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Nurs Outlook 64 (2016) 61e70
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Profession at the crossroads: A dialog concerning the preparation of nursing scholars and leaders Pamela June Grace, RN, PhD, FAAN*, Danny G. Willis, RN, DNS, Sr. Callista Roy, RN, PhD, FAAN, Dorothy A. Jones, RN, EdD, FAAN William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467
article info
abstract
Article history: Received 14 July 2015 Revised 28 September 2015 Accepted 4 October 2015 Available online 22 October 2015
The purpose of a practice discipline’s terminal degree is to develop wise scholars to guide the profession in anticipating and meeting the health-related needs of those served via philosophical, conceptual/theoretical, and empirical inquiry on behalf of professional practice. Each of these dimensions is important for the discipline’s ability to meet its obligations to society. However, contemporary circumstances have created a context within which the maturation of the profession may be threatened by an imbalance among the three dimensions of PhD education. Specifically, we discuss the possibility of a tilt toward the empirical at the expense of the other two. Yet, the philosophical and conceptual/theoretical dimensions are those that have permitted core disciplinary knowledge to be developed. We aim to create a dialog about current challenges and the responsibilities of the discipline’s scholars for stewardship of the discipline and offer some strategies to ensure balance among the three equally important dimensions.
Keywords: Nursing scholarship Disciplinary stewards PhD curricula Nursing inquiry Moral imperative
Cite this article: Grace, P. J., Willis, D. G., Roy, S.. C., & Jones, D. A. (2016, FEBRUARY). Profession at the crossroads: A dialog concerning the preparation of nursing scholars and leaders. Nursing Outlook, 64(1), 61-70. http://dx.doi.org/10.1016/j.outlook.2015.10.002.
In this article, we document our recognition that there is an urgent social responsibility to promote the optimal development of nurse scholars and leaders who will work to improve individual and societal health through an explicit grounding in the discipline of nursing. Moreover, we argue that the goal of preparing exemplary scholars is consistent with the goals of nursing and a moral imperative for the discipline. Our purpose was to raise the consciousness of nursing’s scholars and leaders about our future as a discipline, the dangers we are facing due to lack of clarity around purpose, and our responsibilities as disciplinary stewards. For the discussion, we rely on Donaldson and Crowley (1978)
definition of a professional discipline as “embod(ying) a knowledge base relevant to all realms of professional practice and which links the past, present and future” (p. 117). This broad definition, although subject to contemporary refinements, remains relevant. We contend with the notion of “core disciplinary knowledge,” and its meaning and significance in the ongoing development of disciplinary scholars as recommended by Thorne (2014). In line with these notions, viewing the scope of the discipline’s knowledge interests broadly facilitates the profession’s visionary actions and current practices and permits the profession’s evolution in response to change and future developments in health care.
* Corresponding author: Pamela June Grace, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467 E-mail address: [email protected] (P.J. Grace). 0029-6554/$ - see front matter Ó 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.outlook.2015.10.002
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For the purpose of clarity, a discipline, then, is inextricably related to the profession as a practice and can be distinguished as the body of knowledge that underpins the profession’s actions and guides future growth. The shifting social, political, economic, and environmental contexts of contemporary health care influence service professions and their contributions in a variety of ways. We explore the nature of contemporary influences on the development of the discipline’s scholars and emerging scholars. An ongoing dialog and the development of strategies are needed to influence nursing’s preferred future, one that balances the philosophical, conceptual/theoretical, and empirical aspects of nursing’s disciplinary knowledge development (Fawcett & De Santo-Madeya, 2013) to optimally meet the profession’s goals. We propose ways to anticipate and balance the weighty effects that current funding initiatives and their priorities can have on PhD nursing curricula and on what should be considered the full range of nursing inquiry to advance the discipline, nursing knowledge development, and nursing as nursing practice. Finally, we offer some strategies to ensure that nursing’s scholars are able to advance the discipline. What is needed is a secure grounding in philosophies of nursing science, the possession of appropriate research and collaboration skills, and the ability and motivation to critique the political, socioeconomic, and ethical environments within which practice occurs and evidence is used.
Background The future of nursing as a discipline is at a dramatic crossroads. The direction proposed by our scholars and leaders at this point in time must be carefully mapped as it will influence the future of nursing as a discipline and profession. Key to the profession continuing to meet its social commitments related to promoting human health and well-being and relieving suffering is how we conceptualize and implement nursing PhD education, its foundations, purposes, and characteristics. Both PhD and practice doctorates can be thought of as terminal degrees in nursing; however, our focus in this article was on the development of disciplinary scholars and researchers grounded in pluralistic nursing philosophies, conceptual models, and theories which has been the purview of nursing PhD programs. Both historical developments and contemporary circumstances have helped to create a context within which the current maturation of “nursing as nursing” practice, science, and knowledge development is threatened. Thorne (2014) has recently argued that without clarity on what constitutes core disciplinary knowledge, we are at risk of losing our identity,
especially within the context of the current focus on interdisciplinarity. According to Fawcett (2007), “nursing qua nursing practice is based on unique nursing knowledge rather than knowledge developed by members of other disciplines. Unique nursing knowledge is evident in the many conceptual models of nursing, [and] the more than 50 middle-range theories .” (p. 98). In agreement with Fawcett and Thorne, our perspective is that disciplinary knowledge, and nursing inquiry in general, differs substantively from knowledge developed by other disciplines. We concede that nurses, like the scholars of other disciplines, have successfully shared and adapted knowledge and theories to meet their unique disciplinary goals. Nevertheless, the challenge remains that we need to bring concepts, theories, or knowledge from other disciplines into alignment with, and to be informed by, nursing’s goals and practice environments. We affirm that, then, nursing inquiry results in the development of disciplinary knowledge and is explicitly rooted in the philosophies and nursing philosophies that give, and have given, rise to the epistemological structure of the discipline. Nursing inquiry addresses nursing’s foci of concern, as discussed in more depth shortly, and results in substantive areas of disciplinary knowledge development that are framed within nursing’s purposes, goals and perspectives, conceptual models, and theories. We offer as one example the many middlerange theories (practice oriented) derived from Roy’s model of the human as an adaptive system developed, tested, and refined for nursing practice. In sum, we grant that many nurses who conduct research that is not explicitly based on nursing perspectives, as defined previously, may well be serving the human good, but it is questionable whether such research will contribute to the development of unique nursing knowledge, thus the discipline. Failure to pay attention to this distinction between nurses who undertake research that is not explicitly based on nursing and nurses engaged in nursing knowledge development risks the discipline and the profession. Our concern is that the balance can easily tip toward the former, nurses who undertake research that is not explicitly disciplinary based to the detriment of disciplinary development. The opportunities to advance the discipline through research and funding from external sources have provided for the development and refinement of certain types of knowledge. However, this same precious resource, the existence of funding sources, can detour us away from pursuing other important forms of disciplinary inquiry. Specifically, our concern is to ensure an ongoing focus on illuminating, studying, and explicating the discipline’s phenomena of concern from the point of view of nursing’s unique foci and perspectives. This emphasis is crucial to the continuing existence of the profession (Thorne, 2014).
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Preferred Qualities of Disciplinary Scholars The profession needs to develop well-rounded scholars who have a depth of understanding about substantive areas of nursing inquiry and who are also committed to the discipline’s mission of improving nursing and health care for, and the health of, all. We do not see these two characteristics as mutually exclusive. Such scholars are able to fluidly move up and down the ladder of abstraction from concepts to the design of empirical research, including quasi-experimental and experimental inquiries, and also engage in emancipatory scholarship and historical and philosophical inquiry. They will be capable of asking conceptual questions and be motivated to determine and critique conceptual and theoretical linkages among research areas of inquiry, discipline-relevant questions, and underlying assumptions about appropriate aims, research approaches, and specific methods capable of extending existing knowledge and generating new inquiry. As Thorne (2016) critiques, a review of the current status of nursing’s multiple research designs reveals that “the qualitative nursing research community has traditionally been more hesitant than has been the case in some other disciplines to bend and shape its study designs to more effectively fit its disciplinary objectives” (p. 159). Recently, in exploring evidence-based practice, she has focused on making sense of qualitative research and the scope and limits of its usefulness in the evidence-based practice framework. However, she is concerned that contemporarily many of nursing’s inquiries whether qualitative, quantitative, or mixed methods fail to account for the core epistemological foundations of the discipline and asserts “it seems time to return to the idea that the core epistemological structure can and should scaffold” (p. 159) our empirical nursing inquiries. The study of the content of U.S. Nursing PhD program curricula by Wyman and Henley (2015) seems to point to the unchanging nature of nursing PhD curricular courses with most programs including theory and philosophy courses. Their critique includes the finding that “there was little evidence of innovation in educational approach” (p. 396) which can be seen as a problem of nursing not moving with the times. Although we do believe that the inclusion of courses in philosophy and theory development is necessary, they are not sufficient to develop disciplinary scholars who consistently incorporate philosophical critique and theory into their studies and scholarship, especially when there are many opposing pressures. We agree that creative approaches to PhD education are important to open the door for new ways of thinking and revised pathways to care. Furthermore, if we rely on the notion of “nursing qua nursing” (Fawcett, 2007; Watson, 1997), then nursing inquiries likewise should be grounded in nursing’s knowledge and epistemological structure as exemplified in nursing’s many
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conceptual frameworks and theories including middle range and situation specific.
