Contents lists available at ScienceDirect Nurse Education in Practice journal homepage: www.elsevier.com/locate/nepr Review Work-integrated learning as a pedagogical tool to integrate theory and practice in nursing education – An integrative literature review Ina Berndtsson, Elisabeth Dahlborg, Sandra Pennbrant * University West, Department of Health Sciences, Gustava Melins Gata 2, 461 86, Trollhättan, Sweden ABSTRACT It can be challenging for nursing students to navigate between theory and practice and to implement theoretical knowledge in real work situations and vice-versa. Work-integrated learning can support the students by enabling them to combine theoretical studies with practical work experience during their clinical placement. The aim of this integrative literature review was to identify models for the integration of theory and practice during clinical placements in nursing education by using work-integrated learning. Sixteen articles were found and analyzed using an integrative review method. Three themes were identified: 1) Supervisor support to enable students to develop a professional identity 2) Variety of modalities for teaching and 3) Collaboration between academic lecturers and clinical supervisors aimed at integrating theoretical and practical knowledge. Work-integrated learning enables students to integrate theory and practice, develop skills for knowledge-in- practice and prepares them for working life. It also supports the sharing of experiences between various healthcare professionals. This review identified a need for further research on work-integrated learning as a method for enhancing nursing students’ workplace learning. 1. Introduction During the clinical placement, nursing students are given the op- portunity to experience different learning situations in order to in- tegrate practical professional skills with their theoretical knowledge (Rystedt and Gustafsson, 2013). Learning in practice is complex for the nursing students (Lilja Andersson and Edberg, 2012), as they need to navigate between theory and practice in different situations and con- texts. Transferring theoretical knowledge to real-work situations can be complex within educational structures. Work-integrated learning is a pedagogical method that can facilitate the integration of theoretical knowledge in the workplace and provide students with an opportunity to learn from their experiences in both the educational and workplace contexts (Billett and Choy, 2014; Billett et al., 2016). Factors that can determine the students’ degree of learning include their motivation, prior experience and knowledge, as well as appropriate use of learning theory. Other factors can be the curriculum during their theoretical training, the departments at which their practical training takes place and the competence of their supervisors during the clinical placement. Both teachers and supervisors, together with the students, need to identify the “gap” that can exist between theoretical knowledge and practical skills and enable the students to understand it (Lilja Andersson and Edberg, 2012). In order to facilitate the transformation of theore- tical knowledge into practical skills and vice versa, educators need to develop and implement clear models. In this integrative literature review the aim was to identify models for the integration of theory and practice during clinical placements in nursing education by using work-integrated learning. 1.1. Contemporary healthcare systems Several factors place great demands on a nurse's skills in the western world. One factor is that the population has become more hetero- geneous as a result of refugee and labour immigration and another factor is the ageing population (Östlund et al., 2015). Contemporary healthcare systems face growing differences in economic conditions, increasing life expectancy, more advanced medical treatment and de- mands for evidence-based and person-centred care, while hospital stays are becoming shorter for cost efficiency reasons (Bergh et al., 2014). Since the late 20th century, the marketization of society has gradually changed healthcare, leading to a discursive shift where the patient is seen as an active customer and patient involvement is extended and promoted (Dahlborg Lyckhage et al., 2016). Shorter hospital stays often mean that part of the care is delivered by municipal healthcare provi- ders in the patient's home, which places increased demands on the nurse's ability to make decisions and to educate both the patient and her/his relatives (Berg et al., 2014; Dahlborg Lyckhage et al., 2016). These developments call for educational programmes that are designed to prepare nurses for contemporary healthcare systems (Tanner, 2010). https://doi.org/10.1016/j.nepr.2019.102685 Received 14 January 2018; Received in revised form 12 March 2019; Accepted 5 December 2019 * Corresponding author. E-mail addresses: ina.berndtsson@hv.se (I. Berndtsson), elisabeth.dahlborg@hv.se (E. Dahlborg), sandra.pennbrant@hv.se (S. Pennbrant). Nurse Education in Practice 42 (2020) 102685 1471-5953/ © 2019 Elsevier Ltd. All rights reserved. T