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EVOLUTION AND HISTORICAL IMPACT OF THE DNP

Evolution and Historical Impact of the DNP

Ashley Bryan

Jacksonville State University

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EVOLUTION AND HISTORICAL IMPACT OF THE DNP

Introduction

An increasingly complex population of patients require higher levels of nursing education

and practice, with the role filled by DNP-prepared advanced practice nurses (Moran, Burson, &

Conrad, 2020). DNP programs are increasing in prevalence due to the demands of healthcare in

the country with the American Association of Colleges of Nursing providing the Essentials of

Doctoral Education for Advanced Nursing Practice guidelines to promote rigorous and high-

quality standards (Moran, Burson, & Conrad, 2020). The purpose of the paper is to discuss the

Doctor of Nursing practice (DNP) aspirations and accomplishments with DNP achievement,

nursing science contribution, nursing philosophy and theory, nursing doctoral program

comparison, and the importance of DNP completion.

Aspirations and Accomplishments with DNP Achievement

DNP-prepared nurses have been called to improve healthcare by leading and managing

collaborative efforts with healthcare practitioners (Moran, Burson, & Conrad, 2020). Aspirations

of leading and managing collaborative efforts with healthcare practitioners can be accomplished

with DNP achievement. Integrating science and knowledge from ethics, psychosocial,

biophysical, organizational, and analytical sciences as the base of the highest level of nursing

practice are all portrayed by the DNP graduate (American Association of Colleges of Nursing,

2006). Obtaining the highest level of nursing practice as achieved with DNP accomplishment is

another aspiration. An advanced practice nurse prepared with a DNP degree has advanced

competencies for complex leadership in clinical and faculty roles while providing knowledge in

patient outcomes and nursing practice, with specific leadership skills enabling a more vigorous

practice and healthcare delivery (Moran, Burson, & Conrad, 2020). Complex leadership in a

clinical and faculty role while improving patient outcomes by more substantial healthcare
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delivery in nursing practice are aspirations and accomplishments that can be obtained with DNP

achievement.

Contributions to Nursing Science through the DNP Role

The American Association of Colleges of Nursing (AACN) published The Essentials of

Doctoral Education for Advanced Nursing Practice and clearly defined nursing science as an

entity in itself, existing as a growing body of scientific knowledge, while accepting the value of

incorporating knowledge from other sciences (American Association of Colleges of Nursing,

2006). A distinct concern for the factors affecting human wellness while drawing from broader

realms of theoretical and scientific thought while contributing to the nursing body of knowledge

is known as nursing science (Zaccagnini & Pechacek, 2021). Nursing science is different from

medical science with medicine focused on disease diagnosis and treatment, whereas nursing

science is focused on the response of humans to illness and treatment (Zaccagnini & Pechacek,

2021). A different approach is available when nursing science Is viewed as a basic science with

diverse ways of reasoning and acting by advanced practice nurses (Zaccagnini & Pechacek,

2021). A broad concept of health, wholeness, caring, and healing of entire systems are addressed

by holistic theories and approaches with limitations of curing disease when using the medical

model for treatment (Zaccagnini & Pechacek, 2021). The DNP graduate will contribute to

nursing science as an advanced practice nurse by practicing with a holistic theory and approach,

testing concepts, gathering new evidence, and never treating the patient as an object (Zaccagnini

& Pechacek, 2021).

Nursing Philosophy and Theory

Science and theory are used in nursing to positively impact the health of patients by

improving practice (Zaccagnini & Pechacek, 2021). The cultivated doctor of nursing practice
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(DNP) understands that nurses operate from a philosophical and theoretical base nursing theory

that differentiates from the medical model used by physicians while pursuing discernment of the

values, beliefs, and ideas that apprise of daily practice (Zaccagnini & Pechacek, 2021). There are

many different nursing theories and philosophies which should be evaluated by DNPs with

careful consideration given to which nursing model to use and if more than one should be used in

clinical practice. The assessment could be limited, and vision narrowed when only one nursing

theory is used to guide care for every patient (Zaccagnini & Pechacek, 2021). A holistic

approach to nursing philosophy was chosen due to being the most identified with current nursing

practice. Florence Nightingale’s vision of nursing and philosophy can be placed in many modern

nurses and advanced practice nurses by the holistic approach to care while considering the

impact of environmental conditions on health (Zaccagnini & Pechacek, 2021). A nursing theory

contributed by Florence Nightingale is the environmental theory and is incorporated into the

treatment place to help the patient recover to attain their baseline health environment (Petiprin,

2016). The environment is an essential part of the recovery of the patient in that it can positively

or negatively affect the health of the patient with fresh air, sufficient food, pure water,

appropriate nutrition, cleanliness, and direct sunlight or light positively affecting the person for

the better (Petiprin, 2016). Nightingale found a need to manipulate the environment to help the

patient attain a healthy state by perceiving patients holistically and improving a person’s

intellectual, physical, spiritual, and psychological components (Zaccagnini & Pechacek, 2021).

Another belief of Nightingale was that the work of nursing was not delegated by physicians but

should be a separate and distinct role away from medicine, management, and observation of the

person’s environment while assisting the person towards an optimal health outcome (Zaccagnini

& Pechacek, 2021). Nurses were believed to have the responsibility of another person’s health
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while making health a reality by ensuring a clean, adequately lit, warm, quiet surrounding, and

correct diet a possibility by thinking holistically and considering environmental concerns

(Zaccagnini & Pechacek, 2021). Florence Nightingale’s nursing philosophy is envisioned in

future practice and will be utilized as a basis of healthcare practice as a DNP advanced practice

nurse role. In professional practice, this philosophy will be utilized in the intensive care unit

(ICU) setting. Assessing the environmental theory ensures adequately quiet, calm, and suitable

lighting environments for confused or delirious persons with a proper medication regimen used

as needed to ensure optimization of the health of the person affected by acute delirium in an ICU.

