Nursing theory vs. nursing practice - what does it really look like?

During your nursing training, you will delve deep into the world of nursing theory. You will learn evidence-based standards, scientifically sound procedures and the ideal conditions for optimal care. Every detail, every procedure is taught to you precisely to ensure the best possible patient safety and efficiency. It is a time to build up specialist knowledge and an understanding of the complex interrelationships of the human body and psyche.

But what does everyday nursing care really look like when the textbooks are closed and the mannequins are put away? Nursing theory and nursing practice - two terms that often feel like opposites in the turbulent professional world. While theory is taught in the protected space of the classroom or lecture hall, practice takes place directly with people: with all its unpredictable challenges, complex emotions, lightning-fast decisions and often limited resources. Time is of the essence here, and every situation is unique, far removed from standardized models.

Can you implement everything you have learned one-to-one in the way the curricula prescribe? Or do nursing theory and nursing practice differ significantly, creating a real gap that needs to be bridged in everyday working life? In this article, we would like to give you a very personal insight into precisely this dynamic. We shed light on the fascinating, sometimes frustrating interface between what you have learned and the reality of the nursing profession and show you how theory and practice are inextricably linked and influence each other despite all the differences.

Nursing theory and nursing practice - differences, application & examples

I am currently in the final year of my studies to become a qualified healthcare and nursing assistant. My training is characterized by theoretical courses, informative lectures on various clinical pictures and the regular examination of scientific studies. This course is also closely linked to practical exercises and internships in all areas of nursing. As I find myself right at the interface between theory and practice, I want to enlighten you on how far theory and practice diverge and which skills you can really take from the theoretical lessons.

What is a care theory?

A nursing theory is a scientifically developed concept that explains, structures and justifies nursing actions. It serves as a guideline for nursing staff to make decisions and organize actions in a comprehensible manner. As the DocCheck Flexikon puts it: "A nursing theory is a systematic and comprehensive presentation of concepts, principles and assumptions that form the basis for professional nursing care." (Source: DocCheck Flexikon. Nursing theory).

An example of this is Orem's self-care deficit theory, which shows when patients need support and how to provide targeted help.

What does nursing practice mean?

nursing practice refers to the actual performance of nursing tasks in everyday life - from changing dressings and administering medication to Communication with relatives. It is characterized by time pressure, individual situations, unpredictable events and empirical values. This shows how theoretical knowledge is applied and adapted under real-life conditions.

Theory vs. practice - What are the differences?

What do you think? Are nursing theory and practice really so different, or are they very similar? This question occupies not only students, but also experienced nursing professionals on a daily basis. The answer is complex: while the core principles often remain the same, the actual implementation and framework conditions in everyday nursing care can differ greatly from what is written in the textbook. This discrepancy arises from a variety of factors that can shape practice and separate it from pure doctrine. Basically, it depends on the specific activity, but the way it is carried out is significantly influenced by the reality of everyday nursing care.

The goal of care: 

In the Care theory focuses on the scientific foundation. Ethical principles, ideal processes and the highest quality standards are formulated here to ensure optimal and holistic care. The Nursing Practice, on the other hand, focuses on the direct and immediate patient care under the real conditions of everyday care. The focus here is on the individual needs of the patient, humanity and the need for quick, often pragmatic solutions, which cannot always correspond to the ideal theoretical framework.

The procedure: 

The Theory provides you with standardized and evidence-based procedures. These have been tested by scientific studies and are designed to ensure maximum safety, efficiency and reproducibility. In practice, on the other hand, a high degree of flexibility is often required. Nursing staff must constantly adapt to unforeseen situations, individual patient reactions and changing conditions. Concrete action here often requires quick, situation-dependent decisions that can deviate from pure doctrine without jeopardizing the quality of care.

