Results

In total, 422 undergraduate nursing students participated in the study, where most were female (82.7%, n = 349) and nearly half were aged 23–27 years (49.3%, n = 208). Most participants were assigned to teaching hospitals (86.7%, n = 366), whereas 13.3% (n = 56) practiced in non-teaching hospitals. The majority of students were placed in maternity wards (39.3%, n = 166) (Table 1).

Variables | Frequency | %
Age category |  | 
18–22 years | 208 | 49.3
23–27 years | 207 | 49
≥28 years | 7 | 1.7
Sex |  | 
Male | 73 | 17.3
Female | 349 | 82.7
Types of hospital |  | 
Teaching hospital | 366 | 86.7
Non-teaching hospital | 56 | 13.3
Types of wards |  | 
Surgical ward | 20 | 4.7
Maternity ward | 166 | 39.3
Medical ward | 84 | 19.9
Emergency ward | 84 | 19.9
Pediatric ward | 68 | 16.1

Almost all participants (99.1%, n = 418) reported the existence of a theory–practice gap. The overall mean score for the theory–practice gap was 3.6, and only 0.9% (n = 4) scored below the mean (Figure 1). In terms of institutional factors, the mean score for provision of theoretical teaching was 3.2, and 94.1% (n = 397) of participants scored above the mean. In addition, 41.2% (n = 174) agreed that their institution provided adequate learning resources, whereas 14.0% (n = 59) disagreed (Table 2). In terms of instructor-related factors, 27.5% (n = 117) reported inadequate communication between theoretical and clinical instructors, whereas 26.5% (n = 112) disagreed. Furthermore, 38.2% (n = 161) of clinical practice was not fully consistent with classroom learning (Table 3).

Figure 1: Showing level of theory and practice teaching gap of study participants at west and south west shoa higher teaching institution, 2024.

Question |  | SDA | DA | N | A | SA | Mean | Standard deviation
Does the college provide educational opportunities and sources of self-learning such as the internet or a library? | Freq. | 24 | 59 | 83 | 174 | 82 | 3.54 | 1.22
% | 5.7 | 14 | 19.7 | 41.2 | 19.4
Are the classroom and labs appropriate and equipped with audio and visual aids, and lab supplies? | Freq. | 26 | 75 | 125 | 112 | 84 | 3.4 | 1.2
% | 6.2 | 17.8 | 29.6 | 26.5 | 19.9
Is the college developing your learning skills such as communication and discussion? | Freq. | 26 | 75 | 125 | 112 | 84 | 3.4 | 1.2
% | 6.2 | 17.8 | 29.6 | 26.5 | 19.9
Is the college working with you to promote and develop your self-confidence? | Freq. | 47 | 111 | 82 | 135 | 47 | 3.05 | 1.21
% | 11.1 | 26.3 | 19.4 | 32 | 11.1
Is the college making you aware of the legal and ethical standards of the profession? | Freq. | 76 | 72 | 82 | 142 | 50 | 3.04 | 1.31
% | 18 | 17.1 | 19.4 | 33.6 | 11.8
Does the simulation lab help you to develop a deeper understanding of being a nurse? | Freq. | 72 | 135 | 78 | 112 | 25 | 2.72 | 1.2
% | 17.1 | 32 | 18.5 | 26.5 | 5.9
Do you have sufficient time in theory and practical lectures? | Freq. | 23 | 132 | 82 | 126 | 59 | 3.2 | 1.2
% | 5.5 | 31.3 | 19.4 | 29.9 | 14

Question |  | SDA | DA | N | A | SA | Mean | Standard deviation
There is a lack of communication between theoretical teachers and clinical teachers | Freq. | 80 | 112 | 83 | 116 | 31 | 2.8 | 1.24
% | 19 | 26.5 | 19.7 | 27.5 | 7.3 |  | 
Instructors do not consider differences between students | Freq. | 43 | 106 | 70 | 122 | 81 | 3.2 | 1.3
% | 10.2 | 25.1 | 16.6 | 28.9 | 19.2 |  | 
When you practice in the ward, do you feel that we do not apply all that we learn in theoretical class? | Freq. | 11 | 41 | 135 | 132 | 103 | 3.7 | 1.03
% | 2.6 | 9.7 | 32 | 31.3 | 24.4 |  | 
Does your clinical instructor have poor communication with you when you practice in hospital? | Freq. | 2 | 60 | 101 | 156 | 103 | 3.7 | 1.005
% | 0.5 | 14.2 | 23.9 | 37 | 24.4 |  | 
Does the training in the practice class continue what you had already learned in the theoretical class? | Freq. | 24 | 88 | 95 | 161 | 54 | 3.32 | 1.11
% | 5.7 | 20.9 | 22.5 | 38.2 | 12.8 |  | 

According to multivariate logistic regression analysis, type of hospital was significantly associated with the theory–practice gap. Students assigned to non-teaching hospitals were 2.83 times more likely to experience a theory–practice gap compared with those in teaching hospitals (adjusted odds ratio = 2.829; 95% confidence interval: 1.428–5.602; p = 0.003). The qualitative findings identified two main themes: university/college focus on theoretical teaching and university/college focus on clinical teaching (Table 4). Participants described variability in teaching approaches, curriculum imbalance, limited institutional collaboration, inadequate clinical preparation, and challenges applying theoretical knowledge in clinical settings. They also reported limited educator involvement in clinical environments and gaps in coordination between academic and hospital settings (see Table 5).

Major theme | Sub-themes | Analytic codes
University focus on theoretical teaching | Students' satisfaction with theoretical learning | Perceived satisfaction, indirect evaluation, lack of feedback, workload, motivation
 | Instructors' teaching experience | Active learning methods, limited training, reliance on lecture
 | Importance of courses | Core vs. supportive courses, curriculum balance
 | Curriculum relevance and need for modification | Missing content, imbalance, ongoing revision
 | Training and implementation of problem-based learning | Student-centered learning, institutional support, time limitations

Major theme | Sub-themes | Analytic codes
University/college focus on clinical or hospital teaching | First experience in clinical teaching | Initial fear, emotional adjustment, ethical challenge, transition to practice
 | Institutional disconnection and resource constraints | University–hospital gap, limited resources, restricted educator role
 | Lack of clinical preparedness and support | Inadequate preparation, reliance on prior experience, self-directed learning
The theory–practice gap
– | The theory–practice gap | Knowledge–practice mismatch, curriculum misalignment, poor integration
 | Educator roles and professional identity | Underutilized expertise, weakened identity, need for collaboration