The following two articles in this Special Section for the Topic "Nursing Doctoral Around the World" initiate dialogue regarding Doctoral Education Worldwide.

Introduction

At its best, a doctoral program involves discovering and disseminating knowledge. In countries where nurses have been delayed in gaining admission to doctoral programs, the development of nursing knowledge has also been delayed. Members of any profession are best able to appreciate the essence of their discipline when their educational program includes not only studying, but generating, challenging, and testing the knowledge in their field (Lanara, 1994).

Downs (1988) maintained that adequate preparation of doctoral students is among the most important and pressing educational issue facing nursing, for nursing must depend upon this group of individuals for the critical and creative study of its science. In the U.K. and Ireland there are a number of ways that nurses can study for a doctoral degree. These include the traditional Ph.D. by thesis, the Ph.D. by published work, and the professional Doctor of Nursing Science degree.

In contrast to the United States (U.S.), availability of doctoral education for nurses in the U.K. and Ireland is relatively recent. Originally, a small number of nurses pursued Ph.D.degrees in related fields, such as education, sociology and psychology. In the 1970s the number of U.K. and Irish universities offering nursing Ph.D.degrees could be counted in single figures. Only in the 1990s did nurses begin to undertake doctoral study in significant numbers. After a comprehensive search of the literature, index of theses and research libraries, Traynor (personal communication, 1997) estimated that in 1997 there were three hundred nurses with Ph.D.degrees in the U.K.. In the Republic of Ireland the number was closer to ten. However, as the education of nurses is moving into the university sector, these numbers are increasing exponentially.

Normally, doctoral students in the U.K. and Ireland follow a European model of study, culminating in a thesis. The entry requirement is an undergraduate degree with a grade average above 60%. They do not usually require a master's degree. While full-time study (3 years) is available, most tend to undertake their doctorate part-time (5 years), probably due to the lack of funding for full-time study.

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The average age of students entering nursing doctoral programs is 35. This is in contrast to those U.K. and Irish students who undertake doctoral study in the basic sciences where the average age on entry is 21. In the former, a doctoral degree is normally undertaken part-time after a number of years in practice, education, or both. In the latter, the student commences a doctoral degree full-time immediately following their primary degree. Recently, younger nurses are enrolling in doctoral programs due to the emergence of a small number of full-time research fellowships, the evolving career structures in universities, and the recent introduction of the clinical nurse consultant role, where a doctoral degree is beneficial. Consultant nurses are a recent phenomenon and were supported by the British Prime Minister as a means of retaining higher caliber nurses in clinical settings. The role tends to be 50% clinical practice and 50% leadership and research.

Ten to twenty years ago in the U.K. and Ireland it was common for nurses to have a clear interest in a specific research topic prior to admission into a doctoral program. These nurses had spent many years in nursing practice or education and knew precisely what they wanted to study. Furthermore, they realized that they were going to work on the project for a number of years; consequently they selected a topic that held their interest.

Because schools of nursing wanted to attract doctoral students, research supervisors agreed to supervise on a range of topics. However, faculty have recently become more selective about which research topics they will supervise. An emerging trend is for the supervisor to provide the topic and the research proposal and the student applies through a competitive process to undertake the work.

Another trend is mutual decision-making in supervisor and student selection. The student may check potential supervisors' credibility in the field and the number of students they have supervised to successful completion of the doctoral thesis. Potential students may also speak with other students who had been supervised by the faculty member.

Students are assigned to a research supervisor, or mentor, upon entry to a doctoral program. Supervisors must have a doctorate, be expert in the topic, and have supervised other doctoral students successfully. They usually supervise no more that four full-time or eight part-time doctoral students at one time, although the number can vary depending on other workload commitments.

Often a doctoral student has two supervisors, one familiar with the topic and one familiar with the research methodology. In some new university departments of nursing, a supervisor who has not yet supervised other doctoral students through to successful completion is mentored and advised by a senior colleague who meets all the criteria. Thus some doctoral students have two or, on rare occasions, three supervisors.

To attract high caliber research students many European universities offer attractive studentships that include fees, accommodation and expenses. Students, especially mature ones, expect a high quality infrastructure, including photocopying, stationary, printing, telephone, e-mail, library facilities, computer workstation, office accommodation and paid expenses for at least one conference. University student welfare facilities are also recognizing the importance of supporting doctoral students.

Types of Doctoral Degrees

Three mechanisms for earning a doctoral degree are in place in the U.K. The most traditional and common manner is by thesis. Some universities grant a Ph.D. on the basis of published work. Professional doctorates in nursing are also available.

Doctoral programs that require a thesis do so as a means to prepare future researchers. The supervisor reviews the proposed project for suitability as a Ph.D. or a Masters of Philosophy project. Then the supervisor and student discuss the feasibility of the study, e.g., availability of equipment and resources to support the proposed study, subject availability, and whether ethical permission will be possible.

Normally, the supervisor and the full time student meet one hour per week or one hour every two weeks. For part-time students the average contact time is one hour per month. The student sends written work to the supervisor before the meeting so that issues can be discussed. A detailed record is kept of the supervision meetings.

