Personal reflection and self-assessment

¶ … DNP degree was recognized by the American Association of Colleges of Nursing as representing the highest level of preparation for clinical nursing practice in 2004 and the first doctor of nursing practice (DNP) program was offered in 2001 by the University of Kentucky (Moore, 2014). In contrast to doctoral of philosophy (Phd) nursing program which is research-oriented, DNP programs are regarded as terminal degrees for teaching (Moore, 2014). Nevertheless, DNPs are also required to perform basic research for a wide range of applications with a view towards improving clinical practice (Moore, 2014).

Researching a topic of interest has become far easier than it was in 1957 when the famous German scientist Wernher von Braun explained that, "Basic research is what I am doing when I don't know what I am doing." Today, doctors of nurse practice (DNP) enjoy a veritable cornucopia of academic, professional and scholarly research resources, but the need for conducting basic research in nursing practice has remained essentially unchanged since the mid-19th century when Florence Nightingale pioneered the use of research in nursing practice (Moore, 2014). The basic research required for any type of writing assignment requires critical analysis skills to identify salient information and the ability to interpret the findings that emerge in a meaningful way (Moore, 2014).

The analysis and writing process that follows basic research can be especially challenging, however, because of the same abundance of research riches and performing research today has been likened to drinking from a fire hose. The basic research process used by DNPs also draws on a number of different sources of information, including empirical evidence provided by randomized controlled trials which remain the gold standard for clinical research, as well as descriptive and qualitative research and expert opinions, case reports, and relevant scientific principles (Moore, 2014). When combined, these issues can make the research and writing process an especially daunting one that can be facilitated when faculty members provide their feedback and recommendations for improvements (Steefel & Saver, 2013), a step that greatly assisted me in completing my capstone project thanks to the invaluable assistance provided by my professor. This assistance also served to reinforce the need for disseminating the results of research in order to further contribute to the existing body of nursing practice knowledge.

Because many DNPs have a professional responsibility to also serve as nursing leaders and educators, this mentoring role also extends to helping other nurses learn how to perform actual research in an effective and efficient fashion and when to secure institutional review board approval if human subjects are involved. To this end, my participation in the Collaborative IRB Training Initiative (CITI) provided me with the background I need to ensure the adequate protection of human subjects involved in research projects (Fayer & Zalud, 2011). One of the most important issues that I learned through the completion of the CITI was the tendency for researchers, irrespective of the true probability of harm, to overestimate the potential for harm for human subjects when potential harms are severe and underestimate the probability of potential harms (such as embarrassment) when these potential harms are regarded as less severe (Vanvactor, 2007).

In addition, the completion of the CITI training materials also provided me with up-to-date guidance concerning the responsible conduct of research, professional conflicts of interest and good clinical practice that will help guide me through the ethical dilemmas that are an inexorable part of advanced nursing practice. Although these training materials served to underscore the importance of ethical practice, many DNPs possess more confidence in their ability to exercise ethical judgment while possessing a relatively low level of knowledge concerning ethical practice (Laabs, 2012).

While most DNP programs of instruction include an ethical component in their curricular offerings, there mains a need to measure current levels of ethical knowledge among DNPs in order to determine if additional coursework is required in order to adequately prepare these nursing professional for clinical practice. In this regard, Laabs (2012) emphasizes that, "Given the expanding role of APNs as doctors of nursing practice, research is needed to determine the ethics knowledge needs and teaching strategies to better prepare nurses for the challenges of advanced practice" (p. 10). Because one of the issues being debated in the current presidential election concerns the further expansion of the authority of DNPs nationwide, it is clear that the provision of ethically sound practice will become even more complex in the future. Indeed, the limited amount of research to date in this area confirms that some DNPs tend to experience significant levels of moral distress when they are confronted with ethical dilemmas in their clinical practice that can result in adverse healthcare outcomes for them as well as their patients (Laabs, 2012).

Recent updates and other changes to the American Nursing Association's (ANA) code of ethics in 2015, though, provide some valuable guidance for DNPs who will inevitably be confronted with ethical dilemmas in their clinical practice, a need that reflects the greatly expanded professional roles of DNPs today. For instance, Davis (2015) reports that, "Today, nursing is a much broader profession and the 2015 Code reflects that" and the 2015 Code "is more collaborative and relevant for all levels of nursing, including those with graduate and terminal degrees, such as advanced practice registered nurses or others who are doctors of nursing practice" (p. 17). Moreover, the updated ANA code of ethics also recognizes the expanded roles of DNPs while reinforcing the fact that DNPs are all engaged in nursing practice. In this regard, Davis adds that, "There is an acknowledgement in the Code that nursing practice covers a lot of specialties. In other words, whether we are educators, administrators, or policy folks who may not be doing bedside nursing or direct patient care, we are all doing nursing practice" (2015, p. 17).