of Knowing (Carper 1975). The authors believe that knowledge which exemplifies nursing practice has many dimensions, and that it is crucial for students to explore the derivation of knowledge from an ontological perspective. Carper's framework will enable consideration of knowledge originating not only from empirical, but also aesthetic, personal and ethical sources. An essential feature of the grid is the attempt to link knowledge with practice by demonstrating how Carper's framework, which identifies sources of knowledge, can form the basis for the acquisition of skill. The authors have also incorporated problem-based learning into their teaching, so that the skills are practised within a patient/client orientated situation.