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Theses
OUTCOMES OF SCHOLARLY INQUIRY: AN ANALYSIS OF MASTER’S OF NURSING STUDENTS’ PROJECTS/THESES MARJORIE C. DOBRATZ, DNSc, RN,* JANET PRIMOMO, PHD, RN,y ELIN BJORLING, MA, PHCz
AND
This study examined the first scholarly projects/theses of 112 graduates of a newly formed Master of Nursing (MN) program. The purpose of the analysis was to determine whether MN graduates’ scholarly projects/theses addressed the American Association Colleges of Nursing’s (1996) Essentials of Master’s Education for Advanced Practice Nursing, met program outcomes, and adhered to campus and program values. Other specific questions were formulated to ascertain the method of inquiry most used, the population group most examined, and the outcomes of the inquiry. The sample of 106 scholarly projects and six theses were categorized according to method of inquiry, population group, population type, and scholarly outcomes and then entered into a database software program. The findings showed the method of inquiry most used was literature review, followed by program critique, community assessment, and secondary analysis. The community was the most frequently examined population group, with patient, children, provider, minority, and elderly the most used population type. The most frequent scholarly outcomes were recommendations, study reports, educational materials, and program development. Findings supported the campus’s and program’s mission statement that values community partnership and diversity, improved health care outcomes, as well as an outcome objective of master’s-level proficiencies in research competencies. (Index words: Master’s education; Nursing education; Research competencies; Master’s research; Advanced nursing practice) J Prof Nurs 22:296 – 303, 2006. A 2006 Elsevier Inc. All rights reserved.
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RMED WITH PRACTICE and theoretical knowledge, Master of Nursing (MN) students are expected to focus on empirical knowledge and learn in-depth skills in systematic inquiry or the research process. With a nursing epistemology that involves interpreting and describing phenomena (Schultz & Meleis, 1988), MN graduates are expected to redesign and realign health care systems, manage populations, and measure health care outcomes (Burns et al., 1978; Long, 1994; Tanner, 1997). According to Nursing’s Social Policy Statement
*Professor and Program Director, University of Washington, Tacoma, WA. yAssociate Professor and Graduate Coordinator, University of Washington, Tacoma, WA. zResearch Assistant, University of Washington, Tacoma, WA. Address correspondence and reprint requests to Ms. Dobratz: Professor and Program Director, University of Washington, 1900 Commerce Street, Campus Box 358421, Tacoma, WA 98402. E-mail: [email protected] 8755-7223/$ - see front matter 296 doi:10.1016/j.profnurs.2006.07.010
(American Nurses Association [ANA], 2003), badvanced practice is characterized by the integration and application of a broad range of theoretical and evidence-based knowledgeQ (p. 9). For these reasons, research plays a vital role in master’s education with the expectation that graduates are able to critically examine nursing theory (Algase, Newton, & Higgins, 2001; Burns et al., 1993; Lutjens & Horan, 1992; McEwen, 2000). The American Association of Colleges of Nursing [AACN] (1996) Essentials of Master’s Education for Advanced Practice Nursing document notes: The goal of the research component of the curriculum should be to prepare a clinician who is proficient at the utilization of research including the evaluation of research, problem identification within the clinical practice setting, awareness of practice outcomes, and the clinical application of research. (p. 6) Whereas graduates of master’s programs are expected to integrate research, theory, and practice, and whereas
Journal of Professional Nursing, Vol 22, No 5 (September – October), 2006: pp 296 – 303 A 2006 Elsevier Inc. All rights reserved.
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research is a common thread that is woven throughout graduate nursing education (Burns et al., 1978), few articles were found that describe this anticipated educational outcome. Although Porter (2001) evaluated the impact of various teaching strategies on research comprehension at the undergraduate level, reports of research knowledge development at the graduate level are scarce.
