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Doctoral programmes in the nursing field of study: a scoping review

  • Paweł Chruścielii,
  • Anna Pilewska-Kozak3,
  • Violetta Mianowanaii,
  • Marta Monist4 &
  • Alvisa Palese5

BMC Nursing volume 20, Article number:228 (2021) Cite this article

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Abstract

Background

This report aimed to map and summarise the state of the research regarding doctoral programs in nursing, as well as the issues debated in the context of nursing doctoral education. A Scoping Review in accord with the Preferred Reporting Items for Systematic reviews and Meta-Assay extension scoping reviews statement (PRISMA-ScR) was conducted. Three electronic bibliographic information bases were searched: Cumulative Alphabetize to Nursing and Centrolineal Wellness Literature Consummate, Medline (on EBSCO Host) and SCOPUS to identify empirical studies published between Jan 2009 and December 2019. The review procedure was based on framework identified past Arksey and O'Malley and farther revised by Levac and colleagues. Analysis was performed with the use of the Donabedian framework regarding the structure of the doctorate programmes, the process, and the outcomes.

Results

The review included 41 articles, mostly originating in the United States (n=26) and Europe (due north=8), mainly by collecting the perceptions of students and faculty members with descriptive studies. The following issues were investigated at the (a) structure level: Prerequisite for doctoral candidates, Qualifications of faculty members, Mission of doctoral programs; (b) process level: Doctoral programs contents, Doctoral programs resources and quality, Mentoring and supervision, Doing doctorate abroad; and (c) issue level: Academic performance outcomes in doctoral programs, Doctoral graduates' competences, Doctoral students/graduates' satisfaction, Doctoral graduates' challenges.

Conclusions

Doctoral programs have mainly been investigated to date with descriptive studies, suggesting more than robust inquiry investigating the effectiveness of strategies to prepare future scientists in the nursing field of study. Doctorates are different across countries, and there is no visible cooperation of scholars internationally; their construction and processes have been reported to exist stable over the years, thus not following the enquiry development in nursing, discipline and practice expectations. Moreover, no clear framework of outcomes in the short- and long-term have been established to date to measure the quality and effectiveness of doctorate teaching. National and global strategies might establish mutual construction, process and event frameworks, as well every bit promote robust studies that are capable of assessing the effectiveness of this field of education.

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Background

The doctoral education of nurses has been reported across the world to follow different traditions; as information technology was non previously possible to obtain a doctorate in the nursing discipline, nurses have been doctoral-educated in disciplines other than nursing [i]. In some countries, such equally the Usa (US), nurses have been allowed to obtain a doctorate in teaching since the early 20th century [1,2,iii]; however, doctoral programmes were reported to become nursing-oriented in the 1970 s [4]. In other countries, for example Nordic ones, nursing doctoral programs started to operate a few decades later [v], while in others, for example Slovenia, this was simply a couple of years ago, as well every bit an consequence of Bologna Procedure across Europe re-designing the educational cycles [half-dozen, 7]. At that place is no doubt that doctoral-prepared nurses performing research are crucial [8, nine] and they are required to have an effective scientific education [7, ten, 11].

In recent years, doctoral educational activity in nursing has gained increased attention; a growing number of nurses have been reported to be engaged in doctoral studies [3, v, 11, 12] due to the demand for high quality clinical nursing practice, nursing education and science [xiii, 14]. Nevertheless, the trend of ageing of faculty nurses and their shortage has been debated for over 40 years [15,16,17] and different options have been discussed to increase the number of doctoral-educated nurses [15, xvi, xviii].

Moreover, unlike roles of doctoral-educated nurses take been documented in academia and in clinical settings [19] and challenges regarding competition in the 'scientific market' have been underlined, suggesting that the nursing subject area must be strengthened and recognised in high quality publications [ix]. Therefore, while nurses with a doctorate are expected to be engaged in enquiry projects [8], they are also expected to improve the quality of nursing intendance past irresolute the pedagogy and practice; thus, they are facing multiple expectations [xix, 20]. Every bit a consequence, nursing scholars and leaders are looking for options to develop doctoral studies into the most effective way.

In this context, many primary studies have been published to date (e.1000. [10, 12, 19, 21]). All the same, the available studies have never been summarised in an accessible document that could inform hereafter actions regarding the development of doctoral programmes. Therefore, summarising the state of the art of the inquiry in this field, also as the issues debated in the context of nursing doctoral education, are the master aims of this scoping review.

An overview of doctoral teaching in nursing

At that place are many different nursing doctoral programs across the world, with different solutions regarding titles, the curriculum, competences and career possibilities. Even within a single country, these programs are different and, every bit highlighted by McKenna et al. [7], nigh of them have not included any cross-country collaboration regarding research lines and the curricula. In several countries, for example the U.s. and the United kingdom, 2 doctorate profiles have been established: the Doctor of Nursing practice (DNP), defined every bit a clinical or professional person doctorate, and the Doctor of Philosophy (PhD), defined equally a inquiry doctorate. They have dissimilar aims regarding the discipline and practice evolution: a PhD is research-focused, whereas a DNP is focused on preparing future clinical leaders by guiding show-based nursing practice; in the United states, it is required as an entry level for advanced nursing practice (ANP) [20, 22,23,24,25,26]. Discussions regarding what competences these programmes should ensure and what paradigm should be established when educating nurses on doctoral studies are still open [20]. Moreover, the development of collaborations between these two traditions of pedagogy has been underlined with the intent to promote the quality of care [27, 28].

