Enhancing Nursing Education via Academic-Clinical Partnership: An Integrative Review

This study described the role of academic-clinical partnership in strengthening nursing education. The review highlighted that academic-practice partnerships promote shared goal development for the healthcare system. Academic clinical partnership improves competencies among students and the safety and health outcomes of patients.

Review
Enhancing nursing education via
academiceclinical partnership: An integrative
review
Thokozani Bvumbwe
Mzuzu University, P/Bag 201, Luwinga, Malawi
a r t i c l e i n f o
Article history:
Received 30 May 2016
Accepted 24 July 2016
Available online 1 August 2016
Keywords:
Academic clinical collaboration
Academic clinical partnership
College hospital partnership
Theoryepractice gap
a b s t r a c t
A competent nursing workforce is important for an effective healthcare system. However,
concerns on the poor quality of nursing care and poor competencies among nursing stu-
dents, nurses, and midwives are increasing in Malawi. Anecdotal notes from stakeholders
show shortfalls in nursing education. Furthermore, a large gap between theory and prac-
tice exists. This study described the role of academiceclinical partnership in strengthening
nursing education. A search of ScienceDirect, PubMed, Medline, and PsychINFO on EBC-
SOhost and Google Scholar was conducted using the following key words: academic
eclinical collaboration, academiceclinical partnership, academic practitioner gap, and
college hospital partnership or/and nursing. Furthermore, peer reviewed reports on aca-
demiceclinical partnership in nursing were included in the search. Thirty-three records
from 2002 to 2016 were reviewed. Six themes emerged from the review: mutual and shared
goals, evidence-based practice, resource sharing and collaboration, capacity building,
partnership elements, and challenges of academic clinical partnership. The review high-
lighted that academicepractice partnerships promote shared goal development for the
healthcare system. The gap between theory and practice is reduced by the sharing of
expertise and by increasing evidence-based practice. Academic clinical partnership im-
proves competencies among students and the safety and health outcomes of patients. The
study concluded that the nursing education implemented within an academic clinical
partnership becomes relevant to the needs and demands of the healthcare system.
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j o u r n a lhomepage: h t t p : / / w w w . e l s e v i e r . c o m / j o u r n a l s / i n t e r n a t i o n a l -
j o u r n a l - o f - n u r s i n g - s c i e n c e s / 2 3 5 2 - 0 1 3 2
i n t e r n a t i o n a l j o u r n a l o f n u r s i n g s c i e n c e s 3 ( 2 0 1 6 )3 1 4 e3 2 2

2.2.1. Search process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
4.1. Theme 1: mutual and shared goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
4.2. Theme 2: evidence-based practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
4.3. Theme 3: resource sharing and collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
4.4. Themes 4: capacity building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
4.5. Theme 5: partnership elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
4.6. Theme 6: challenges of academicepractice partnerships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
6. Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
1. Introduction
The Nursing Education Partnership Initiative (NEPI) was
established by the U.S. President's Emergency Plan for AIDS
Relief in response to the key capacity building challenges
facing pre-service nursing and midwifery in Sub-Saharan Af-
rica [1]. In Malawi, NEPI has embarked on numerous activities
such as faculty workforce capacity building, clinical teaching
strengthening support, provision of teaching and learning
resources, and development of model teaching wards at four
public hospitals. The NEPI project has facilitated a number of
consultative sessions between the academe and clinical
practice. One important highlight in the review shows that an
adequate and competent nursing and midwifery workforce is
critical to an effective healthcare system in Malawi, and
nursing education remains a key component of this system.
However, anecdotal notes from stakeholders show shortfalls
in the way graduates are being prepared.
Numerous challenges have been reported on the nursing
education in Malawi [2,3].The growing number of students
being admitted into the nursing programs has resulted in the
overcrowding of students and shortage of clinical sites for
clinical practice, shortage of nurse educators, and insufficient
teaching and learning resources. Increased faculty re-
sponsibility and distance to clinical practice sites have resul-
ted in reduced clinical contact hours for students in most
colleges. The poor or negative attitude of nurses toward stu-
dents has also been reported [4]. The recent licensure exami-
institutions also complained of poor clinical learning environ-
ments. Therefore, the roles of both the academic and clinical
settings in training nursing students cannot be ignored.