Contemporary Challenges and the Development of the Disciplinary Perspective In many countries around the world, nursing has continued to mature as evidenced in the growth of disciplinary scholarship and PhD programs in nursing. Over the course of several decades, this growth has been infused with ongoing dialogue about nursing’s central concerns, foci, theoretical development and evolution, and future directions for knowledge development (Meleis, 2012). Historically, many of the international nurse scholars educated within the United States have returned to their countries of origin to influence and lead PhD nursing education in their settings. For many, the challenge remains how to manage the tension between the preparation of nurses who can design and conduct research projects and nurses who will explore, uncover, and expand nursing science in the interests of enhancing the lives of humans globally. PhD nursing education continues to occur within the context of complex social, political, and economic conditions that inform and shape the future of core disciplinary knowledge and its potential to influence the health of society. From a nursing perspective, present day conditions can have both positive and negative influences on individual and societal health. For example, burgeoning biotechnological/biomedical advances have improved the quality and quantity of life for many but have also led to questions about when and how they should be used and the meanings of their use for individual persons. Increased funding has permitted leaps in knowledge development but can also distort the motives of scientists and scholars who need the funding for personal and professional advancement (Kassirer, 2007; Mintz, Savage, & Carter, 2010). The negative influences may be so subtle and insinuating that we fail to notice them until it is too late (Rolfe, 2013). Ongoing mindfulness and vigilance are needed on the part of nurse scholars and leaders about those conditions that are most likely to fulfill or obstruct nursing’s goals. These dispositions are critical for the advancement of the discipline and promotion of health and social justice. Recognition of emerging problematic conditions and motivation to mediate those conditions that are detrimental to achieving nursing’s purposes are both needed. Therefore, as we move to craft innovation, refinement, and realignment in PhD nursing education, it is essential that we prepare the discipline’s scholars to think more broadly about the demands and needs of the changing health care environment and society at large. Tracing the development of the nursing discipline to its current situation, among other contextual factors, facilitates our understanding that the
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profession has an evaluative and a practical goal (Meleis, 2012). We must continually question how likely it is that our knowledge and theoretical development activities will serve our professional goals related to promoting a human good rather than the objectives of other interested parties. These dual purposes allow us to understand both current movements in nursing PhD education and how realignment in nursing PhD curricula can be designed as necessary to ensure that nursing goals continue to provide an anchor for the work of emerging scholars and leaders. Having an anchor in nursing goals is especially relevant in the context of current pressures to engage in interdisciplinary research endeavors. It is our view that interdisciplinary endeavors can be useful, even critical, for addressing complex multifaceted social and health-related problems. However, by definition to engage in interdisciplinary work presupposes a strong sense of one’s own discipline and its particular contributions.
Challenges The historical movement of nursing education into academic settings and the subsequent development of higher education for nurses including PhD education are self-evidently good for the profession and its goals. Higher level thinking and questioning are needed to develop knowledge that specifically addresses nursing’s phenomena of concern. In turn, this necessitates acceptance that there is substantive disciplinary knowledge. However, some have argued that economic pressures including market forces and corporatization (Kassirer, 2007; Miller & Bellamy, 2012; Petrovskaya, McDonald, & McIntyre, 2011; Woodhouse, 2009) have had a constricting effect on the freedom of faculty, including nursing faculty to pursue disciplinary goals. That is, scholars may be hindered by such pressures from focusing on the development of disciplinary knowledge and scholarship in the broadest sense (Mintz et al., 2010; Readings, 1996; Rolfe, 2013; Woodhouse, 2009). Paradoxically, the availability of research funding has also been seen as a contributing factor to the changing face of academic settings generally within contemporary political and economic contexts (Rolfe, 2013; Schuster & Finkelstein, 2006; Woodhouse, 2009) narrowing the scope of academic inquiry in a variety of disciplines and is, arguably, having a spillover effect on nursing PhD curricula. Although we were unable to find published evidence to support our suspicions that an emphasis on the substance of the discipline is diminishing in nursing PhD programs, we have collective experiences as four faculty involved in PhD education. During the past 3 years, we have participated in the interview process for numerous faculty candidates from at least 10 of the more highly ranked Nursing PhD programs, less than a quarter of these were able to clearly articulate in what sense their research was aligned with nursing goals and perspectives.
Over the past few decades, the implementation of PhD programs in nursing has continued to proliferate, influenced by the perseverance of nurse leaders who recognized the importance of disciplinary substance and the potential for nursing knowledge to impact the health of society. For many early leaders in nursing, access to PhD study was by route of other disciplines due to the limited availability of doctoral programs in nursing (Rodgers, 2005). These nurse leaders, then, used their own experiences and education to pave the way for the development of additional higher level education programs specifically for nurses. As the profession’s visionaries, they understood that the development of nurse scholars informed with disciplinary substance infused the discipline with a clear perspective about its nature. This was essential in generating wisdom about, and knowledge for, disciplinary purposes in the interests of individual and societal good. Academics were aware of the need to expand, refine, test, and generate knowledge for the discipline. Knowledge development aimed to inform practice, guide care and raise questions, and generate new knowledge for the future. The appropriate education of future nurses depended on this view of knowledge development.
Substantive Nursing Knowledge: The Core of the Discipline From the rich literature on knowledge development in nursing, we highlight here the core of the discipline, its boundaries, and relationship to other disciplines. An early literature review by Donaldson and Crowley (1978) identified general themes of inquiry for nursing. The authors’ work indicated that the goal of nursing was affecting positive changes in health status by understanding the principles and laws that govern life processes, well-being, and optimum functioning of human beingsdsick or well and the patterning of human behavior in interaction with the environment in critical life situations. By the early 1980s, a number of nursing scholars identified a growing consensus that the phenomena of the science of nursing were person, health, environment, and nursing which became known as the metaparadigm concepts of nursing (Fawcett & De Santo-Madeya, 2013). Over several decades, the phenomena of concern to nurses were clarified largely due to efforts to create, use, and test nursing theory (McEwen & Wills, 2014). Each major theorist provided a nursing perspective on persons and their health in interaction with the environment and specific goals for nursing. Pluralism in theory led to efforts to provide an updated focus for the discipline. Walker and Avant (1988) proposed four conceptual foci of nursing phenomena for nursing inquiry: health behavior and health status, stress and coping, developmental and health-related transitions, and person-environment
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interactions. Focusing on clients and their health was recognized as the areas of overlap among the health care disciplines. More recently, the perspectives taken on persons and the goal related to the health of persons have facilitated providing the unique disciplinary perspective of nursing. In 1991, Newman et al. published a focus of the discipline of nursing which built on earlier nursing scholarship to submit that the domain of inquiry of nursing is “caring in the human health experience” (Newman, Sime, & Corcoran-Perry, 1991). Since then, Newman’s ideas have been revisited (Newman, Smith, Pharris, & Jones, 2008), refined, and reified in the assertion that the “caring, knowing presence of the nurse taps into what is meaningful for the patient” (2008, E16). This focus regardless of underlying philosophical assumptions permits the unification of nursing practice, thus also knowledge development, across settings and countries. The articulation of a central unifying focus for the discipline by Willis, Grace, and Roy (2008) has been recognized (Meleis, 2012; Walker & Avant, 2011) as providing a disciplinary perspective that accommodates many philosophical perspectives. This clarifying statement transcends any one theoretical model to address the essential nature of the discipline. The view of person and goal of nursing are provided in the statement that the unifying focus of the discipline is facilitating humanization, meaning, choice, quality of life, and healing in living and dying. For nurses, persons are “relational, experiential, valuable, respectworthy, meaning-oriented, flawed, imperfect, vulnerable, fragile, complex, and capable of health and healing even if not capable of being cured” (E34). Nurses promote health as “the embodiment of wholeness and integrity in living and dying” (E35). The preparation of nurse scholars who can articulate their research interests within the disciplinary perspective will contribute to nursing knowledge that is useful for nurses in practice and for nurses to contribute to multidisciplinary changes in health care.
Emerging Challenges More recently, Chinn (2014) draws our attention to the fact that “over the years, nursing’s theoretical and philosophic heritage has been discounted, even deleted from nursing curricula in favor of content deemed to be more essential” (p. 1). Knowledge advancements are beneficial but not when compartmentalized and isolated from the substance of the discipline and its vital building blocks. Based on insights from a nascent but growing body of literature and our observations as faculty involved in PhD education, we highlight five factors requiring immediate attention and vigilance. These factors include the following: 1) content linked to the teaching and immersion within the perspectives, concepts, and theories of the discipline is at risk of being subjugated to other priorities (Kneipp, Canales, Fahrenwald, & Taylor, 2007);
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2) an increase in PhD programs in nursing that seem less firmly rooted in nursing’s basic ontology or central foci of concern than previously (observations from an unpublished review of PhD program websites); 3) emerging disciplinary scholars who cannot clearly and substantively articulate the nursing perspective foreboding a failure to do so when engaged in interdisciplinary collaborations and with implications for nursing science, education, and practice; 4) a focus on the role preparation of practitioners and scholars which can detract from emphasizing the importance of developing a science and using core disciplinary knowledge; and 5) pressures to focus inquiry toward fundable research questions sometimes at the expense of expanding and refining fundamental disciplinary knowledge (Broome, 2013; Mintz et al., 2010; Petrovskaya et al., 2011). These factors are examples of current concerns that will affect and direct nursing’s focus related to research, practice innovations, and policy initiatives as we move into an uncertain precarious future.