Fifty-fifty though the number of doctoral-prepared nurses is increasing, difficulties in recruiting nurses to doctoral programs have been documented [29]. Firstly, nurses are more than attracted to gaining clinical experience and condign kinesthesia members after; additionally, there are some barriers to entry into doctoral pedagogy, for instance heavy nursing care workloads, high competition, and minor salaries. Moreover, other barriers are too set in the following phase, with regard to beingness recruited and remaining in the faculty: despite the great demand for nurses in the kinesthesia, those who are already appointed have been reported to have loftier burnout and an intention to go out the position [xxx, 31], as well as due to the excessive pressure regarding publications, projects, and grants [17]. Additionally, while some countries have established the requirement that nursing departments must recruit staff with a research-doctorate (due east.g., the US, Australia, Prc, South-Eastern asia), others, such equally the U.k., are nonetheless in continuing transition, employing nurses at the university level, without PhDs, and some are even employed without master's level qualifications [32].

Different innovations accept been discussed in guild to prevent the lack of nursing scholars, such as establishing new pathways to obtain doctorates, allowing new graduates to admission the doctorate programme directly afterwards the BNS (Bachelor in Nursing Science) or a pre-baccalaureate to the PhD programme with individually tailored curricula [16, eighteen, 33]. Even though this option is criticised by some academics because of a lack of clinical experience earlier entry to doctoral programs [18], such candidates are immature and may take a longer career every bit researchers, which is of import when because predictions regarding retirement trends amidst the faculty [xviii].

In addition to the in a higher place-mentioned factors, some researchers (e.g. Mckenna et al. [7]) also discussed the quality of doctoral programs. An urgent need to change these programs to back up the advancement of nursing science has been stated [10]. Moreover, the need to enrich nursing doctorate pedagogy with knowledge of other disciplines, due east.one thousand., humanistic, social or biological sciences [34, 35], as well as in quantitative methods [8], accept been solicited. Given that research findings must be published to inform developments of the nursing discipline, different methods are under word regarding the dissemination of doctoral dissertations [36] and increased popularity has been accomplished by using the manuscript dissertation format [37].

The post-doctorate programme is likewise debated: McNelis et al. [12] reported that nursing doctoral students take not been prepared for the academic role, specifically for pedagogy; while Bullin [nineteen] too added considered their competences in implementing innovative methods in educational activity, suggesting that they require additional preparation though a revision of the curriculum [12]. Moreover, the roles of doctoral-prepared nurses in clinical settings are also discussed. Andreassen and Christensen [38] highlighted that those nurses belongings a doctorate should change their practise, functioning equally a leader in incorporating the evidence in the clinical field. However, experienced clinical nurses with doctorates have been documented to meet several challenges when they start working in academia [17] suggesting that a articulate career strategy should be developed for those willing to stay in a clinical setting.

Methods

Design

A scoping review has been performed past following the available frameworks [39, xl] in the following steps: (1) enquiry question identification; (2) relevant studies identification; (iii) studies choice; (4) data charting; and (five) results collation, summary and report. Specifically, methods and findings take been reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension-Scoping Reviews (PRISMA-ScR) statement [41].

Inquiry questions

The post-obit enquiry questions were addressed: (a) What is the state of the research in the nursing field regarding the doctorate programmes, and (b) what are the chief issues debated to appointment in the bachelor literature?

Studies identification

A comprehensive electronic database literature search was conducted in January 2020. The Boolean operator AND was used with combinations of search terms including the post-obit: PhD/doctorate in nursing, competence and career pathways. The Cumulative Index to Nursing and Allied Wellness Literature (CINAHL) Consummate, Medline (on EBSCO Host), and SCOPUS were searched to place articles published betwixt January 2009 and December 2019. This period was chosen because two main reasons: (a) the availability of a previous review regarding doctoral nursing students' persistence and the challenges faced by them, covering sources published between 1985 and 2011 [42], and (b) the Bologna Procedure regulating education cycles beyond Europe that has reached its 20 yr anniversary in 2019: specifically, 2010 was the yr which was established equally the aim of European Higher Education Area development [6].

Articles written in English, peer-reviewed, with an bachelor abstract, and reporting both primary (qualitative, quantitative and mix-methods), and secondary (systematic reviews and meta-assay) information were included. A full of 1412 records were identified; after screening and eligibility analysis, 41 articles were deemed eligible (Fig. i). Therefore, articles not meeting these criteria and those focused but on problems and the situation of kinesthesia members with a doctorate (e.g. [31]), were not included.

Fig. 1
figure 1

Flow diagram search and choice process of scoping review [41, 62].

Full size prototype

At the kickoff level, titles and abstracts were screened past ii researchers independently and then the findings were discussed. In the 2nd stage, the eligible studies were evaluated through total texts in an independent manner by two researchers; when these satisfied the inclusion criteria and the researchers agreed, the study was included. In cases of disagreement, other researchers engaged in the analysis were contacted, and when agreement was reached the study was included or excluded.

Information charting

The following data expressing the characteristics of studies were extracted from each included study: (1) author(south); (2) publication year; (3) country; (4) study aim(s); (5) method(s) and research blueprint; (6) participants (when available); and (7) main findings relevant to the aim of our study. The filigree was piloted among v studies and then used for all included articles. Two authors independently assessed and extracted the data and agreed upon the findings. Discrepancies were discussed with other researchers.

