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Authors

  1. Alexander, Susan DNP, ANP-BC, ADM-BC

Article Content

Doctor of nursing practice (DNP) programs continue to proliferate, preparing more and more students in the use of research to influence practice for a variety of healthcare settings and populations. An estimated 264 DNP programs presently exist in 48 states, including the District of Columbia, enrolling a total of 18 352 students in 2014 Nursing.1 The purpose of the DNP degree was described in 2006 by the American Association of Colleges of Nursing (AACN) as a practice-based doctorate that prepares individuals to be leaders in many areas of practice, including interdisciplinary care, quality improvement, patient safety, and use of information systems. The DNP degree is now widely viewed as the terminal degree for the practicing nurse, and it is important that there is uniformity about the content of DNP educational programs, and how DNP graduates are prepared to function in the current environment of healthcare.2 Although often positive, change may be accompanied by confusion. In an effort to better describe the characteristics of DNP scholarship, the AACN released a report from the Task Force on the Implementation of the DNP in August 2015. The report contains useful information for DNP faculty and administrators, as it expands upon recommendations for DNP program curricula, practice, and collaborative partnership guidelines described originally in the 2006 Essentials of Doctoral Education for Advanced Nursing Practice.3

 

CHARACTERISTICS OF DNP PROGRAMS

Generation of Knowledge. The distinction between research-and practice-focused doctoral programs is clarified in the report from the Task Force.3 While DNP projects have traditionally been associated with the translation, application, and evaluation of scientific knowledge, the AACN Task Force acknowledges that graduates of DNP programs may also be prepared to generate new knowledge by methodologies different from those found in research-based programs. These methodologies include practice change efforts, evidence translation, and implementation of quality improvement processes for specific populations. Such methodologies have the potential to create a positive impact for patients with multiple disorders. Integration of evidence-based guidelines from the US Department of Health and Human Services "Million Hearts" initiative as a DNP-led quality improvement project in a primary care practice resulted in achievement of the project's primary objective: more than 80% of adults documenting self-management goals for healthy eating, physical activity, tobacco cessation, and others (P = .008).4

 

The AACN Task Force states that while new knowledge gained from DNP scholarship activities may be transferable, it should not be considered generalizable, as is knowledge yielded from the traditional research doctorate, yet translational research also has value in the larger healthcare environment. Projects such as the one conducted by Davison4 serve as an example of the type of scholarly service, which is needed in healthcare today: the scholarship of application. This is a dynamic process in which "[horizontal ellipsis]new intellectual understandings can arise out of the very act of application[horizontal ellipsis] In activities such as these, theory and practice vitally interact, and one renews the other."5(p574) Doctor of nursing practice projects arise from the need to address questions that stem from practice and have the potential to facilitate change at many levels of the healthcare environment. The need for advanced practice nurses who are able to translate and apply research to the clinical setting is underscored in the Task Force report, which goes on to state that differences in knowledge generation, between practice- and research-based doctorates, should not be viewed in a hierarchical relationship.3 The skills of DNP- and doctor of philosophy (PhD)-prepared nurses are complementary, and collaborative efforts between these 2 disciplines should be encouraged. A recent partnership between a DNP and PhD yielded multiple publications in the field of transplant science.6-9

 

DNP Projects. In response to the continued growth of DNP programs, the AACN realizes the need for clarification of the components of the final project that exhibits the DNP student's achievements in clinical scholarship. The DNP project is the mechanism for evaluating the student's growth in clinical knowledge and expertise; it synthesizes clinical and classroom learning experiences to demonstrate achievement of both program competencies and the Essentials of DNP Education outlined by the AACN. The Task Force offers a set of recommendations on titling of the project, components for inclusion, faculty participation, dissemination, and long-term storage of the projects.3

 

Although many names have been used to label the student's culminating assignment of the DNP program, including titles such as "practice dissertation" or "capstone project," the Task Force proposes that the title of "DNP project" be adopted in all DNP programs in order to distinguish the project from other research-based doctorates.3 The Task Force reassures DNP faculty that while all 8 DNP Essentials do not need to be validated in the DNP project, each project should include key components that are evidence of the student's achievements in the scholarship of translation (Table). The Task Force further states its findings that integrative and systematic reviews and portfolios are not sufficient to fulfill the requirements of the DNP projects and should not be considered as such.3

  
Table. Key Component... - Click to enlarge in new windowTable. Key Components of All DNP Projects

Other changes suggested by the Task Force for DNP faculty include replacement of the term "committee" with "DNP project team"; this change is needed to better distinguish the traditional dissertation committee used in the PhD program with the DNP faculty and clinical mentors who work with DNP students. In constructing a DNP project team, DNP faculty should consider the need for academic rigor, application to practice, significance to the healthcare setting, and opportunities for dissemination. At a minimum, teams should consist of 1 doctorally prepared faculty member and a practice mentor who may be external to the university setting. Stakeholders and peers, along with faculty, may be needed for adequate assessment of the final DNP project in the academic setting.