A good evidence of effective learning exists when students
are placed in clinical settings that encourage learning during
care delivery. Ensuring the effective preparation of qualified
nursing graduates becomes the responsibility of both the
training institutions and clinical settings [11]. Academic clin-
ical partnership is an important mechanism for strengthening
nursing education, practice, and research. It helps nurses
become well-positioned to lead in change and advance health.
Despite the increasing efforts to bridge the theoryepractice
gap, the lack of formal partnership between academic and
practice leads to disintegrated efforts in the improvement of
nursing education in Malawi. Hope for an improved nursing
education system exists if nurse educators and practitioners
understand and appreciate academiceclinical partnership, its
benefits, elements, and challenges. The findings of the review
reveal a framework that will strengthen academiceclinical
partnerships in nursing education in Malawi.
2. Aims and methods
2.1. Aims
The aim of the integrative review was to describe the role of
academiceclinical partnership in strengthening nursing ed-
i n t e r n a t i o n a l j o u r n a l o f n u r s i n g s c i e n c e s 3 ( 2 0 1 6 )3 1 4 e3 2 2 315

2.2.1.1.Problem identification. The research problem
emanated from a NEPI review process that identified the
insufficient collaboration between academic and practical
settings as a major setback in the training of nurses in Malawi.
The review was guided by the following research question:
what is the role of academiceclinical partnership in
improving nursing education?
2.2.1.2.Literature search.A search of ScienceDirect, PubMed,
stakeholders were individually approached to provide mate-
rials they knew would be relevant, including government
policies, project reports, and progress reports on nursing
education.
2.2.1.3.Data evaluation. Records were evaluated for their
authenticity, methodological quality, and informational
value. Records were initially selected on the basis of their ti-
tles. The abstracts of the selected titles were analyzed to
assess their relevance to the research question. All records
Fig. 1 e Process of review search.
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Table 1 e Summary of records.
Themes Author/s Contribution
Mutual and shared goals Breslin et al., 2011 Communication and development of consensus of common approach
among all partners
Missal, B., Schafer, B.K, Halm,
M.A. & Schaffer, M.A., 2010
Shared goal, collaboration, mutual support, valuing each others'
contribution, shared knowledge and resources
Murray, T.A., Macintyre,
R.C. & Teel, C.S., 2011
Development of academic-service partnership practices to facilitate
successful, sustainable, and replicable partnerships that benefit both
institutions
Hendrix, C.C., Matters, L., West, Y., Stewart,
B., & McConnell, E.S. (2011)
Collaboration should be built on shared goals. Should be deliberately
eliciting and building upon areas of overlap or synergy. Strong shared
governance that could respond flexibly to challenges
Erickson, J. et al., 2011 Shared vision and philosophy, Engagement at all levels
Evidence based practice Missal, B., Schafer, B.K, Halm,
M.A. & Schaffer, M.A., 2010
Nurses used the evidence-based results to improve their practice. The
partnership stimulated action for further inquiry into best practices
McConnell, E.S., Lekan, D., Hebert, C. &
Leatherwood, L., 2007
Demonstrate the feasibility and value of an academic practice
partnership to implement evidence-based approaches to solving
health care problems
Didion, J. et al., 2013 Increase students exposure to one site to appreciate system issues and
effectively work with a stable health care team
Dobalian, A.,Bowman, C.C.,
Wyte-Lake, T.,Pearson,
M.L.,Dougherty, M.B. & Needleman, J., 2014
Actionable guidelines for structuring and implementing effective
academic-practice partnerships that support undergraduate nursing
education
Emanuel, V, Day, K, Diegnan,
L & Pryce-Miller, M, 2010
Nurses are increasingly being challenged to deliver high-quality care
supported by evidence based practice. Evidence based practice within
nursing is achieved by nurse educators by developing and supporting
patient- centered approaches to care
Goosby, E. P. & von Zinkernagel, D, 2014 Investments in curricula, innovative learning technologies, clinical
mentoring, and research opportunities are providing a strong base to
advance high-quality education
Dyess, S.M. & Sherman, R.O. 2009 Continuing education initiatives that can be designed to meet new
graduates transition into practice
