SPECIAL SECTION: Doctoral Education Worldwide
The following two articles in this Special Section for the Topic "Nursing Doctoral Around the World" initiate dialogue regarding Doctoral Education Worldwide.
Shaké Ketefian, EdD, RN, FAAN
Eloita Pereira Neves, DNSc, RN
Maria Gaby Gutiérrez, PhD, RN
This paper deals with nursing doctoral education in the Americas. It provides an overview of existing doctoral programs in four countries where such research training is provided, namely, Canada and the United States in North America, Brazil and Venezuela in South America. For each country, patterns of education are described, including curriculum elements, students, research training, the dissertation, quality monitoring issues, and trends that may be emerging. Commonalities and differences are then identified, and recommendations are presented for those countries developing doctoral education; the potential for collaboration is highlighted between countries with extensive experience in doctoral education and those that are at the beginning stages of development.
Citation: Ketefian S., Neves E., Gutiérrez M. (May 31, 2001) "Nursing Doctoral Education in the Americas" Online Journal of Issues in Nursing. Vol. 6 No. 2. Available www.nursingworld.org//MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/ArticlePreviousTopic/DoctoralEducationAmericas.aspx
Key words: Nursing doctoral education in the Americas; International doctoral education; Patterns of doctoral education
Nursing Doctoral Education in the Americas
In reviewing the picture of nursing doctoral education in the region of the Americas, one finds a picture of extremes. On the one hand, the United States has offered doctoral study in nursing since the 1930s (Redman & Ketefian, 1997), and now has one of the most advanced and extensive systems in the world. On the other, a number of countries within South America are now making plans to offer doctoral study and are in the exploratory stages. In this paper we will provide an overview of patterns of education for existing doctoral programs in four countries, will review trends now shaping for the next decade, and make recommendations for countries now considering the establishment of doctoral programs.
Overview of Doctoral Education in Nursing
In providing an overview of existing doctoral programs, four countries will be considered, as follows: within North America, Canada and the United States; within South America, Brazil and Venezuela. They will be reviewed in the historical order in which doctoral education was initiated.
United States of America
Doctoral education was first initiated at Teachers College, Columbia University (1933), and at New York University (1934) with the doctor of education (EdD) degree. In the next 25 years only two more doctoral programs were established. Since then, the growth of doctoral programs has occurred rapidly (Redman & Ketefian, 1997). At last count, over 85 institutions were offering doctoral education for nurses. Approximately 80 percent of the degrees are the PhD [research degree], with the remaining being either DNS/DNSc or EdD [professional degrees]. The research doctorate, PhD, has wide acceptance in higher education, and is awarded for the highest attainment of scholarship in most disciplines.
Grace (1978) and Murphy (1981) have characterized the evolution of doctoral programs in phases. Phase I included education for nurses for functional roles such as education or administration (inception to 1959); Phase II involved education for nurses in a second discipline, referred to as nurse scientist training (1960-1969), although this phase continued well into the 1970s so enrolled students could complete their studies; Phase III involved education in and of nursing (1970 to present).
Doctoral education builds on undergraduate and master's study.
It is generally accepted that the purpose of doctoral education is to prepare scientists who are qualified to contribute to the development of nursing knowledge and who are leaders in health care, education and other enterprises.
The curricular components have evolved over the years, and in most cases, is now focused on advanced scientific training in the discipline of nursing. It is generally accepted that the purpose of doctoral education is to prepare scientists who are qualified to contribute to the development of nursing knowledge and who are leaders in health care, education and other enterprises.
While there are program variations, the curricular components in general are similar; these include research and theory in substantive nursing subjects, research methods and designs, theory building and philosophy of science, cognate studies in related fields, supervised research practicums, one or more research projects, and a dissertation. Graduates of doctoral programs teach, conduct research, lead, or direct health-related enterprises, and function in settings such as universities, policy arenas, private businesses, and the like.
Each university posits its own admission criteria. In the main, applicants are reviewed on the basis of the following criteria: Graduate Record Examination scores, grade point average attained in undergraduate and master's study, reference letters, statement of goals, and quality of scholarly papers they submit. Some schools require prior nursing and professional experience, some do not. Typically, entrants to doctoral study tend to be in their mid- to late thirties and by the time they graduate they are in their early forties. Strategies are now being considered to attract entrants to doctoral study earlier in their careers.