Background and Significance At the master’s level, learning goals for the research component are well delineated: students are expected to be proficient in their ability to access data to solve nursing problems, analyze outcomes of nursing practice, comprehend statistics and research methods, use technology and information systems to retrieve extant information, and be able to integrate the research process in oral and written communication (AACN, 1996, pp. 6-7). The Institute of Medicine’s (2001) Health Professions Education: A Bridge to Quality supports AACN’s recommendations for a research-based curriculum at the master’s level. The Bridge to Quality reports that health professionals are expected to use evidence-based research in their practice settings, to participate in research, and to use informatics as core competencies for 21st century health care. Despite MN graduates’ use of and reliance on research skills (Brown, 1998), the inclusion of research courses in graduate nursing programs (Burns et al., 1978), and national standards for research competencies (AACN, 1996, 1999), few descriptions are found that delineate these outcomes for advanced nursing practice. From in-depth interviews with master’s-level faculty, Ashworth, Gerrish, and McManus (2001) concluded that characteristics of graduate education are cognitive and practice-related competencies and a research orientation. Although these attributes support the value of master’s education, they reflected faculty’s perspectives rather than those of the graduates themselves. Sparacino (2000) noted that bgraduate nursing preparation varies substantially, especially as there is no nationally standardized or professionally endorsed curriculumQ (p. 126). Sparacino went on to say that binstitutional and faculty philosophiesQ (p. 126) also influence a graduate program’s direction and student learning. Hence, faculty interests are known to affect student learning outcomes and direct what research products students complete. Whyte, Lugton, and Fawcett (2000) studied graduates’ perceptions of the value of their master’s education and found that 89% of the graduates felt that advanced education was relevant to their work. In the opinion of the nurses that were surveyed, a master’s degree gave them the ability to bappraise, utilize and undertake researchQ (p. 1075). In examining the value of master’s preparation in the clinical setting, Brown (1998) found that graduates most valued research critique and utilization skills, as well as their ability to work cooperatively with others and counsel patients and
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families. Although the importance of research-based graduate nursing education was supported in the literature, no studies were found that describe the end product of this educational outcome or how students master this curriculum component.
Purpose and Questions Given that research is an expected competency of master’s-level education, the purpose of this project was to describe MN students’ completed scholarly projects/thesis. The questions that guided this project were the following: (1) Do MN graduates’ scholarly projects/theses adhere to AACN research expectations? (2) Do MN graduates’ scholarly projects/theses meet program outcomes? (3) Do MN graduates’ scholarly projects/theses adhere to the values as set forth in the program’s mission statement? (4) What method of scholarly inquiry is most used by MN graduates? (5) What population groups are most examined by MN students? (6) What are the outcomes or products of MN graduates’ scholarly projects/theses? (7) Do MN graduates’ capstone projects meet outcome objectives? According to Shultz and Meleis (1988), nursing epistemology is the bstudy of how nurses come to know what they know, what exactly nurses do know, how knowledge is structured, and on what basis knowledge claims are madeQ (p.217). This article attempts to answer the above questions and to determine how research knowledge is structured in one MN program.
Program Characteristics The University of Washington, Tacoma (UWT), was established in 1990 to provide upper division and graduate-level education in the South Puget Sound region to place-bound students who are constrained by geography, employment, and family duties. A Bachelor of Science in Nursing program was initiated in 1992 for registered nurses who sought higher education, and the MN program followed in 1996. The Higher Education Coordinating Board (HECB) of Washington State approved a request for two pathways: (1) Population-Based Provider with specialization in the assessment, planning, implementation and evaluation of health services for groups and communities, and in the formation and analysis of health care policies and (2) Primary Health Care Provider with specialization in the assessment and implementation of personal health services, focusing on the individual and family as client (University of Washington, Bothell and Tacoma, HECB Report, 1994). Although approved for both pathways, the graduate program’s (MN) focus is the population-based provider of care. Because of the place-bound population that UWT serves, the majority of MN students are employed on a full-time basis and they attend school part-time. Classes are scheduled for late afternoons and evenings or 1 day a week to increase access to graduate study for working nurses. The part-time 45-credit program takes 2 years to complete.