Results collation, summary and report

In line with the ii-fold enquiry questions, the included studies were considered analytically according to their main features: first, the primary characteristics of the studies were summarised, and and then, with regards to the second aim, issues were categorised according to the Donabedian [43] framework for problems regarding the construction of the doctorate programmes, the procedure, and the outcomes. Under the structure component, nosotros categorised the prerequisite for doctoral candidates, their motivation, the qualifications of the kinesthesia members, the organisation of the doctoral programs, and the mission of the program. Nether the Process component, we included doctoral program implementation, strategies and methods used in education, and interactions between the faculty, the doctoral students, and other stakeholders. Under the outcomes component, the results of doctoral programs documented at different levels (e.thou., doctoral graduates, nursing equally a discipline, doctoral students) were categorised. In some cases, difficulties were found in categorisation, as overlap exists between the three chief categories. Ii researchers categorised the main findings according to the Donabedian model [43] and other researchers resolved inconsistencies. At each stage of the assay, because the Donabedian model, differences between doctoral programs, if any, were highlighted and reported.

Results

What is the state of the research in the nursing field regarding the doctorate programmes?

Equally reported in Table 1, the included manufactures mainly represent iv continents: Northward America (n=27) [two, 3, 8, x,11,12,xiii, 15,16,17,18,nineteen,xx, 27, 28, 30, 33, 36, 37, 44, 49,50,51,52,53,54]; Europe (due north=8). [v, 7, 24, 25, 35, 38, 48, 57], Asia (north=4) [fourteen, 46, 47, 55], and Australia [21]. Two are multi-country studies [five, 45], and well-nigh studies originated in the USA (due north=26; [two, 3, 8, x,xi,12,13, 15,16,17,xviii, twenty, 27, 28, xxx, 33, 36, 37, 44, 49,50,51,52,53,54]). Nearly of the studies were published in the last 6 years (n=28; [iii, 5, 8, x,11,12,xiii,14,15,16,17, 19,20,21, 27, 28, 30, 33, 35,36,37,38, 45, 48, 54,55,56,57], with 11 in 2019 [three, 5, 11, 12, 17, xx, 27, 35, 36, 56, 57].

Table i Characteristics of the included studies

Full size table

The bulk of studies used a quantitative approach (due north=xx; [2, 3, 5, 7, ten, 11, thirteen,fourteen,15, 18, 30, 35, 37, 44, 45, 49, 50, 52,53,54]), while others applied a qualitative (n=15; [12, 17, 20, 24, 25, 28, 33, 35, 38, 46, 47, 51, 55,56,57]) or mix-methods design (north=iii; [8, 16, 21]). Only one integrative review emerged [19] forth with two example analyses (due north=ii; [27, 48]).

Most of the studies referred to PhD programmes (n=22) [5, viii, 10, eleven, 14, 16, xviii, 19, 21, 30, 33, 35,36,37,38, 47,48,49, 51, 53, 55, 57], with DNP analysed in 5 cases [2, 25, 44, 50, 56], while both programs were tackled in nine studies [three, 12, 13, 15, 17, xx, 27, 28, 54]; in addition, some articles have shown research regarding doctoral programs without specifying its kind (n=5) [7, 24, 45, 46, 52]. The majority (n=35) of studies investigated the experience and expectations of students/faculty members/directors of doctoral programmes and deans, ANPs with PhDs by involving between three [48] and one,668 participants [45], with a total of 7,159 participants in all 35 studies. Of the remaining, iii studies have analysed doctoral programmes (with the number of programmes analysed from 56 to 120, e.g. [ten, 37, 49], the thesis produced (north=61, [35]), examples of collaboration (n=4, [27]) and studies published regarding PhD requirements (n=139, [xix])).

What are the chief bug debated in the bachelor literature to date?

Structure level: (1) Prerequisite for doctoral candidates

2 main issues emerged: regarding the access criteria of doctoral programs and the doctoral candidates' criteria/motivations for choosing the programme. Admission criteria for doctoral candidates take been documented as dissimilar: for example, Squires et al. [18], in the example of straight entry PhD programs from a available'due south degree, reported a requirement of at least one year of clinical experience as a registered nurse. The number of required clinical hours earlier the access to the DNP has been documented to range between 0 and i,000 [44]. Specifically, DNP programs do not require additional practice hours for supplementing previous master'due south-level supervised clinical hours. Even so, 20 % of programs reported having a separate clinical course, 26 % reported an end-of-program practice immersion feel, and 38 % required both a supplemental and finish-of-programme immersion experience [44].

In the study conducted by Squires et al. [18] for straight entry PhD programs from a available's degree, a graduate level statistics course, an access interview, and the Grade Point Averages (GPA) were besides reported. Megginson [49] investigated the admission criteria in PhD nursing programs and documented that the GPA was required in 100 % of cases, set-up mostly at 3.0 as a minimum; moreover, 82 % of analysed Us programs also considered the Graduate Record Examinations (GRE) scores during the admission conclusion. Furthermore, ane or more than examples of writing (east.grand., the scholarly project), a letter of recommendation (by a Professor), the applicants' interviews and the enquiry line matching that of the faculty take been likewise reported.