The extent and depth of research training varies somewhat, depending on type of institution. Programs that reside in research-intensive universities provide the most demanding and extensive research training. The substantive nursing focus offered by programs is typically a function of the faculty and their own areas of research. In research intensive institutions, it is a requirement that a critical mass of faculty be engaged in a common area of investigation, have track records of scholarly productivity, and have funded programs of research before a curricular focus can be offered to students. Such faculty engagement is thought to enhance and enrich the learning experiences of students.
It is typical within the United States for students to go through a period of coursework. Upon the completion of course requirements, students undergo an examination to demonstrate mastery of the subject matter of their interest; upon successful completion, they are admitted to candidacy, and can proceed to the dissertation phase. Many institutions have research experience or internship requirements for students to spend a period of time learning research hands-on as they work with a faculty member on ongoing research, and continue this involvement throughout their program of study. As a result of this approach students tend to accumulate a scholarly track record while in doctoral study, gaining valuable experience in co-authoring papers and scientific presentations with their mentors, preparing research proposals, posters, and the like, which serves them in good stead upon graduation.
Dissertation topics selected should be in line with the curricular focus and faculty expertise,
Dissertation topics selected should be in line with the curricular focus and faculty expertise, be significant to society, and promise to make a contribution to nursing science.
be significant to society, and promise to make a contribution to nursing science as well as demonstrate that the student has acquired the necessary skills to be able to function as an independent scholar upon graduation. A faculty committee that includes nursing as well as non-nursing faculty from other departments supervises and determines the quality of dissertations. Its scholarly character, theoretical soundness, scope, significance, and methodological sophistication are considerations in determining quality. An oral defense, which may or may not be public, culminates the process. Publications based on the dissertation are encouraged. Doctoral education is monitored by the universities, although day to day responsibility falls to the nursing faculty. The university involvement assures that nursing students meet all requirements of the institution, similar to students in other fields.
Many doctoral students study on a part-time basis, although the ratio of part-time to full-time students varies greatly within doctoral programs. The national average for time to degree, from beginning to completion, is five years.
A trend at present is for several institutions to collaborate. Typically, the impetus for this has come from governmental bodies for whom budgetary considerations weigh heavily, and collaboratively offering doctoral programs are deemed more efficient. Another interesting trend is for courses to be offered on the WorldWideWeb, (on-line) or using other distance learning technologies. Use of such technologies has rendered the geographic location of the student irrelevant, and many potential students are attracted to programs that offer either courses or entire programs through distance education. On the other hand, some institutions have resisted use of these modes, maintaining that one-on-one relationship with the faculty mentor is an indispensable part of doctoral education and would be compromised if the student were not on campus.
The first doctoral program in Canada was offered at the University of Alberta in 1991.
An important part of the application in some schools is the presentation of a detailed career plan, and delineation of specific research interests to be pursued, which should be congruent with the focus of the particular program.
The country now has six institutions [research universities] offering doctoral programs in nursing. The purpose of doctoral study is to prepare individuals who are capable of developing and testing knowledge, and pursuing scholarship. Applicants must possess a master's degree in nursing during which they have conducted a research-based thesis, and have a sound nursing background; they must have a strong academic background as indicated by grade point averages attained, have demonstrable potential and a strong commitment to nursing research, verified through reference letters. An important part of the application in some schools is the presentation of a detailed career plan, and delineation of specific research interests to be pursued, which should be congruent with the focus of the particular program. Determination of a faculty supervisor is made prior to admission.
The amount and type of coursework vary across these schools, and even within schools, depending on student background, experience, and career goals. Students are required to take courses in research methods and designs, theory development, and the philosophical basis of nursing science. The supervisory committee may recommend other nursing or non-nursing courses. A comprehensive examination is taken within a specified period from entry into the program or at completion of coursework. This exam is typically made of several major papers. The examining committee may be a combination of nursing and other university faculty.
