552016
research-article2014
JAPXXX10.1177/1078390314552016Journal of the American Psychiatric Nurses AssociationRice and Cunningham
APNA Board of Directors’ Column
Psychiatric Nursing Researchers: Canaries in the Gold Mine?
Journal of the American Psychiatric Nurses Association 2014, Vol. 20(5) 340–344 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1078390314552016 jap.sagepub.com
Michael J. Rice1 and Patricia Duffy Cunningham2 Stein (2014) recently raised a series of valid questions about the number of abstracts at the 27th Annual American Psychiatric Nursing (APNA) Conference. The number of psychiatric nursing research presentations is a frequent topic of discussion at psychiatric nursing conferences over the past few years, including our own annual conference. Discussions often begin with a comparison of the percentage of research presentations compared to the percentage of practice and education presentations. At first glance, the percentage of presentations by psychiatric nurse researchers appears to be far fewer than compared to education and practice. Discussion of the paucity of research presentations inevitably reaches an alarming tone. Several of the discussions draw similarities between psychiatric nurse researcher presentations at conferences and canaries singing in coalmines. Historically, canaries, being sensitive due to their small size and rapid respiratory rates, become ill before the miners feel the effects of toxic gases. The sudden absence of the canaries’ songs means it is time for miners to either put on respirators or leave the mine (National Research Council, Committee on Animals as Monitors of Environmental Hazards, 1991). The end point of these discussions inevitably focuses on a single question, “Where are all the psychiatric nurse researchers”? The APNA Board of Directors decided to explore and respond to these questions raised by nurse researchers. One source of data that is available are data on abstract submissions for the annual APNA conference. The process for reviewing potential presentations at the APNA conference involves a series of steps. The first step in the review process is constructing a panel of review members with established expertise in one of four areas: Research, Education, Administration, and Practice. A call goes out each year to APNA members requesting that they submit their credentials to serve on one of the review panels. A volunteer’s credentials and expertise are reviewed prior to being assigned to a content review panel. This process ensures presentations will be reviewed by those with expertise in a specific area. Thus, research papers are reviewed by researcher experts, practice papers are reviewed by practice experts, and so on. Each potential presentation is submitted as an abstract to APNA to one of four categories, Research, Practice, Education, and Administration, which is self-identified
by the individual submitting the paper. The presentation is then blindly reviewed and scored by the expert panel using a standardized scoring system. The scoring system for each presentation includes evaluation of commonly accepted elements, such as format and content, required for each type of presentation. The elements for an administrative presentation vary slightly from the elements required for a research or practice presentation due to variations in the content area. Each presentation is scored by assigned volunteer reviewers with the scores compiled and submitted to a panel chair. The panel chair then reports these scores and identifies the papers accepted for presentation at the next national conference. At this point, the APNA staff notifies all of those who submitted a potential presentation of the results of the review panels.
Research Presentations APNA has tracked the data on the number of abstracts submitted for potential presentations for the past 4 years (Table 1). Data from the table show that APNA receives a large number of high-quality abstracts for potential presentations in all content areas. The data do indicate that there are some variations in the number of potential research presentations submited each year. The year 2012 had the highest number of research papers submitted, and 2013 had the smallest number of research papers submitted. In comparison, the practice area also had a comparable reduction in the number of submissions in 2012. While there are not enough data available to run any meaningful trend analysis, there are enough to begin to plot the trends in submissions and acceptance of the presentations. As indicated in Figure 1, the number of submissions, acceptance, and podium presentations for papers in all four categories is very similar. The pattern shows that the number of potential 1
Michael J. Rice, PhD, APRN-BC, University of Colorado, Aurora, CO, USA 2 Patricia Duffy Cunningham, DNSc, APRN-BC, The University of Memphis, Memphis, TN, USA Corresponding Author: Michael Rice, University of Colorado, Campus Box C-288-03, Bldg P28Center, 13120 E. 19th Ave., Aurora, CO 80054, USA. Email: [email protected]
Downloaded from jap.sagepub.com at Bobst Library, New York University on May 17, 2015
341
Rice and Cunningham Table 1. Abstract Submission Categories for APNA Conferences (Last 4 Years). Category/Year Research abstracts submitted Practice abstracts submitted Administration abstracts submitted Education abstracts submitted Research abstracts accepted Practice abstracts accepted Administration abstracts accepted Education abstracts accepted Research abstracts—Podium Practice abstracts—Podium Administration abstracts—Podium Education abstracts—Podium Research abstracts—% Accepted Practice abstracts—% Accepted Administration abstracts—% Accepted Education abstracts—% Accepted
2010
2011
2012
2013
72.00 149.00 11.00 39.00 72.00 149.00 11.00 39.00 21.00 49.00 2.00 15.00 100.00 100.00 100.00 100.00
90.00 169.00 15.00 55.00 90.00 169.00 15.00 55.00 25.00 57.00 6.00 15.00 100.00 100.00 100.00 100.00
101.00 154.00 11.00 83.00 58.00 113.00 6.00 58.00 27.00 52.00 4.00 27.00 57.00 73.00 54.50 69.80
68.00 154.00 6.00 76.00 58.00 135.00 6.00 69.00 14.00 62.00 3.00 21.00 85.00 87.70 100.00 90.80
Figure 1. Percentage of abstracts accepted for presentation over time.