Examples and areas of application: 

The Care theory often works with comprehensive models such as those by Orem, Krohwinkel or Peplau, which serve as conceptual frameworks for holistic care planning. They offer abstract principles for understanding and designing care processes. The Nursing Practice, on the other hand, deals with the concrete, often recurring activities of everyday life: placing infusions, taking blood samples, changing dressings or administering medication. What counts here is efficiency, routine and often individual handling in order to complete the tasks under time pressure.

Influencing factors on the implementation: 

The Care theory is largely shaped by care research, scientific studies and the development of new models. It searches for the optimal and well-founded path. The nursing practice, on the other hand, is influenced by a multitude of real factors. These include the ever-present pressure of time, the lack of staff and resources, the dynamics of the care team and even the personal habits or learning styles of individual caregivers. These factors can lead to theoretically ideal processes being modified on a day-to-day basis in order to provide the best possible care under the given circumstances.

Important care theories at a glance

Care theories provide a structured framework for nursing action and promote clinical decision-making. "Nursing theories not only structure nursing actions, but also serve as orientation for nursing staff in everyday life - regardless of the individual case." (Source: Sanubi. Nursing Theories & Nursing Models - Definition and Explanation). Theories such as those of Orem or Henderson enable nursing staff to better identify individual care needs and initiate targeted measures (Source: GRIN Verlag. How important are nursing theories really for nursing practice?).

Here are some of the most important care theories you'll find in the Education will be encountered:

• Dorothea Orem: Self-Care Deficit Theory - When does a person need support and how can they be motivated to self-care?
• Monika Krohwinkel: ABEDLs (Activities, relationships and existential experiences of life) - A holistic approach that structures care along life activities.
• Hildegard Peplau: Interaction Theory - Focus on the therapeutic relationship between nurse and patient:in as a nursing process.
• Virginia Henderson: Theory of Basic Needs -Describes 14 basic needs whose fulfillment helps promote independence and health.
• Madeleine Leininger: Transcultural Care - Emphasizes the importance of understanding cultural backgrounds for culturally sensitive care.

Practical examples: This is what care really looks like

In my nursing training, there are practical lessons in which all nursing activities are taught. So-called "action checklists" are used here, which are evidence-based and describe the sequence of an activity step by step. Practical mannequins or fellow students are used to practice diligently so that the practical skills are in place during the nursing internship. But is nursing practice really what you have learned?

In my nursing training, I often experienced how different theory and practice look. Here are a few personal insights:

Placing an indwelling bladder catheter: The individual touch

For example, take the placement of an indwelling bladder catheter. You will need a catheter set containing sterile swabs and two sterile forceps as well as sterile gloves. Some of the qualified healthcare and nursing staff clean the genitals with the first pair of tweezers and the sterile swabs and then insert the catheter sterilely with the second pair of tweezers. The other part of the nursing staff uses the first pair of tweezers for cleaning, but then inserts the catheter by hand, as they are wearing sterile gloves anyway. The procedure is the same for this activity, but you carry it out in the way that is easiest and most convenient for you.

Mirroring infusions: The pressure of time in everyday life

Why do theory and practice actually differ? Due to time stress, nursing activities are often carried out differently to the way they were taught in training. Imagine you have 30 patients on your ward, all of whom are receiving one or maybe even two infusions. In class, you learn that each infusion must be prepared promptly, i.e. the medication must be dissolved in the infusion immediately before administration. You should then go to the patient's room, stand by their bed and then mirror the infusion. Flipping the infusion means that you turn the infusion on and let it run before attaching it to the patient so that the infusion tube is flushed with liquid and no air remains in it. Then attach the infusion.

Now you've done all this and realize that it's quite a time-consuming task. And then you're supposed to do this for all 30 patients? Wouldn't it be much easier and quicker to prepare all the infusions at once, mirror them and then distribute them to the patient rooms? The answer is clearly yes. And that's exactly how it works in nursing practice. This saves an enormous amount of time, which you already have too little of due to a lack of nursing staff.