A dissertation is required. The purpose is to contribute to the science of nursing and/or demonstrate ability to develop new methodology or advance existing methods by applying them within a new area of health care or nursing research. An oral defense of the thesis/dissertation is required. The faculty supervisor is the primary resource for the student. Along with a faculty committee, the student is guided throughout the program of study in selecting appropriate courses and other learning experiences; the committee must approve the dissertation proposal, and assures that the student has acquired the needed skills to carry out the research, and determines the existence of resources needed to carry out the study. The committee monitors the quality of the research, and its approval of the thesis designates satisfactory completion. The supervising committee is comprised of members from nursing and other disciplines. Members outside of the university may be nominated if indicated.
The doctoral programs are offered within the overall university requirements in that students must meet the same requirements as students in other disciplines. The universities provide overall quality monitoring mechanisms under the umbrella of a graduate school. All doctoral programs in Canada are located within research universities where doctorates in many other fields are also offered.
Some universities in Canada are experimenting with flexible options and introducing non-traditional learning modalities that enable students to complete degree requirements through combinations of on-campus and off-campus learning experiences.
Brazil began offering doctoral education in nursing in 1981 through an inter-institutional doctoral program, which was a joint venture between two universities. Subsequently, additional programs were established. At present, nine nursing doctoral programs are offered in the country, by five universities, with some institutions offering more than one program. They are intended to prepare individuals for leadership positions in research and teaching, although other areas of endeavor in health care or governmental agencies can also be chosen.
The Brazilian governmental guidelines for doctoral programs do not require master's degree for admission; however, all nursing doctoral programs have chosen to require the master's for admission. Each doctoral program establishes its own criteria for admission. The criteria for most programs include: a preliminary research proposal that is relevant for developing nursing knowledge; curriculum vitae that describes relevance of applicant's professional experience, educational background, research activities (publications), and proficiency in English (reading/comprehension abilities). There is a tendency to admit younger students (early thirties) who have experience in the teaching or practice arena, and who demonstrate potential for leadership in research.
The typical doctoral program involves approximately two years of coursework and an equal amount of time for dissertation work. One assigned major professor is responsible for supervising student research, and for assuring the completion of studies in the required time frame.
The curricular components are similar to the U.S.A., emphasizing epistemology, philosophy of science, research methods, cognate studies in fields related to the topic of the dissertation, and supervised research practicum. It is expected that the level of conceptualization is more advanced than at the master's program; further, doctoral programs are expected to contribute to science development in substantive nursing knowledge, and to the improvement in quality of nursing practice (or education and health care services).
All programs require a qualifying exam before the candidate can implement the research proposal for the dissertation. The proposal must be defended before a committee of three to five faculty members.
Doctoral dissertation research topics are derived from the research lines of investigation established by the research groups coordinated by faculty who are the major professors of doctoral students. Those lines of investigation encompass themes related to the following areas: assistance, professional, and organization of nursing and health care services.
The doctoral programs do not require previous research experience on the part of the student before he/she can start the dissertation.
The members of the research group jointly develop a program of research. Faculty members with doctoral degrees coordinate one of the projects, and are responsible for the overall project.
The trend is that students, upon admission to the program, become involved in a research project and join one of the research groups. The research groups may have one or more faculty members who hold doctoral degrees, faculty with master's degrees, nurses from health care agencies who hold master's degrees or specialization in the topics of study, master's, doctoral, and undergraduate students that receive scholarships or work on a voluntary basis. The members of the research group jointly develop a program of research. Faculty members with doctoral degrees coordinate one of the projects, and are responsible for the overall project. Doctoral students engage in research activities within the projects that are guided by their major professor. Through this type of hands-on participation students have the opportunity to learn to conduct research, as well as be part of the decisions that need to be made on a regular basis to resolve issues, as well as develop leadership skills.
The requirements for the dissertation are that the student has completed coursework, and that the dissertation (called doctoral thesis) follows the theoretical and methodological rigor expected. The goal of the dissertation is to contribute to the scientific body of knowledge in nursing, and to offer the student an opportunity to learn how to conduct scientific research.
Upon completion of the dissertation the candidate defends it in a public exam. The student also must submit an original article derived from the dissertation, for publication in a national or international peer reviewed journal (after approval of the committee). The members of the dissertation committee represent different content areas. Public universities require five-member committees, three of whom are external to the institution. The requirements for nursing doctoral programs are the same as for other disciplines.
