The nursing doctorate program is based on several competencies. The competencies allow the graduates to utilize clinical scholarship and analytical methods for evidence-based practice. At the end of each semester, graduates are expected to have advanced their competency levels successfully. Earning a doctorate nursing practice degree requires a minimum residency of two consecutive study periods and hence four levels. Competency progression from one semester to another is mandatory and advances in complexity through the semesters. A preceding semester offers foundation for the succeeding semester. Blooms taxonomy provides a precise and well-structured tool for elaborating the level progressions of a graduate undertaking a doctor of the nursing program at the University Of Virginia (UVA, 4).
The program learning experiences are designed to assist the students to be able to effectively utilize clinical scholarship and analytical methods for evidence-based practice in a handling real-life problems and challenges within the nursing practice (UVA, 4). In essence, this translates to affect all spheres of nursing practice and hence is vital in training doctoral nursing students. Ultimately the graduates should be able to assimilate the knowledge learned and high-level complexity and specialty practice in handling nursing scenarios based on evidence. Ultimate proficiency may require the incorporation of several methods including case study analysis, patient-practice contact hours, specified procedures completion, experience competency demonstration or in some instances a combination of either of methods mentioned (Boyer, 1997).
Evidence-based practice forms the basis of the mentioned objective. It is a derivation of evidence-based medicine. It involves conscious and judicious judgment based on existing evidence to come up with rational decisions regarding a particular case. This approach involves collection, interpretation and gathering of information which are relevant, valid and applicable to patient case scenario.
The resulting report is based on clinician observed, tested and research-driven information as evidence to the selected line of treatment. This method emphasizes the incorporation of particularized clinical expertise and external clinical evidence into the interpretation and analysis of collected data in order to come up with relevant diagnoses (Burke et al., 2005). In general, this practice is based on evidence and independent analysis of each patient case.
It explicitly acknowledges the role of evidence in assisting decision-making about patient case treatment (Burke et al., 2005). Clinical decisions are to a large extent based on the level of collected evidence. However, it is important to note that such evidence is evaluated against available research evidence (Edgerton, 2000). The clinical cases study presented in this paper takes a step-by-step approach towards evidence-based clinical practice.
Doctoral Education is often founded on research and scholarship. While basic research has over time been revered as the largely indispensable scholarly engagement, doctoral nursing enlarge this perspective by offering alternative paradigms upon which nursing practice can derive new knowledge (Edgerton, 2000). Based on Blooms taxonomy, the doctoral nursing program at the University of Virginia can be grouped into a four-level triangle as shown by the diagram below. Each level represents a competency level and is discussed thereafter.
The sections represent the respective competencies expected of the graduates as they progress across the levels of study. Level one is the lowest while the top-most level represents the highest level of study/competency. At level one, the student’s memories are refreshed through an extensive review of the development of evidence-based practice, its applications to historical situations, shortcomings and strengths. Additionally, they are introduced to concepts that form pillars to future studies they engage in. level two introduces new concepts about discovery and integration scholarship. Students are exposed to investigative and synthesis aspects of academic life and the impacts of the same to nursing practice.
The third level takes a more meaningful approach as the scholars are exposed to the concept of giving meaning to facts that are isolated and the same are connected to other disciplines through integration scholarship (Fitzpatrick & Wallace, 2009). The final level requires students’ application of the knowledge gained from the prior levels to problem case scenarios. This level has often been referred to as the scholarship of practice in nursing (Fitzpatrick & Wallace, 2009). A deeper understanding of the program will however require an in-depth examination of the levels briefly mentioned above.
Level one: Basic Introduction and Historical Development
Like most education programs, the first level of study is often characterized by introductory aspects of the course of study. The same is seen in the doctoral program. The first level takes the graduates through an extensive study of the historical development of doctoral nursing (Melnyk & Fineout, 2005). Graduates are led into understanding what the program entails, its purpose of development, the person(s) who conceptualized the idea and the factor that drove him/them into the idea.
This level allows students to understand and appreciate the historical development of the program and also acquire basic facts that will later facilitate their study at other levels. Other than historical development, the foundations of the programs are laid. Relevant subject areas that would be useful but are not directly linked to the course/program are introduced to the graduates laying a foundation for the students in readiness for later study.
While students joining the program will usually have already acquired most of the prerequisites of studying the course, the program acknowledges the need to reinforce some of these prerequisites within context and learning approach of the program. This not only mentally equips the graduates with insightful understanding of evidence-based practice but also physically and emotionally prepares them for the course/program requisites.