presentations submitted is consistently highest for research and practice. The number of potential presentations submitted for administration and education is far fewer, with educational presentations showing a steady increase over time. One possible explanation for the perception that there are fewer nurse researchers presenting at the annual APNA conference might be a change in the rate of the acceptance of research presentations. However, a review of the acceptance rate of research presentations (Figure 1) indicates that the vast majority of the research presentations are accepted. The data show that in 2010 and 2011, 100% of the research papers submitted was accepted for presentation at the annual conference. The data also
indicate that in 2012, while there was a reduction in the number of potential presentations submitted, there was also a reduction in the number accepted for presentation in all four content areas!. The downward trend is counterbalanced by the trend in 2013. The data show 2013 acceptance rates increased. Using these data, there is no support for the position that there is a differential decrease in the number of psychiatric nurse researcher presentations at APNA conferences.
Multiple Variables The perception that there are fewer psychiatric nursing research presentations may be associated with other
Downloaded from jap.sagepub.com at Bobst Library, New York University on May 17, 2015
342
Journal of the American Psychiatric Nurses Association 20(5)
variables, such as conference site, timing, and national economy. There is little argument that psychiatric nursing researchers serve a vital role to the specialty. Psychiatric nurse researchers’ role is the discovery of new knowledge and adding to the knowledge base of the profession deemed essential for future growth of the specialty. Unfortunately, there is a marked lack of data in the literature on the number of psychiatric nurses engaged in research activities. While there is some recent major reports on the psychiatric nursing workforce (Bureau of Primary Health Care, Division of Shortage Designation, 2014; Delaney, 2012; Hanrahan, Delaney, & Stuart, 2012), there is no information about the numbers of psychiatric nurses conducting or presenting research. There are, however, a number of variables that could be affecting the number of psychiatric nurses conducting and presenting research at specialty conferences. The most prominent include (a) redefinition of scholarship, (b) DNP programs, and (c) funding sources for psychiatric nursing research.
translation into clinical practice, and exploring knowledge in the areas for the best educational practices, such as simulation. The expanded definition of scholarship was operationalized by the American Association of Colleges of Nursing (AACN) definition of nursing scholarship in 1999. The AACN further defines a series of concrete examples in each of the four areas outlined by Boyer (1990). These expanded definitions of scholarship allow all nurse scholars, including psychiatric nurse researchers, the opportunity to diversify their activities beyond traditional research trajectories focusing on the discovery of new knowledge. The end result may be a subtle reduction in the total number psychiatric researchers and may have reduced presentations at the national specialty conferences.