Because the traditional Ph.D. is by thesis only, it is not a requirement that students attend lectures or undertake examinations or coursework. Increasingly however, Ph.D. students are encouraged to attend lectures on research methods and theory. Some universities have Research Graduate Schools where students have regular seminars on key skills such as the use of quantitative and qualitative data analysis software, presentation software, writing for publication, writing grant proposals, and presenting at conferences.

In most universities, students are expected to present seminars to an audience of their peers three times during their doctoral career. The first seminar is prepared in close co-operation with the supervisor and relates to the project background, the overall aim of the project, the proposed methods and the objectives for the first year. The second seminar takes place about half way into the program and relates to progress and results obtained to date. The third and final seminar is a rehearsal for the submission of the thesis and addresses the following questions:

1. Has the work made a measurable and worthwhile contribution to the field of study?
2. Is the practical component of the work completed, or almost completed?
3. Has an outline of the thesis been decided upon?
4. Has the work been subject to external review through conference presentation or full papers?
5. Is the student and supervisor(s) satisfied that the written thesis will be submitted on time? If not, would assessors support an extension?

The culmination of a traditional Ph.D. is a research thesis of approximately 100,000 words indicating that a process of research training has occurred and the student has made a substantial contribution to the subject area. Students are encouraged to submit on time and the Higher Education Funding Council strictly monitors U.K. university completion times and rates. Full-time students should submit their theses within three years. Part-time students are allowed five years.

The submitted thesis is sent to an external examiner who is an expert in the field. There is also an internal examiner who is a member of academic staff in the student's university. The student defends the thesis to the examiners during a one- to two-hour oral examination. Supervisors have observer status in the oral examination. There can be one of six outcomes to such an examination:

1. The student is awarded a Ph.D. with no changes required to the thesis.
2. The student is awarded a Ph.D. based on making minor changes to the thesis.
3. The student is awarded a Ph.D. based on making more substantial changes to the thesis.
4. The student fails the Ph.D. but is awarded a Master of Philosophy.
5. The student is awarded a Master of Philosophy based on making changes to the thesis.
6. The student fails the thesis outright.

After a successful defense, the relationship between the supervisor and student continues with joint publications and conference presentations being commonplace. In the U.K.'s Research Assessment Exercise, which audits the quality of a university's research infrastructure, activities, and outputs, faculty and university departments get credit for successful Ph.D. completions.

The Student's Experience. Mason and McKenna (1995) explored the problems and difficulties involved in undertaking a nursing Ph.D. in the U.K. in detail. Many students found the "non-taught" nature of this degree a lonely and frustrating endeavor. Non-completion was a major problem. Although some students lack financial resources for program completion, full-time students can earn extra money by undertaking demonstrations and tutorials within the university. However, a fellowship sponsor may place restrictions on what a student can be asked to do outside the boundaries of their project.

Ph.D. by Published Work

A Ph.D. by published work requires the student to have a portfolio of scholarly work consisting of a number of papers published in international, peer-reviewed journals on a particular topic. Individuals may choose this route because they are unable to undertake a Ph.D. thesis in the traditional manner.

Normally the portfolio is composed of an introductory theoretical chapter, followed by a number of published peer-reviewed papers, each relating to the research topic. A final chapter brings the entire portfolio to a conclusion and documents how the author has expanded the knowledge base of the field. The oral examination is held in the manner outlined above for the Ph.D. by thesis; and if successful the individual is awarded a Ph.D.

This approach to doctoral study is similar to that in Sweden, where students undertake their research project supervised by a mentor. Sweden's Ph.D. by published work involves a thesis consisting of a number (5-6) of peer-reviewed papers "top and tailed" by introductory and concluding chapters.

Professional Doctorates in Nursing

Currently much discussion is occurring in Europe about the introduction of professionally taught doctoral programs for nurses. These doctoral programs are similar to the U.S.A. Doctor in Nursing Science (D.N.Sc.) degrees programs and have stimulated interest in Europe for the following reasons:

The Pursuit of Nursing's Substance. To most academics in Europe, doctoral education means Ph.D. study. However, the traditional Ph.D. has not always strengthened the links between research, theory and practice. Invariably, Ph.D. students know a great deal about the literature pertaining to their topic and they can discuss their method at some length and in great depth. However, the application of their findings to practice or future research tends to be a matter for the briefest consideration (McKenna, 1997). In contrast, the professional doctorate focuses specifically on the theory, practice, research linkage.

University Integration. Within the past ten years, nursing education in Europe has entered the university sector.Neophyte nurse academics realize that having a successful career in this new environment necessitates gaining a doctoral degree. However, they are employed to teach nursing and they accept that it is sensible to ensure that their doctoral thesis expands the boundaries of knowledge in that field. Consequently, in the U.K. and Ireland, a cadre of nurses has began to consider professional doctoral routes, where nursing knowledge, nursing scholarship and the essence of nursing are given equal weight with research methods and techniques.

The first D.N.Sc. program in the U.K. began in 1994 at the University of Ulster. Its establishment was a laborious process that included different layers of stringent validation and review (Boore, 1996). Applicants were carefully screened to ensure that their motivation for applying to the program was to make a contribution to nursing rather than simply to gain an academic ticket for career purposes.