Maintaining a Disciplinary Focus: External Distracting Influences There are strong reasons to believe also that the availability of funding for empirical research increasingly drives the questions that faculty and doctoral students ask and seek to answer. As we listen to the dialog in a variety of venues, funding appears to be becoming the driving force of PhD nursing education, tilting the balance at times among the philosophical, conceptual/theoretical, and empirical structure of nursing knowledge (Fawcett & De Santo-Madeya, 2013) toward the empirical. We are neither arguing that the availability of substantial funding is inherently bad for the discipline nor that the idea of interdisciplinary study is unimportant for realizing nursing goals. It is critical however that funding or other sorts of support are also available for disciplinary scholars to critique, evaluate, and advance forms of inquiry that contribute to the substance of the discipline in a fluid environment that may not necessarily align easily with highpriority research areas of various funding bodies. It is also vital, as noted earlier, that one knows one’s own discipline before engaging in interdisciplinary work. A full range of inquiry and in-depth grounding in the discipline of nursing, as defined above, is crucial to the project of meeting the health needs of individuals and society.
Exclusionary Bias We are concerned about balance and exclusionary biases. By exclusionary biases, we mean the
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marginalization of philosophical and conceptual scholarship that advances the discipline as discipline and does not necessarily require major funding. A lack of emphasis on the formation of scholars who are steeped in the varied lenses of nursing philosophy, core knowledge of the discipline, including its conceptual models and theories (middle range and situation specific), mutes or silences nursing’s voice and threatens the disciplinary perspective in the classroom and in collaborative endeavors. This loss of disciplinary perspective, in turn, has implications for the populations we serve. The emerging nurse scholar’s ability to articulate the goals of nursing and hold a nursing perspective on the problem at issue in both disciplinary and interdisciplinary contexts is crucial. Well-rounded scholars are needed to ensure that the discipline’s moral imperative to meet its goals for individuals and society (American Nurses Association [ANA], 2010; ANA, 2015; International Council for Nurses [ICN], 2012) is realized. Furthermore, without these broader, analytic, and critical skills, scholars may not recognize which funding priorities ought to be supported and which challenged as not likely to further disciplinary knowledge development and the profession’s goals. As part of the publics who will contribute to setting priorities, we need to depend on our emerging scholars to have these skills. This emerging shift in priorities for nursing PhD education creates a situation in which scholars may design questions to align with funding availability at the expense of asking other important questions that may not be as fundable. In the process, PhD education becomes slanted toward learning how to achieve funding at the expense of developing critical evaluative skills. The loss of critical analytic skills in turn traps the researcher into the funding wheel.
The Influence of Funding for Research Contemporarily, in the so called “research intensive” institutionsdthose that typically are charged with overseeing a discipline’s terminal research degreed the acquisition of funding brings acclaim to the institution and provides resources both for the university administration and scholars. In the United States, colleges and schools of nursing are ranked, in part, on their ability to bring in education and research funding from federal sources, including the National Institutes of Health. When what is fundable drives the discipline’s scholarly activities, there is a danger that substantive disciplinary questions grounded in nursing’s conceptual and theoretical understandings of disciplinary goals and ways to meet these, will be neglected. Worse approaches using emancipatory perspectives and philosophical or critical inquiry to uncover knowledge not only are disvalued but also are marginalized as not contributing to the “excellence” of the university (Rolfe, 2013).
When important areas for research to advance the discipline, especially a young one like nursing, are not pursued because they are not fundable, it becomes difficult to discern what the object of “excellence” is. That is, one is left in ignorance about the meaning of “excel”? Do students seek to work with scholars who are known for their excellence in an area of important nursing inquiry or do they only seek out those faculty that have funding? Or, are the two taken uncritically as being synonymous? The potential exists that this increasing ambiguity about a university’s focus makes us vulnerable to a vicious circle of molding questions to fit funding priorities or nondisciplinary ideals of excellence, whether these are the ones nurses are most passionate about or have relevance for advancing nursing as nursing or most affect our practice populations. The risk exists that obtaining funding becomes the driving force within the academy at the expense of contributions to the advancement of nursing knowledge overall. When a constricted focus on funding and fundable research questions develops or predominates within an academic institutiondPhD curricula will be reviewed, revised, and validated based on the overvaluing of funding and research skills in relation to other important aspects of nursing’s disciplinary substance and a diverse range of nursing inquiry. We are concerned that soon it will be only by accident that well-rounded nursing scholars are prepared to answer fundamental questions of the discipline or who can lead disciplinary and interdisciplinary dialogue (Evans, 2012; Mintz et al., 2010; Woodhouse, 2009). How we think about PhD education, then, and its impact on society becomes an ethical issue for the discipline to address. It is linked to consensus around the goals of the nursing related to human health and the disciplinary knowledge needed to further those goals. Nursing remains what Windt (1989) defines as a critical service profession. Critical service professions are those without which the society would not function well. The profession exists under a social sanction and serves a societal need (ANA, 2010; Grace, 2014; ICN, 2012) but what if it can no longer do this? Vital to anticipating and addressing the broader concerns of individuals and populations is our ability to maintain a “big picture” perspective on the scope of our charge from society. Funded research can address, and lead to the amelioration of, some of the health challenges facing people, but without a critical stance regarding what and who is fundable, who determines appropriate questions in nursing science, and which modes of inquiry are valued and most appropriate to address a wide range of nursing concerns and phenomena, the discipline is both blinkered and subjected to the influence of money and the market that becomes the sponsor for its direction (Kassirer, 2007; Petrovskaya et al., 2011; Rolfe, 2013; Schroeder, 2003; Woodhouse, 2009). Can our PhD scholars effectively steward the discipline if we all become thus blinkered?
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Achieving Balance: A Need for Action This is a time of reckoning in the discipline. It is critical at this point in nursing’s history that we seek to achieve balance among the philosophical, conceptual/ theoretical, and empirical aspects of PhD education. Each dimension is important for the discipline’s ability to meet its obligations to society. We have to continue the dialogue about nursing’s foci and core disciplinary knowledge at the PhD level. Disciplinary scholars need to be steeped in the knowledge of the discipline and learn about multiple approaches to knowledge development. Insights traditionally developed as part of nursing PhD education are needed including science, reason, logic, problem solving, research methods, and philosophical analysis. Historically, the evolution of professional nursing and its position within the academy was not dependent on funding. Rather, it was emerged from nurse scholars’ commitment to understanding and furthering the goals of the discipline and its conceptual and theoretical development, which included empirical approaches. This commitment to multiple approaches to inquiry meant that funding was only one vehicle for knowledge development.
Empirical Incursion: The Marginalization of Critical Inquiry We interpret this emerging shift away from nursing’s traditional approach to knowledge development for disciplinary purposes, as the empirical incursion or in popular parlance “creep.” By empirical creep, we mean the increasing tendency to overvalue the achievement of research funding for data-based inquiry as the marker of scholarly distinction and the subtle and sometimes not so subtle edging out of respect for other modes of critical inquiry that advance the disciplinary perspective on human health and well-being. Thus, empirical creep can negatively influence how the other two dimensions of the three dimensional goal of nursing doctoral education, wisdom about the discipline and addressing practice questions, are viewed in terms of a hierarchy of importance. Although the impact of empirical creep on academic goals and values is a problem in other practice disciplines, nursing is, arguably, more vulnerable to dissolution because of its current stage of development as a discipline and lack of unity among its scholars and educators around the central foci and substantive knowledge of the discipline. Because practice professions exist to serve the individual and social good (Grace, 1998, 2001), there is a moral obligation to include in knowledge development multiple forms of knowing the human condition. Constriction on what is considered valid or sound knowledge truncates critical appraisal and can limit how one sees and responds to human needs. To be clear, we are not denigrating the need for empirical investigations or funding to assist
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with this. The authors have all engaged in both philosophical and empirical inquiries and have received competitive funding for their research and scholarly projects. The development of research skills is critically important for disciplinary scholars and ultimately nursing’s goal. Our concern is for balance among the three dimensions of nursing scholarship.
Raising the Alarm As noted, we ground our position in the moral imperative for the profession to hold true to its philosophical, theoretical, and practice goals. In analyzing the current situation, it is clear that we cannot ignore the relationship between contemporary movements within the profession and movements within the broader sociopolitical context that influence academia and the directions of knowledge development. The discipline needs to prepare scholars who are both skilled researchersdusing a broad understanding of what constitutes research (Grace & Perry, 2013)dand critical thinkers who predicate their inquiries on disciplinary goals and purposes. A unified understanding of nursing’s purposes and substance is a link to the philosophical and theoretical perspectives of the discipline as they have historically developed, including the evolution of practice theories. Reliance on these perspectives permits critical evaluation of assumptions, contexts, and influences underlying human health experiences. Such understandings lead to valid nursing questions and the use of the most appropriate methods to address them and permitting innovation in addressing fluid environments and overcoming obstacles. Although it is beyond the scope of this article to provide an in-depth discussion of the effects of market forces on academic institutions and academic freedoms, others have written extensively on this topic (Kneipp et al., 2007; Schreker, 1986, 2010; Woodhouse, 2009). Certainly, for the nursing profession, an important aspect of academic freedom is that it permits scholars to pursue knowledge that furthers the discipline’s goals. Although this seems a common-sense proposition increasingly, there are economic and other forces that work against the freedom to determine nursing’s preferred future. If we view a discipline as Dewey (1976) did, that is, as a scientific association that would “solidify and reinforce otherwise scattered and casual (individual) efforts” (Vol. 2, p. 56) toward a particular purpose, then we must claim the autonomy to do so and resist opposing forces.