Redefining Scholarship Traditional definitions of scholarship focus on the discovery of new knowledge or research (Boyer, 1990). The outcomes of scholarship restricted to traditional research activities are often measured in terms of the number of research grants and publications (Barhyte & Redman, 1993). Yet, in defining developing nursing scholarship, there are several challenges associated with a practice profession. Hinshaw (1989) identifies the challenge across a number of areas of scholarship as follows: To develop the substantive content needed for practice within nursing’s disciplinary perspective, to sustain excellence in the developing science base and in the preparation of nurse researchers, and of disseminating stable, appropriate research results to the profession’s clinicians and to the public. (p. 163)
Boyer (1990), through a series of studies by the Carnegie Foundation, reexamined scholarship from academics’ perspectives. Boyer suggested the data revealed four overlapping scholarship functions, The scholarship of discovery, the scholarship of inte-gration, the scholarship of application, and the scholarship of teaching. (p. 16)
These views significantly expanded the definition of scholarship beyond traditional definitions focusing on the discovery of new knowledge, long held to be the role of the PhD nurse researcher. The expanded definition of scholarship includes the integration of existing knowledge into practice, application of exiting knowledge through
DNP Programs The AACN redefinition of scholarship occurs at about the same time as the development of the Doctorate in Nursing Practice (DNP) degree. By design, the DNP is the practice doctoral degree alternative to research-focused PhD degrees (AACN, 2014a). DNP programs focus on the scholarship of practice implementation, as does Medicine (MD), Dentistry (DDS), Pharmacy (PharmD), and Psychology (PsyD) (AACN, 2014a). Expert practice and practice inquiry is the focus of the DNP degree. Education for the DNP should include reflective practice, evidence appraisal and translation, as well as practice knowledge and skills (Brown & Crabtree, 2013). While career scientists focus on theory testing, tool development, and generation of new knowledge, practitioners evaluate current practice approaches, analyze what is known, and translate knowledge to improve practice and health outcomes. Dissemination of these practice-oriented efforts for peer review and validation of its usefulness is expected (Brown & Crabtree, 2013). DNP scholarship requires skills for practice inquiry with leadership, quality-improvement strategies, program evaluation, qualitative/quantitative analysis, and clinical significance. There is some concern about the impact DNP enrollment has had on enrollment in PhD programs, which would have a direct effect on the number of traditionally prepared psychiatric nurse researchers (AACN, 2014b). The evidence suggests that the concern is not supported! The AACN reports indicate the DNP programs began about 2003, with, enrollment in the PhD-focused research programs initially increasing 52% (AACN, 2014b). Assuming that the percentage of those interested in conducting psychiatric nursing research remains constant across doctoral programs, there should be a concurrent increase in the number of psychiatric nurse researchers
Downloaded from jap.sagepub.com at Bobst Library, New York University on May 17, 2015
343
Rice and Cunningham matching the increase in national enrollments. Unfortunately, there are no specific data available on the number of PhD enrollments that are psychiatric nurse researchers.
Funding of Psychiatric Nursing Research A final variable affecting the number of psychiatric nurse researcher presentations may be tied to funding. The survival of traditional nurse researchers is linked to an ability to consistently generate two essential products, grants and publications (Barhyte & Redman, 1993). Nursing research in general faces a number of issues related to establishing a steady funding stream. The development of the National Institute for Nursing Research (NINR) was a major accomplishment in obtaining a consistent source of funding for nursing research. Yet, while the funding of NINR consistently increases, the percentage of increases is not comparable to increases seen in the other National Institutes of Health (NIH) agencies (AACN, 2014b). A review of the NIH Research Portfolio Online Reporting (REPORT) tools show that there are currently four mental health studies currently funded by the NINR in 2013. The focus of these four studies include child attachment, human animal interaction effects on mental and emotional health, genomics with posttraumatic stress disorder pathways, and sedentary behavior in youth connected to obesity. While four major studies may not seem like a lot, one must recall that psychiatric nurse researchers compete with all of the other nursing specialties also applying for funding. The four studies in psychiatric mental health currently listed in the NIH REPORT files also provide an indication of two additional issues affecting psychiatric nursing research. First, as the health care landscape has changed with movement into interprofessional teams and integrated behavioral health care, psychiatric nurse researchers have moved away from traditional specialty focused psychiatric nursing research. The development of interprofessional teams provides psychiatric nurse researchers with a greater range of funding opportunities and a chance to be funded by other NIH institutes independent of NINR (AACN, 2014b). This change in funding opportunities is reflected in the work of a number of many wellknown and established psychiatric nurse researchers. Consistently funded psychiatric nurse researchers are involved in research on a range of behavioral factors such as tobacco cessation, mental health factors associated with obesity and weight management, late-stage dementia, depression associated with cardiac conditions, the impact of abuse on maternal health, and other issues commonly associated with integrated behavioral health care. Often, the psychiatric nurse researchers are leading the
interprofessional teams and championing the changes needed for integrated behavioral health care. These shifts in funding opportunities may be the variable that has the largest impact on psychiatric nursing presentations at specialty conferences. Psychiatric nurse researchers who move into comorbid and integrated care issues are to be obliged to disseminate the findings at non– psychiatric specialty conferences. In order to maintain their funding, psychiatric nurse researchers are obliged to present their results at conferences on pulmonology, cardiology, oncology, and gerontology. This moves those presentations and publications out of psychiatric nursing specialty arenas and is reflected in the fluctuating number of psychiatric specialty conference presentations.
