Mortell Manfred
Adult Cardiac Surgical Intensive Care Unit, King Abdulaziz Cardiac Center, Riyadh, Kingdom of Suadi Arabia.
Br J Nurs. 2012;21(17):1011-4. doi: 10.12968/bjon.2012.21.17.1011.
Practice is usually based on tradition, rituals and outdated information; there is often an additional gap between theoretical knowledge and its application in practice. This theory-practice gap has long existed (Allmark, 1995; Hewison et al, 1996). It often arises when theory is ignored because it is seen as idealistic and impractical, even if it is practical and beneficial. Most research relating to the lack of integration between theory and practice has concluded that environmental factors are responsible and will affect learning and practice outcomes. The author believes an additional dimension of ethics is required to bridge the gap between theory and practice. This would be a moral obligation to ensure theory and practice are integrated. To implement new practices effectively, healthcare practitioners must deem these practices worthwhile and relevant to their role. This introduces a new concept that the author calls the theory-practice-ethics gap. This theory-practice-ethics gap must be considered when examining some of the unacceptable outcomes in healthcare practice (Mortell, 2009). The literature suggests that there is a crisis of ethics where theory and practice integrate, and practitioners are failing to fulfil their duty as providers of healthcare and as patient advocates. This article examines the theory-practice-ethics gap when applied to hand hygiene. Non-compliance exists in hand hygiene among practitioners, which may increase patient mortality and morbidity rates, and raise healthcare costs. Infection prevention and control programmes to improve hand hygiene among staff include: ongoing education and training; easy access to facilities such as wash basins; antiseptic/alcohol handgels that are convenient, effective, and skin- and user-friendly; and organisational recognition and support for clinicians in hand washing and handgel practices. Yet these all appear to have failed to achieve the required and desired compliance in hand hygiene.
实践通常基于传统、惯例和过时的信息；理论知识与其在实践中的应用之间往往还存在差距。这种理论与实践的差距长期存在（奥尔马克，1995年；休伊森等人，1996年）。当理论被忽视时，这种差距常常出现，因为理论被视为理想主义和不切实际的，即便它是实用且有益的。大多数关于理论与实践缺乏整合的研究得出结论，环境因素是造成这种情况的原因，并且会影响学习和实践结果。作者认为需要一个额外的伦理维度来弥合理论与实践之间的差距。这将是一项道德义务，以确保理论与实践相结合。为了有效地实施新的实践，医疗从业者必须认为这些实践是有价值的，并且与他们的角色相关。这引入了一个作者称之为理论 - 实践 - 伦理差距的新概念。在审视医疗实践中一些不可接受的结果时，必须考虑这种理论 - 实践 - 伦理差距（莫特尔，2009年）。文献表明，在理论与实践相结合的地方存在伦理危机，从业者未能履行其作为医疗服务提供者和患者倡导者的职责。本文探讨了应用于手部卫生时的理论 - 实践 - 伦理差距。从业者手部卫生存在不依从现象，这可能会增加患者的死亡率和发病率，并提高医疗成本。提高工作人员手部卫生水平的感染预防与控制计划包括：持续的教育和培训；方便使用诸如洗手盆等设施；方便、有效、对皮肤和使用者友好的抗菌/酒精洗手液；以及组织对手部清洗和使用洗手液实践中的临床医生的认可和支持。然而，这些措施似乎都未能在手部卫生方面达到所需的和期望的依从性。