On the side of the candidates, the decision to enter a doctoral programme (both PhD and DNP) has been underlined as beingness affected by fiscal aspects and funding availability [fifteen, sixteen]. Specifically, three aspects have been reported every bit crucial [xv]: (a) paying for instruction, (b) returning investments in the time to come, and (c) impacting future salary. When choosing the plan, respondents have been documented to consider what would all-time fit to their busy life [eastward.g., a hybrid course of education with online courses], but also the fourth dimension available and that requested [e.g., for degree completion – which has been reported to be more important in the case of DNP than PhD]. Time has been considered as 1 of the three main barriers identified for bachelor/main/DNP students to start a PhD [eighteen]. The other two barriers are costs and the issue of experience, every bit students want to gain clinical experience before entering the plan. However, 69 % of students sampled indicated that they would consider a PhD straight afterwards their electric current programme of study [18].

Choosing a professional doctorate or non has been reported to exist influenced by the information available to the potential candidates; students chose a PhD as they were non enlightened of the DNP [24]. According to a study performed in China [14], the bulk of PhD students take been reported to pursue a doctorate according to their career plan (73 %) and to better their research abilities (53.nine %). Science passion and motivation to piece of work for nursing discipline development, and through science for the improvement of quality of life, was also reported amidst BNS/BS–PhD students. However, their challenge was the lack of experience in clinical exercise. This has been reported as the nursing identity threat more often than not due to the opinions of "older" nurses, and also challenged their future career prospects in case they were non productive as scientists. Moreover, their life is challenged because they are the youngest students in doctoral programs and are also dealing with financial and family responsibilities [33].

Structure level: (two) Qualifications of faculty members

The contour of faculty education in DNP and PhD programs has been documented as unlike [13]. Those staff who teach DNP students are more likely to have DNP degrees and be engaged in clinical practice, whereas lecturers with a PhD unremarkably teach PhD students and are more than likely to exist engaged in research activities with students while mentoring enquiry and supervising doctoral candidates or postdoctoral fellows. Notwithstanding, in a written report among the deans of those nursing schools offering DNPs, simply 1 of the 33 institutions with previous PhD and DNP students reported no kinesthesia overlap [50].

Construction level: (3) Mission of doctoral programs

McKenna et al. [7] documented that staff members are more probable than students to agree that the emphasis of the doctoral curriculum should be consequent with the mission of the university and the subject field of nursing. Because the growing popularity of DNP programs, east.k., in the Us, divisions betwixt PhD and DNP have been documented to be at need of discussion regarding further development and the aim of these programs [20]. Staffileno et al. [28] reported that DNP and PhD students take difficulties cooperating due to dissimilar 'languages' and the challenges involved in agreement the role of this new degree. However, the importance of promoting collaboration betwixt PhD and DNP students has been underlined, and it is frequently an consequence associated with the personal characteristics of individuals involved rather than an outcome related to the type of degree. Specifically, PhD and DNP students tin can collaborate within the course and as graduates, due east.g., DNP students accept a clinical perspective, and so they know the correct inquiry question to ask, whereas PhD students have methodological knowledge and know how to ask questions. Moreover, PhD students/graduates may help DNPs to get fiscal support and grants when they experience difficulties, and they can mentor DNP in their scientific work [28]. In the context of cooperation between academia and clinical practice, Cygan and Reed [27] have provided an example where academia nurses and clinical nurses shared the complementary skills that they have in order to prepare projects to be scientifically and practically relevant.

Process level (i) Doctoral programs contents

There is a plethora of different subjects in nursing doctoral programs: in a United states of america study regarding research-focused doctoral programs, all of those under investigation included statistics/quantitative design, philosophy/theory development and qualitative methods. However, only 55 % of programs showed bear witness of including a nursing inquiry [x]. According to Minnick et al. [50], around 81 % of DNP programs in the U.s. take been reported to crave inquiry courses, 79 % require clinical practice, with more than BNS-DNP than MSN (Principal's caste)-DNP programs, and just 5 % require teaching exercise. Regarding other issues related to doctoral student qualifications, 43.3 % of programs included research ethics, 55.eight % education/teaching, l % policy and 36.vii % leadership contents. A little deviation between programs from 30 years ago, and those available at the time of the report have emerged, also suggesting that programs exercise not respond to research priorities [10].

Students have been reported to assess doctoral programs different to the faculty. In McKenna et al. [7], staff members reported that each pupil had relevant ethical training in preparation for undertaking enquiry, and that they had provided students with diverse and challenging learning experiences (east.g., social, ethical, cultural, economic and political issues related to nursing, wellness care and enquiry). On their part, students have reported disagreement with such statements.

Nursing PhD students have been reported to need more than practice secondary data for analysis using large data sets, biomedical information science data interpretation, and an agreement of applied machine learning algorithms. They likewise required more in-depth statistical courses [eight]. Additionally, PhD students have highlighted that learning scholarly writing is more constructive when you accept someone to explain information technology (expert-faculty to guide) and when the support system in this telescopic is established [51].

Procedure level (2) Doctoral programs resources and quality

Having research support for students has been highlighted equally important for doctoral instruction. In a U.s. study, amidst the deans of nursing schools offering a doctoral degree, 75 % accept reported offering a research office to increment the amount of external funding, to promote scholarly work including publications, and collaboration with other disciplines. In this line, grant development, assembly, budget development, research seminars and statistical consultation were the most activities performed by the office [52].

