Implications for Doctoral Preparation in Nursing
It will be clear from the previous section that there are a number of trends confronting nursing in the new millennium. They are issues that are relevant to the profession as a whole. However, the matter of how we address these issues is of vital importance. The decisions made must be based on a highly informed discourse. The responsibility for informing this discourse remains with those we might identify as nursing scholars. The preparation of such scholars is encompassed within doctoral programs.
Significant Aspects
The issue now confronting us is the form these programs will take in the future. In considering this issue it is useful to summarize the position as presented in the previous sections, in terms of the emerging trends and their implications for doctoral education. Based upon these considerations there are perhaps eight significant aspects that must be considered in establishing the nature, structure and content of future doctoral education.
1: Establishing the theoretical and practical basis for advancement. It is important that nursing establishes and affirms its body of theory and practice, and arrives at a shared paradigm as a sound springboard for moving forward.
2: Taking account of context. Nursing must be recognized as a relational activity that takes place within social contexts, ranging from intimate interpersonal relationships to global dimensions. Being in essence a social contract between those caring and those cared for, the future of nursing will emerge from these relations rather than any insular and inward-thinking processes.
3: Recognizing complexity. In developing its knowledge and theoretical base, nursing must recognize the limitations of linear thinking and the dangers of fragmented worldviews inherent in traditional ways of thinking. More reflective approaches to seeking new ways of addressing new problems, rather than assuming old formulae will suffice, must be developed.
4: Adopting a critical stance. It is important that nursing becomes more conscious of dominant discourses that impose excessively rationalistic and instrumental ways of being that may not adequately address the knowledge and practice base essential to effective nursing. This will involve a more skeptical orientation towards discourses that are essentially gendered and impose a unimodal scientific orientation that excludes alternative patterns of knowing and being.
5: Harnessing the forces of modernity. Adopting the aforementioned critical stance should not amount to an unreasoned and irrational rejection of the vast improvements that science and technology have brought to the modern world and in particular healthcare. It is important that society as a whole controls the way in which such developments advance the well-being of humankind , and that the risks emerging from such developments are minimized. Nursing must also embrace these opportunities and address the emerging risks.
6: Sustaining and enhancing quality within modern healthcare settings. It is important that nursing, in the aforementioned harnessing of modernity develops its own practices on the basis of best available evidence. This requires recognizing that within the wider context of evidence-based healthcare, there is a need for ensuring that the body of evidence for nursing is also advanced.
But it also requires a recognition that problems of health and well-being do not fit neatly into uni-disciplinary modes of thinking and that such issues must be addressed from a multidisciplinary perspective—in terms of how we think, learn and practice.
7: Developing a global nursing consciousness. As globalization advances, there is a need to recognize not only the impact of what happens in one nation upon all others, but also how the impact of the global influence of all nations now impacts upon each one. The specific health implications of these trends upon nursing must be confronted. However, of equal importance the potential of an emerging nursing global consciousness as a humanizing influence upon an increasingly alienating and threatening world must also be maximized.
8: The creation of a new professional orientation. In the past nursing you have aspired to a professional status without a full appreciation of the implications of this aspiration or its relevance to nursing. It becomes increasingly clear that the old notions of a profession are inadequate for the new age. Instead, a more appropriate model must be developed, that emphasizes facilitative, empowering and negotiating aspects of a professional—client relationship, within which complexity and often new problems are resolved in partnership.
As is often the case, we have succeeded only insofar as we have identified questions more than answers. However, this is how it should be. There is indeed a range of fundamental questions that the nursing profession must address. Paradoxically, these questions also relate to the future nature and content of doctoral education, while at the same time those in the ranks of postdoctoral nursing and those undertaking doctoral studies are those who must find answers to these questions.
We conclude by presenting these not as assertions that should necessarily be accepted or rejected, but rather as declarative statements that in the course of future dialogue should be challenged and indeed interrogated rigorously as we seek a way forward.
Confronting Change
The world is new, rapidly changing and increasingly global in its impact. We are called to review the nature of nursing, its professional orientation, and new ways of addressing new issues for which previous solutions are inadequate. This must reflect directly on the nature and content of doctoral education in nursing.
Achieving Clarity and Consensus
On an international level, while there are variations on the theme, doctoral education consists of a dichotomy between the PhD that primarily prepares researchers and other doctorates (of which the Professional Doctorate is the most common form) that aims to provide a broader preparation for research, leadership, education, managerial, advanced practice and/or practice development roles. There is a need for further clarity and consensus on this dichotomy, the differences in the two routes, or indeed the desirability of moving towards an acceptance of greater diversity in a range of routes.
Widening Dialogue
In the past the issue of doctoral education, and indeed the role of postdoctoral nurses, has tended to be an issue largely restricted to the academic community. It must be assumed that those at the doctoral level within the profession have an important future role in establishing and enhancing the knowledge and practice base, and determining the future shape of the profession.
Yet this issue has rarely been an important topic of debate within the wider profession, and at policy level such roles have often not been identified within human resources and strategic planning. Decisions regarding the future nature, kind and content of doctoral education should be a matter for the profession as a whole.
Leaders within the profession have a responsibility to ensure that such dialogue is carried forward, and that it is informed by and also informs healthcare policy. Importantly, we must also listen to the voices of those we serve, for they must also be involved in the shaping of the future of those who claim their best interests.
Deciding Content
There is a broad consensus that doctoral education in whatever form should not be narrowly concerned with training in research skills. Nor should it be within a particular paradigm that is exclusively provided through mentorship/supervisory approaches, but should include other learning approaches and broader educational content that prepare doctoral candidates for postdoctoral professional life.
Maintaining Consistency and Credibility
While in general the aforementioned PhD/Professional Doctorate (or its equivalents) dichotomy may be helpful, as the issue of content of doctoral programs is addressed, the range of programs and diversity of content are increasing confusion within the profession as a whole and prospective doctoral candidates in particular.
Although diversity is necessary for future development, there is a need to ensure that programs have sufficient consistency at their core to have currency and credibility within the profession, within healthcare systems, and at national, international and global levels.
Achieving Balance
On a global level, there is recognition, not only in nursing but also in other disciplines and across nations, that doctoral education is concerned with advancing knowledge and, in turn, practice. It is important that for the new millennium such preparation includes content that adequately prepares doctoral students for postdoctoral work in real-world situations.
However, this should not compromise the universally accepted goal that such programs prepare for research and scholarly inquiry. Although the ratio of what might be termed research to supporting educational content may vary between routes such as those identified in Declaration Two, careful attention must be given to the two aspects, how they are integrated and made complementary, and how appropriate balance is achieved.
Assuring Quality
It is recognized that quality assurance of education, including doctoral education, is increasingly emphasized at higher education institutional and national levels, and indeed in some instances is being addressed across nations. However, in an increasingly global context nursing has itself a vested interest in ensuring that doctoral education meets the demands of nursing for a sound knowledge and practice base across borders.
The emerging global consciousness within nursing must be seen as an opportunity for working together, sharing best practices and developing doctoral education. These declarative statements resonate throughout this book. Hopefully, here and in the remainder of this book we have demonstrated the current situation and the challenges to be met.
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