Conclusion Examining the variables affecting the number of psychiatric nursing research presentations may initially produce some alarm and concern about a future reduction of presentations. Such alarm may be a reaction to a situation that is transient and not well supported by the existing data. A review of the variables affecting the number of psychiatric nurse researchers does suggest, assuming that there is a constant on the percentage of those interested in psychiatric nursing research degrees, there should be a parallel increase in presentations with the increased PhD enrollments. However, enthusiasm associated with the forthcoming abundance of new psychiatric nurse researchers should be tempered. There are now a large number of additional funding opportunities moving psychiatric nurse researchers out of specialty focused investigations into those more closely allied with integrated care. Several of psychiatric nursing’s more prominent psychiatric nurse researchers, by nature of their clinical focus, must also look at presenting and publishing outside of the specialty. The alarm raised in discussions at the psychiatric nursing conferences infers that the absence of research presentations is analogous to the absence of canaries’ songs in the coalmine, or in this case specialty conferences, and suggests there is some risk or danger to the specialty. However, psychiatric nurse researchers’ role within the profession is to discover new knowledge and forge new frontiers for application of science, such as concerns about the comorbid medical conditions and integrated behavioral health care. In addition, including the role of the DNP to expand scholarship into practice inquiry is a heartening development with the nursing profession. The distinctions between DNP and PhD scholarship are clear, and the expanding options for psychiatric nurses to pursue scholarship are also clear. The potential partnership between the doctoral prepared psychiatric mental health nurses is an exciting possibility.
Downloaded from jap.sagepub.com at Bobst Library, New York University on May 17, 2015
344
Journal of the American Psychiatric Nurses Association 20(5)
Using the evidence available, one may still question whether psychiatric nurse researchers are singing their songs in the coalmines? But the evidence also raises the question of whether we should notice that psychiatric nurse researchers, with opportunities to help craft the expanded scope of psychiatric-mental health nursing scholarship, may actually reflect canaries singing their songs in the gold mine!
Bureau of Health Workforce National Center for Health Workforce Analysis. (2014). US health workforce state profiles. Retrieved Sept. 9 2014, from http://bhpr.hrsa.gov/ healthworkforce/supplydemand/usworkforce/stateprofiles/ usworkforcestateprofiles.pdf Delaney, K. (2012). Registered nurse workforce trends for new entrants age 23-26: Hope for the psychiatric nursing workforce shortage. Issues in Mental Health Nursing, 33, 340-341. Hanrahan, N. P., Delaney, K. R., & Stuart, G. W. (2012). Blueprint for development of the advanced practice psychiatric nurse workforce. Nursing Outlook, 60(2), 91-104. doi:10.1016/j.outlook.2011.04.007 Hinshaw, A. S. (1989). Nursing science: The challenge to develop knowledge. Nursing Science Quarterly, 2(4), 162-171. National Research Council, Committee on Animals as Monitors of Environmental Hazards. (1991). Animals as sentinels of environmental health hazards: Committee on animals as monitors of environmental hazards. Washing-ton, DC: National Academy Press. Stein, K. F. (2014). Research: An essential (but perhaps underutilized) component of effective psychiatric mental health nursing practice. Journal of the American Psychia-tric Nurses Association, 20(1), 29-30.
References American Association of Colleges of Nursing. (2014a). DNP fact sheet. Retrieved from http://www.aacn.nche.edu/ media-relations/fact-sheets/dnp American Association of Colleges of Nursing. (2014b). Nursing Research . http://www.aacn.nche.edu/publications/position/ nursing-research Barhyte, D., & Redman, R. (1993). Factors related to graduate nursing faculty scholarly productivity. Nursing Research, 43(3), 179-183. Boyer, E. (1990). Scholarship reconsidered: Priorities for the professoriate. Princeton, NJ: Carnegie Foundation for the Advancement of Teaching. Brown, M. A., & Crabtree, K. (2013). The development of practice scholarship in DNP programs: A paradigm shift. Journal of Professional Nursing, 29(6), 330-337.