The admission, process and submission stages for these programs are similar to that of the traditional Ph.D. The main difference is that D.N.Sc. students attend classes and submit coursework. D.N.Sc. students tend to be clinicians who want to remain in practice. They like the camaraderie and debate that being in a class group engenders. The students need the coursework milestones of the D.N.Sc.; they are not attracted to what they perceive to be the lonely route of the traditional Ph.D.

Most European universities that have adopted this professional nursing doctorate approach have accepted that the educational challenge is to endow students with a clear sense of purpose and a lifetime love for expanding their intellectual horizons with regard to the substance of nursing. Students are encouraged to recognize themselves as emergent scientists and appreciate the significance of the development of scholarly endeavours. Attempts are made to enrich the student with the ability to think critically, to identify the gaps in nursing knowledge, to search for truth without prejudice, to take risks with ideas, and to be creative and imaginative in solving problems. In addition, the students acquire the ability and desire to present their work to their contemporaries and to accept critical comments without intense feelings of personal attack.

Students gain epistemological and ontological insights and are involved in seminar work that takes them along the continuum from identifying interesting phenomena in practice to formulating and testing concepts and theoretical propositions. They explore knowledge of other disciplines to identify new paradigms and methodologies that may generate new nursing knowledge. As recommended by Meleis (1981), knowledge is explored epistemologically in relation to its preparadigmatic origins, analytically in relation to its theoretical components, and critically in terms of its significance and influence on the discipline of nursing.

The professional nursing doctorate seeks to take the doctoral student beyond what Benner (1984) referred to as expert practice to advanced practice. In Benner's study expert nurses participants could not always articulate why they knew certain things or why they practiced in a particular way. The professional doctorate attempts to exploit tacit and explicit knowledge (Polanyi, 1958) so that successful graduates can articulate the reasons for their actions.

According to Benoliel (1977), scholars need to be able to move back and forth between the empirical world of nursing practice and the abstract world of knowledge development. The D.N.Sc. program in the U.K. is based upon patient care as the seedbed for substance. Knowledge is generated from practice and has to be refined and returned to inform or be tested in practice. Therefore, all applicants to the D.N.Sc. must have easy access to patient care settings. This requirement is not merely to increase clinical expertise but to foster the linkage among theory, research, and practice necessary for developing and testing nursing science.

The D.N.Sc. can be a challenge to faculty and it is one that is taken very seriously. There must be a persistent vigilance to ensure that the D.N.Sc. does not become another series of taught modules where students master the content so that they can regurgitate it back in end of term assignments. According to Grace (1978) such a process is anathema to the independent and creative enterprise that needs to exist if a doctoral program is to be of value in extending the boundaries of nursing knowledge.

Ph.D. versus D.N.Sc.

According to Lash (1987) and Grace (1978), North American nurses have difficulty differentiating between research and professional doctorates. Lash argued that these programs are similar in that each has a theory strand, a research component, and an integrative science component. He stated that the many similarities between these higher degrees made it difficult to tell them apart.

In the U.K. and Ireland, the problems of differentiation between the Ph.D. and the D.N.Sc. are not so acute. This mix of approaches to doctoral education is appropriate for the current stage of nursing development. Both degrees are of equal rigor and both are organized systematically in terms of length of program, supervision and support. Both are concerned with the training of students in research methods, the generation of new knowledge, and the presentation of primary research in the form of a dissertation.

The major differences are in the delivery and the mission of the two programs. The D.N.Sc. is a taught degree in which students pass examination and coursework milestones. All D.N.Sc. students are encouraged to explore the substantive content of nursing knowledge and to become adept in a wide range of qualitative and quantitative methods. In contrast, the Ph.D. students may only study the method they are using for their study, and the final thesis may not pertain to practice or patient care.

Conclusion

Some physicians and nurses disagree with the move to doctoral education for nurses in the U.K. and Ireland. They feel that nursing is moving too fast and is leaving behind or rejecting important knowledge, skills and tasks. In particular, they have faulted the Ph.D. as an academic pursuit with no clear linkage to patient care. Interestingly, the introduction of professionally taught doctorates has encouraged a different viewpoint. Here the emphasis is on marrying theory and research with practice. It is also interesting that practitioners are undertaking these doctorates, stressing that they want a career in clinical practice as advanced practitioners rather than as university-based faculty. Both degrees are undertaken rigorously and systematically and both have value in the pluralistic world that is modern nursing.

Authors

Hugh McKenna, RGN, RMN, DipN(Lond.), BSc(Hons), AdvDipEd, RNT, PhD, FFN FRCSI
E-mail: hp.mckenna@ulst.ac.uk

Dr. McKenna is the Head of School of Health Sciences, University of Ulster, Jordanstown, Co Antrim BT37 0QB, Northern Ireland.

John Cutcliffe, PhD, RMN, BSc(Hons)
E-mail: jr.cutcliffe@ulst.ac.uk

Dr. Cutcliffe is Senior Lecturer in Mental Health Nursing, University of Ulster, Coleraine, Co Derry BT42 1SA Northern Ireland.