Resource sharing
and collaboration
Stuart-Shor, E.M., Anathan,
J.,Jacobsen, L.,Foradori, L.,
Cunningham, E., 2016
Provide urgently needed resources and expertise that improves the
learning environment, with a priority on clinical education enrichment
and health specialties in greatest need
Chan, Chan & Liu, 2012 Understanding of collaboration, shared expertise, partner
commitment, common planning
Fetsch, S.H., & DeBasio, N.O., 2011 Collaborative partnership has enhanced organizational efficiency and
efficacy. It increases transformative impact on both nursing education
and professional practice
Murray, T.A & James, D.C., 2012 Resource sharing to achieve mutual goals
Missal, B., Schafer, B.K, Halm,
M.A. & Schaffer, M.A., 2010
Collaboration, mutual support, shared knowledge and resources
(continued on next page)
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Table 1 e (continued )
Themes Author/s Contribution
Capacity building Stuart-Shor, E.M., Anathan, J, Jacobsen, L,
Foradori, L & Cunningham, E., 2016
Intentional pairing of the US/African nurse educators, emphasis on
faculty supervised clinical instruction
Niederhauser, V., Schoessler,
M., Magnussen, L.,
Gubrud-Howe, P.M. & Codier, E, 2011
Capacity for nursing students to maximize scarce resources. Ability for
practicing nurses in health care settings to assist with educating
nursing students
Einterz, R.M., Kimaiyo, S., Mengech,
H.N.K, Khwa-Otsyula,
B.O., Esamai, F., Quigley, F. &
Mamlin, J.J., 2007
Increased capacity of the clinical setting to reach more people on HIV/
AIDS treatment
Schinka G., 2013 Team building valuing the contribution of each member 's efforts, trust,
knowledge sharing and rapport
Middleton, L et al., 2015 Addressing the shortage of highly qualified faculty, and for remedying
the inadequate teaching and learning infrastructure. Equipping
clinical staff to teach students
Tache, S., Kaaya, E., Omer, S.,
Mkony, CA., Lyamuya,
E., Pallangyo, K., Debas, HT. &
MacFarlane, SB, 2008
Quality education and continuing professional development
opportunities for the healthcare workforce
Bartz, C. & Dean-Baar, S., 2003 Students in the partnership have a unique opportunity for learning the
art and science of nursing in a complex, integrated health care system
with a strong emphasis on quality of environment, providers, and care
delivery
Slattery, M.J., Logan, B.L., Mudge, B., Secore,
K., von Reyn, L.J., & Maue, R.A., 2016
Students'exposure to multiple advanced practice roles influenced
their career goals. Clinically based mentors promote the scientific
foundation for nursing practice. Capacity of clinical mentors was
enhanced by collaborating with students
Jeffs, D., & Brown, L. 2014 Partnership built with goals of advancing nurses'academic education
and preparing the future nursing workforce
Taylor, M.A., Brammer, J.D.,
Cameron, M. & Perrin, C.A, 2014
Partnerships achieve student engagement, clinical leadership and
increased capacity
El Ansari, W., Phillips, C.J. &
Zwi, A.B., 2002
Programme models need to consciously incorporate in their design
and implementation, capacity building, skills transfer and
empowerment strategies
Elements of effective
partnerships
Beal et al., 2011, Partnership should be based on mutual goals and shared vision,
mutual investment, commitment to the relationship - trust, and
respect, open and free communication, frequent contact and
engagement
Brush, B., Baiardi, J.M. & Lapides, S, 2011 Developing strategies that promote trust and equalize power dynamics
Jukkala et al., 2013 On-going dialogue, collaboration, shared knowledge, mutual support
and faculty guidance
El Ansari, Ceri J. & Phillips, W., 2001 Working relationships, attention to structural and operational
dimensions
Didion, J. et al., 2013 Trust and communication, resource sharing, faculty coordination
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themes, variations, and relationships. Conclusions were
then drawn from the data.
3. Results
The search conducted yielded a total of 240 records: 65 re-
cords were obtained from the EBSCOhost database, 79 from
ScienceDirect, 35 from PubMed, and 61 from Google Scholar.
Thirty-three records addressed the academiceclinical part-
nership in healthcare worker training and were finally
included in the review. A total of 25 records were reported in
developed countries, 6 from Sub-Saharan Africa, and 2 from
the rest of Africa (Fig. 1).
Five themes emerged from the review, namely, mutual
and shared goals, evidence-based practice, resource sharing
and collaboration, capacity building, partnership elements,
and challenges of academiceclinical partnership (Table 1).