Strategies and Recommendations As described previously, critical vigilance is needed to continue the development of nursing’s knowledge for the purposes of nursing practice and the good of society in the face of opposing forces. Contemporarily,
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epistemological concerns in nursing should be focused on understanding the ways in which the central foci of the discipline are known, communicated, tested, revised, extended, refined, enacted in practice, and inserted into multidisciplinary health policy. This is a moral imperative for the discipline related to providing a good for the individuals and the society it exists to serve. Gaining a deeper understanding of the discipline, its nature and responsibilities are the surest path to knowledge development and are in line with nursing goals. This project self-evidently requires clarity of purpose and the use of diverse modes of inquiry. All modes of inquiry, empirical, not directly empirical and nonempirical, are important for achieving balance, scope, and effectiveness. The motivation and capacity to question the status quo are all critical skills of a scholar. These cannot be lost if the discipline is to continue to develop and fulfill its social mandate to optimize health and well-being (Erickson, Jones, & Ditomassi, 2013; Grace & Willis, 2012; Newman et al., 2008; Willis et al., 2008; Willis & Griffith, 2010). Threats to PhD education within the framework of empirical discovery are embedded in myopic understandings about what constitute the full range of valid methods or modes of discovery and inquiry. Without being challenged, these truncated understandings can potentially compromise both the development of the scholar and the advancement of nursing science. Ultimately, the reason for the being of nursing, clinical practice, will be affected. Acknowledging these threats permits the development of strategies to anticipate and restrain them. They must be managed in order for nursing’s distinct goals, and perspectives on human health and flourishing, to remain visible in the increasingly interdisciplinary settings of contemporary knowledge development for health care.
Honoring the PastdEnvisioning the Future: Adumbrations of Nursing PhD Curricula It is critical that Nursing PhD curricula of the future is mapped from the phenomena of concern, central unifying foci, and is responsive to the profession’s social mandate. Those educated at the PhD level are the scholars, leaders, and educators of the future; their appropriate education is the surest way to ensure the discipline’s ongoing ability to anticipate and meet the health needs of people and society. Recognition of changing conditions within the context of environment and the contemporary world calls for a transformative approach to preparing scholars for the future. Mindfulness that contemporary circumstances may work against accepting broad perspectives on what constitutes sound knowledge development for disciplinary circumstances is warranted. We noted earlier that as a result of the work of nurse leaders and visionary scholars, the curriculum structure of PhD
programs in nursingdin the United States and elsewheredhad been built around a three part goal that was expected to result in well-rounded scholars. These scholars were prepared to generate, develop, test, and refine knowledge for the discipline’s practice through inquiry (American Association of Colleges of Nursing [AACN], 2001; McEwen & Bechtel, 2000). Changing times require a remapping of our vision for PhD education but do not necessarily mean that traditional aims of this type of education are now irrelevant. Indeed, they are more relevant than ever. Several aims are discernible in the literature as critically related to the optimal development of nurse scholars. The first aim was to gain an in-depth historic understanding of the goals and perspectives of the discipline. The second aim was to promote inquiry around an underexplored area related to an emerging scholar’s practice to develop knowledge that would address nursing goals. The third aim was to foster education that would facilitate the acquisition of academic and research acumen for emerging nurse scholars to further generate, test, and refine knowledge to inform and advance the profession in behalf of those served (AACN, 2001; Roy & Jones, 2007). In addition, just as disciplinary leaders were the catalysts for developing PhD educational programs, a fourth and critically important aim for the future is the development of new visionary disciplinary leaders responsive to the emerging health and social challenges. Such leaders are needed to advance nursing knowledge and practice through critical inquiry, empirical research, discovery, and application. Although this approach has stood the test of time, we have reason to worry that these aims are not always as clearly followed as previously. The discipline can become side tracked, resulting in the loss of mission and purpose. We need to stop, take stock, get clear on direction, and intentionally advance in light of this fuller model of nursing PhD education. It is essential that this more comprehensive perspective prevails and results in an innovative model of PhD nursing education that is responsive to the needs of human beings and the changing dynamics of the world. In Table 1, we offer some strategies for redirection related to PhD education and ultimately the course of the discipline. The strategies are predicated on the discipline of nursing and the goals of nursing as providing the essential foundation for all nursing activities including knowledge development. Nurses at all levels will be taught based on the substantive knowledge of the discipline and its purposes and perspectives, including ways to deal with the questions and problems appropriate for nurses to solve. Nurses’ collaborative endeavors will use nursing’s perspective as an important addition to those brought by other disciplines. Nurses will be skilled in critiquing the socialepolitical climate and how it affects nursing questions. They will recognize the importance and place of knowledge derived from other disciplines and filtered through the discipline with careful attention to
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Table 1 e Strategic Aims of Nursing PhD Programs 1. All nurse clinicians, educators, and scientists possess a foundational understanding of nursing goals and purposes. These goals and purposes are described in the central focus and mission of the discipline (ANA, 2015; ICN, 2012; Willis et al., 2008). 2. Assuring that all nursing curricula are grounded in the ethical imperative of the discipline to further its goals related to promoting a good for individuals and society (ANA, 2015; ICN, 2012). 3. Preparing a diverse faculty including scholars who are skilled in developing critical thinkers. 4. Preparing the discipline’s emerging scholars to understand which questions and problems are appropriate for the profession to solve and which are best methods for solving them. 5. Ensuring that emerging and seasoned scholars grasp the importance of including nursing’s perspective in interdisciplinary collaborations and use such collaborations to strengthen the profession’s capacity for resolving nursing problems. 6. Nurse scholars understand the importance and place of knowledge and theories developed within other disciplines but used in the service of nursing goals and perspectives on health and well-being. 7. Nurse scholars and clinicians acknowledge the increasingly global nature of nursing work and are prepared accordingly. 8. Nurse scholars can critically evaluate the benefits and potential limitations associated with funding sources and judiciously use these to address health problems. 9. Nurse scholars and leaders are prepared to critically evaluate the environments within which knowledge development occurs for their congruence with nursing and health care goals. 10. Nurse scholars understand their roles and responsibilities to influence policies and decisions that impact nursing populations, including funding initiatives. 11. Nurse scholars are responsive to the changing environment of health care including anticipating and accounting for the implications of biotechnological advances for human health.
a nursing lens in the service of nursing goals for health and human flourishing. Nurses will have key roles in impacting funding initiatives for the good of populations.
Conclusion Nursing practice is grounded in relationships with those who need our services. Nursing has historically focused on human responses to health and illness challenges and the meanings these challenges hold for individuals and the society. PhD education in nursing is about the search for tentative “truths” that can further the well-being of individuals. This process of knowledge development should be a continuous, mutual, and iterative one. Nursing inquiry raises questions that emerge from practice and seek to
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extend or refine existing knowledge and generate new knowledge. The generation of new knowledge that is responsive to individuals and fluid environments, shapes practice, informs health care policy, and promotes the common good is a critical task of disciplinary scholars. The future of the discipline depends on appropriately prepared scholars. PhD students become the profession’s leadersdthey are our future. We cannot afford to allow narrowed perspectives on knowledge development to become the norm. We are aware that there are many barriers ahead for nursing, and for other health care professions, and a commitment to anticipate and move aside road blocks is needed by nursing’s scholars and educators. A moral imperative exists to continue to strengthen the profession’s ability to meet its goals and continue to serve individual and social good. If our ideas open a dialogue about to what extent our arguments are sound and what can be done, we will have achieved our purposes in articulating our concerns.
references
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Grace, P. J., & Perry, D. J. (2013). Philosophical inquiry and the goals of nursing: a critical approach for knowledge development and action. Advances in Nursing Science, 36(2), 64e79. Grace, P. J., & Willis, D. G. (2012). Nursing responsibilities and social justice: An analysis in support of disciplinary goals. Nursing Outlook, 60(4), 198e207. International Council of Nurses (ICN). (2012). The ICN code of ethics for nurses. Geneva, CH: Author. Retreived from. http://www. icn.ch/images/stories/documents/about/icncode_english.pdf. Kassirer, J. (2007). Commercialism and medicine: An overview. Cambridge Quarterly of Healthcare Ethics, 16, 377e386. http://dx. doi.org/10.1017/S0963180107070478. Kneipp, S. M., Canales, M. K., Fahrenwald, M., & Taylor, J. Y. (2007). Academic freedom protecting “liberal science” in nursing in the 21st Century. Advances in Nursing Science, 30(1), 3e13. McEwen, M., & Bechtel, G. A. (2000). Characteristics of nursing doctoral programs in the United States. Journal of Professional Nursing, 16(5), 282e292. McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.) Philadelphia, PA: Walters Kluwer: Lippincott, Williams and Wilkins. Meleis, A. I. (2012). Theoretical nursing: Development and progress (5th ed.) Philadelphia, PA: Walters Kluwer Health: Lippincott, Williams and Wilkins. Miller, K. S., & Bellamy, R. (2012). Fine print, restrictive grants, and academic freedom. American Association of University Professors; Academe, Washington, DC. Retrieved from http:// www.aaup.org/article/fine-print-restrictive-grants-andacademic-freedom#.VBtReZRdUrU. Mintz, S., Savage, A., & Carter, R. (2010). Commercialism and universities: An ethical analysis. Journal of Academic Ethics, 8, 1e19. Newman, M. A., Sime, A. M., & Corcoran-Perry, S. A. (1991). The focus of the discipline of nursing. Advances in Nursing Science, 14(1), 1e6. Newman, M. A., Smith, M. C., Pharris, M. D., & Jones, D. (2008). The focus of the discipline revisited. Advances in Nursing Science, 31(1), E16eE27. http://dx.doi.org/10.1097/01.ANS. 0000311533.65941.f1. Petrovskaya, O., McDonald, C., & McIntyre, M. (2011). Dialectic of the university: A critique of instrumental reason in graduate nursing education. Nursing Philosophy, 12(4), 239e247. http:// dx.doi.org/10.1111/j.1466-769X.2010.00479.x. Readings, B. (1996). The university in dissent. Cambridge, MA: Harvard University Presss. Rodgers, B. (2005). Developing nursing knowledge: Philosophical traditions and influences. Philadelphia, PA: Lippincott Williams & Wilkins.