Downloaded from jap.sagepub.com at Bobst Library, New York University on May 17, 2015
research-article2014
JAPXXX10.1177/1078390314552016Journal of the American Psychiatric Nurses AssociationRice and Cunningham
APNA Board of Directors’ Column
Psychiatric Nursing Researchers: Canaries in the Gold Mine?
Journal of the American Psychiatric Nurses Association 2014, Vol. 20(5) 340–344 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1078390314552016 jap.sagepub.com
Michael J. Rice1 and Patricia Duffy Cunningham2 Stein (2014) recently raised a series of valid questions about the number of abstracts at the 27th Annual American Psychiatric Nursing (APNA) Conference. The number of psychiatric nursing research presentations is a frequent topic of discussion at psychiatric nursing conferences over the past few years, including our own annual conference. Discussions often begin with a comparison of the percentage of research presentations compared to the percentage of practice and education presentations. At first glance, the percentage of presentations by psychiatric nurse researchers appears to be far fewer than compared to education and practice. Discussion of the paucity of research presentations inevitably reaches an alarming tone. Several of the discussions draw similarities between psychiatric nurse researcher presentations at conferences and canaries singing in coalmines. Historically, canaries, being sensitive due to their small size and rapid respiratory rates, become ill before the miners feel the effects of toxic gases. The sudden absence of the canaries’ songs means it is time for miners to either put on respirators or leave the mine (National Research Council, Committee on Animals as Monitors of Environmental Hazards, 1991). The end point of these discussions inevitably focuses on a single question, “Where are all the psychiatric nurse researchers”? The APNA Board of Directors decided to explore and respond to these questions raised by nurse researchers. One source of data that is available are data on abstract submissions for the annual APNA conference. The process for reviewing potential presentations at the APNA conference involves a series of steps. The first step in the review process is constructing a panel of review members with established expertise in one of four areas: Research, Education, Administration, and Practice. A call goes out each year to APNA members requesting that they submit their credentials to serve on one of the review panels. A volunteer’s credentials and expertise are reviewed prior to being assigned to a content review panel. This process ensures presentations will be reviewed by those with expertise in a specific area. Thus, research papers are reviewed by researcher experts, practice papers are reviewed by practice experts, and so on. Each potential presentation is submitted as an abstract to APNA to one of four categories, Research, Practice, Education, and Administration, which is self-identified
by the individual submitting the paper. The presentation is then blindly reviewed and scored by the expert panel using a standardized scoring system. The scoring system for each presentation includes evaluation of commonly accepted elements, such as format and content, required for each type of presentation. The elements for an administrative presentation vary slightly from the elements required for a research or practice presentation due to variations in the content area. Each presentation is scored by assigned volunteer reviewers with the scores compiled and submitted to a panel chair. The panel chair then reports these scores and identifies the papers accepted for presentation at the next national conference. At this point, the APNA staff notifies all of those who submitted a potential presentation of the results of the review panels.
Research Presentations APNA has tracked the data on the number of abstracts submitted for potential presentations for the past 4 years (Table 1). Data from the table show that APNA receives a large number of high-quality abstracts for potential presentations in all content areas. The data do indicate that there are some variations in the number of potential research presentations submited each year. The year 2012 had the highest number of research papers submitted, and 2013 had the smallest number of research papers submitted. In comparison, the practice area also had a comparable reduction in the number of submissions in 2012. While there are not enough data available to run any meaningful trend analysis, there are enough to begin to plot the trends in submissions and acceptance of the presentations. As indicated in Figure 1, the number of submissions, acceptance, and podium presentations for papers in all four categories is very similar. The pattern shows that the number of potential 1
Michael J. Rice, PhD, APRN-BC, University of Colorado, Aurora, CO, USA 2 Patricia Duffy Cunningham, DNSc, APRN-BC, The University of Memphis, Memphis, TN, USA Corresponding Author: Michael Rice, University of Colorado, Campus Box C-288-03, Bldg P28Center, 13120 E. 19th Ave., Aurora, CO 80054, USA. Email: [email protected]
Downloaded from jap.sagepub.com at Bobst Library, New York University on May 17, 2015
341
Rice and Cunningham Table 1. Abstract Submission Categories for APNA Conferences (Last 4 Years). Category/Year Research abstracts submitted Practice abstracts submitted Administration abstracts submitted Education abstracts submitted Research abstracts accepted Practice abstracts accepted Administration abstracts accepted Education abstracts accepted Research abstracts—Podium Practice abstracts—Podium Administration abstracts—Podium Education abstracts—Podium Research abstracts—% Accepted Practice abstracts—% Accepted Administration abstracts—% Accepted Education abstracts—% Accepted
2010
2011
2012
2013
72.00 149.00 11.00 39.00 72.00 149.00 11.00 39.00 21.00 49.00 2.00 15.00 100.00 100.00 100.00 100.00
90.00 169.00 15.00 55.00 90.00 169.00 15.00 55.00 25.00 57.00 6.00 15.00 100.00 100.00 100.00 100.00
101.00 154.00 11.00 83.00 58.00 113.00 6.00 58.00 27.00 52.00 4.00 27.00 57.00 73.00 54.50 69.80
68.00 154.00 6.00 76.00 58.00 135.00 6.00 69.00 14.00 62.00 3.00 21.00 85.00 87.70 100.00 90.80
Figure 1. Percentage of abstracts accepted for presentation over time.