 

Dissemination of DNP Project Results. Dissemination of the knowledge gained from DNP projects is of vital importance to the rapidly changing arena of today's healthcare. Multiple avenues have been acknowledged by the Task Force as appropriate for dissemination of DNP project results, in lieu of, or in addition to acceptance by a peer-reviewed journal or poster/podium presentation. With the common theme being presentation of results to a community beyond the student's personal academic setting or DNP project team members, the Task Force proposes multiple examples of opportunities for dissemination including written or verbal summary presentation to stakeholders, publication in a nonrefereed lay publication, publication of digital poster, and presentation for a public or professional site (eg, social media, the public, or a professional seminar).3

 

Scholarly practice projects can serve as an important mechanism of fostering future scholarship in students who possess a great fund of clinical knowledge, but may lack experience in techniques needed to disseminate that knowledge to the professional community. As students prepare to disseminate outcomes of DNP projects, it is important to consider the differences that delineate DNP scholarly practice projects and the traditional dissertation associated with PhD program. These differences are apparent in the design, conduct, and dissemination of the DNP project results. To ensure the greatest impact, DNP faculty should work closely with students to identify the venue that is the best match for the project population and outcomes.

 

The key to selection of the appropriate channel for dissemination of project results stems from understanding the differences in the accepted methods of research and the emerging evidence-based and quality improvement projects associated with translational science. Presenting a manuscript recounting a quality improvement or practice-change project, in the format of a research project, to a journal that publishes biomedical research reports has been cited as a source of confusion for editors.10 Inaccurate manuscript submission is likely to result in rejection of the manuscript and may lead to disappointment and dismay for the student, who then may be unwilling to resubmit to other journals. In 2012, after reviewing many quality improvement and performance evaluation manuscripts, the editors of the Journal of Obstetrics, Gynecological, and Neonatal Nursing decided that these article types had merit in the practice arena and were of interest to their readership. Articles of those types are now published in the "Principles and Practice" section.11

 

Poster sessions are an additional method of disseminating project outcomes identified by the Task Force. Many opportunities for exhibition of both digital and print posters exist at local, regional, and national levels. Content of posters should reflect key components of the DNP project, in a visually attractive manner. Students may need guidance in creating posters with appropriate content and visual impact. Universities may require certain elements, such as logos, headers, or taglines, to be included on their student poster submissions. It is important for faculty to help students remember that those who view posters may remember only one key point about a poster that they have viewed; thus, in creating a poster, it is necessary to consider their potential audience and the value that could be derived from viewing it.12 Live poster sessions may offer students multiple chances to discuss aspects of scholarly projects individually or in small groups of session attendees, presenting an added chance for professional networking. The Task Force advises that faculty in DNP programs locate a durable digital repository for maintenance of DNP projects. While universities may have their own digital storage systems, students may also choose Web-based storage for their final project manuscripts.13 On the Web page doctorsofnursingpractice.org, DNP students are encouraged to upload abstracts and contact information for their projects.

 

CONTINUED DEVELOPMENT OF DNP PROGRAMS

Variation in DNP Programs. The AACN Task Force report acknowledges the variations that continue to exist in length of DNP programs, available resources, and curricular design and notes the importance of demonstrating evidence of achievement and that "[horizontal ellipsis]graduates are meeting the outcome expectations outlined in the DNP Essentials."3(p9) Mapping of the DNP Essentials into the curriculum and incorporation into student learning objectives is needed for students to demonstrate progress. The use of strategies such as DNP student portfolios can help students to reflect on their progress, while being an important tool for use in accreditation purposes.

 

The Task Force encourages the development of new and innovative models designed to use academic resources more efficiently for the benefit of students and faculty in DNP programs. The use of scholarly writing or statistical analysis teams for the support of DNP students, composed by interprofessional university faculty, are 2 of the suggestions proposed by the Task Force in Appendix B of the report.

 

Faculty Development. The importance of faculty development cannot be overlooked as DNP programs continue to grow. To improve the design and delivery of DNP programs, faculty are likely to need further development in curricular design, teaching methodologies, and practice opportunities that can be used to support the learning outcomes identified in the DNP Essentials.3 Doctor of nursing practice-prepared faculty are likely to require further preparation in the role of nurse educator, if their programs of study did not include specific instruction in the educator role.