Rolfe, G. (2013). The university in dissent. New York, NY: Routledge. Roy, C., & Jones, D. (2007). Nursing knowledge development and clinical practice. New York: Springer. Schreker, E. (2010). The lost soul of higher education: Corporatization, the assault on academic freedom and the end of the American University. New York, NY: The New Press. Schroeder, C. (2003). The tyranny of profit: Concentration of wealth, corporate globalization, and the failed US health care system. Advances in Nursing Science, 26(3), 173e184. Schuster, J., & Finkelstein, M. J. (2006). The restructuring of academic work and careers: The American faculty. Baltimore, MD: Johns Hopkins. Schreker, E. W. (1986). No ivory tower: McCarthyism and the Universities. New York: Oxford University Press. Thorne, S. (2016). The status and use value of qualitative research findings: New ways to make sense of qualitative work. In M. Lipscomb (Ed.), Exploring evidence based practice: Debates and challenges in nursing (pp. 151e164). New York, NY: Routledge. Thorne, S. (2014). What constitutes core disciplinary knowledge? Nursing Inquiry, 21(1), 1e2. http://dx.doi.org/10. 1111/nin.12062. Walker, L. O., & Avant, K. C. (1988). Strategies for theory construction in nursing (2nd ed.) Norwalk, CT: Appleton and Lange. Walker, L. O., & Avant, K. C. (2011). Strategies for theory construction in nursing (5th ed.) Upper Saddle River, NJ: Prentice Hall. Watson, J. (1997). The theory of human caring: Retrospective and prospective. Nursing Science Quarterly, 10, 49e52. Willis, D. G., Grace, P. J., & Roy, C. (2008). A central unifying focus for the discipline: Facilitating humanization, meaning, choice, quality of life, and healing in living and dying. Advances in Nursing Science, 31(1), E28eE40. Willis, D. G., & Griffith, C. (2010). Healing patterns revealed in middle school boys’ experiences of being bullied using Roger’s science of unitary human beings (SUHB). Journal of Child and Adolescent Psychiatric Nursing, 23(3), 125e132. Windt, P. Y. (1989). Introductory essay. In P. Y. Windt, P. C. Appleby, M. P. Battin, L. P. Francis, & B. M. Landesman (Eds.), Ethical issues in the professions (pp. 1e24). Englewood Cliffs, NJ: Prentice-Hall. Woodhouse, H. (2009). Selling out: Academic freedom and the corporate market. Montreal, Canada: McGill-Queens University Press. Wyman, J. F., & Henly, S. J. (2015). PhD programs in nursing in the United States: Visibility of the American Association of College of Nursing core curricular elements and emerging areas of science. Nursing Outlook, 63(4), 390e397.
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www.nursingoutlook.org
Profession at the crossroads: A dialog concerning the preparation of nursing scholars and leaders Pamela June Grace, RN, PhD, FAAN*, Danny G. Willis, RN, DNS, Sr. Callista Roy, RN, PhD, FAAN, Dorothy A. Jones, RN, EdD, FAAN William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467
article info
abstract
Article history: Received 14 July 2015 Revised 28 September 2015 Accepted 4 October 2015 Available online 22 October 2015
The purpose of a practice discipline’s terminal degree is to develop wise scholars to guide the profession in anticipating and meeting the health-related needs of those served via philosophical, conceptual/theoretical, and empirical inquiry on behalf of professional practice. Each of these dimensions is important for the discipline’s ability to meet its obligations to society. However, contemporary circumstances have created a context within which the maturation of the profession may be threatened by an imbalance among the three dimensions of PhD education. Specifically, we discuss the possibility of a tilt toward the empirical at the expense of the other two. Yet, the philosophical and conceptual/theoretical dimensions are those that have permitted core disciplinary knowledge to be developed. We aim to create a dialog about current challenges and the responsibilities of the discipline’s scholars for stewardship of the discipline and offer some strategies to ensure balance among the three equally important dimensions.
Keywords: Nursing scholarship Disciplinary stewards PhD curricula Nursing inquiry Moral imperative
Cite this article: Grace, P. J., Willis, D. G., Roy, S.. C., & Jones, D. A. (2016, FEBRUARY). Profession at the crossroads: A dialog concerning the preparation of nursing scholars and leaders. Nursing Outlook, 64(1), 61-70. http://dx.doi.org/10.1016/j.outlook.2015.10.002.
In this article, we document our recognition that there is an urgent social responsibility to promote the optimal development of nurse scholars and leaders who will work to improve individual and societal health through an explicit grounding in the discipline of nursing. Moreover, we argue that the goal of preparing exemplary scholars is consistent with the goals of nursing and a moral imperative for the discipline. Our purpose was to raise the consciousness of nursing’s scholars and leaders about our future as a discipline, the dangers we are facing due to lack of clarity around purpose, and our responsibilities as disciplinary stewards. For the discussion, we rely on Donaldson and Crowley (1978)
definition of a professional discipline as “embod(ying) a knowledge base relevant to all realms of professional practice and which links the past, present and future” (p. 117). This broad definition, although subject to contemporary refinements, remains relevant. We contend with the notion of “core disciplinary knowledge,” and its meaning and significance in the ongoing development of disciplinary scholars as recommended by Thorne (2014). In line with these notions, viewing the scope of the discipline’s knowledge interests broadly facilitates the profession’s visionary actions and current practices and permits the profession’s evolution in response to change and future developments in health care.
* Corresponding author: Pamela June Grace, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467 E-mail address: [email protected] (P.J. Grace). 0029-6554/$ - see front matter Ó 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.outlook.2015.10.002
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For the purpose of clarity, a discipline, then, is inextricably related to the profession as a practice and can be distinguished as the body of knowledge that underpins the profession’s actions and guides future growth. The shifting social, political, economic, and environmental contexts of contemporary health care influence service professions and their contributions in a variety of ways. We explore the nature of contemporary influences on the development of the discipline’s scholars and emerging scholars. An ongoing dialog and the development of strategies are needed to influence nursing’s preferred future, one that balances the philosophical, conceptual/theoretical, and empirical aspects of nursing’s disciplinary knowledge development (Fawcett & De Santo-Madeya, 2013) to optimally meet the profession’s goals. We propose ways to anticipate and balance the weighty effects that current funding initiatives and their priorities can have on PhD nursing curricula and on what should be considered the full range of nursing inquiry to advance the discipline, nursing knowledge development, and nursing as nursing practice. Finally, we offer some strategies to ensure that nursing’s scholars are able to advance the discipline. What is needed is a secure grounding in philosophies of nursing science, the possession of appropriate research and collaboration skills, and the ability and motivation to critique the political, socioeconomic, and ethical environments within which practice occurs and evidence is used.
Background The future of nursing as a discipline is at a dramatic crossroads. The direction proposed by our scholars and leaders at this point in time must be carefully mapped as it will influence the future of nursing as a discipline and profession. Key to the profession continuing to meet its social commitments related to promoting human health and well-being and relieving suffering is how we conceptualize and implement nursing PhD education, its foundations, purposes, and characteristics. Both PhD and practice doctorates can be thought of as terminal degrees in nursing; however, our focus in this article was on the development of disciplinary scholars and researchers grounded in pluralistic nursing philosophies, conceptual models, and theories which has been the purview of nursing PhD programs. Both historical developments and contemporary circumstances have helped to create a context within which the current maturation of “nursing as nursing” practice, science, and knowledge development is threatened. Thorne (2014) has recently argued that without clarity on what constitutes core disciplinary knowledge, we are at risk of losing our identity,
especially within the context of the current focus on interdisciplinarity. According to Fawcett (2007), “nursing qua nursing practice is based on unique nursing knowledge rather than knowledge developed by members of other disciplines. Unique nursing knowledge is evident in the many conceptual models of nursing, [and] the more than 50 middle-range theories .” (p. 98). In agreement with Fawcett and Thorne, our perspective is that disciplinary knowledge, and nursing inquiry in general, differs substantively from knowledge developed by other disciplines. We concede that nurses, like the scholars of other disciplines, have successfully shared and adapted knowledge and theories to meet their unique disciplinary goals. Nevertheless, the challenge remains that we need to bring concepts, theories, or knowledge from other disciplines into alignment with, and to be informed by, nursing’s goals and practice environments. We affirm that, then, nursing inquiry results in the development of disciplinary knowledge and is explicitly rooted in the philosophies and nursing philosophies that give, and have given, rise to the epistemological structure of the discipline. Nursing inquiry addresses nursing’s foci of concern, as discussed in more depth shortly, and results in substantive areas of disciplinary knowledge development that are framed within nursing’s purposes, goals and perspectives, conceptual models, and theories. We offer as one example the many middlerange theories (practice oriented) derived from Roy’s model of the human as an adaptive system developed, tested, and refined for nursing practice. In sum, we grant that many nurses who conduct research that is not explicitly based on nursing perspectives, as defined previously, may well be serving the human good, but it is questionable whether such research will contribute to the development of unique nursing knowledge, thus the discipline. Failure to pay attention to this distinction between nurses who undertake research that is not explicitly based on nursing and nurses engaged in nursing knowledge development risks the discipline and the profession. Our concern is that the balance can easily tip toward the former, nurses who undertake research that is not explicitly disciplinary based to the detriment of disciplinary development. The opportunities to advance the discipline through research and funding from external sources have provided for the development and refinement of certain types of knowledge. However, this same precious resource, the existence of funding sources, can detour us away from pursuing other important forms of disciplinary inquiry. Specifically, our concern is to ensure an ongoing focus on illuminating, studying, and explicating the discipline’s phenomena of concern from the point of view of nursing’s unique foci and perspectives. This emphasis is crucial to the continuing existence of the profession (Thorne, 2014).