However, the resources and quality of the doctoral programmes are non always perceived homogeneously from the side of the faculty and the students. In a study involving seven countries, both faculty and students/graduates accept rated the overall quality of nursing doctoral education as good to splendid. The highest average score was reported for the faculty domain. In all countries surveyed, the faculty assessed the quality college than students/graduates in iii out of four domains (namely: program, faculty and evaluation) [45]. In dissimilarity, in a single country study involving UK doctoral students and faculty, students assessed the quality of doctoral programs higher than kinesthesia members. Even so, students did not agree that the environs and resource available, such as fiscal support, time allocated by staff to support students, and level of the technical support, were of an appropriate quality [7].

Strengths and weaknesses in the quality of doctorate programmes have been documented in a Korean study where the strengths included kinesthesia research productivity, the application of new research methods, students' various backgrounds and interdisciplinary courses. Amongst the weaknesses were the crumbling faculty, decreased number of candidates for doctoral report, and a lack of funding support for research [46].

In add-on to the above-mentioned aspects of quality, doctoral program quality indicators have also been reported in the doctoral comprehensive/qualifying examinations. Mawn and Goldberg [53] investigated research-focused doctoral programs, and reported different methods for such examination, ranging from the written take-home exam to a written publishable paper with follow-up oral defence of the paper.

Process level (3) Mentoring and supervision

According to some authors [iii, 16, 21], mentoring is very of import in directing research during a doctoral program (both PhD and DNP). Mentoring relationships have mostly been focused on the pursuit of scientific research, the transfer of knowledge, facilitating research activities and developing inquiry partnerships [19]. However, there are different expectations when mentoring doctoral students co-ordinate to the caste plan. In the case of PhD students, faculty mentors are expected to hold a PhD, be engaged in research, publish manufactures, and have an overall scientific portfolio. In the example of DNP students, faculty mentors must hold a doctoral degree (DNP or PhD), be active clinical practitioners (east.g., ANPs) and take experience as a mentor in specific topics such equally quality improvement and patient safety [3]. However, in a U.k. study, it was institute that supervisors did not distinguish betwixt the needs of professional doctorates and PhD students and reported the same expectations regarding research [25].

To be constructive, mentors of doctoral students should be trained; also, the number of students allocated to a single mentor is of import, as is the time available and the students' readiness for a degree [3]. Moreover, students' readiness for a career has been documented as beingness greater when they have one or more mentor/advisor [11].

PhD students highlighted the importance of good supervision when doing doctorates, and most reported positive comments almost their supervisors [21]. In the study past Lee [25], students of a professional doctorate program have been reported to welcome a supervisor with a different groundwork, who could develop their knowledge and skills and add new dimensions to their inquiry, while supervisors were more probable to want to lucifer their background with that of the students. From the perspective of supervisors, critical thinking, independence and autonomy in the supervision process accept been highlighted, whereas students wanted aid and support to further develop their disquisitional thinking and writing skills. Students see supervision every bit a mutual relationship with mutual learning. Also, they wanted to use their practical expertise together with doctoral studies in order to generate knowledge for application in practice, rather than to only learn how to apply other evidence [25]. Moreover, PhD students reported positive experiences regarding the timing of feedback received from their supervisors, but they reported that this feedback was not always helpful and was often accompanied past conflicting expectations [21]. In a study of PhD and DNP students, stressors which significantly predicted students' leaving the plan were primarily related to the relationship with the faculty/counselor [54].

Process level (4) Doing doctorate abroad

Doing a doctorate away has been documented as promoting learning independence and increasing the understanding of cultural differences [47]. Moreover, in a qualitative report of 17 students representing 9 different countries from vi different UK universities, the majority (northward=thirteen) reported expecting greater focus on professional issues within their programme and were surprised at the almost exclusive emphasis on research. They expected to have more clinical preparation. Additionally, respondents highlighted the demand to accommodate to the self-directed democratic nature of learning at a doctoral level, which was very difficult, equally also reported previously [47].

Many strange students noted that their educational backgrounds trained them to draw and replicate cognition rather than create it. Nonetheless, students have stated that it was good to discover their own vocalism and articulate their own ideas [24]. Additionally, they indicated the enormous challenge of studying in English. When abroad, students described a strong need for support through supervisors, interactions with the department/establishment and relationships with other students and wider social networks. Supervision has been reported to be dissimilar to that in students' countries; they were supposed to be more independent in their piece of work, and not told what to do, but supervisors were both approachable and friendly [24].

Struggling with loneliness, isolation and the toll of living in the United kingdom of great britain and northern ireland take been also underlined. Most participants carried the weight of high expectations from their family, colleagues and sponsors on their shoulders, which, in some cases, clearly led to chronic anxiety almost whether they would succeed [24].

Outcome levels (1) Bookish performance outcomes in doctoral programs

Six common bookish performance outcomes in nursing PhD programs take been identified to date: comprehensive examination (80 %), ongoing minimum graduate GPA (79 %) of 3.0, formal dissertation (82 %): chapter format (77 %); time to degree attainment (71 %); degree attainment (71 %); and time to candidacy (63 %) [49]. PhD programmes mostly end with a dissertation, while quality improvement projects and the translation of evidence-based practice have by and large been reported for DNPs [3].

With regards to the content of the thesis, Jensen [35] discovered that a few have been developed upon a nursing theory, whereas the bulk of PhD graduates employed a traditional format for their dissertation, and over xl % of them never published their dissertation findings in peer-reviewed journals [36]. In a report of 79 PhD programs in the Us, 84 % offered the traditional format for dissertation and 71 % the manuscript option format, while 59 % offered both. The manuscript/publication format has been chosen every bit it may increase the transition of pupil nurse scholars to academic positions and provide preparation for the function. Still, students with no bookish writing skills are challenged; moreover, in that location is no agreement regarding the number of manuscripts and their status, and whether information technology should be already published, submitted or reviewed [37].