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The first curriculum option in the MN program, Communities, Populations and Health, was established in 1996 followed by a second option, Healthcare Leadership and Management, in 1999. The most recent curriculum option is the Nurse Educator that was initiated in 2002. There is also an Independent option in which students are able to blend course work from the above three curriculum options. The MN curriculum was built upon the PEW Health Commission (1991, 1998) competencies that were outlined for advanced practice in graduate education. Graduates are expected to be able to promote and improve health services for diverse populations, assure health care access for individuals, families, and communities, and work in new health settings and interdisciplinary teams to meet the public’s health care needs. In addition to the reports by the PEW Health Professions Commission (1991, 1998), the MN Program also adopted the essentials of master’s education (AACN, 1996) document as the framework for the curriculum. As identified in this document, the core curriculum of graduate education includes research and methods of inquiry, organization and financing of health care, ethics, professional role development, theoretical foundations of nursing practice, human diversity and social issues, and health promotion and disease prevention (pp. 6-12). A matrix that linked these essential curriculum components to individual courses was developed in 2000, and a curriculum review assured the inclusion of these essential components in the MN curriculum. The UWT Nursing Program shares Commission on Collegiate Nursing Education accreditation with the University of Washington School of Nursing on the Seattle campus, as well as outcome objectives. Correspondingly, the UWT MN program promotes the values of scholarly inquiry, discovery, and dissemination of knowledge that are fostered by its parent institution in Seattle. Shared outcomes objectives include the ability of graduates to demonstrate competency in development of inquiry related to practice, education, or administration. There is also the expectation that graduates evaluate the adequacy of underlying knowledge from nursing science, related fields, and professional foundations as it informs advanced practice. In addition, the nursing program supports a UWT campus mission that is dedicated to interdisciplinarity, innovative teaching and scholarship, and mutually beneficial community partnerships, and is committed to diversity. Correspondingly, the program’s mission statement flows from its parent institution and reads as follows: The Nursing Program shares the University of Washington, Tacoma’s mission to provide upper division and graduate education for the diverse citizens of the South Puget Sound region. The Nursing Program supports the interdisciplinary of the UWT campus through teaching and scholarly inquiry. Within the overall mission of the campus, the nursing program focuses on the discovery and
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dissemination of knowledge that promotes health. The curriculum emphasizes and fosters the integration of teaching, inquiry, and service among a community of learners. Partnerships with the community assist the program in providing learning environments in which learners build their skills and knowledge to strengthen their understanding of local, national, and global health issues. In keeping with the above outcome objectives, the MN program requires six credits of methods of systematic inquiry (two research methods courses). Students engage in systematic inquiry by completing a thesis (nine credits) or a scholarly project (six credits). In the scholarly project or nonthesis option, students select a project that is relevant to their practice area and curriculum option and that shows the potential for advancing or changing nursing practice. The scholarly project reflects an integration of knowledge gained from coursework and demonstrates an extension of knowledge within the focused area of inquiry. For both systematic inquiry options (project or thesis), students select a supervisory committee of two to three faculty members. A one-credit seminar is also offered as part of the six credits of scholarly inquiry. In the seminar, students receive assistance in human subjects applications, in writing their proposal, and in forming their supervisory committees. The curriculum includes nine credits of core courses (health policy, access and utilization of health care, and social justice) as well as 12 credits of required work in students’ curriculum option (Communities, Populations, and Health; Healthcare Leadership and Management; and Nurse Educator). There is a 6-credit fieldwork experience, as well as 6 credits of related fields that round out the 45-credit program. The first of three core courses that all students take provides an indepth inquiry into health care access and utilization patterns among diverse populations with an emphasis on management strategies. Another core course focuses on the critical analysis of social inequities and issues as they pertain to health. The third core course examines health policy development within the context of the organizational and political systems. This core coursework provides students with a theoretical foundation that is system oriented, community based, and prevention focused. By contextualizing health and health care from a community and population perspective, students learn to span the boundaries between traditional health care settings and the community. Both the needs and strengths of communities, populations, and systems are addressed. Furthermore, models of health and health care that address chronic care needs are stressed. The two research courses are designed to advance students’ understanding of theoretical frameworks, in-depth research on selected concepts, descriptive and inferential statistics, research design methods, ethical issues in research, data collection, data analysis, including the use of a statistical program (SPSS), and research report writing. At the completion of their first year of study,
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which includes the two research courses, students are then eligible to begin their thesis or scholarly project.
Methodology In order to examine scholarly outcomes of master’s students’ projects/theses, we analyzed the written products of the scholarly inquiry requirement. The sample represented 106 scholarly projects (six credits) and six theses (nine credits) that were completed since the MN program opened in 1996. The authors developed the categories and the research assistant categorized the projects/theses. These categories were then entered into Microsoft Access, a data-management program. The developed categories were the following: method of inquiry (community assessment; literature review; program critique; program evaluation: qualitative, quantitative, and secondary analysis; site evaluation, survey; other; and unlisted), population group (clinical, community), population type (academic, administrative, children, elderly, minority, patient, provider, women, other), and scholarly outcomes (program development, curriculum development, study report [database research], clinical manual, educational materials, health report, paper, proposal, evaluation report, recommendations, and other). In explanation, the subcategory of method of inquiry reflected the various ways by which students approached their inquiry process. The category of population type was defined as being mutually exclusive, with coding based on the emphasis of the literature review. For example, Russian women were coded as bminorityQ if the primary focus was on immigrant status rather than women’s health. The subcategories for population group (clinical, community) were defined as follows: (a) Clinical pertained to the health care environment or an illness. Some examples of clinical groups included the impact of pain in hospice patients, assessing quality of life in patients who had undergone gastric bypass, and clinical testing of patients’ reading levels. (b) Community as a category reflected health care populations, aggregates, or communities. Community examples included fire department disaster preparation, community mapping of adult health care services,
Table 2. Population Type Category
Number
Percent
Patient Children Provider Minority Elderly Women Academic Administrative Other Total
32 18 18 16 11 8 5 2 2 112
28.5 16.1 16.1 14.3 9.8 7.1 4.5 1.8 1.8 100.0
health data tracking in schools, and policy implications of tobacco settlement. The category of scholarly outcomes titled recommendations was further reduced to education, policy, practice, and research.