Blood glucose measurement: change through science

Another reason why many nursing activities look different in practice is that action steps have changed over the years and everyone learns something in a different way. Imagine you have a diabetic on the ward. You have to measure their blood sugar regularly to keep it within the normal range and correct it with insulin or glucose if necessary. The procedure for measuring blood glucose is as follows: first disinfect the patient's finger, leave the disinfectant to work for 30 seconds, then prick the patient's finger with the needle and place a drop of blood on the meter.

First of all, you will see that not everyone observes the 30-second application time, as for some it simply takes too long. In addition, the procedures differ once you have pricked the patient with the needle: Do you have to wipe away the first drop of blood, or can you already put it on the measuring device? I learned in my nursing studies that I can put the first drop of blood on the blade of the measuring device. Other students, on the other hand, were taught that the first drop of blood must be wiped away. These different teaching methods were changed within a year. But why do such procedures change? The reason is scientific studies. Nursing research is concerned with how nursing activities can be carried out most effectively and successfully. If a new, scientifically sound finding is made, then this is taken into account in the curriculum. This allows you to recognize very well in nursing practice how and when someone has learned something.

Central venous catheter (CVC): Routes and lack of material

In addition, long distances and a lack of materials could be reasons for changing processes in order to be able to adhere to the exact theoretical procedure. Let's take a look at connecting and disconnecting infusions from a central venous catheter (CVC). A CVC is an access with a plastic tube that is inserted into a vein in the neck and opens into the superior vena cava. As the CVC provides a direct route to the heart, great care must be taken. The connection to which the infusion is to be attached must remain sterile at all times. In practical lessons, you therefore learn to hold a sterile swab with disinfectant under the connection every time you change the infusion. In practice, sterile swabs are often not available in the patient rooms, which is why nurses carry out the infusion change without holding sterile swabs underneath, as they would otherwise have to keep fetching extra ones. Many justify this by saying that they are very careful and make sure that the connection does not touch anything. Others, on the other hand, learned how to do it without sterile swabs at nursing school.

Non-Touch-Technique: Saving Resources

Furthermore, it may be that many nurses want to save resources, as a lot of material is already being used anyway. For example, when you change a dressing, you learn in class that you need sterile tweezers to clean the wound and apply the sterile swabs to the wound. In nursing practice, the situation is quite different. The so-called "non-touch technique" is used. As the name suggests, this means that the wound is cleaned with the sterile swabs in such a way that no bacteria get in. To do this, the swabs are usually applied to the corners that do not touch the wound anyway. However, the middle of the swabs is still sterile as you have not touched it, so they are placed over the wound and the wound is cleaned. This saves you having to use sterile tweezers when carrying out this activity, which then do not have to be thrown away or reprocessed.

Blood loss: Self-protection vs. habit

Some actions also get sloppier over time. Here I give you the example of taking blood. During your training, you learn that you should tourniquet the vein, palpate it and then decongest it again. Then you disinfect the area where the vein is located and where you want to puncture it. Then you put on gloves, staunch the vein again and prick it to draw blood. If you are in a hospital, you can often see that the nursing staff follow all the steps in this way, but do not put on gloves. In this case, the gloves only serve as self-protection for the caregivers. As many find it inconvenient to put on extra gloves, they simply leave them off. This does not put the patient at a disadvantage, but the caregiver could contaminate their hands with blood.

Patient identification: A constant in care

So is there something that looks exactly the same in theory and in practice? Basically, all care procedures always look the same. Some have been modified over the years, but these have usually only been minor changes, so the basics have always remained the same. One example of this is giving an enema. The basic steps are that you put something lubricating on the intestinal tube, then push it into the anus with slight twisting movements and then push in stool-dissolving liquids, such as Klysmol. This procedure is the same for everyone, but everyone uses it differently. Some use Vaseline for the lubricant, others use a lubricating gel. The only thing that matters here is that it can be inserted into the anus well and without irritation. Everyone can decide individually what to use.