The monitoring processes and procedures are rigorous, and operate at several levels. The Ministry of Education/Coordination of Higher Education must give authorization/approval before a program can begin. All programs must also attain accreditation before they may award degrees. Additionally, every three years, programs are evaluated through a peer review process involving external consultants, according to established criteria and national guidelines. The areas being evaluated pertain to the plan of studies, faculty, research activities, educational activities, student body, dissertation, and thesis quality, and scholarly productivity of faculty and students. The results of this evaluation are circulated and are publicly available, providing a ranking of the program in comparison with others and recommendations for improvement. The results of this review are used by funding agencies to allocate federal resources for education and research (Neves and Mauro, 2000).
Internally, each program conducts its own periodic evaluation as well, with appropriate changes implemented to stay in compliance with governmental requirements. An important indicator in these reviews is scientific productivity, involving the conduct of research and resultant publications; these scholarly activities are expected to occur following national guidelines for the profession. Lines of investigation initially established in 1982 are currently being revised, to reflect nursing research priorities which are under development. These priorities take into consideration both national as well as regional health research needs. Nursing is allowed latitude in determining its own priorities within the national/regional frameworks. Each school can then determine its own focus as it deems appropriate, in view of its faculty expertise and resources.
Some doctoral programs are offered collaboratively among schools. In some of these instances, the collaboration is between schools that have well established, accredited programs, and those that have not reached the required level of maturity. These projects focus on under-served geographical regions with the aim of decreasing the inequality in regional development. In addition, there are projects that address the needs for development of Latin American countries, in which Brazilian schools with mature doctoral programs are engaged in assisting other countries to develop doctoral programs.
Venezuela is the second country in Latin America to offer nursing doctoral education. The first nursing doctoral program was initiated in 1998 at Universidad de Carabobo, Facultad de Ciencias de la Salud, Escuela de Enfermeria B Valencia, Venezuela. This program was made possible as a result of the financial support of Pan American Health Organization, and the technical support provided by the faculty of the Federal University of Santa Catarina, Brazil. The doctoral program is one of the major projects of the REDEV -- Red para el Desarollo de la Enfermeria Venezoelana, a network for the development of Venezuelan Nursing, created at the same time. University of Carabobo offers 26 graduate programs, six of which are at doctoral level, in a variety of fields.
The focus of this nursing doctoral program is: development of knowledge through research and scholarship; personal and professional development for transforming nursing practice; leadership in the production, application and diffusion of knowledge that supports the art and science of nursing, and caring for health and human life.
Criteria for admission to the doctoral program include a master's degree, a preliminary research proposal in one of the existing lines of investigation, a letter of acceptance from a major professor and a "co-tutor" (from nursing or one of selected fields), curriculum vitae, and proficiency in a foreign language. Applicants are required to take an entry exam.
The initial group of students is a seasoned group, comprising of mid-career professionals, some of whom are leaders, and hold teaching or other important positions. A total of 56 credits are required for the degree, distributed between coursework and the doctoral thesis (12 credits). Three years are required for the completion of degree requirements, with the possibility of an additional year, with appropriate justification.
The main focus of the program is health and human caring.
The main focus of the program is health and human caring. The curricular components include philosophical, theoretical and historical foundations of human caring; fundamentals of science and epistemology and its application to nursing; foundations for management of health and nursing services; foundations of general and health education; theoretical and philosophical conceptions of health/life promotion and maintenance; research process in nursing and health.
Doctoral students and faculty are required to engage in research endeavors developed by research groups at the nursing school. The research studies should encompass one of the following units of investigation in nursing; adolescent reproductive health; and management of care and nursing services.
Doctoral students are required to give lectures, conduct workshops and other educational activities to nurses or other professionals in order to generate financial resources to support their own investigation and studies. They are also required to travel abroad in order to broaden their nursing views and to establish exchange with other nursing colleagues.
Students are required to present, defend, and get approval of the doctoral thesis in a public exam, according to policies established by the University. The thesis committee is composed of university faculty who possesses doctoral degrees and expertise in the area of the thesis topic. The chair of the dissertation committee is a nurse with doctoral preparation, and a faculty member of the doctoral program. At least one committee member is from another university.