presentations submitted is consistently highest for research and practice. The number of potential presentations submitted for administration and education is far fewer, with educational presentations showing a steady increase over time. One possible explanation for the perception that there are fewer nurse researchers presenting at the annual APNA conference might be a change in the rate of the acceptance of research presentations. However, a review of the acceptance rate of research presentations (Figure 1) indicates that the vast majority of the research presentations are accepted. The data show that in 2010 and 2011, 100% of the research papers submitted was accepted for presentation at the annual conference. The data also
indicate that in 2012, while there was a reduction in the number of potential presentations submitted, there was also a reduction in the number accepted for presentation in all four content areas!. The downward trend is counterbalanced by the trend in 2013. The data show 2013 acceptance rates increased. Using these data, there is no support for the position that there is a differential decrease in the number of psychiatric nurse researcher presentations at APNA conferences.
Multiple Variables The perception that there are fewer psychiatric nursing research presentations may be associated with other
Downloaded from jap.sagepub.com at Bobst Library, New York University on May 17, 2015
342
Journal of the American Psychiatric Nurses Association 20(5)
variables, such as conference site, timing, and national economy. There is little argument that psychiatric nursing researchers serve a vital role to the specialty. Psychiatric nurse researchers’ role is the discovery of new knowledge and adding to the knowledge base of the profession deemed essential for future growth of the specialty. Unfortunately, there is a marked lack of data in the literature on the number of psychiatric nurses engaged in research activities. While there is some recent major reports on the psychiatric nursing workforce (Bureau of Primary Health Care, Division of Shortage Designation, 2014; Delaney, 2012; Hanrahan, Delaney, & Stuart, 2012), there is no information about the numbers of psychiatric nurses conducting or presenting research. There are, however, a number of variables that could be affecting the number of psychiatric nurses conducting and presenting research at specialty conferences. The most prominent include (a) redefinition of scholarship, (b) DNP programs, and (c) funding sources for psychiatric nursing research.
translation into clinical practice, and exploring knowledge in the areas for the best educational practices, such as simulation. The expanded definition of scholarship was operationalized by the American Association of Colleges of Nursing (AACN) definition of nursing scholarship in 1999. The AACN further defines a series of concrete examples in each of the four areas outlined by Boyer (1990). These expanded definitions of scholarship allow all nurse scholars, including psychiatric nurse researchers, the opportunity to diversify their activities beyond traditional research trajectories focusing on the discovery of new knowledge. The end result may be a subtle reduction in the total number psychiatric researchers and may have reduced presentations at the national specialty conferences.