Results Of the 112 projects/theses, the method of inquiry most used was literature review (37 [33.0%]), followed by program critique (19 [16.9%]), community assessment (17 [15.2%]), and secondary analysis (11 [9.8%]). When traditional research or empirical methods, which include the categories of qualitative, quantitative, survey, secondary analysis, and program evaluation, are combined, 25% of projects/theses are represented. For a complete description of the 112 projects/theses, see Table 1. For population group, there were 65 (58.0%) community and 47 (41.9%) completed clinical projects/theses. The population type most listed was patient (32 [28.5%]), children (18 [16.1%]), provider (18 [16.1%]), minority (16 [14.3%]), and elderly (11 [9.8%]). Table 2 lists a complete overview of the population type. For scholarly outcomes, the highest numbers were 38 (33.9%) recommendations, 14 (12.5%) study reports, 11 (9.8%) educational materials, and 11 (9.8%) program development. Table 3 reports the complete listing of scholarly outcomes. It is important to note that many projects/theses included multiple recommendations. The 38 recommendations Table 3. Scholarly Outcome
Table 1. Method of Inquiry Category
Number
Percent
Literature review Program critique Community assessment Secondary analysis Qualitative Program evaluation Survey Quantitative Site evaluation Other Unlisted Total
37 19 17 11 8 4 3 2 2 7 2 112
33.0 16.9 15.2 9.8 7.1 3.6 2.7 1.8 1.8 6.2 1.8 100.0
Category
Number
Percent
Recommendation Study report Educational materials Program development Evaluation report Paper Clinical manual Curriculum development Health report Proposal Other Unlisted Total
38 14 11 11 9 9 5 4 2 2 4 3 112
33.9 12.5 9.8 9.8 8.0 8.0 4.5 3.6 1.8 1.8 3.6 2.7 100.0
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were further broken down into practice (26), research (7), education (3), and policy (2). Examples of the outcome categories for the projects and theses are described next.
Discussion The high number of community-focused projects (58%) supports the institutional mission of creating community partnerships and validates a social context (Vinson, 2000). Lindeman (2000) noted that a community-based curriculum is tied to external accountability and this study confirms her thesis. According to Lindeman, ba community-based curriculum is essential because it is the only way we can fulfill our commitment to serve the communityQ (p. 7). An example of a community scholarly project is bClean Air for Kids: Asthma Outreach Worker Evaluation.Q This project was coded as community for the population group, with children the population type, program evaluation the method of inquiry, and program evaluation the scholarly outcome. An important outcome of this project was the evidence it provided about the effectiveness of a communityoutreach worker program that helped families to minimize asthma triggers in the home environments of high-risk children with asthma. As reported in Table 1, the high number of community assessment projects also affirms the campus mission and program’s values. Some selected community assessments were bCommunity Members Creating Change: A Homeless Situation,Q bConducting Youth Forums in a Rural School Setting,Q and bDevelopment of a Sexual Assault Clinic in a Rural Community.Q The high number of practice recommendations (26) validates the potential of these scholarly projects/theses to improve health care outcomes. These end products support practice-related competencies (Ashworth et al., 2001). They also confirm that bthe extraction of knowledge imbedded in practiceQ (Vinson, 2000, p. 40) is the basis for nursing’s epistemology. All of the secondary analyses (11) were practice related and they crossed both clinical and community populations. For example, one clinical analysis looked at bRedicivism in the Emergency Room,Q whereas another investigated bClinical Testing of Patient’s Reading Levels.Q In the community arena, an example was titled bSecondary Analysis of the dCelebrate Seniority SurveyT.Q Although the most common method of inquiry was literature review (33%), these projects met AACN (1996) goals that master’s students should be able to initiate inquiry into comprehensive databases, write and communicate effectively by identifying a clinical problem, demonstrate an understanding of research related to this problem, critically analyze the problem and current knowledge, and develop a strategy for incorporating research. For example, in support of the AACN (1996) research goals for master’s-level students, a literature review project titled bAssessing Quality of Life in Gastric Bypass SurgeryQ was presented at a national research conference. This same project was