4. Discussion
This integrative review has attempted to synthesize other
relevant published works on academiceclinical partnership
in nursing and recommend a framework for nursing educa-
tion in Malawi. The findings revealed that nursing education
outcomes can be improved when a collaborative imple-
mentation of nursing education exists between the academe
and clinical practice. Students are engaged in a learning
environment that has a common goal toward quality patient
care, improved health outcomes, and strong health systems.
The findings show that in poor resource settings, such as
Malawi, a collaborative approach to the training of nurses
maximizes the use of both material and human resources.
The results also indicated the need for a deliberate effort to
establish a conducive environment for effective partnership
that includes shared vision, joint planning, open communi-
cation, trust, respect, and commitment. The review also
revealed that academiceclinical partnerships face many
challenges. Some partnerships can be built on unclear terms,
rigid agreements, poor sharing of resources, lack of mutual
support, and commitment among partners.
4.1. Theme 1: mutual and shared goals
Nursing is a vital component of the healthcare system. An
Beal et al., 2011, Culture crush, lack of time and resources, poor leadership
Beal et al., 2012 Low training institution capacity because of insufficient number of
faculty, limited clinical sites
Jeffries, P. et al., 2013 Mixed reactions among clinical partners, concerns for investment in
students, Resistance about an aggressive timeline, lack of collaborative
planning. Poor faculty support, shortage of staff, duo roles on part of
clinical staff resulted in burn out
DeBourgh, G., 2012 Poor partners commitment in teaching student resulting into medical
errors, patient harm, lack of clarified professional actions
Laitila, A. & Rekola, L., 2014 Benefits only one partner, rigid agreements, tight schedules, not clear
partnership terms, uncoordinated cooperation. Shortage of staff, lack
of management commitment and support, lack of time to participate
in the partnership, inadequate preparation, negative attitudes
Brush, B., Baiardi, J.M. & Lapides, S, 2011 Partnerships often struggle with fundamental issues that affect
sustainability, effectiveness, and efficiency.
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that the training of nurses should be a shared responsibility.
Globally, the healthcare system is becoming increasingly
complex and its demands for adequate and quality nursing
services are increasing. An approach that advances mutual
and shared interests is now needed more than before to
improve the overall health of Malawians as envisioned in the
national health strategic plan. Therefore, an academ-
icepractice partnership can be best understood from the
perspective where the academic and practice players come
together and work collaboratively for a common goal [18]. The
implementation of shared goals should involve specific re-
sponsibilities for educators, hospital administrators, students,
and nurse practitioners through a systems approach [19]. An
academiceclinical partnership should be designed on the
basis of mutual understanding and shared goal to ensure a
responsive health system that has positive health outcomes.
4.2. Theme 2: evidence-based practice
Nurses are on the frontline of healthcare and have a unique
opportunity to improve patient care through evidence-based
practice. Evidence-based practice requires decisions on
healthcare based on the best available, current, valid, and
relevant evidence. Goosby and von Zinkernagel [20] high-
lighted that academiceclinical partnerships form a strong
foundation for the planning and delivery of evidence-based
health services. The review studies show that academ-
icepractice partnerships promote focus on evidence-based
practice and enhance the learning culture [17,19].
The shortage of staff, inadequate knowledge of nurses on
evidence-based practice, and lack of resources and time in
Malawi evidently hinder the use of evidence-based knowledge
to improve nursing care. Therefore, collaboration is important
where partners recognize that theory and practice are equally
important and are two parts of the same agenda. Partnerships
create research opportunities for faculty and clinical
personnel, thereby improving evidence-based healthcare.
4.3. Theme 3: resource sharing and collaboration
Records of the review indicate that academiceclinical part-
nerships provide an opportunity for partners to share re-
sources. With the growing number of students being enrolled
in nursing programs in Malawi, the need for a synergetic use
of resources exists. Students in Malawi traditionally rotate
between blocks of theory and practice sessions, which come
dependent on the preparation and willingness of practice
partners. Jukkala et al. [22] reported that a new innovative
program on clinical nurse leadership was successful because
partners shared knowledge and expertise.
4.4. Themes 4: capacity building
Academiceclinical partnership provides an opportunity for
the capacity building of stakeholders both in academia and
practice. The capacity of clinical mentors to engage in
research improves when the mentors work with students.