Regarding the doctorate duration, students who enter PhD programs every bit undergraduates have been reported to need less time cumulatively to terminate a doctorate compared to those entering after a Main'due south. However, on average, undergraduate students take longer to consummate a PhD (from 5.ii to five.9 years) in comparing to those who beginning a PhD after a Primary's education (from five to five.1 years) [xvi, 30]. With regards to the DNP, the average length of time for students to finish the MSN-DNP programme was 2.43 years, whilst BSN-DNP was 3.8 years [l]. Time for degree completion was more of import for DNP than PhD students; family unit and job obligations interfered with studying and writing [xv].

Outcome levels (2) Doctoral graduates' competences

Findings from PhD and DNP students and recent graduates have reported a lack of training for faculty roles, specifically for teaching [12], equally likewise reported past Nehls et al. [16] in PhD students with different entry paths. Graduates with a PhD accept become both a required and preferred option for didactics positions in many universities; given that teaching more often than not occupies the majority of the faculty's time, they accept been reported to exist inadequately prepared co-ordinate to the priority given to research [19].

Despite these issues, Fang et al. [30] reported that the majority of PhD students at the end of the programme programme their bookish career in teaching more than than in research due to the interest in teaching and the perceived contribution of enquiry to patient care. Interestingly, well-nigh one-half of students surveyed who had not-academic career plans at the beginning of the programme changed their mind during the doctoral report. Similar findings were documented by Bai et al. [fourteen], who found that 60.7 % of PhD students want to work in an educational institution, especially reputable universities. Their desired field of work was nursing instruction in the majority (75.iii %) and the clinical setting in simply a few (16.nine %).

In contrast, PhD students who entered a doctoral programme via an early entry pathway, such as pre-baccalaureate or mail service-baccalaureate, take been reported to more often choose a research career [16]. However, they accept also noted concerns regarding their clinical competences [55]. In this context, PhD didactics has been recommended to develop their clinical competences in lodge to ready them to provide the clinical educator role.

Moreover, some DNP graduates have been reported to come dorsum to the doctoral programme to do a PhD [56]. Their decision was mostly motivated by wanting to know more, especially regarding translating research into practice and implementing enquiry findings, but also with the social tension of not having skills or competences to apply for specific roles at the faculty level.

Outcome levels (3) Doctoral students/graduates' satisfaction

Doctoral didactics has been reported to exist worth the time commitment and the money invested; PhD students and graduates, more than their DNP colleagues, have been documented to believe that doctoral programs prepared them extremely well for research activity and faculty roles [15].

Outcome levels (iv) Doctoral graduates challenges

In a qualitative study amid the PhD and DNP-prepared faculty on tenure rails in academia [17], the importance of the evolution of meaningful partnerships and continuity was reported. Too, the need to balance responsibilities was documented, as was having time for research, publications, and the direction of administrative requests. Both PhD and DNP staff on the tenure track have reported hostile handling and criticism by senior faculty members; however, 'caste shaming' has been reported more often past DNP staff. Despite this, many staff on the tenure runway take also reported beingness valued and appreciated. Additionally, they showed the demand to be mentored, supported and coached, specifically in more advanced research.

In Nicholes and Dyer [24], 61.3 % of the DNP faculty were eligible for tenure. Yet, there is a concern that they are non trained well enough for the research activity, which may influence the development of the nursing field of study.

In the case of PhD nurses who are APNs working in a clinical surroundings, even though they undertake several important roles for nursing practice development (such as clinical inquiry, inquiry skills and irresolute practise), they take encountered challenges with integrating themselves into the team without the support of nursing leaders [48]. Co-ordinate to Orton et al. [57], RNs with a PhD in the clinical environment also experience challenges: they have been reported to desire to change practice, but in doing this, they must face barriers. They have admitted that their motivation to pb the evidence-base practice is stiff, but doing their own research was difficult, mostly because of the lack of fourth dimension. They have often been assigned to the clinical pedagogy of nursing students, or to aid colleagues in developing cognition and skills. Therefore, farther role clarity is needed in clinical settings. Like findings have been reported past Sørensen et al. [54] who surveyed nurses with PhDs working in Nordic university hospitals. They reported sharing their work time betwixt research, didactics, supervision and administration given that the majority of them held positions shared between the university and the hospital. Moreover, Andreassen and Christensen [38] underlined the fact that nurses with a PhD working in clinical areas are seen by their colleagues and by themselves as those who implement inquiry results into do. They are seen every bit a resource of health intendance institutions; withal, their position in clinical settings is uncertain.

Discussion

We have performed a Scoping Review with the aim of assessing the state of the art and issues regarding doctoral programs of nurses. A meaning number of studies accept emerged in the final 10 years, mainly in the US and Europe, with a few examples of international approaches [5, 45] suggesting an impulse in this direction. Moreover, studies are mainly quantitative and qualitative, where the experiences/expectations of students, doctorates and faculty members, as unlike groups (e.g. [three]) or integrated (east.g. [55]), have mainly been investigated. Therefore, the available bear witness is mainly descriptive of different aspects of education, highlighting that more than longitudinal or experimental [1] studies are needed in this field of enquiry to investigate the effects of this pedagogy likewise as its changes, in the long-term, from unlike points of view, including that of students, doctors and faculty members.