Redefining Scholarship Traditional definitions of scholarship focus on the discovery of new knowledge or research (Boyer, 1990). The outcomes of scholarship restricted to traditional research activities are often measured in terms of the number of research grants and publications (Barhyte & Redman, 1993). Yet, in defining developing nursing scholarship, there are several challenges associated with a practice profession. Hinshaw (1989) identifies the challenge across a number of areas of scholarship as follows: To develop the substantive content needed for practice within nursing’s disciplinary perspective, to sustain excellence in the developing science base and in the preparation of nurse researchers, and of disseminating stable, appropriate research results to the profession’s clinicians and to the public. (p. 163)
Boyer (1990), through a series of studies by the Carnegie Foundation, reexamined scholarship from academics’ perspectives. Boyer suggested the data revealed four overlapping scholarship functions, The scholarship of discovery, the scholarship of inte-gration, the scholarship of application, and the scholarship of teaching. (p. 16)
These views significantly expanded the definition of scholarship beyond traditional definitions focusing on the discovery of new knowledge, long held to be the role of the PhD nurse researcher. The expanded definition of scholarship includes the integration of existing knowledge into practice, application of exiting knowledge through
DNP Programs The AACN redefinition of scholarship occurs at about the same time as the development of the Doctorate in Nursing Practice (DNP) degree. By design, the DNP is the practice doctoral degree alternative to research-focused PhD degrees (AACN, 2014a). DNP programs focus on the scholarship of practice implementation, as does Medicine (MD), Dentistry (DDS), Pharmacy (PharmD), and Psychology (PsyD) (AACN, 2014a). Expert practice and practice inquiry is the focus of the DNP degree. Education for the DNP should include reflective practice, evidence appraisal and translation, as well as practice knowledge and skills (Brown & Crabtree, 2013). While career scientists focus on theory testing, tool development, and generation of new knowledge, practitioners evaluate current practice approaches, analyze what is known, and translate knowledge to improve practice and health outcomes. Dissemination of these practice-oriented efforts for peer review and validation of its usefulness is expected (Brown & Crabtree, 2013). DNP scholarship requires skills for practice inquiry with leadership, quality-improvement strategies, program evaluation, qualitative/quantitative analysis, and clinical significance. There is some concern about the impact DNP enrollment has had on enrollment in PhD programs, which would have a direct effect on the number of traditionally prepared psychiatric nurse researchers (AACN, 2014b). The evidence suggests that the concern is not supported! The AACN reports indicate the DNP programs began about 2003, with, enrollment in the PhD-focused research programs initially increasing 52% (AACN, 2014b). Assuming that the percentage of those interested in conducting psychiatric nursing research remains constant across doctoral programs, there should be a concurrent increase in the number of psychiatric nurse researchers
Downloaded from jap.sagepub.com at Bobst Library, New York University on May 17, 2015
343
Rice and Cunningham matching the increase in national enrollments. Unfortunately, there are no specific data available on the number of PhD enrollments that are psychiatric nurse researchers.
Funding of Psychiatric Nursing Research A final variable affecting the number of psychiatric nurse researcher presentations may be tied to funding. The survival of traditional nurse researchers is linked to an ability to consistently generate two essential products, grants and publications (Barhyte & Redman, 1993). Nursing research in general faces a number of issues related to establishing a steady funding stream. The development of the National Institute for Nursing Research (NINR) was a major accomplishment in obtaining a consistent source of funding for nursing research. Yet, while the funding of NINR consistently increases, the percentage of increases is not comparable to increases seen in the other National Institutes of Health (NIH) agencies (AACN, 2014b). A review of the NIH Research Portfolio Online Reporting (REPORT) tools show that there are currently four mental health studies currently funded by the NINR in 2013. The focus of these four studies include child attachment, human animal interaction effects on mental and emotional health, genomics with posttraumatic stress disorder pathways, and sedentary behavior in youth connected to obesity. While four major studies may not seem like a lot, one must recall that psychiatric nurse researchers compete with all of the other nursing specialties also applying for funding. The four studies in psychiatric mental health currently listed in the NIH REPORT files also provide an indication of two additional issues affecting psychiatric nursing research. First, as the health care landscape has changed with movement into interprofessional teams and integrated behavioral health care, psychiatric nurse researchers have moved away from traditional specialty focused psychiatric nursing research. The development of interprofessional teams provides psychiatric nurse researchers with a greater range of funding opportunities and a chance to be funded by other NIH institutes independent of NINR (AACN, 2014b). This change in funding opportunities is reflected in the work of a number of many wellknown and established psychiatric nurse researchers. Consistently funded psychiatric nurse researchers are involved in research on a range of behavioral factors such as tobacco cessation, mental health factors associated with obesity and weight management, late-stage dementia, depression associated with cardiac conditions, the impact of abuse on maternal health, and other issues commonly associated with integrated behavioral health care. Often, the psychiatric nurse researchers are leading the
interprofessional teams and championing the changes needed for integrated behavioral health care. These shifts in funding opportunities may be the variable that has the largest impact on psychiatric nursing presentations at specialty conferences. Psychiatric nurse researchers who move into comorbid and integrated care issues are to be obliged to disseminate the findings at non– psychiatric specialty conferences. In order to maintain their funding, psychiatric nurse researchers are obliged to present their results at conferences on pulmonology, cardiology, oncology, and gerontology. This moves those presentations and publications out of psychiatric nursing specialty arenas and is reflected in the fluctuating number of psychiatric specialty conference presentations.