Level Two: Discovery and Integration Scholarship
The utilization of clinical scholarship and analytical methods for evidence-based practice is basically about individual case discovery and integration of nursing scholarship in order to come up with reasoned and rational diagnoses (Elaine & Tracy, 2005). This stage is fundamental and critical to achieving the objects discussed in this paper. Students’ knowledge base and analytical skills are honed in such ways that will assist their exponential growth even after completion of study. The course activities at this level are designed to encourage students’ reading ability, critique prowess and literature application to problems.
Generally, the level does well in assisting students to learn techniques and approaches to connecting knowledge and discovered ideas into enlarged patterns that enhance diagnosis. This is expected to allow new perspective development. It is important to note that integration may transcend disciplinary limitations. However, these aspects are reserved for the next competency level. Cross-disciplinary boundaries may cover aspects like technology incorporation. By the end of this level, the students should be able to integrate discovered facts into scholarly nursing decision-making.
Level Three: Isolated Facts Identification and Connection to Other Disciplines
As mentioned integration scholarship transcends disciplinary boundaries. This level introduces the graduates into the science of identifying isolated nursing facts/cases, gives them meaning and engages cross-boundary disciplines to give a nursing context meaning (Elaine & Tracy, 2005). It involves application of literature from multi-science disciplines within the realm of clinical practice without losing focus on their health-affiliated scientific discipline. Generally, this aspect gives meaning to all individual nursing approaches to the diagnosis of cases. Critical thinking is an important prerequisite to this level.
Literature from shared sciences is applied to students’ understanding of complex phenomena encountered during practice and during case reviews. Research literature is drawn from various scientific disciplines including biology, chemistry, physiology and behavioral sciences. Though definitions within context of these sciences may differ from nursing definitions, they offer insightful information which can be interrelated with nursing cases scenarios to come up with appropriate definitions to isolated nursing cases (Melnyk & Fineout, 2005).
The level assists the students to recognize that individual science disciplines share important methodological means and theoretical foundations. Such can be used in favor of one scientific discipline in this case nursing when handling uniquely isolated cases. United conceptions can therefore be developed. By the end of this level, students should be able to identify isolated nursing facts and with the help of other disciplines come up with appropriate decisions.
Level five: Scholarly Application
The prime objective of the whole product ought to achieve by the end of level four. At this level, students ought to be able to scholarly apply knowledge gained to the benefit of the ultimate objective which is to utilize clinical scholarship and analytical methods for evidence-based practice. It involves research knowledge translation into nursing practice and dissemination/integration of the same into activities fundamental to the doctorate of nursing program. At the end of this level, the graduates ought to exercise expanded knowledge realm through facts discovery and use it towards humane useful ends.
In general it will be useful to reiterate that nursing program epitomizes the application scholarship that addresses human care and need’s fundamentals (Orlich et al., 2004). The study levels form a pillar upon which new nursing understandings emerge. The competency levels sequentially develop the knowledge of the students to incorporate diverse sources and disciplines in solving problems encountered in nursing practice situations and hence enhance health outcomes.
The objective attainment process is designed to equip the student with necessary skills that enhance new knowledge and concepts into nursing discipline. Generally, the competency levels facilitate the objective by widening knowledge competence levels, transforming research into nursing practice, evaluating the practice and using the knowledge learned in improving healthcare practices/outcome reliability (Elaine & Tracy, 2005). Pursuing this objective prepares the students to:
- Apply analytical techniques learned in critical appraisal of existing literature and other evidence in best evidence determination and implementation.
- Develop and oversee implementation of processes aimed at evaluating practice outcomes, patterns and acre systems with the setting of nursing practice.
- Apply relevant nursing findings to development of guidelines that facilitate improvements in healthcare.
- Apply information technology into research methodology.
The above-mentioned facilitate the final objective which ability to disseminate evidence-based practice findings to improve the outcomes of the health practice.
Boyer, E. L. (1997). Scholarship reconsidered: Priorities of the professoriate. San Francisco: Jossey-Bass.
Burke, L.E. et al. (2005). Developing Research Competence to Support Evidence-Based Practice. Journal of Professional Nursing, 21(6), p 358-363.
Edgerton, R. (2000). The re-examination of faculty priorities. In D. DeZure (Ed.), Learning from Change: Landmarks in teaching and learning from Change magazine 1969-1999. Sterling, VA: Stylus.
Fitzpatrick, J. J. & Wallace, M. (2009).The Doctor of Nursing Practice and Clinical Nurse Leader: Essentials of Program Development and Implementation for Clinical Practice. New York: Springer Publishing House.
Elaine M. F. & Tracy, A. (2005). Fostering the scholarship of discovery and integration for advanced practice education. Nursing Education Perspectives, 4(3), p 5 -9.
Melnyk, B. M. & Fineout, E. (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams & Wilkins.
Orlich, C. et al. (2004). Teaching strategies: A guide to effective instruction. (7th ed.). Boston: Houghton Mifflin Company. UVA. Web.