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Preferred Qualities of Disciplinary Scholars The profession needs to develop well-rounded scholars who have a depth of understanding about substantive areas of nursing inquiry and who are also committed to the discipline’s mission of improving nursing and health care for, and the health of, all. We do not see these two characteristics as mutually exclusive. Such scholars are able to fluidly move up and down the ladder of abstraction from concepts to the design of empirical research, including quasi-experimental and experimental inquiries, and also engage in emancipatory scholarship and historical and philosophical inquiry. They will be capable of asking conceptual questions and be motivated to determine and critique conceptual and theoretical linkages among research areas of inquiry, discipline-relevant questions, and underlying assumptions about appropriate aims, research approaches, and specific methods capable of extending existing knowledge and generating new inquiry. As Thorne (2016) critiques, a review of the current status of nursing’s multiple research designs reveals that “the qualitative nursing research community has traditionally been more hesitant than has been the case in some other disciplines to bend and shape its study designs to more effectively fit its disciplinary objectives” (p. 159). Recently, in exploring evidence-based practice, she has focused on making sense of qualitative research and the scope and limits of its usefulness in the evidence-based practice framework. However, she is concerned that contemporarily many of nursing’s inquiries whether qualitative, quantitative, or mixed methods fail to account for the core epistemological foundations of the discipline and asserts “it seems time to return to the idea that the core epistemological structure can and should scaffold” (p. 159) our empirical nursing inquiries. The study of the content of U.S. Nursing PhD program curricula by Wyman and Henley (2015) seems to point to the unchanging nature of nursing PhD curricular courses with most programs including theory and philosophy courses. Their critique includes the finding that “there was little evidence of innovation in educational approach” (p. 396) which can be seen as a problem of nursing not moving with the times. Although we do believe that the inclusion of courses in philosophy and theory development is necessary, they are not sufficient to develop disciplinary scholars who consistently incorporate philosophical critique and theory into their studies and scholarship, especially when there are many opposing pressures. We agree that creative approaches to PhD education are important to open the door for new ways of thinking and revised pathways to care. Furthermore, if we rely on the notion of “nursing qua nursing” (Fawcett, 2007; Watson, 1997), then nursing inquiries likewise should be grounded in nursing’s knowledge and epistemological structure as exemplified in nursing’s many
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conceptual frameworks and theories including middle range and situation specific.
Contemporary Challenges and the Development of the Disciplinary Perspective In many countries around the world, nursing has continued to mature as evidenced in the growth of disciplinary scholarship and PhD programs in nursing. Over the course of several decades, this growth has been infused with ongoing dialogue about nursing’s central concerns, foci, theoretical development and evolution, and future directions for knowledge development (Meleis, 2012). Historically, many of the international nurse scholars educated within the United States have returned to their countries of origin to influence and lead PhD nursing education in their settings. For many, the challenge remains how to manage the tension between the preparation of nurses who can design and conduct research projects and nurses who will explore, uncover, and expand nursing science in the interests of enhancing the lives of humans globally. PhD nursing education continues to occur within the context of complex social, political, and economic conditions that inform and shape the future of core disciplinary knowledge and its potential to influence the health of society. From a nursing perspective, present day conditions can have both positive and negative influences on individual and societal health. For example, burgeoning biotechnological/biomedical advances have improved the quality and quantity of life for many but have also led to questions about when and how they should be used and the meanings of their use for individual persons. Increased funding has permitted leaps in knowledge development but can also distort the motives of scientists and scholars who need the funding for personal and professional advancement (Kassirer, 2007; Mintz, Savage, & Carter, 2010). The negative influences may be so subtle and insinuating that we fail to notice them until it is too late (Rolfe, 2013). Ongoing mindfulness and vigilance are needed on the part of nurse scholars and leaders about those conditions that are most likely to fulfill or obstruct nursing’s goals. These dispositions are critical for the advancement of the discipline and promotion of health and social justice. Recognition of emerging problematic conditions and motivation to mediate those conditions that are detrimental to achieving nursing’s purposes are both needed. Therefore, as we move to craft innovation, refinement, and realignment in PhD nursing education, it is essential that we prepare the discipline’s scholars to think more broadly about the demands and needs of the changing health care environment and society at large. Tracing the development of the nursing discipline to its current situation, among other contextual factors, facilitates our understanding that the
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profession has an evaluative and a practical goal (Meleis, 2012). We must continually question how likely it is that our knowledge and theoretical development activities will serve our professional goals related to promoting a human good rather than the objectives of other interested parties. These dual purposes allow us to understand both current movements in nursing PhD education and how realignment in nursing PhD curricula can be designed as necessary to ensure that nursing goals continue to provide an anchor for the work of emerging scholars and leaders. Having an anchor in nursing goals is especially relevant in the context of current pressures to engage in interdisciplinary research endeavors. It is our view that interdisciplinary endeavors can be useful, even critical, for addressing complex multifaceted social and health-related problems. However, by definition to engage in interdisciplinary work presupposes a strong sense of one’s own discipline and its particular contributions.
Challenges The historical movement of nursing education into academic settings and the subsequent development of higher education for nurses including PhD education are self-evidently good for the profession and its goals. Higher level thinking and questioning are needed to develop knowledge that specifically addresses nursing’s phenomena of concern. In turn, this necessitates acceptance that there is substantive disciplinary knowledge. However, some have argued that economic pressures including market forces and corporatization (Kassirer, 2007; Miller & Bellamy, 2012; Petrovskaya, McDonald, & McIntyre, 2011; Woodhouse, 2009) have had a constricting effect on the freedom of faculty, including nursing faculty to pursue disciplinary goals. That is, scholars may be hindered by such pressures from focusing on the development of disciplinary knowledge and scholarship in the broadest sense (Mintz et al., 2010; Readings, 1996; Rolfe, 2013; Woodhouse, 2009). Paradoxically, the availability of research funding has also been seen as a contributing factor to the changing face of academic settings generally within contemporary political and economic contexts (Rolfe, 2013; Schuster & Finkelstein, 2006; Woodhouse, 2009) narrowing the scope of academic inquiry in a variety of disciplines and is, arguably, having a spillover effect on nursing PhD curricula. Although we were unable to find published evidence to support our suspicions that an emphasis on the substance of the discipline is diminishing in nursing PhD programs, we have collective experiences as four faculty involved in PhD education. During the past 3 years, we have participated in the interview process for numerous faculty candidates from at least 10 of the more highly ranked Nursing PhD programs, less than a quarter of these were able to clearly articulate in what sense their research was aligned with nursing goals and perspectives.
Over the past few decades, the implementation of PhD programs in nursing has continued to proliferate, influenced by the perseverance of nurse leaders who recognized the importance of disciplinary substance and the potential for nursing knowledge to impact the health of society. For many early leaders in nursing, access to PhD study was by route of other disciplines due to the limited availability of doctoral programs in nursing (Rodgers, 2005). These nurse leaders, then, used their own experiences and education to pave the way for the development of additional higher level education programs specifically for nurses. As the profession’s visionaries, they understood that the development of nurse scholars informed with disciplinary substance infused the discipline with a clear perspective about its nature. This was essential in generating wisdom about, and knowledge for, disciplinary purposes in the interests of individual and societal good. Academics were aware of the need to expand, refine, test, and generate knowledge for the discipline. Knowledge development aimed to inform practice, guide care and raise questions, and generate new knowledge for the future. The appropriate education of future nurses depended on this view of knowledge development.
Substantive Nursing Knowledge: The Core of the Discipline From the rich literature on knowledge development in nursing, we highlight here the core of the discipline, its boundaries, and relationship to other disciplines. An early literature review by Donaldson and Crowley (1978) identified general themes of inquiry for nursing. The authors’ work indicated that the goal of nursing was affecting positive changes in health status by understanding the principles and laws that govern life processes, well-being, and optimum functioning of human beingsdsick or well and the patterning of human behavior in interaction with the environment in critical life situations. By the early 1980s, a number of nursing scholars identified a growing consensus that the phenomena of the science of nursing were person, health, environment, and nursing which became known as the metaparadigm concepts of nursing (Fawcett & De Santo-Madeya, 2013). Over several decades, the phenomena of concern to nurses were clarified largely due to efforts to create, use, and test nursing theory (McEwen & Wills, 2014). Each major theorist provided a nursing perspective on persons and their health in interaction with the environment and specific goals for nursing. Pluralism in theory led to efforts to provide an updated focus for the discipline. Walker and Avant (1988) proposed four conceptual foci of nursing phenomena for nursing inquiry: health behavior and health status, stress and coping, developmental and health-related transitions, and person-environment
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interactions. Focusing on clients and their health was recognized as the areas of overlap among the health care disciplines. More recently, the perspectives taken on persons and the goal related to the health of persons have facilitated providing the unique disciplinary perspective of nursing. In 1991, Newman et al. published a focus of the discipline of nursing which built on earlier nursing scholarship to submit that the domain of inquiry of nursing is “caring in the human health experience” (Newman, Sime, & Corcoran-Perry, 1991). Since then, Newman’s ideas have been revisited (Newman, Smith, Pharris, & Jones, 2008), refined, and reified in the assertion that the “caring, knowing presence of the nurse taps into what is meaningful for the patient” (2008, E16). This focus regardless of underlying philosophical assumptions permits the unification of nursing practice, thus also knowledge development, across settings and countries. The articulation of a central unifying focus for the discipline by Willis, Grace, and Roy (2008) has been recognized (Meleis, 2012; Walker & Avant, 2011) as providing a disciplinary perspective that accommodates many philosophical perspectives. This clarifying statement transcends any one theoretical model to address the essential nature of the discipline. The view of person and goal of nursing are provided in the statement that the unifying focus of the discipline is facilitating humanization, meaning, choice, quality of life, and healing in living and dying. For nurses, persons are “relational, experiential, valuable, respectworthy, meaning-oriented, flawed, imperfect, vulnerable, fragile, complex, and capable of health and healing even if not capable of being cured” (E34). Nurses promote health as “the embodiment of wholeness and integrity in living and dying” (E35). The preparation of nurse scholars who can articulate their research interests within the disciplinary perspective will contribute to nursing knowledge that is useful for nurses in practice and for nurses to contribute to multidisciplinary changes in health care.