Conclusion Examining the variables affecting the number of psychiatric nursing research presentations may initially produce some alarm and concern about a future reduction of presentations. Such alarm may be a reaction to a situation that is transient and not well supported by the existing data. A review of the variables affecting the number of psychiatric nurse researchers does suggest, assuming that there is a constant on the percentage of those interested in psychiatric nursing research degrees, there should be a parallel increase in presentations with the increased PhD enrollments. However, enthusiasm associated with the forthcoming abundance of new psychiatric nurse researchers should be tempered. There are now a large number of additional funding opportunities moving psychiatric nurse researchers out of specialty focused investigations into those more closely allied with integrated care. Several of psychiatric nursing’s more prominent psychiatric nurse researchers, by nature of their clinical focus, must also look at presenting and publishing outside of the specialty. The alarm raised in discussions at the psychiatric nursing conferences infers that the absence of research presentations is analogous to the absence of canaries’ songs in the coalmine, or in this case specialty conferences, and suggests there is some risk or danger to the specialty. However, psychiatric nurse researchers’ role within the profession is to discover new knowledge and forge new frontiers for application of science, such as concerns about the comorbid medical conditions and integrated behavioral health care. In addition, including the role of the DNP to expand scholarship into practice inquiry is a heartening development with the nursing profession. The distinctions between DNP and PhD scholarship are clear, and the expanding options for psychiatric nurses to pursue scholarship are also clear. The potential partnership between the doctoral prepared psychiatric mental health nurses is an exciting possibility.
Downloaded from jap.sagepub.com at Bobst Library, New York University on May 17, 2015
344
Journal of the American Psychiatric Nurses Association 20(5)
Using the evidence available, one may still question whether psychiatric nurse researchers are singing their songs in the coalmines? But the evidence also raises the question of whether we should notice that psychiatric nurse researchers, with opportunities to help craft the expanded scope of psychiatric-mental health nursing scholarship, may actually reflect canaries singing their songs in the gold mine!
Bureau of Health Workforce National Center for Health Workforce Analysis. (2014). US health workforce state profiles. Retrieved Sept. 9 2014, from http://bhpr.hrsa.gov/ healthworkforce/supplydemand/usworkforce/stateprofiles/ usworkforcestateprofiles.pdf Delaney, K. (2012). Registered nurse workforce trends for new entrants age 23-26: Hope for the psychiatric nursing workforce shortage. Issues in Mental Health Nursing, 33, 340-341. Hanrahan, N. P., Delaney, K. R., & Stuart, G. W. (2012). Blueprint for development of the advanced practice psychiatric nurse workforce. Nursing Outlook, 60(2), 91-104. doi:10.1016/j.outlook.2011.04.007 Hinshaw, A. S. (1989). Nursing science: The challenge to develop knowledge. Nursing Science Quarterly, 2(4), 162-171. National Research Council, Committee on Animals as Monitors of Environmental Hazards. (1991). Animals as sentinels of environmental health hazards: Committee on animals as monitors of environmental hazards. Washing-ton, DC: National Academy Press. Stein, K. F. (2014). Research: An essential (but perhaps underutilized) component of effective psychiatric mental health nursing practice. Journal of the American Psychia-tric Nurses Association, 20(1), 29-30.
References American Association of Colleges of Nursing. (2014a). DNP fact sheet. Retrieved from http://www.aacn.nche.edu/ media-relations/fact-sheets/dnp American Association of Colleges of Nursing. (2014b). Nursing Research . http://www.aacn.nche.edu/publications/position/ nursing-research Barhyte, D., & Redman, R. (1993). Factors related to graduate nursing faculty scholarly productivity. Nursing Research, 43(3), 179-183. Boyer, E. (1990). Scholarship reconsidered: Priorities for the professoriate. Princeton, NJ: Carnegie Foundation for the Advancement of Teaching. Brown, M. A., & Crabtree, K. (2013). The development of practice scholarship in DNP programs: A paradigm shift. Journal of Professional Nursing, 29(6), 330-337.
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