DNP Role Development for Doctoral Advanced Nursing Practice, Second Edition

36 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION

DNP graduates should also help broaden the definition of evidence through their
work- based problem solving. Very traditional definition of “what is evidence in the
health professions” was challenged by Pearson, Wiechula, Court, and Lockwood (2007)
at the Joanna Briggs Institute at the University of Adelaide in Adelaide, Australia, and
American DNP (and PhD) nursing faculty would benefit from exploring this literature.
Initially, Pearson and colleagues describe four different types of clinical evidence that are
posited based on a clinical question: (a) evidence of feasibility; (b) evidence of appropri-
ateness; (c) evidence of meaningfulness; and (d) evidence of effectiveness. More recently,
the Joanne Briggs Institute has expanded their taxonomy of evidence and offered a more
detailed, descriptive reorganization of levels of evidence based on: (a) levels of evidence
for effectiveness, (b) levels of evidence for diagnosis, (c) levels of evidence for prognosis,
(d) levels of evidence for economic evaluations; and (e) levels of evidence for meaningful-
ness (Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working
Party, 2013). It is highly recommended that both DNP faculty and students review this
document as the clinical problem is identified and the methodology developed.
DNP- generated knowledge can also be described as mode 2 knowledge, which is
work based, practice oriented, is derived differently and disseminated differently than
mode 1 knowledge (Gibbons et al., 1994; Nowotny, Scott, & Gibbons, 2001; Reed, 2006;
Smith Glasgow & Dreher, 2010). Mode 1 knowledge is mostly traditional, empirical, the-
oretical, and disseminated very typically according to academy norms. Mode 2 is where
the professional/ practice doctorate graduate should excel. This author has proposed
that the DNP graduate generate practice knowledge (output) through the lens of prac-
tice inquiry (input) and by utilizing practice research methods (process; Dreher, 2010b,
2016b). This is illustrated in Figure 1.4.

• Not a method, but a “practice lens” and domain/boundary of possible practice
  epistemolgy


• Specific nursing sensitive focus


• Specific health orientation focus


• Traditional empirical methods


• Intermediary, alternate analytical methods


• Interpretive inquiry methods


• Newly generated


• Practice focused


• Clinical or organizational oriented
  Practice • Translational/transdisciplinary applications
  Knowledge

The Practice

of Research

Practice

Inquiry

INPUT

PROCESS

OUTPUT

FIGURE 1.4 Path of practice knowledge generation in an emerging nursing epistemology.

Modifi ed from Dahnke and Dreher (2010, 2016).