574 ■ III: ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
solutions. Problem- solving skills needs to be developed and applied not only to course
assignments, but also to practice settings. The Future of Nursing document (IOM, 2010)
included two recommendations specifically germane to this discussion of DNP scholar-
practitioners: (a) develop “scientifically aware” nurse clinicians who will collaborate
with nurse scientists to move research to the bedside. Focus on “Evidence- Creating
Nursing,” the direct collaboration between nurse clinicians and nurse scientists and
(b) reengineer the DNP to include the conduct of research in the form of a practice
dissertation (Smith Glasgow, Dunphy, & Mainous, 2010). In my opinion, these are
essential.
For the scholar– practitioner, metacognition is an essential meaning- making
activity involving reflection in- action and reflection on- action (Schön, 1983, 1987) as
related to professional contexts rich in teachable moments and challenging dilem-
mas. The initial process occurs through critical reflection about disorienting dilem-
mas. The concept of reflective practice has generated other tools and methods to
analyze and reflect on errors, dissatisfaction, and outcomes in health care practice,
resulting in improvements in the quality of care. At the metacognitive level, the
scholar- practitioners’ analysis of their practice, especially as they consider what
decisions they made and what caused them to make those decisions, enables them
to access knowledge that often operates at an intuitive level. In assigning meaning
to their professional and educational experiences, they acknowledge their signifi-
cance and inform their developing practice. A clinician who has developed aware-
ness of metacognition is better situated to reflect on the possible consequences of a
specific action, and make valuable and practical contributions. Foreseeable conse-
quences can be prevented, or managed and therefore do not result in unintended
consequences. Complex organizations or complex systems are often characterized
by “unknown unknowns.” A DNP who has developed metacognition will be able to
bridge the unknown gap and be able to demonstrate that some unknowns are actu-
ally known,and therefore can be prevented, or the consequences resulting from an
action can be mitigated.
Limited research has been published concerning transformative learning in doc-
toral students. Transformative learning, discussed by Mezirow (1991, 2000) and oth-
ers, generally refers to learning experiences resulting in a transformational outcome,
a change in worldview or perspective. Taylor (1998, 2007, 2008) conducted systematic
reviews of completed studies related to transformative learning in higher education,
its relationship to learner- centered teaching, and the impact of context. Stevens-
Long, Schapiro, and McClintock (2004a) conducted a study that sought to develop
an integrated understanding of transformative learning among graduate students.
Participants in their study reported more perceptive and complex thinking, capability
for multiple perspectives, ability to appreciate research and theory, more tolerance
and confidence, and expanded consciousness. In respect to the impact of graduate
education on their behaviors, they described themselves as being continuous learners,
more communicative, and resilient. Behavior changes indicated that the students were
acting on their changed perspectives, not just thinking about them. Participants iden-
tified key factors in their transformative learning – interactive learning, self- reflection
and self- direction, interpersonal relationships with faculty and peers, and curricular
content that led to a transformation in perspective and worldview. Most importantly,
the self- directed study in the program evaluated may have created a disorienting
dilemma for the students, as they were not told what to do by faculty. The authors
concluded that doctoral students experienced multiple learning outcomes, beyond
intellectual development, which they attributed to transformative learning because of
the changes in perspective.