The requirements for nursing doctoral study and the thesis are the same as for other fields within the university. The quality of the doctoral program is monitored by mechanisms of self-evaluation, and external evaluation. The evaluation is performed according to a model called Cinda that encompasses six dimensions, as follows: relevance, effectiveness, and availability of resources, efficiency, efficacy, and processes. The process of evaluation also includes dimensions and indicators of national accreditation of graduate programs established by the National Council of Universities.
Several countries in the Americas are now engaged in initiatives to develop doctoral programs. Among these are Argentina, Chile, Colombia, Mexico, and Peru. Faculties planning these new doctoral programs are working with various international consultants within the region to develop offerings appropriate for the needs of their respective countries.
Commonalities and Differences
In a recent paper by Ketefian and Redman (2001), the authors described two prevalent patterns of doctoral education, which they called the European model and the North American model. In the European model there is no coursework, and the program is conducted through individually supervised research. While in the North American model, there is a period of rather extensive coursework, 1-2 years in length, during which the student obtains supervised research experience by working with faculty; this phase is followed by an examination; upon successful completion, the student undertakes the dissertation, which is supervised by a committee of faculty comprised of nursing and other university faculty.
A review of doctoral education in the four countries in the Americas suggests that they are designed in the North American model, which can now be called the "Pan American Model."
Clearly, each country that begins doctoral education has been influenced by the developments in doctoral study in the preceding countries; yet, it is significant that each country has developed its educational programs in a manner that best fits within its own unique historical and cultural traditions, state of science, the health care needs of the population, and health manpower needs.
In all cases, the purpose of doctoral study is to prepare leaders in nursing and health care, with an emphasis on knowledge development. There is a clear component of coursework, supervised research, and the dissertation/thesis requirement. All countries have stated that they follow the overall requirements of doctoral education within the home university setting, and are subject to the monitoring and control mechanisms in place in their universities and countries. Clearly, each country that begins doctoral education has been influenced by the developments in doctoral study in the preceding countries; yet, it is significant that each country has developed its educational programs in a manner that best fits within its own unique historical and cultural traditions, state of science, the health care needs of the population, and health manpower needs.
Collaborative partnerships are evident across institutions to address inequality of manpower distribution, or to better use resources and share expertise; collaboration can be seen across countries as well, to take advantage of more experienced teams of experts during initial stages of program development.
There are likely to be differences as well; however, the level of detail at which this report was compiled was not capable of detecting specific ways in which differences could be exhibited. There appears to be a preponderant use made of doctoral graduates in academic and teaching roles, reflecting the current needs of the countries. To what extent do different countries make use of individuals prepared with the doctorate in policy roles within health care or industry is not known.
The pattern within Canadian institutions appears to be a combination of the European model and the American model. The extent of required coursework appears less extensive than within the U.S.A. and pursuit of individual research with a supervisor appears to begin at application or soon thereafter.
In discussing international perspectives on doctoral program quality indicators, Neves Arruda and de Silva (1999) present three dimensions for evaluating quality from the South American perspective; these are the socio-political, technical, and subjective. The socio-political dimension encompasses the production and transmission of knowledge; it also incorporates the development of a national identity, values, attitudes and behaviors that make life possible in a democratic and participative society. It involves the development of the capacity to be productive in a critical and creative manner, communicate effectively, and work in teams.
The technical dimension addresses the program of studies and educational experiences and environments that enable the development of expertise as well as open discussion and respect for intellectual and ideological diversity.
The subjective dimension addresses the affective domain such as satisfaction with the educational experience and with the level of competence attained to function effectively within the social and professional environments.
Collectively, these dimensions call forth the need to develop competencies that meet internal disciplinary demands, as well as the needs of the learner, both intellectual and subjective; they also address the need to meet external societal needs both in producing experts as well as active citizen/scientists who shape health and social policy through the use of their expertise.
The extent to which the above elements have validity for other countries, it would be important to determine whether the doctoral programs in the Americas systematically incorporate these elements. The current data did not yield sufficient information to make this determination.
