1: THE HISTORICAL AND POLITICAL PATH OF DOCTORAL NURSING EDUCATION ■ 33
2010b, 2016b). This knowledge is created through practice- based research and inquiry
that leads to practice- based evidence (Barkham & Mellor- Clark, 2003; Hellerstein, 2008;
San Francisco AIDS Foundation, 2008). The left circle represents theoretical knowledge
or mode 1 knowledge, and it is here where the PhD student is more prepared to con-
duct theoretical knowledge and generate evidence- based practice knowledge using larger
data sets. The knowledge emanating from the best DNP programs, however, would be
more practice oriented, closely connected to the work or clinical environment, and likely
conducted in real time. Then, after rigorous but efficient analysis, the findings are trans-
lated into practice on a smaller scale until larger, more empirical work (evidence- based
practice) can be conducted. Indeed, this drive for practice- based evidence should not be
construed as a lesser research function. Some new or novel phenomena are just not ready
for multisite, clinical trial investigation, or even multivariate analysis. The practitioner
or clinical executive scholar closest to practice is in the best position to identify new clin-
ical problems that need clinical investigation. The intersection of the two circles in the
Venn diagram represents research that is highly contextualized to both practice- based evi-
dence and evidence- based practice domains. Here the final research project (whatever it
is called), whether PhD or DNP, is simply indistinguishable. Herein lies the rigor of the best
DNP programs and the PhD programs where clinical practice problem solving is the over-
whelming emphasis. This author believes that this is where the knowledge development
is the most highly developed and relevant to the discipline. These DNP or PhD student-
led studies include both large and small data sets (again, depending contextually on the
clinical or practice question), with some DNP projects/ clinical dissertations/ DNP theses
(you name it!) more focused on practice- based evidence and others on creating knowl-
edge for evidence- based practice. A more complete description of this model (Figure 1.3)
can be found in Chapter 16, “Next Steps Toward Practice Knowledge Development: An
Emerging Epistemology in Nursing,” in Dahnke and Dreher’s (2016) recently published
second edition Philosophy of Science for Nursing Practice: Concepts and Applications.
■ WHERE WE STAND NOW: A RELATIVELY NEW DEGREE,
PROGRESS, AND UNRESOLVED ISSUES
PROGRESS
This chapter concludes with a short overview of some of the progress and central chal-
lenges or unresolved issues that the DNP degree now faces after a decade of imple-
mentation. Resolving these is essential as this still relatively new doctoral degree tries
to gain a foothold in academic nursing circles and into the consciousness of the health
care market. This market is extensive and very competitive and includes peer health
professionals, the consumer public, and individuals from all walks of life who have
substantive policy input and authority that impacts nursing. Certainly, three Institute of
Medicine (IOM) reports, To Err Is Human: Building a Safer Health System (1999), Crossing
the Quality Chasm, A New Health System for the 21st Century (2001), and Health Professions
Education: A Bridge to Quality (2003), influenced the AACN leadership in their delib-
erations about moving forward with the DNP degree. Florczak (2010), however, writes
creatively and extensively about the influence of the IOM reports and concludes “she
remained somewhat confused about the link between the IOM reports and the push to-
ward the DNP” (p. 15). Perhaps a more influential report was by the National Academy
of Sciences (NAS, 2005), which then called for nursing to consider developing a nonre-
search clinical doctorate to prepare expert practitioners who could also serve as faculty.