What is also carried out in the same way in every area of care is patient identification before administering a medication. Imagine you are a registered nurse and you administer a medication to your patient, in any form. How do you know for sure that the person in front of you is the right patient? The name, date of birth, time of administration and, in hospitals, the room number are written on every medication that is to be administered. Before administering the medication, ask the patient for their date of birth and first name. This way you can make sure that it is the right person and that there is no mix-up.

Why theory remains important in education

Even if the dynamic everyday life of nursing often requires quick adjustments and not everything can always be done exactly according to the textbook: The theory provides security and an indispensable foundation. It is far more than just dry knowledge; it is your intellectual toolbox that helps you analyze complex situations, informed decisions and Scientifically justifying care. Those who understand the theoretical concepts can critically reflect on their own practice, recognize weaknesses and continuously improve it.

As already quoted, experts emphasize the fundamental importance: "Nursing theories provide a structured basis for nursing action and promote clinical decision-making." (Source: StudySmarter. Nursing Theory: Definition & Orem). This structured basis is crucial to avoid mistakes and ensure patient safety, even when time pressure is high. Theoretical knowledge enables you to assume your responsibility and to make ethically correct decisions - a core aspect of the nursing profession (Learn more about care ethics). It also allows you to quickly grasp new situations and unknown clinical pictures and derive adequate measures instead of just relying on routine or habit. A deep understanding of evidence-based care is key to continuous professionalization and adaptation to new research (What evidence-based care means).

noracares is aware of the importance of sound training and competent nursing staff. As platform where Nurses find suitable jobs (Find jobs here) and speak directly with families to care for their loved ones, we value expertise and transparency. Families can find the qualified caregivers they need here. We support caregivers in making full use of their skills and offer families transparent and fair conditions based on trust and quality. Our goal is to revolutionize the care market and bridge the gap between theory and practice in everyday life by promoting and supporting professional action.

In almost all cases, caregivers can be trusted to do the right thing. Just because two caregivers have a different approach doesn't mean one is wrong or the other is right. As I mentioned earlier, it often depends on how a caregiver has learned the caregiving actions.

Theory is not a luxury - it is the basis for professional care. Even if not everything in everyday life goes exactly as it does in the book, theoretical knowledge helps you to make confident and well-founded decisions. If you are in training, theory helps you to understand. If you are already working, it will help you to reflect and adapt to real-life conditions. Nursing needs heart - and a clear foundation.

If you are still unsure, you can also ask the carer directly why they carry out an activity in this way. The caregiver will then explain their actions to you and explain why they are doing it this way.

All the best, 

Nora

• ABEDLs (activities, relationships and existential experiences of life) -  A care model by Monika Krohwinkel that focuses on the holistic view of the individual.
• Diplomierte Gesundheits- und Krankenpfleger:in - In Austria, the job title for a registered nurse with academic training.
• Evidence-based - Based on scientifically proven facts and study results. In nursing practice, this means justifying actions on the basis of the best available scientific evidence.
• Action checklists - Detailed step-by-step instructions for nursing activities designed to ensure correct and safe procedures.
• Klysmol - A medical preparation used as an enema to empty the bowels or to treat constipation.
• Non-touch technique - A hygiene technique for wound dressings in which the wound and sterile material are not touched directly with non-sterile hands in order to avoid contamination.
• Care research - The scientific field that deals with the investigation and improvement of nursing processes, methods and their effectiveness.
• Nursing Theory -A systematic concept that describes, explains and justifies nursing actions in order to create a scientific basis for nursing practice.
• Care model -A concretized application of a nursing theory that serves as a practical framework for planning, implementing and evaluating nursing care.
• Steril - Free from living microorganisms (bacteria, viruses, fungi, etc.).). Sterile materials are used in care to prevent infections.
• Central venous catheter (CVC) - A catheter that is inserted into a large vein (often in the neck or under the collarbone) and reaches close to the heart. It is used to administer medication, fluids or to measure central blood pressure values.