The trend within the past decade to focus doctoral curriculums on the study and creation of disciplinary nursing knowledge has clearly taken hold, and appears to be the direction for the countries reviewed. For countries in the process of developing doctoral programs this should be an important consideration. It is also important for each country to identify its unique needs, educational and social traditions, and design doctoral programs that will be responsive to those needs. Thus, a two-pronged approach is recommended, whereby new doctoral programs attempt to learn from lessons of others who have traveled this road before, while at the same time, heeding the imperatives of their own situations and societies.
There is a clear need to develop the social consciousness of students regarding their broader societal responsibilities within Americas. Anecdotal evidence would suggest that currently the individuals who have developed the capacities that Neves Arruda and de Silva (1999) talk about are small in number. The presence of faculty role models within doctoral programs in this regard is not known.
New doctoral programs should clearly bear in mind the health care needs in the countries/regions in which they are located so as to be responsive to society. The type of educational and research experiences designed for students need to incorporate the imperatives of society as well as that of the discipline of nursing, so that nurse scholars can be seen as relevant, rather than standing apart from the societies within which they function.
At the present time there is no clear evidence of the presence of international perspectives within the programs in the countries examined.
A feature noted in Brazil is instructive. Brazil is reported to have ongoing projects to address the development needs within Latin America, part of which is to provide assistance to other countries in developing their doctoral programs. This model can have major impact in regional development if adopted by the countries in North America, especially Canada and the United States.
Knowledge about health care needs and nursing in other countries tends to be acquired randomly or through individual efforts, rather than systematically developed as part of a program of study. Many nursing programs are now providing optional international experiences to doctoral students. Also, an increasing number of faculties are working in other countries to collaborate in research and other areas. However, these are in the main individual initiatives. Those institutions with World Health Organization Collaborating Centers are providing broader institutional level leadership that promises to have more lasting impact. However, the number of these institutions is quite small. A feature noted in Brazil is instructive. Brazil is reported to have ongoing projects to address the development needs within Latin America, part of which is to provide assistance to other countries in developing their doctoral programs. This model can have major impact in regional development if adopted by the countries in North America, especially Canada and the United States.
The region of the Americas has over 40 countries, spanning from the very rich to the very poor nations. Many countries have dire health and manpower needs. At present only four countries offer doctoral education in nursing. A systematic plan can be put in place to better use the expertise available within the region to assist other countries where this type of nursing development is indicated. Regional organizations, foundations, selected institutions, and non-governmental agencies/organizations all can play an important role in achieving this goal in an organized manner. In this vein, it is worth noting that a new group, The International Network for Doctoral Education in Nursing, has been formed, and the expertise of its members, drawn from 25 countries, is extensive; this group is in a position to provide leadership to assist in this type of organized effort; this international network is currently developing international standards and quality indicators for doctoral education for consideration.
Many countries of the world, especially within Asia and Africa, are systematically building various collaborative models in their doctoral programs. Some of these models are innovative and are being tested now. Others are using distance learning strategies and technologies in combinations. There is a need to systematically evaluate these strategies as they emerge so lessons can be learned for the benefit of all.
Shaké Ketefian, EdD, RN, FAAN
Shaké Ketefian, EdD, RN, FAAN, Professor; Director of Doctoral/Postdoctoral Studies and International Affairs, University of Michigan, School of Nursing, 400 North Ingalls, Ann Arbor, MI 48109, USA; Dr. Ketefian is also the Chairperson of the International Network for Doctoral Education in Nursing [URL: www.umich.edu/~inden/]
Tel.: 734/764-9454; FAX: 734/763-6668.
Eloita Pereira Neves, DNSc, RN
Eloita Pereira Neves, DNSc, RN, is a former professor of nursing at the Nursing Doctoral Program - Federal University of Santa Catarina, Florianopolis SC and Visiting Professor, State University of Rio de Janeiro, Rua 28 de Setembro 174 Rio de Janeiro, RJ Brazil
Maria Gaby Gutiérrez, PhD, RN
Maria Gaby Gutiérrez, PhD, RN, is a representative of nursing at CAPES, Ministry of Education - Coordination of Higher Education and a Professor, at the Federal University of Sao Paulo, Brazil
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© 2001 Online Journal of Issues in Nursing
Article published May 31, 2001
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