52chapter ONE
Refl ective Response
Lynne M. Dunphy
This first chapter of the second edition of this book provides a vigorous, excellently
argued overview of the rich discourse that follows throughout the textbook, as refer-
ences are cited throughout the chapter to later content. Dreher has made a strong
choice on the use of the term political path in the title, as the convoluted story of the
evolution of this role is fraught with political (and social) implications that are diffi-
cult to summarize, synthesize, and explain. Here, Dreher succeeds admirably. He also
does not attempt to bring premature closure to some of these complex and deep (in the
sense of knowledge development and philosophy of science) issues. These issues have
only intensified and multiplied. He challenges the reader to think through the many
potential implications of the previous courses of action in nursing that have influenced
the evolution of doctoral education in nursing in general and the development of the
doctorate of nursing practice in particular. I would suggest, this chapter could use ad-
ditional work— and I would direct the readers of the text to this task— in the further
description of nursing in the context of broader historical trends and sociopolitical
disciplinary environments in general. Dreher cites the work of labor historian Barbara
Melosh, as well as provides the context to ideas about knowledge development by
comparing and contrasting the doctorate of nursing practice programs with the evo-
lution of the PysD, for example, in psychology, and similar disciplinary endeavors in
pharmacology (the PharmD), physical therapy, and public health, and even occasion-
ally medicine.
However admirable the work of Melosh (which this author by and large endorses),
it is only one viewpoint on nursing’s rich history. Also, it begs the question of larger
issues in the evolution of science, technology, and therapeutics in general across the 20th
century, as well as the rise (and fall) of other health professions in the same time frame
(medicine comes to mind), and the even broader cultural, political, and social changes
that framed the times and these issues. So, I would see the readers of this text being
guided to a broader variety of other historical and sociological readings with which to
frame the nursing- specific debates, power plays, and dissension.
I would also direct the reader to the work of David Allen, critical social theorist in
nursing, who was one of the first in nursing to raise the issue (along with Melosh, to be
fair) of the limits of advanced education as a “professionalizing strategy” for nursing
(Allen, 1986). Historians and sociologists have also pointed out the use of “education”