Terminally Educated

Continuing Education 18

History of Nursing Knowledge Development 

The history of nursing knowledge development has evolved from a pattern of the perceptions and understandings of the nursing ideals and customs to utilizing what we know to effectively communicate and share with others within our communities.  By increasing and sharing our nursing knowledge with others, the nursing profession has advanced our society as a whole on many levels, not only by physically improving the health of others, but ethically, morally, politically and socially (Chin & Kramer, 2011).

Embracing patterns of knowing implores the nursing professional to continue to implement current evidence-based practice in the assessment, diagnosis, planning, implementation and evaluation of patient outcomes.  In turn, the health care professional unites the innate art of nursing through compassion and nurture with the science of nursing by increasing and sharing gained knowledge with a systematic and scientific approach to treat the patient as a whole. In addition, continuing nursing education fulfills both our deontological and teleological roles as healthcare providers, fulfilling one’s responsibility to another human being and increasing knowledge to promote optimal patient outcomes

The current view of knowledge has developed over time from nurses being influenced solely by the culture and beliefs of their societies to gaining knowledge of health and disease states, and implementing such knowledge to developing theoretical frameworks to improve health outcomes.  For example, it was previously believed in some societies that sinful transgressions caused disease or that pagan and folk healer rituals could combat illness. Through gaining understandings of the development of disease states, knowledge can now be shared on preventative measures for preventable illnesses.  Nightingale’s legacy began during this development of knowledge when she wrote her book after the Crimean War influencing nursing education on the importance of sanitary conditions to promote a restorative and healing environment for the patient (Chin & Kramer, 2011).  Nursing knowledge will continue to positively affect our society as a whole, as long as we continue to increase and share our knowledge without neglecting the basics of our profession, as Nightingale began during her legacy.

Nursing – An Art or Science?

Due to nurses continuing their education and advancing nursing knowledge, the profession as progressed from an art of technical experience, duty, nurturing and caring for others to embodying higher education, nursing research and utilizing that knowledge for evidence-based practice in the clinical setting (Chin & Kramer, 2011).  By producing knowledge with nursing research, nurses then become an active participant as a nursing scientist, empowering their profession and society as a whole.  Nurses working in the clinical setting who continue their education and knowledge advancement are empowered to translate and implement evidence-based practice from research findings to ultimately improve patient outcomes as translational research nursing scientists.

Development of Doctorally Prepared Nurses

By studying the development of nursing knowledge at the doctoral level to receive a terminal degree in one’s chosen profession, nursing science will continue to progress by understanding the basic foundation of nursing knowledge as nurturing and caring to continuing the basic underpinnings for nursing practice with the natural and social sciences, theories and growing concepts. This growing body of knowledge will lead the nursing profession as it constantly evolves (Chism, 2013).  Studying nursing knowledge at the doctoral level inspires the doctoral student to foster a thirst for persistence in learning and cultivating a desire to develop the nursing body of knowledge and the profession, as it has continued to develop over time.

There are nine essentials for doctoral education for advanced nursing practice.  Two of these essentials are the scientific underpinnings for practice and healthcare policy advocacy (Chism, 2013). Traditionally nurses have played an integral role in public health and health policy. Refining education for clinical practice includes application of the patterns of knowing for cultivation of the nursing doctorate essentials in role development.  Igniting emancipatory knowing empowers one to accept the challenges associated with social injustice.  According to Chinn & Kramer, emancipatory knowing integrates both action and reflection, which in turn fosters praxis, or critiquing the status quo, to be a change agent.  Emancipatory knowing illuminates the underlying concerns and the actions necessary to challenge social injustices (2011).  When concerned regarding public health and human rights, knowledge of nursing ethics enables one as a change agent to evaluate the proposed actions to ensure appropriate provision of care (Guido, 2014).

Terminal Nursing Degree: PhD or DNP?

Fawcett states to identify nursing as a distinct profession, it must rely upon nursing knowledge to guide clinical practice.  Without a distinct body of knowledge and theoretical frameworks to guide care, nursing will be nothing more than a trade working alongside physicians without their individual body of knowledge (Butts, Rich & Fawcett, 2012). Therefore, nurses must continue education leading to discovery of new information contributing to the nursing body of knowledge.

The Doctor of Nursing Practice (DNP) degree directs more emphasis towards clinical practice, compared to Doctor of Philosophy (PhD) with an emphasis on theory and research. Whereas a PhD degree dissertation would document development of new knowledge (Chism, 2013), the DNP degree capstone would be rooted in translating the newly developed evidence-based research into the clinical practice setting; thus, improving outcomes. Although the PhD research doctorate and DNP clinical practice doctorate differ in preparation and expertise, they parallel one another with the mutual goal of “scholarly approach to the discipline and a commitment to the advancement of the profession” (AACN, 2006, p. 3). The two terminal nursing degrees compliment one another: the PhD develops new knowledge and the DNP translates that research into clinical practice.

Some may ask, “if you call yourself Dr. LastName, won’t that confuse people that you are the doctor?” It’s important to use this as an opportunity to provide education on the difference between a profession and an academic degree. The term doctor is an academic title indicating to others that one has obtained their terminal degree in their chosen profession. The chosen profession could be as an audiologist, nurse, pharmacist,  physician, physical therapist, psychologist, or speech pathologist. One profession shouldn’t hold a hierarchal title over another, preventing one with a doctorate education from receiving acknowledgement of their advanced degree. Furthermore, society should encourage higher education of all professions and professionally recognize one’s dedication in continued education and increasing knowledge. Therefore, my answer to the question is “no.” As long as one understands the difference between an academic title and a professional title, there is no confusion. My academic title is doctor. My profession is nursing as a nurse practitioner.

I chose a doctor of nursing practice program (DNP) rather than a doctor of philosophy (PhD) nursing program to obtain a practice (clinical) doctorate as an advanced practice nurse.  Although I enjoy nursing research, a core component of the PhD program, my passion is implementing the research into everyday clinical practice. Hence, I implement translational research from the PhD prepared nurse’s primary research findings. My passion is seeing the improved patient outcomes in the clinical setting and appreciate the value both PhD and DNP prepared nurses contribute to the nursing profession and body of knowledge.  I’ve concluded nursing is a lifelong learning endeavor.  According Melnyk and Fineout-Overholt, investing in lifelong learning with a spirit of inquiry is the foundation for applying evidence-based practice.  In conclusion, investment in lifelong learning and evidence-based practice has shown to promote empowerment and job satisfaction (2011).


American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. Washington, DC: AACN. Retrieved from http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf.

Butts, J. B., Rich, K. L., & Fawcett, J. (2012). The Future of Nursing: How Important is Discipline-Specific Knowledge? A Conversation with Jacqueline Fawcett. Nursing Science Quarterly, 25(2), 151-154. doi:10.1177/0894318412437955

Chin, P., & Kramer, M. (2011). Integrated theory and knowledge  development in nursing. (8th ed.). St. Louis, MO: Elsevier Mosby.

Chism, L. (2013). The doctor of nursing practice. (2nd ed.). Burlington, MA: Jones & Bartlett Learning.

Fawcett, J. (2005).  Contemporary nursing knowledge: Analyses and evaluation of nursing models and theories. (2nd ed.). Philadelphia: F.A. Davis

Guido, G. (2014). Legal and ethical issues in nursing. (6th ed.). Upper Saddle River, NJ: Pearson.

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

(This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at The Days When I’m Not A NurseFind out how to participate.)

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