Another example of utilizing the environmental theory in practice is considering the impact of

prolonged intubation and ventilation on a person’s physical and psychological wellbeing during

the acute stage of care in the ICU setting, throughout the hospital stay, and optimizing health

outcomes to attain a healthy state for the person.

Educational Requirements for Doctoral Programs

The American Association of Colleges of Nursing defined the DNP degree as a practice-

focused, terminal degree in nursing practice (American Association of Colleges of Nursing,

2006). American Association of Colleges of the Nursing list the DNP curricula as eight

essentials of doctoral education for advanced nursing practice and include:

scientific underpinnings for practice, organizational and systems leadership for quality

improvement and systems thinking, clinical scholarship and analytical methods for

evidence-based practice, information systems/technology, and patient care technology for

the improvement and transformation of healthcare, healthcare policy for advocacy in

health care, interprofessional collaboration for improving patient and population health
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outcomes, clinical prevention and population health for improving the nation’s health,

and advanced nursing practice (Butts & Rich, 2018).

The first doctoral nursing program was in 1954 at the University of Pittsburgh, focusing

only on maternal-child health with a doctor of nursing science (DNS) program started at Boston

University in 1960 (Butts & Rich, 2018). The DNS degree was perceived as the first practice-

focused doctorate. It was initially created to establish and equip nurses as practice experts but

over time, turned into a resemblance of the PhD programs in nursing (Butts & Rich, 2018). Due

to the transition of DNS degree to a more research-focused degree, the AACN labeled all DNS

programs as research-focused degrees (Butts & Rich, 2018). The traditional doctor of philosophy

(PhD) degree is a research-focused degree versus the practice-focused DNP degree (Butts &

Rich, 2018). The DNP and PhD degree are similar in the scholarly approach to the commitment

and discipline of the advancement of the profession (Butts & Rich, 2018). The PhD degree is

focused on theory and research methodology with the DNP degree focused on emphasis on

practice (American Association of Colleges of Nursing, 2006). The program of study objectives

for PhD and DNS prepare nurse researchers compared to DNP preparing nurse specialists for the

highest level of advanced practice (Butts & Rich, 2018). DNP students focus on improvement in

patient outcomes with a commitment to a practice career compared to PhD/DNS students

focused on new knowledge development with a commitment to a research career (Butts & Rich,

2018). DNP program faculty have a practice doctorate with experience in the field of the area of

teaching, leadership in the specialty practice area, with expertise in specialty practice that fits and

focuses on the academic program (Butts & Rich, 2018). PhD and DNS program faculty have a

doctorate based on research in nursing or related field, sustained research funding leadership

experience, and expertise in the study that fits and focuses on the academic program (Butts &
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Rich, 2018). DNP program assessment and evaluation include improvements in healthcare by

contributions from the policy change, practice, and practice scholarship (Butts & Rich, 2018).

Oversight by the institution’s regional accreditors, authorized bodies receive accreditation from a

nursing accreditor allowing graduates eligibility to sit for a national certification exam (Butts &

Rich, 2018). PhD/DNS program assessment and evaluation program outcomes contribute to the

healthcare improvements through new knowledge development and scholarly projects, providing

a foundation for nursing science advancement (Butts & Rich, 2018). PhD and DNS programs

also have oversight by authorized bodies and regional accreditors (Butts & Rich, 2018).

Importance of DNP Completion

The DNP degree was recommended by the AACN to become the terminal practice-

focused degree for nursing by 2015 (Butts & Rich, 2018). The importance of DNP degree

completion ensures the highest level of practice and education available to an advanced practice

nurse. Doctoral-level education provides graduates an opportunity to be leaders in advanced

practice, in the community, with preparation and willingness to take on leadership roles in

different contexts (Butts & Rich, 2018). DNP completion is essential for advanced practice

nurses to enable future leaders in advanced nursing practice. For the holistic treatment of patients

and the community that benefits from DNP degrees in advanced nursing practice.

Conclusion

In conclusion, many different qualities affect a DNP-prepared nurse such as aspirations

and accomplishments available for achievement, nursing science contribution, adapting a nursing

philosophy, differences in education requirements for doctoral programs, and the importance of

DNP completion. The DNP prepared nurse has the competencies that healthcare providers must

have for evidence-based practice with higher-quality care that is patient-centered utilizing an
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interdisciplinary team and information technology. DNP-prepared nurses are managing and

leading collaborative efforts to improve health care outcomes with other healthcare practitioners

(Moran, Burson, & Conrad, 2020).

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References

American Association of Colleges of Nursing. (2006) The essentials of doctoral education for
advanced nursing practice.
https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

Butts, J., Rich, K. (2018) Philosophies and theories: For advanced nursing practice. (3rd ed.).
Jones and Bartlett Learning.

Moran, K., Burson, R., Conrad, D. (2020) The doctor of nursing practice project: A framework
for success. (3rd ed.). Jones and Bartlett Learning.

Petiprin, A. (2016). Florence Nightingale: Nursing theorist. Nursing theory

https://nursing-theory.org/nursing-theorists/Florence-Nightingale.php

Zaccagnini, M., Pechacek, J. (2021) The doctor of nursing practice essentials: A new model for
advanced practice nursing. (4th ed.). Jones and Bartlett Learning.