At the structural level of doctoral programs, a great variability of admission criteria has been documented to appointment, some regarding the academic grooming or potentialities (eastward.thou., GPA, GRE, writing essay, [49]), and others regarding the attitudes and competences as either bodily or potential, as certified with a alphabetic character of recommendation. An ample debate has besides emerged regarding solutions concerning the minimum requirements of clinical hours for younger candidates (due east.grand. [44]), approaching doctoral studies in the curt-term. Some data accept already been produced regarding early on undergraduate entry in a PhD programme on adept research productivity, research career interests and longer time productivity for the nursing discipline [16]. However, the experiences available are mainly descriptive, and at that place are calls to conduct studies investigating predictors of doctoral programme success regarding all of these aspects with the intent to inform the best decisions regarding the establishment of a common framework of admission criteria that might be useful, especially for transnational doctoral programmes. On the side of candidates/students, issues associated with the financial implication both in the brusque- (fees) and long-term (e.g., the bear on of time to come bacon) should be considered in those countries where a limited number of doctoral-prepared nurses are available. Issues regarding the preparation of the faculty accept been less well-investigated to date [thirteen], while emphasis has been placed regarding the mission of doctoral education, not just concerning the differences betwixt PhD and DNP programmes but also regarding their collaboration with the practice. The aspect of cooperation between graduates of these 2 programmes are also highlighted by position papers published by the American Association of Colleges of Nursing [22, 23].

With regards to process dimensions, a regular upgrading of the programme contents [10] as well every bit in the modalities of the terminal examination [53] are recommended, given that studies have reported some class of stability over the years [10], while these programmes are required to respond to emerging research priorities, innovations in methodologies and competence, as underlined by the American and Canadian organisations working for nursing science excellence [22, 59, 60]. Additionally, the majority of studies available have reported a difference in the perceptions of doctoral program quality between the faculty and students, with high values among the get-go (e.g. [7, 8]): in a student-centred approach, understanding this gap and promoting improvements is recommended as a strategy to align the programme delivered to the expectations of attendees. Moreover, the quality of a doctoral programme is besides enhanced by the research unit/centres and support offered to students – suggesting therefore that each doctorate programme should be equipped past the resources established at the academic level – thus assuasive students to access non only traditional resources (faculty members, supervisors, and librarian) but also a centre devoted to supporting enquiry. Special equipment should be ensured in those doctoral programmes hosting foreign students which accept been documented to take additional needs requiring appropriate support (east.g. [24, 47]).

A skilful relationship of PhD students with their supervisors is of import for programme completion, besides every bit for growing every bit a person and a scientist. To appointment, different dimensions have been debated in the supervisor's training, background, number of students to supervise, and number of mentors for each student (e.m. [11, 25]), leaving the supervision process nonetheless under-researched [24]. Moreover, bachelor studies seem to accept considered singular elements of the procedure rather than the quality of the entire academic surround equally beingness capable or non of promoting excellence in doctorate education. This is visible in the position statement launched by the American Association of Colleges of Nursing [22], likewise equally in the Quality Standards for Canadian Doctoral Education in Nursing, which underlines that the criteria required for excellence in PhD education include: active faculty researchers who would be capable of mentoring PhD students in research and helping with socialisation that is important in the competitive context; and opportunities for the active appointment of doctoral students in a scholarly surroundings with recognition of their contribution in the subject field development [59].

Finally, regarding outcomes, there has been no articulate gear up of indicators established to date as doctoral programme outputs. A set of agreed outcomes measuring both the procedure (e.thou., PhD/DNP duration) and end points (e.g., publications) in the short- and long-term (career achievements) in addition to the degree of satisfaction [15] are encouraged. All of these might back up evaluation of the effectiveness of improvements – likewise at the international levels. Career plan expectations accept been reported to change over the years and are different: in the clinical arena for DNP, and in teaching for PhD, also every bit early entry [30]. The issues documented in the literature propose that at least constituent courses should exist promoted to improve instruction and clinical competences. However, challenges have been underlined in the following career, not simply due to the lack of some competences, only besides due to entering a hostile academic surround [17] and in clinical practice where the support of leaders is crucial [48]. A wider career training should be an important element of doctoral programs from the initial stages [37]; besides, in this case, more than studies are required to empathize factors promoting and hindering success in the transition from the educatee's role to a doctorate position, both in the academic and clinical arenas, in order to design constructive strategies. These strategies accept also been underlined by the American Association of Colleges of Nursing and other stakeholders [22, sixty]. About doctoral students have reported the plan to work in educational institutions, but not many PhD graduates in clinical settings [fourteen]; therefore, there is a need to prepare students for faculty roles without neglecting the clinical area [15].

In terms of roles, establishing the DNP has been recognised equally a step forward in developing clinical nursing practice, as the number of nurses with a DNP is increasing apace. However, as numbers of PhD nurses decrease, it can exist seen as a threat regarding the development of science in nursing as PhD candidates decrease, and they are seen as future scientific scholars [1, 58]. Moreover, degree confusion may be observed beyond the world considering that DNP is popular in but a few countries, generally in the US [26].

