The Doctor of Nursing Practice (DNP) program lists several categories of competencies that a graduate should master; these categories are described by the American Association of Colleges of Nursing as part of the essentials of doctoral education for nurses (AACN, 2006). Helpful strategies for evaluating these competencies are self-assessment and reflection on how successfully a learner has mastered them throughout the course. In my reflection, I will evaluate my experience of improving my skills, abilities, and knowledge associated with analyzing scientific data, synthesizing clinical prevention and population health concepts, and evaluating care delivery models.
You Decide Reflection
Scientific Data Analysis
The first category of competencies is associated with the ability to “[a]nalyze epidemiological, biostatistical, environmental, and other appropriate scientific data related to individual, aggregate, and population health” (AACN, 2006, p. 16). I think that the most important aspect of developing this ability is improving one’s understanding of how scientific data is obtained. For this, a DNP-prepared nurse should explore the methods and instruments employed in academic and experimental studies that address health- and health care-related issues on various levels. For example, when trying to use primary research findings for my own research conducted as part of an academic assignment, I found it rather difficult because I found several studies the results of which were conflicting, i.e. it was difficult to present all of them in one research paper. This experience helped me realize that it was challenging for me to integrate scientific data into my own secondary research because I lacked proper understanding of how that data had been generated and what it meant.
What I found particularly useful to address this issue is reading extensively on research methods in health research. I think the course was successful in terms of providing me with relevant information about methodology, e.g. experimental studies, interventions, or establishing correlations and causations. In most scientific works, authors indicate recognized limitations of their research, and I have learned to always pay attention to this part, too. An important part of mastering an instrument, such as a certain method of public health intervention, is comprehending to what extent the instrument can be effective and to what cases it cannot be applied. For example, Westreich et al. (2016) discuss the causal impact framework, which is an approach to health research that is different from conventional approaches but has an advantage of exploring effects and consequences of interventions more closely instead of examining situations in terms of risk factors only. Readings like this one helped me gain insight into health research.
Also, what is important in analyzing scientific data is assessing how it can be applied to real-life situations. Any scientific data (in case it is research data and not theory) is based on studies, i.e. practice of observing actual individuals, groups, and populations and applying certain interventions to them. Seeing how authors collected data, analyzed it, and made conclusions helps a nurse run this process in reverse, i.e. apply the data to individual and population-wide health care.
Synthesis of Clinical Prevention and Population Health Concepts
The second category of competencies is formulated in the Essentials (AACN, 2006) as the ability to “[s]ynthesize concepts…related to clinical prevention and population health in developing, implementing, and evaluating interventions to address health promotion/disease prevention efforts, improve health status/access patterns, and/or address gaps in care of individuals, aggregates, or populations” (p. 16). These concepts include psychological dimensions and cultural dimensions. The notion of concepts synthesis was challenging for me because there is a wide variety of available concepts and perspectives in health care, and it is not always clear how they can be fused into single ideas. However, any intervention requires an integral conceptual framework, which means that a nurse who develops, implements, and evaluates interventions should base these efforts on certain understandings of health phenomena described through concepts.
Again, what I think is crucial in concepts synthesis is understanding how concepts were initially developed and how their meanings are different in different studies. For example, the concept of cultural diversity is recognized today as an important component of delivering health care, and the concept is addressed in nursing curricula by developing and strengthening the cultural competence of learners, i.e. “cultural awareness, knowledge, skills, and comfort among nurses” (Mareno & Hart, 2014, p. 83). With the recognition of its importance, however, does not come the clarity of the concept’s boundaries and applicability. Different sources may describe differently the limits of cultural diversity considerations, i.e. which aspects of care a nurse should adjust to the cultural backgrounds of patients, communities, and populations and which aspects should be subject to universal standards of delivering health care.
This process of clarifying and specifying the meanings of concepts and the means of their application is the core of this category of competencies. Upon dealing with various concepts and attempting to apply them to practice, I can say I have learned to develop and implement conceptual frameworks more effectively. In the presented example of cultural diversity, I have learned not only to recognize the cultural aspects of care but also to analyze how cultural considerations affect the quality of care, the successfulness of interventions, and the actual patient outcomes. Looking into the concept’s development through readings on cultural diversity in nursing has helped me gain competence and confidence to synthesize various culture-related concepts.
Care Delivery Models Evaluation
The third category of competencies describes nurses’ ability to “[e]valuate care delivery models and/or strategies using concepts related to community, environmental and occupational health, and cultural and socioeconomic dimensions of health” (AACN, 2006, p. 16). At the beginning of the course, dealing with care delivery models was difficult for me because I did not understand the differences among them. There are general principles of nursing care, and the aspects of high-quality care recognized in different models are essentially the same. I saw that different models simply list the aspects of care in different orders, and this is why I did not understand the need for having so many different care delivery models. I was particularly confused because I thought that all the models described things that nurses already do and that they know they should do, so it seemed to me that many models I had familiarized myself with were redundant.
However, as I learned more from course materials, I realized that I had been confused about the notions of nursing theories, care models, and case management. There is a variety of terms used in theorizing about nursing, and their meanings sometimes overlap (Cherry & Jacob, 2016). What makes one nursing care delivery model or strategy different from another one is not a different set of principles (I think I was right at the beginning of the course when I though that general principles of nursing care were essentially the same across models) but a different emphasis and a different pattern of organizing the work of nurses. Now that I have explored various models, I can say I am prepared to evaluate them in a given case as well as to propose a model based on characteristics related to patients, communities, and populations.
One of the ways to improve the ability to evaluate care delivery models and strategies is to address their classification. For example, Dubois et al. (2012) propose primary division of all models into two categories: professional and functional. The former put an emphasis on registered nurses and their professional practice, while the latter put an emphasis on licensed practical nurses and orderlies and their perception of their practice. This example of distinction among models shows that the roles of nurses are presented differently, and I think that defining the role of a nurse in delivering care is the most important aspect of evaluating a care delivery model.
Conclusion
With each of the three categories of competencies, I have developed strategies to master them better. To improve the ability to analyze scientific data, I have learned to look more closely at research methods and the ways the data is obtained. To improve the ability to synthesize concepts, I have learned to examine concepts’ origins and differences among ways in which given concepts are used in different contexts. To evaluate care delivery models better, I have addressed the definition of such models and their classification. Overall, I think I managed to achieve mastery of the competencies required from a DNP-prepared nurse, and I am planning to continue the improvement through my education.
References
American Association of Colleges of Nursing [AACN]. (2006). The essentials of doctoral education for advanced nursing practice. Washington, DC: Author.
Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management (7th ed.). St. Louis, MO: Elsevier.
Dubois, C. A., D’Amour, D., Tchouaket, E., Rivard, M., Clarke, S., & Blais, R. (2012). A taxonomy of nursing care organization models in hospitals. BMC Health Services Research, 12(1), 286-301.
Mareno, N., & Hart, P. L. (2014). Cultural competency among nurses with undergraduate and graduate degrees: Implications for nursing education. Nursing Education Perspectives, 35(2), 83-88.
Westreich, D., Edwards, J. K., Rogawski, E. T., Hudgens, M. G., Stuart, E. A., & Cole, S. R. (2016). Causal impact: Epidemiological approaches for a public health of consequence. American Journal of Public Health, 106(6), 1011-1012.