24: ESSENTIALS OF DOCTORAL EDUCATION ■ 537practice- based evidence, and essential to DNP student practice inquiry. Nevertheless,
it is probably inappropriate to have discussion of nursing theory and nursing sci-
ence at the doctoral level without a proper philosophical foundation in the philoso-
phy of science. However, its omission in many DNP programs (or its cursory treat-
ment) remains problematic, especially as the AACN has now acknowledged in its
new white paper (2015) that indeed the DNP graduate should (and can) create new
evidence for the discipline, specifically practice evidence.
Essential II: Organizational and Systems Leadership for Quality
Improvement and Systems Thinking
In this essential, the AACN emphasizes that the DNP graduate should:
- Develop and evaluate care delivery approaches, which meet current and
future needs of patient populations based on scientific findings in nursing
and other clinical sciences, as well as organizational, political, and economic
sciences - Ensure accountability for quality of health care and patient safety for popula-
tions with whom they work - Develop and/ or evaluate effective strategies for managing the ethical di-
lemmas inherent in patient care, the health care organization, and research
(AACN, 2006, p. 9)
In many ways, this essential is strongly represented in most DNP curricula, with
the exception of degree of emphasis on ethics at the doctoral level. First, however, qual-
ity and safety are paramount issues across all levels of nursing, from professional to
advanced practice, and to doctoral advanced nursing levels (Dolansky & Moore, 2013).
The newly renamed Journal of Doctoral Nursing Practice (2016; previously Clinical Scholars
Review ) publishes many studies authored or coauthored by DNP graduates whose focus
is in the area of patient safety and quality. The Joint Commission (2016) core measure
sets provides an enormous area of data areas where DNP student inquiry could be more
focused, and where an emphasis on measures of quality and safety measures can be
employed (see Table 24.4 ).
Although content and coursework on health care quality and safety is explicit
in most DNP programs, such explicit emphasizes on ethics, whether clinical ethics or
organizational ethics (for students in organizational/ leadership- focused DNP pro-
grams), is uneven. This author believes that graduate content in ethics ought to be
taught by faculty with specific training and education in ethics at the graduate level.
This issue of the proper educational preparation to teach ethics has had some notice in
the literature (Dreher, 2016a ; Kalb & O’Conner- Von, 2007; Morse, 1999; Rizzuti, 1983).
The Johns Hopkins Berman Institute of Bioethics has had a very purposeful focus on
encouraging more ethics education in nursing. In a likely recent but undated statement,
they state that in the area of ethics in nursing education there is “little or no faculty train-
ing” and seek to make “faculty ethics education and training a priority” (Johns Hopkins
Berman Institute of Bioethics, n.d.). It is still a curious transition that in the revised 2011
AACN Essentials of Master’s Education in Nursing ethics education was rewritten as one
of the nine essentials to an area of emphasis within five of the nine essentials (AACN,
2011). Some could interpret that as progress, with ethics content integrated throughout
most of the new essentials. Others could view an integration of content as a way that it
can easily be de- emphasized, even nonpurposively. From my own practical curriculum
experience, when an individual course loses its identity as a stand- alone course and the
content is instead integrated across the curriculum, that is often the beginning of the