Fitting Square Theories Into Round Projects

Abstract

Colleagues, the time has come for me to stand on my soapbox and proselytize about the difference between the kinds of end products/projects/dissertations we expect from PhD, DNS, DNSc, EdD, and DNP students. More than that, however, is the need to provide appropriate learning experiences regarding that difference. I have tried to be diplomatic and not create too many waves (e.g., a tsunami) among some of my colleagues, but the time has come for me to speak out regardless of how wet I get.What has spurred this transition? I have been involved in developing and teaching in three different DNP programs during the past several years and have noticed important differences among programs. One of these has to do with the faculty's understanding of the difference between research and evidence-based practice (EBP) improvement projects. EBP improvement projects are geared to improving health care in a specific organization or agency. In contrast, research is geared toward discovering new knowledge. I have seen the differences among programs in approach, courses, and learning experiences. More to the point, I was in the midst of evaluating the presentations of several DNP students in one of these agencies while beginning this column and experienced the difficulty students have with differentiating between research and EBP. One part of this challenge has to do with the type of content courses they are receiving and how these courses prepare DNP students for the real world of practice improvement, not to mention their capstone projects.Let us begin with how we determine the differential content in or scientific underpinnings courses between research and practice doctorates. When we conduct research, having a theoretical or conceptual framework or model is important for a deductive study. When we are conducting practice improvement projects; however, what is far more important are the models we use to guide our approach to implementing innovative projects for real clinical problems. When there are theory courses in a DNP curriculum that focus on old nursing models or theories to be tested (e.g., Roger's science of man or Orem's of self-care deficits), this course does not facilitate the DNP students' project development. They become confused. And the students try to fit square theories into round projects.So what do we need to include in the theory course for DNP students versus the traditional content we include in research doctorates? There are numerous EBP, PI, and EBPI models out there that need to have the floor in theoretical/conceptual models courses for DNP students. Here are some examples:* The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model (Levin, Fineout- Overholt, Melnyk, Barnes, & Vetter, 2011)* The PARIHS model (Rycroft-Malone, 2010)* The IOWA model (Titler, 2010)* The Evidence-Based Practice Improvement (EBPI) model (Levin et al., 2010)* The Clinical Microsystems model (Nelson, Batalden, & Godfrey, 2007)These are the kinds of models or frameworks that are helpful in directing practice improvement projects.We might also wish to include theories related to the major concepts of the DNP curriculum in such a course. In addition to EBP, these concepts may include primary care, interprofessional collaboration, leadership, and/or quality and safety. …