 

To help DNP faculty better understand requirements for DNP student education, the report from the Task Force more clearly defines practice experiences, practice hours, and collaborative partnerships. Doctor of nursing practice faculty are reminded of the requirement for DNP students to complete a minimum of 1000 postbaccalaureate practice hours as part of an academic program. All students must complete the supervised practice hours, including those in leadership and health policy positions. The report states that practice hours spent in master's nursing programs may be counted as postbaccalaureate hours, but should be verified by transcript review from the student's master's program and documentation of national certification. The Task Force also states that schools may credit practice hours to a post-master's degree DNP student who holds current national certification and has a minimum of a graduate degree. Practice as a nurse educator in the academic setting should not be included as DNP practice hours.3 Faculty are also encouraged to review the principles for collaborative partnerships within their DNP programs and to consider expanding their academic-practice partnerships, encompassing areas of high need and potential value for the student.

 

Healthcare is changing rapidly, and the need for highly trained clinicians in the practice environment will continue to expand. With a unique skill set, the DNP-prepared nurse is well prepared to create a positive impact in the healthcare arena. Ensuring consistency and uniformity in DNP programs will reinforce value of this highly trained change agent to the wider healthcare community. Partnering with DNP students in the preparation, implementation, and dissemination of innovative DNP projects offers faculty members an exciting opportunity to work with an emerging group of healthcare leaders.

 

References

 

1. DNP Fact Sheet [press release]. American Association of the Colleges of Nursing 2015. http://www.aacn.nche.edu/media-relations/fact-sheets/dnp. Accessed November 4, 2015. [Context Link]

 

2. Reid Ponte P, Nicholas PK. Addressing the confusion related to DNS, DNSc, and DSN degrees, with lessons for the nursing profession. J Nurs Scholarsh. 2015; 47( 4): 347-353. [Context Link]

 

3. American Association of Colleges of Nursing. The doctor of nursing practice: current issues and clarifying recommendations report from the Task Force on the Implementation of the DNP. 2015. http://www.aacn.nche.edu/aacn-publications/white-papers/DNP-Implementation-TF-Re. Accessed August 26, 2015. [Context Link]

 

4. Davison JA. Hypertension self-management support in primary care: a DNP quality improvement project and a charge for leadership and advocacy with the Million Hearts. Tar Heel Nurse. 2015; 77( 5): 14-16. [Context Link]

 

5. Boyer EL. Chapter 2: enlarging the perspective. Special Report. Princeton, NJ: The Carnegie Foundation for the Advancement of Teaching; 1990 [reprinted with permission from Boyer EL, Scholarship Reconsidered: Priorities of the Professoriate. Also reprinted courtesy of The Boyer Center, Messiah College, Grantham, PA]. Phys Ther. 2004; 84( 6): 571-575. [Context Link]

 

6. Alexander S, Hoy H, Maskey M, Conover H, Gamble J, Fraley A. Initiating collaboration among organ transplant professionals through Web portals and mobile applications. Online J Issues Nurs. 2013; 18( 2): 7. [Context Link]

 

7. Hoy H, Alexander S, Frith KH. Effect of transplant education on nurses' attitudes toward organ donation and plans to work with transplant patients. Prog Transplant. 2011; 21( 4): 317-321. [Context Link]

 

8. Hoy H, Alexander S, Payne J, Zavala E. The role of advanced practice nurses in transplant center staffing. Prog Transplant. 2011; 21( 4): 294-298. [Context Link]

 

9. Hoy HM, Feurer ID, Alexander S, Loyd J, Wells N, Pinson CW. Negative effects of pretransplant body mass index on physical health-related quality of life after lung transplant. Prog Transplant. 2012; 22( 4): 363-368. [Context Link]

 

10. Records K. Differentiating the generation of knowledge from the application of knowledge. J Obstet Gynecol Neonatal Nurs. 2014; 43( 4): 399-400. [Context Link]

 

11. Cook PF, Lowe NK. Differentiating the scientific endeavors of research, program evaluation, and quality improvement studies. J Obstet Gynecol Neonatal Nurs. 2012; 41( 1): 1-3. [Context Link]

 

12. Christenbery TL, Latham TG. Creating effective scholarly posters: a guide for DNP students. J Am Assoc Nurse Pract. 2013; 25( 1): 16-23. [Context Link]

 

13. O'Dell D. Doctors of nursing practice. 2015. http://www.doctorsofnursingpractice.org. Accessed October 4, 2015. [Context Link]