published in the Journal of PeriAnesthesia Nursing. For this particular project, in a field in which little had been written, recommendations included the need for a multidisciplinary team approach to support a healthy postoperative gastric bypass lifestyle. This example shows that a clinician who now manages a gastric bypass clinic is proficient in applying research-based evidence to the practice setting. The critical review and implementation of research findings in practice settings has been identified as a key component of graduate education (AACN, 1999). In addition to using researchbased articles from the published literature, MN students also met the challenge of building new theory through their scholarly projects/theses. As noted by Fawcett (1978), there are two types of theory-related research: theory building and theory testing. There were eight qualitative studies, two quantitative projects, 11 secondary analyses, and two surveys that accounted for 25% of the scholarly inquiry methods (Table 1). These initial empirical inquiries have the potential to build nursing theory, as they discover relationships that lend themselves to further study. It is important to note that secondary analyses can facilitate master’s students’ use of the research process without having to collect data independently. Scholarly projects using secondary analyses provided students with the opportunity to engage in the conceptualization or a research problem, pose research questions, complete human subjects applications, conduct and report data analyses, discuss findings, clarify limitations of studies, identify implications for practice, and propose further research. Examples of secondary analyses include bPatient Factors Related to Noncompliance with Urinary Biofeedback Therapy in Female SoldiersQ and bIdentification of Patient and Treatment Factors that Affect Health Outcomes in End-Stage Renal Disease.Q As anticipated, a small number (six) of students completed theses to fulfill their scholarly inquiry requirement. The limited number of theses (six) supports the AACN’s (1996) position that a research thesis is an optional requirement for students in a professional master’s program. An example of one of the six theses is bPractice Patterns for the Type and Frequency of Total Hip and Knee Arthroplasty Follow-up Care: A Secondary Analysis of a Survey of the American Association of Hip and Knee Surgeons.Q This large-scale national study, with the surgeon as the lead author, the MN graduate as a listed author, and a faculty member of the supervisory committee as another author, was also presented at a national orthopedic meeting and published in a leading orthopedic journal. This thesis demonstrated the ability for binterprofessional collaboration in planning and evaluating health programs for populations groups risk related to the specialtyQ (American Nurses Association, 2003, p. 52). The graduate who conducted this research is now involved with large federal and statewide grants and has acquired needed research skills that are used in
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her position. Because of the large data set that was used and the analysis that was involved, the above thesis was one of the two quantitative coded project/thesis. Evaluation reports demonstrate the development of competencies in clinical inquiry that are relevant to health systems and policy (AACN, 1999; Tanner, 1997). As noted, nine projects were coded as evaluation reports. An example of an evaluation report was a project titled bIncarcerated Women and Their Infants: Early Head Start’s First Steps Toward Program Evaluation.Q This community project evaluated the effect of a Head Start Program at the Washington State Women’s Correctional Center. Another community project looked into the bDevelopment of a Project for Gaining Entry into the Local Samoan Community.Q Under scholarly outcomes, two projects categorized as botherQ were Web site development. These projects included developing a Web site for registered nurses seeking overseas experiences (57,000 inquiries) and an information Web site for parents with infants in a neonatal intensive care setting. This application of technology supports nursing’s social policy statement that declares nursing must be a leader in the bdevelopment of new knowledge and technology through researchQ (American Nurses Association, 2003, p. 30). Clearly, the projects/theses reflect not only students’ but also the faculty’s perspectives, worldviews, and areas of expertise (Sparacino, 2000). With faculty expertise in selected areas of community health that include domestic violence, vulnerable populations, health promotion, disease prevention, chronic illness, and health care within and across settings, project analysis makes evident the strong connection between projects/thesis and faculty interest. For example, projects related to domestic violence addressed bDevelopment of a Sexual Assault Clinic in a Rural Community,Q bIntimate Partner Violence: Assessing the Needs of Female Victims,Q and bIntimate Partner Violence Screening.Q Other faculty members with expertise in hospice and palliative care directed projects that addressed bThe Impact of Pain on Hospice Patient’s Quality of Life,Q bThe Emotional Support of the Newly Diagnosed Cancer Patient,Q and bCreating a PACT with Patients and Families to Prevent Experiences of Oppression in the Acute Care Setting at End of Life,Q and bPalliative Care Pathway.Q Finally, a number of projects in emergency nursing and critical care reflected the scholarly background of other faculty. Some of these projects and theses addressed bPhysicians’ Decisions to Write Versus not Write Prescriptions for Automated External Defibrillators for Post-First Myocardial Infarction PatientsQ and bProfessional Characteristics and Skills of Registered Nurses in a Designated Level II Trauma Center.Q The proficiency of the faculty is also demonstrated in research methodologies that were selected. For instance, the number of qualitative projects demonstrates faculty expertise in ethnographic, participatory