Emerging Challenges More recently, Chinn (2014) draws our attention to the fact that “over the years, nursing’s theoretical and philosophic heritage has been discounted, even deleted from nursing curricula in favor of content deemed to be more essential” (p. 1). Knowledge advancements are beneficial but not when compartmentalized and isolated from the substance of the discipline and its vital building blocks. Based on insights from a nascent but growing body of literature and our observations as faculty involved in PhD education, we highlight five factors requiring immediate attention and vigilance. These factors include the following: 1) content linked to the teaching and immersion within the perspectives, concepts, and theories of the discipline is at risk of being subjugated to other priorities (Kneipp, Canales, Fahrenwald, & Taylor, 2007);
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2) an increase in PhD programs in nursing that seem less firmly rooted in nursing’s basic ontology or central foci of concern than previously (observations from an unpublished review of PhD program websites); 3) emerging disciplinary scholars who cannot clearly and substantively articulate the nursing perspective foreboding a failure to do so when engaged in interdisciplinary collaborations and with implications for nursing science, education, and practice; 4) a focus on the role preparation of practitioners and scholars which can detract from emphasizing the importance of developing a science and using core disciplinary knowledge; and 5) pressures to focus inquiry toward fundable research questions sometimes at the expense of expanding and refining fundamental disciplinary knowledge (Broome, 2013; Mintz et al., 2010; Petrovskaya et al., 2011). These factors are examples of current concerns that will affect and direct nursing’s focus related to research, practice innovations, and policy initiatives as we move into an uncertain precarious future.
Maintaining a Disciplinary Focus: External Distracting Influences There are strong reasons to believe also that the availability of funding for empirical research increasingly drives the questions that faculty and doctoral students ask and seek to answer. As we listen to the dialog in a variety of venues, funding appears to be becoming the driving force of PhD nursing education, tilting the balance at times among the philosophical, conceptual/theoretical, and empirical structure of nursing knowledge (Fawcett & De Santo-Madeya, 2013) toward the empirical. We are neither arguing that the availability of substantial funding is inherently bad for the discipline nor that the idea of interdisciplinary study is unimportant for realizing nursing goals. It is critical however that funding or other sorts of support are also available for disciplinary scholars to critique, evaluate, and advance forms of inquiry that contribute to the substance of the discipline in a fluid environment that may not necessarily align easily with highpriority research areas of various funding bodies. It is also vital, as noted earlier, that one knows one’s own discipline before engaging in interdisciplinary work. A full range of inquiry and in-depth grounding in the discipline of nursing, as defined above, is crucial to the project of meeting the health needs of individuals and society.
Exclusionary Bias We are concerned about balance and exclusionary biases. By exclusionary biases, we mean the
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marginalization of philosophical and conceptual scholarship that advances the discipline as discipline and does not necessarily require major funding. A lack of emphasis on the formation of scholars who are steeped in the varied lenses of nursing philosophy, core knowledge of the discipline, including its conceptual models and theories (middle range and situation specific), mutes or silences nursing’s voice and threatens the disciplinary perspective in the classroom and in collaborative endeavors. This loss of disciplinary perspective, in turn, has implications for the populations we serve. The emerging nurse scholar’s ability to articulate the goals of nursing and hold a nursing perspective on the problem at issue in both disciplinary and interdisciplinary contexts is crucial. Well-rounded scholars are needed to ensure that the discipline’s moral imperative to meet its goals for individuals and society (American Nurses Association [ANA], 2010; ANA, 2015; International Council for Nurses [ICN], 2012) is realized. Furthermore, without these broader, analytic, and critical skills, scholars may not recognize which funding priorities ought to be supported and which challenged as not likely to further disciplinary knowledge development and the profession’s goals. As part of the publics who will contribute to setting priorities, we need to depend on our emerging scholars to have these skills. This emerging shift in priorities for nursing PhD education creates a situation in which scholars may design questions to align with funding availability at the expense of asking other important questions that may not be as fundable. In the process, PhD education becomes slanted toward learning how to achieve funding at the expense of developing critical evaluative skills. The loss of critical analytic skills in turn traps the researcher into the funding wheel.
The Influence of Funding for Research Contemporarily, in the so called “research intensive” institutionsdthose that typically are charged with overseeing a discipline’s terminal research degreed the acquisition of funding brings acclaim to the institution and provides resources both for the university administration and scholars. In the United States, colleges and schools of nursing are ranked, in part, on their ability to bring in education and research funding from federal sources, including the National Institutes of Health. When what is fundable drives the discipline’s scholarly activities, there is a danger that substantive disciplinary questions grounded in nursing’s conceptual and theoretical understandings of disciplinary goals and ways to meet these, will be neglected. Worse approaches using emancipatory perspectives and philosophical or critical inquiry to uncover knowledge not only are disvalued but also are marginalized as not contributing to the “excellence” of the university (Rolfe, 2013).
When important areas for research to advance the discipline, especially a young one like nursing, are not pursued because they are not fundable, it becomes difficult to discern what the object of “excellence” is. That is, one is left in ignorance about the meaning of “excel”? Do students seek to work with scholars who are known for their excellence in an area of important nursing inquiry or do they only seek out those faculty that have funding? Or, are the two taken uncritically as being synonymous? The potential exists that this increasing ambiguity about a university’s focus makes us vulnerable to a vicious circle of molding questions to fit funding priorities or nondisciplinary ideals of excellence, whether these are the ones nurses are most passionate about or have relevance for advancing nursing as nursing or most affect our practice populations. The risk exists that obtaining funding becomes the driving force within the academy at the expense of contributions to the advancement of nursing knowledge overall. When a constricted focus on funding and fundable research questions develops or predominates within an academic institutiondPhD curricula will be reviewed, revised, and validated based on the overvaluing of funding and research skills in relation to other important aspects of nursing’s disciplinary substance and a diverse range of nursing inquiry. We are concerned that soon it will be only by accident that well-rounded nursing scholars are prepared to answer fundamental questions of the discipline or who can lead disciplinary and interdisciplinary dialogue (Evans, 2012; Mintz et al., 2010; Woodhouse, 2009). How we think about PhD education, then, and its impact on society becomes an ethical issue for the discipline to address. It is linked to consensus around the goals of the nursing related to human health and the disciplinary knowledge needed to further those goals. Nursing remains what Windt (1989) defines as a critical service profession. Critical service professions are those without which the society would not function well. The profession exists under a social sanction and serves a societal need (ANA, 2010; Grace, 2014; ICN, 2012) but what if it can no longer do this? Vital to anticipating and addressing the broader concerns of individuals and populations is our ability to maintain a “big picture” perspective on the scope of our charge from society. Funded research can address, and lead to the amelioration of, some of the health challenges facing people, but without a critical stance regarding what and who is fundable, who determines appropriate questions in nursing science, and which modes of inquiry are valued and most appropriate to address a wide range of nursing concerns and phenomena, the discipline is both blinkered and subjected to the influence of money and the market that becomes the sponsor for its direction (Kassirer, 2007; Petrovskaya et al., 2011; Rolfe, 2013; Schroeder, 2003; Woodhouse, 2009). Can our PhD scholars effectively steward the discipline if we all become thus blinkered?
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Achieving Balance: A Need for Action This is a time of reckoning in the discipline. It is critical at this point in nursing’s history that we seek to achieve balance among the philosophical, conceptual/ theoretical, and empirical aspects of PhD education. Each dimension is important for the discipline’s ability to meet its obligations to society. We have to continue the dialogue about nursing’s foci and core disciplinary knowledge at the PhD level. Disciplinary scholars need to be steeped in the knowledge of the discipline and learn about multiple approaches to knowledge development. Insights traditionally developed as part of nursing PhD education are needed including science, reason, logic, problem solving, research methods, and philosophical analysis. Historically, the evolution of professional nursing and its position within the academy was not dependent on funding. Rather, it was emerged from nurse scholars’ commitment to understanding and furthering the goals of the discipline and its conceptual and theoretical development, which included empirical approaches. This commitment to multiple approaches to inquiry meant that funding was only one vehicle for knowledge development.
Empirical Incursion: The Marginalization of Critical Inquiry We interpret this emerging shift away from nursing’s traditional approach to knowledge development for disciplinary purposes, as the empirical incursion or in popular parlance “creep.” By empirical creep, we mean the increasing tendency to overvalue the achievement of research funding for data-based inquiry as the marker of scholarly distinction and the subtle and sometimes not so subtle edging out of respect for other modes of critical inquiry that advance the disciplinary perspective on human health and well-being. Thus, empirical creep can negatively influence how the other two dimensions of the three dimensional goal of nursing doctoral education, wisdom about the discipline and addressing practice questions, are viewed in terms of a hierarchy of importance. Although the impact of empirical creep on academic goals and values is a problem in other practice disciplines, nursing is, arguably, more vulnerable to dissolution because of its current stage of development as a discipline and lack of unity among its scholars and educators around the central foci and substantive knowledge of the discipline. Because practice professions exist to serve the individual and social good (Grace, 1998, 2001), there is a moral obligation to include in knowledge development multiple forms of knowing the human condition. Constriction on what is considered valid or sound knowledge truncates critical appraisal and can limit how one sees and responds to human needs. To be clear, we are not denigrating the need for empirical investigations or funding to assist
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with this. The authors have all engaged in both philosophical and empirical inquiries and have received competitive funding for their research and scholarly projects. The development of research skills is critically important for disciplinary scholars and ultimately nursing’s goal. Our concern is for balance among the three dimensions of nursing scholarship.