This Scoping Review has several limitations. Firstly, just three databases were searched, with inclusion criteria express to but publications in English; moreover, despite the systematic method used, some papers might have been missed. In addition, no grey literature has been searched, as more emphasis was placed on peer-reviewed primary studies published up to January 2020, thus missing publications which were more recent (eastward.one thousand. [61]). Additionally, review/conceptual papers were also not included, so this is recommended for time to come analyses, as the discussion amid scholars in this regard is lively e.g., [1, 4, 58]. When analysing the included studies, any differences have been introduced between PhD and DNP programmes that take been considered together co-ordinate to the chief aim of the report, while differences, if whatever, have been highlighted when reporting findings. Moreover, we used the Donabedian framework [43] to organise the report findings, given their ample diversity. However, our study did not intend to assess the quality of doctoral programmes in their triad of structure, process and effect dimensions.

Conclusions

Doctoral education is expected to bring very complex outcomes – to prepare graduates equally experts in the subject, education, research, clinical practice, leadership, and policy-makers. Considering studies published in the concluding 10 years, deep give-and-take regarding doctoral programs for nurses is being provided past scholars and nursing leaders in the United states and in Europe. Doctoral programs are different beyond countries, with no visible cooperation of scholars internationally; their structure and content has been reported every bit stable over the years, thus not following the research development in nursing, discipline and practice expectations.

Reflecting on the mission of the doctoral programmes, which volition assistance to fix future scientists equipped with strong competences in inquiry methodology, in that location is a need to motion the research produced from descriptive to more robust approaches that are capable of intercepting the effects of this education in their different features in the brusk- and long-term, in guild to inform the establishment of bear witness-based doctoral educational activity pathways across the earth.

Studies investigating predictors of success informing an bear witness-based approach regarding the access criteria, as well equally regarding other process elements (east.thou., the quality of the programme, the quality of the supervision) are recommended. Aslope the investigation of singular elements, scaling up the perspective by because the quality of the entire bookish surroundings equally capable or not of promoting excellence in doctorate pedagogy is strongly suggested given the acknowledged importance of the environments on the learning process.

Doctorates in nursing should be equipped with appropriate resource and should embody an appropriate caste of continuing innovation in their programmes, equally well as rigours evaluating outcomes in the curt- and long-term. In this light, national and global strategies might be useful to ensure consistency and raise the quality of the programmes and resource for doctoral educational activity in nursing, as well as to link them to a university career plan. Authorities agencies should support the institution of doctorate instruction; international professional person organisations (east.1000., the International Network for Doctoral Education in Nursing, International Council of Nurses; the Theta Tau International; European Academy of Nursing Science) might play a pivotal function past proposing doctorate frameworks [45]. It may be useful specifically for those countries which start with their doctoral programs in nursing or those who only plan to open it. However, career advancement, both with regards to clinical and bookish roles, should be monitored in order to understand the implied factors and wastes in this context in club to preclude overeducated nurses not engaging in roles according to their competences.

Availability of data and materials

All information generated or analysed during this study are included in this published article.

Abbreviations

APN:

Avant-garde Nurse Practitioners

BSN:

Bachelor caste

DNP:

Doc of Nursing Exercise

GPA:

Class Point Averages

GRE:

Graduate Tape Examinations

MSN:

Primary's caste

PhD:

Doctor of Philosophy

PRISMA-ScR:

Preferred Reporting Items for Systematic reviews and Meta-Assay extension scoping reviews statement

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Funding

No funding available for this study.

Author information

Affiliations

  1. Department of Holistic Care and Management in Nursing, Faculty of Health Sciences, Medical University of Lublin, Staszica Str. 4-6, Lublin, Poland

    Beata Dobrowolska

  2. Department of Nursing Development, Faculty of Health Sciences, Medical University of Lublin, Staszica Str. 4-6, Lublin, Poland

    Paweł Chruściel & Violetta Mianowana

  3. Department of Gynaecology and Gynaecological Endocrinology, Faculty of Health Sciences, Medical University of Lublin, Staszica Str. 4-half-dozen, Lublin, Poland

    Anna Pilewska-Kozak

  4. 2nd Department of Gynaecology, Medical University of Lublin, Jaczewskiego Str. eight, Lublin, Poland

    Marta Monist

  5. Section of Medical Sciences, University of Udine, Viale Ungheria, twenty, 33100, Udine, Italy

    Alvisa Palese

Contributions

BD, PCh, AP-K, VM, MM, AP - Have made substantial contributions to conception and pattern, or acquisition of information, or analysis and interpretation of information. BD, PCh, AP-Thou, VM, MM, AP - Been involved in drafting the manuscript or revising it critically for important intellectual content. BD, PCh, AP-K, VM, MM, AP - Given final approving of the version to be published. Each author have participated sufficiently in the work to take public responsibility for appropriate portions of the content. BD, PCh, AP-K, VM, MM, AP - Agreed to exist answerable for all aspects of the work in ensuring that questions related to the accurateness or integrity of any role of the work are appropriately investigated and resolved.

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Correspondence to Beata Dobrowolska.

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Dobrowolska, B., Chruściel, P., Pilewska-Kozak, A. et al. Doctoral programmes in the nursing bailiwick: a scoping review. BMC Nurs 20, 228 (2021). https://doi.org/ten.1186/s12912-021-00753-6

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  • DOI : https://doi.org/10.1186/s12912-021-00753-half dozen

Keywords

  • Doctorate Instruction
  • Doctorate of nursing practice
  • PhD/doctorate in nursing
  • Nursing Discipline
  • Research
  • Scoping review

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Source: https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00753-6

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