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action and other qualitative research designs. One of these faculty members guided a student’s scholarly project that examined bPerceptions and Experiences of Women during the Early Postpartum Period,Q whereas yet another faculty member chaired a project titled bInroads to Outreach in the Mexican American Community of Puyallup and Sumner, Washington.Q This latter student entered a PhD program, carried this same project forward, and she is now the program’s first doctoral candidate. The faculty’s expertise in issues concerning social justice and vulnerable populations surfaced in the number of projects that focused on children (16.1%), the elderly (9.8%), and minority populations (14.3%). Some of these projects addressed cultural sensitivity in printed materials for African Americans with diabetes, evaluated a community care network for elderly Chinese Americans, researched a caregiving project associated with dementia in the Puyallup American Indians, interviewed key informants in the Russianspeaking community, and explored gender-specific issues for incarcerated women. These projects confirmed that graduates’ inquiry took place within a social context (American Nurses Association, 2003; Vinson, 2000) and validated the value of diversity to the mission of the campus and program.
Conclusions This initial analysis of MN students’ scholarly projects/ theses is limited by the coding categories. For example, it was difficult to differentiate among the codes titled: program critique, program evaluation, and site evaluation. It was also challenging to conclude whether some projects belonged in the quantitative or secondary analysis category, as these projects all included descriptive and sometimes inferential statistics. A scrutiny of the coding categories by the Master of Nursing Committee (MNC) determined that the quantitative category assumes the categories titled survey and secondary analysis. This same group of faculty members proposed that site evaluation be included in the community assessment code. The MNC also developed a coding sheet that chairs complete at the time of the students’ graduation. These codes are now entered into a database that maintains an up-to-date record of the students’ scholarly projects/ theses. The MNC plans to provide clearer definitions of the population types as well as continued clarification of the coding categories. Nonetheless, this initial analysis of the scholarly projects/thesis at one MN program determined which method of inquiry was most used, what population groups were most frequently studied, and what outcomes were proposed. At this particular educational institution, MN students demonstrated their ability to integrate the theoretical and empirical literature as it related to diverse community and clinical health care practice settings, as well as population groups. More importantly, this retrospective analysis of MN graduates’
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scholarly projects/theses did provide conclusive evidence that the program adheres to the AACN’s (1996, 1999) expectations, meets program goals, and supports the campus mission. Most importantly, the implications of these results go well beyond faculty interests and outcome objectives. Given that a program’s mission statement is the most important guiding document that it possesses, these results support the value of this document, as well as its underlying philosophical beliefs, in shaping the curriculum (Johnson, 2006). As noted by Johnson (2006), a mission statement defines a program’s uniqueness, describes the population that it serves, influences faculty roles, and accounts end-of-program outcomes. Thus, in curriculum development, a program’s mission statement points the way forward or becomes the road map by which students advance through the program. The philosophical beliefs that are embedded within the mission statement also define the important values that the program upholds. For instance, if social justice and equality for all individuals regardless of class, race, and economic background are important philosophical beliefs, they are then woven into the curriculum. At the end of their educational journey, students will complete courses that address health disparities and inequalities, and they should also work with individuals who are considered a vulnerable population. For the above reason, this program analysis serves as an example for other nursing programs within other academic institutions. Although at the outset of this project the open scrutiny of students’ work and the supervising faculty’s input was somewhat arduous, many benefits were gained. Specifically, before this analysis was conducted, there was no clear picture of the depth and breadth of students’ scholarship, nor was there a way to assess the overall content of their scholarly projects. It was also unknown whether or not students’ projects were adhering to the values as set forth in the program’s mission statement. In other words, there was no overall, collective scrutiny of MN students’ capstone work and culminating projects. Thus, this collective analysis of the MN students’ scholarly projects for the first few years of a new program’s existence described the program’s accountability to improve health care outcomes and to form partnerships within the community that it serves. It offered health care outcomes from the perspective of a population-based health expert (Radzyminski, 2005). Moreover, the quality of the students’ work validated end-of-program objectives that address competency related to the development of inquiry. Thus, another benefit to this analysis was assuring that outcome objectives were being met. The program uses a Scholarly Inquiry Scale in which faculty members rate a student’s individual project at the end of their program. Although the Scholarly Inquiry Scales asks faculty to evaluate students’ projects in relationship to outcomes objectives, this form does not capture the content of the projects or ascertain whether or not a