Raising the Alarm As noted, we ground our position in the moral imperative for the profession to hold true to its philosophical, theoretical, and practice goals. In analyzing the current situation, it is clear that we cannot ignore the relationship between contemporary movements within the profession and movements within the broader sociopolitical context that influence academia and the directions of knowledge development. The discipline needs to prepare scholars who are both skilled researchersdusing a broad understanding of what constitutes research (Grace & Perry, 2013)dand critical thinkers who predicate their inquiries on disciplinary goals and purposes. A unified understanding of nursing’s purposes and substance is a link to the philosophical and theoretical perspectives of the discipline as they have historically developed, including the evolution of practice theories. Reliance on these perspectives permits critical evaluation of assumptions, contexts, and influences underlying human health experiences. Such understandings lead to valid nursing questions and the use of the most appropriate methods to address them and permitting innovation in addressing fluid environments and overcoming obstacles. Although it is beyond the scope of this article to provide an in-depth discussion of the effects of market forces on academic institutions and academic freedoms, others have written extensively on this topic (Kneipp et al., 2007; Schreker, 1986, 2010; Woodhouse, 2009). Certainly, for the nursing profession, an important aspect of academic freedom is that it permits scholars to pursue knowledge that furthers the discipline’s goals. Although this seems a common-sense proposition increasingly, there are economic and other forces that work against the freedom to determine nursing’s preferred future. If we view a discipline as Dewey (1976) did, that is, as a scientific association that would “solidify and reinforce otherwise scattered and casual (individual) efforts” (Vol. 2, p. 56) toward a particular purpose, then we must claim the autonomy to do so and resist opposing forces.
Strategies and Recommendations As described previously, critical vigilance is needed to continue the development of nursing’s knowledge for the purposes of nursing practice and the good of society in the face of opposing forces. Contemporarily,
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epistemological concerns in nursing should be focused on understanding the ways in which the central foci of the discipline are known, communicated, tested, revised, extended, refined, enacted in practice, and inserted into multidisciplinary health policy. This is a moral imperative for the discipline related to providing a good for the individuals and the society it exists to serve. Gaining a deeper understanding of the discipline, its nature and responsibilities are the surest path to knowledge development and are in line with nursing goals. This project self-evidently requires clarity of purpose and the use of diverse modes of inquiry. All modes of inquiry, empirical, not directly empirical and nonempirical, are important for achieving balance, scope, and effectiveness. The motivation and capacity to question the status quo are all critical skills of a scholar. These cannot be lost if the discipline is to continue to develop and fulfill its social mandate to optimize health and well-being (Erickson, Jones, & Ditomassi, 2013; Grace & Willis, 2012; Newman et al., 2008; Willis et al., 2008; Willis & Griffith, 2010). Threats to PhD education within the framework of empirical discovery are embedded in myopic understandings about what constitute the full range of valid methods or modes of discovery and inquiry. Without being challenged, these truncated understandings can potentially compromise both the development of the scholar and the advancement of nursing science. Ultimately, the reason for the being of nursing, clinical practice, will be affected. Acknowledging these threats permits the development of strategies to anticipate and restrain them. They must be managed in order for nursing’s distinct goals, and perspectives on human health and flourishing, to remain visible in the increasingly interdisciplinary settings of contemporary knowledge development for health care.
Honoring the PastdEnvisioning the Future: Adumbrations of Nursing PhD Curricula It is critical that Nursing PhD curricula of the future is mapped from the phenomena of concern, central unifying foci, and is responsive to the profession’s social mandate. Those educated at the PhD level are the scholars, leaders, and educators of the future; their appropriate education is the surest way to ensure the discipline’s ongoing ability to anticipate and meet the health needs of people and society. Recognition of changing conditions within the context of environment and the contemporary world calls for a transformative approach to preparing scholars for the future. Mindfulness that contemporary circumstances may work against accepting broad perspectives on what constitutes sound knowledge development for disciplinary circumstances is warranted. We noted earlier that as a result of the work of nurse leaders and visionary scholars, the curriculum structure of PhD
programs in nursingdin the United States and elsewheredhad been built around a three part goal that was expected to result in well-rounded scholars. These scholars were prepared to generate, develop, test, and refine knowledge for the discipline’s practice through inquiry (American Association of Colleges of Nursing [AACN], 2001; McEwen & Bechtel, 2000). Changing times require a remapping of our vision for PhD education but do not necessarily mean that traditional aims of this type of education are now irrelevant. Indeed, they are more relevant than ever. Several aims are discernible in the literature as critically related to the optimal development of nurse scholars. The first aim was to gain an in-depth historic understanding of the goals and perspectives of the discipline. The second aim was to promote inquiry around an underexplored area related to an emerging scholar’s practice to develop knowledge that would address nursing goals. The third aim was to foster education that would facilitate the acquisition of academic and research acumen for emerging nurse scholars to further generate, test, and refine knowledge to inform and advance the profession in behalf of those served (AACN, 2001; Roy & Jones, 2007). In addition, just as disciplinary leaders were the catalysts for developing PhD educational programs, a fourth and critically important aim for the future is the development of new visionary disciplinary leaders responsive to the emerging health and social challenges. Such leaders are needed to advance nursing knowledge and practice through critical inquiry, empirical research, discovery, and application. Although this approach has stood the test of time, we have reason to worry that these aims are not always as clearly followed as previously. The discipline can become side tracked, resulting in the loss of mission and purpose. We need to stop, take stock, get clear on direction, and intentionally advance in light of this fuller model of nursing PhD education. It is essential that this more comprehensive perspective prevails and results in an innovative model of PhD nursing education that is responsive to the needs of human beings and the changing dynamics of the world. In Table 1, we offer some strategies for redirection related to PhD education and ultimately the course of the discipline. The strategies are predicated on the discipline of nursing and the goals of nursing as providing the essential foundation for all nursing activities including knowledge development. Nurses at all levels will be taught based on the substantive knowledge of the discipline and its purposes and perspectives, including ways to deal with the questions and problems appropriate for nurses to solve. Nurses’ collaborative endeavors will use nursing’s perspective as an important addition to those brought by other disciplines. Nurses will be skilled in critiquing the socialepolitical climate and how it affects nursing questions. They will recognize the importance and place of knowledge derived from other disciplines and filtered through the discipline with careful attention to
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Table 1 e Strategic Aims of Nursing PhD Programs 1. All nurse clinicians, educators, and scientists possess a foundational understanding of nursing goals and purposes. These goals and purposes are described in the central focus and mission of the discipline (ANA, 2015; ICN, 2012; Willis et al., 2008). 2. Assuring that all nursing curricula are grounded in the ethical imperative of the discipline to further its goals related to promoting a good for individuals and society (ANA, 2015; ICN, 2012). 3. Preparing a diverse faculty including scholars who are skilled in developing critical thinkers. 4. Preparing the discipline’s emerging scholars to understand which questions and problems are appropriate for the profession to solve and which are best methods for solving them. 5. Ensuring that emerging and seasoned scholars grasp the importance of including nursing’s perspective in interdisciplinary collaborations and use such collaborations to strengthen the profession’s capacity for resolving nursing problems. 6. Nurse scholars understand the importance and place of knowledge and theories developed within other disciplines but used in the service of nursing goals and perspectives on health and well-being. 7. Nurse scholars and clinicians acknowledge the increasingly global nature of nursing work and are prepared accordingly. 8. Nurse scholars can critically evaluate the benefits and potential limitations associated with funding sources and judiciously use these to address health problems. 9. Nurse scholars and leaders are prepared to critically evaluate the environments within which knowledge development occurs for their congruence with nursing and health care goals. 10. Nurse scholars understand their roles and responsibilities to influence policies and decisions that impact nursing populations, including funding initiatives. 11. Nurse scholars are responsive to the changing environment of health care including anticipating and accounting for the implications of biotechnological advances for human health.
a nursing lens in the service of nursing goals for health and human flourishing. Nurses will have key roles in impacting funding initiatives for the good of populations.
Conclusion Nursing practice is grounded in relationships with those who need our services. Nursing has historically focused on human responses to health and illness challenges and the meanings these challenges hold for individuals and the society. PhD education in nursing is about the search for tentative “truths” that can further the well-being of individuals. This process of knowledge development should be a continuous, mutual, and iterative one. Nursing inquiry raises questions that emerge from practice and seek to
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extend or refine existing knowledge and generate new knowledge. The generation of new knowledge that is responsive to individuals and fluid environments, shapes practice, informs health care policy, and promotes the common good is a critical task of disciplinary scholars. The future of the discipline depends on appropriately prepared scholars. PhD students become the profession’s leadersdthey are our future. We cannot afford to allow narrowed perspectives on knowledge development to become the norm. We are aware that there are many barriers ahead for nursing, and for other health care professions, and a commitment to anticipate and move aside road blocks is needed by nursing’s scholars and educators. A moral imperative exists to continue to strengthen the profession’s ability to meet its goals and continue to serve individual and social good. If our ideas open a dialogue about to what extent our arguments are sound and what can be done, we will have achieved our purposes in articulating our concerns.
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