Similarly, the exposure of students to multiple advanced
clinical roles influences their career goals. Nursing education
programs need to incorporate capacity building, skills trans-
fer, and empowerment strategies consciously in their design
and implementation to ensure positive training outcomes [23].
The practice setting provides a positive learning environ-
ment for students to acquire the skills and competence
needed to provide nursing care [24]. Middleton et al. [1] indi-
cated that partnerships can help address the shortage of
highly qualified faculty, and remedy the inadequate teaching
and learning infrastructure. Crabtree et al. [25] support that
academicepractice partnership accords partners an opportu-
nity to participate in the development of scholarly products,
which results in professional growth and development.
4.5. Theme 5: partnership elements
Communication among partners and developing consensus
for common strategies to address issues are key for the
advancement of the academicepractice partnership [26].
Nurses' attitudes toward students improve when partnerships
are developed via open lines of communication [27].
Respectful interaction among partners is important when
sharing diverse views and expertise. The majority of records
indicate that partnerships were built on common values, in-
terests, respect, and mutual trust [28]. This finding implies
that a relationship that is built on common understanding
and mutual support ensures maximum benefits.
The current clinical preceptorship and mentorship pro-
grams need to be implemented via a formalized academ-
icepractice partnership that enhances collaboration at
implementation levels. Ongoing dialogue between partners
widens ideals and contributions toward successful in-
terventions or programs [22]. Appropriate communication,
trust, collegiality, openness, respect, and mutual support are
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4.6. Theme 6: challenges of academicepractice
partnerships
Health program implementation in many countries, particu-
larly poor resource countries, appears to be fragmented
[30,31]. Most programs are designed as vertical programs with
no provision for expansion and sustainability and with little
integration with local health systems. Individual partners in
academic and practice institutions should develop links into
academicepractice partnership. Findings from the review
reveal that some partnerships have limited awareness among
partners, which represses growth. If other healthcare pro-
fessionals are excluded from the partnership, they would
likely provide poor support [22,32]. Formal information
sharing sessions are important to obtain the support of other
healthcare professionals. Experience shows that academic
members are highly regarded in terms of status. Often times,
other partners tend to be passive in collaborative programs.
This might also be true where knowledge levels are different
[19].Therefore, partners should deliberately share informa-
tion regarding their roles within the partnership.
The need for multiple stakeholders in partnerships has
shown to cause cultural crash among partners in some in-
stances [26,28]. Each academic and practice partners has set
values and priorities. The shared understanding and setting of
mutual goals strengthens the need to collaborate in strategy
implementation. However, H€aggman-Laitila and Rekola [33]
indicated that rigid agreements, tight schedules, unclear
partnership terms, and uncoordinated cooperation affect the
effectiveness and sustainability of partnerships.
The severe shortage of nurse educators and nursing
personnel in practice fuels feelings of role straining among
nurses in initiatives like these, thus resulting in burn out [34].
High expectations among partners in an academicepractice
partnership often exist [22]. Mutual setting of targets is
necessary to ensure that partners move at the same wave
length. Building partnerships requires a slow, incremental
frequent, and deliberate interaction that regularly reviews
progress [17]. Various partnerships have emerged and others
have disappeared because of poor sustainability strategies. An
academicepractice partnership should institute a credible
committee that meets regularly with proper succession plans.
This objective requires a strong and committed leadership to
monitor mutual goals and strategic contributions and to use
resources effectively [35].
nurses. The concept of theoryepractice gap is a byproduct of
factors in both the educational and clinical settings. Therefore,
partners should strive to sustain and support the survival of an
academicepractice partnership that fosters collaboration,
shared goals, resources, and partner commitment. The review
recommends partnerships that promote sharing of resources
and expertise, and facilitates innovation to improve the quality
and relevance of nursing. The poor or absence of effective
academicepractice partnerships results in the clinical staff
neglecting students because of poor staff attitude toward stu-
dents. Academic clinical partnership in Malawi will ensure an
establishment of a good clinical learning environment where
theory and practice complement each other.
Funding
This work was part of the doctorate studies funded by ICAP
Columbia University through NEPI. The manuscript writing
workshop was funded by The University of KwaZulu-Natal
Health Sciences Research Office.
Acknowledgments
The author expresses gratitude to Prof. Moses Chimbiri and
Prof. Benn Sartorius for a mentorship workshop on manu-
script writing.
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