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project builds on the program’s mission. Another weakness that was uncovered was a place to note the interdisciplinary nature of a student’s project. With the mission supporting interdisciplinary work, a statement that captures this question will be added to the newly developed Scholarly Outcome Evaluation Checklist (coding sheet). Therefore, the analysis we conducted in this project serves as a quality improvement activity whereby the faculty ascertains congruence among its mission, philosophical beliefs, and student outcomes. When conducting a similar analysis, further questions that can be examined are as follows: What does the mission statement say about the population that it serves? Do graduate students’ scholarly projects/theses build on the program’s mission? Are the end-of-program objectives congruent with the curriculum? What courses are in place to reach these terminal objectives? Do students’ scholarly projects/theses reflect the terminal outcomes? With an acquired graduate degree as an indicator of a higher level of professionalism (Wynd, 2003), the untold benefits may extend far beyond this current analysis. The greatest outcome of all may be a nurse who is empowered by the educational process—one who finds new worth and value in his/her profession.
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Lutjens, L. J., & Horan, M. L. (1992). Nursing theory in nursing education: An educational imperative. Journal of Professional Nursing, 8, 276 – 281. McEwen, M. (2000). Teaching theory at the master’s level: Report of a national survey of theory instructors. Journal of Professional Nursing, 16, 354 – 361. PEW Health Professions Commission. (1991). Health America: Practitioners for 2005. San Francisco, CA: Center for the Health Professions. Author. PEW Health Professions Commission. (1998). Recreating health professional practice for a new century. San Francisco, CA: Center for the Health Professions. Author. Porter, E. J. (2001). Teaching undergraduate nursing research: A narrative review of evaluation studies and a typology for further research. Journal of Nursing Education, 40, 53 – 62. Radzyminski, S. (2005). Advances in graduate nursing education: Beyond the advanced practice nurse. Journal of Professional Nursing, 21, 119 – 125. Schultz, P. R., & Meleis, A. I. (1988). Nursing epistemology: Traditions, insights, questions. Image: Journal of Nursing Scholarship, 20, 217 – 221.
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Sparacino, P. S. A. (2000). Nursing research and graduate student involvement. Clinical Nurse Specialist CNS, 14, 126. Tanner, C. (1997). Graduate education in nursing: Beyond essentials. Journal of Nursing Education, 36, 52 – 53. University of Washington, Bothell, and University of Washington, Tacoma (1994). Master of Nursing proposal. Report submitted to the Washington public four-year colleges and universities, Higher Education Coordinating Board. Vinson, J. A. (2000). Nursing’s epistemology revisited in relation to professional education competencies. Journal of Professional Nursing, 16, 39 – 46. Whyte, D. A., Lugton, J., & Fawcett, T. N. (2000). Fit for purpose: The relevance of masters preparation for the professional practice of nursing. A 10-year follow-up study of postgraduate nursing courses in the University of Edinburgh. Journal of Advanced Nursing, 31, 1072 – 1080. Wynd, C. A. (2003). Current factors contributing to professionalism in nursing. Journal of Professional Nursing, 19, 251 – 261.
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This study examined the first scholarly projects/theses of 112 graduates of a newly formed Master of Nursing (MN) program. The purpose of the analysis was to determine whether MN graduates’ scholarly projects/theses addressed the American Association Colleges of Nursing’s (1996) Essentials of Master’s Education for Advanced Practice Nursing, met program outcomes, and adhered to campus and program values. Other specific questions were formulated to ascertain the method of inquiry most used, the population group most examined, and the outcomes of the inquiry. The sample of 106 scholarly projects and six theses were categorized according to method of inquiry, population group, population type, and scholarly outcomes and then entered into a database software program. The findings showed the method of inquiry most used was literature review, followed by program critique, community assessment, and secondary analysis. The community was the most frequently examined population group, with patient, children, provider, minority, and elderly the most used population type. The most frequent scholarly outcomes were recommendations, study reports, educational materials, and program development. Findings supported the campus’s and program’s mission statement that values community partnership and diversity, improved health care outcomes, as well as an outcome objective of master’s-level proficiencies in research competencies. (Index words: Master’s education; Nursing education; Research competencies; Master’s research; Advanced nursing practice) J Prof Nurs 22:296 – 303, 2006. A 2006 Elsevier Inc. All rights reserved.
A
RMED WITH PRACTICE and theoretical knowledge, Master of Nursing (MN) students are expected to focus on empirical knowledge and learn in-depth skills in systematic inquiry or the research process. With a nursing epistemology that involves interpreting and describing phenomena (Schultz & Meleis, 1988), MN graduates are expected to redesign and realign health care systems, manage populations, and measure health care outcomes (Burns et al., 1978; Long, 1994; Tanner, 1997). According to Nursing’s Social Policy Statement
*Professor and Program Director, University of Washington, Tacoma, WA. yAssociate Professor and Graduate Coordinator, University of Washington, Tacoma, WA. zResearch Assistant, University of Washington, Tacoma, WA. Address correspondence and reprint requests to Ms. Dobratz: Professor and Program Director, University of Washington, 1900 Commerce Street, Campus Box 358421, Tacoma, WA 98402. E-mail: [email protected] 8755-7223/$ - see front matter 296 doi:10.1016/j.profnurs.2006.07.010
(American Nurses Association [ANA], 2003), badvanced practice is characterized by the integration and application of a broad range of theoretical and evidence-based knowledgeQ (p. 9). For these reasons, research plays a vital role in master’s education with the expectation that graduates are able to critically examine nursing theory (Algase, Newton, & Higgins, 2001; Burns et al., 1993; Lutjens & Horan, 1992; McEwen, 2000). The American Association of Colleges of Nursing [AACN] (1996) Essentials of Master’s Education for Advanced Practice Nursing document notes: The goal of the research component of the curriculum should be to prepare a clinician who is proficient at the utilization of research including the evaluation of research, problem identification within the clinical practice setting, awareness of practice outcomes, and the clinical application of research. (p. 6) Whereas graduates of master’s programs are expected to integrate research, theory, and practice, and whereas
Journal of Professional Nursing, Vol 22, No 5 (September – October), 2006: pp 296 – 303 A 2006 Elsevier Inc. All rights reserved.
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research is a common thread that is woven throughout graduate nursing education (Burns et al., 1978), few articles were found that describe this anticipated educational outcome. Although Porter (2001) evaluated the impact of various teaching strategies on research comprehension at the undergraduate level, reports of research knowledge development at the graduate level are scarce.
Background and Significance At the master’s level, learning goals for the research component are well delineated: students are expected to be proficient in their ability to access data to solve nursing problems, analyze outcomes of nursing practice, comprehend statistics and research methods, use technology and information systems to retrieve extant information, and be able to integrate the research process in oral and written communication (AACN, 1996, pp. 6-7). The Institute of Medicine’s (2001) Health Professions Education: A Bridge to Quality supports AACN’s recommendations for a research-based curriculum at the master’s level. The Bridge to Quality reports that health professionals are expected to use evidence-based research in their practice settings, to participate in research, and to use informatics as core competencies for 21st century health care. Despite MN graduates’ use of and reliance on research skills (Brown, 1998), the inclusion of research courses in graduate nursing programs (Burns et al., 1978), and national standards for research competencies (AACN, 1996, 1999), few descriptions are found that delineate these outcomes for advanced nursing practice. From in-depth interviews with master’s-level faculty, Ashworth, Gerrish, and McManus (2001) concluded that characteristics of graduate education are cognitive and practice-related competencies and a research orientation. Although these attributes support the value of master’s education, they reflected faculty’s perspectives rather than those of the graduates themselves. Sparacino (2000) noted that bgraduate nursing preparation varies substantially, especially as there is no nationally standardized or professionally endorsed curriculumQ (p. 126). Sparacino went on to say that binstitutional and faculty philosophiesQ (p. 126) also influence a graduate program’s direction and student learning. Hence, faculty interests are known to affect student learning outcomes and direct what research products students complete. Whyte, Lugton, and Fawcett (2000) studied graduates’ perceptions of the value of their master’s education and found that 89% of the graduates felt that advanced education was relevant to their work. In the opinion of the nurses that were surveyed, a master’s degree gave them the ability to bappraise, utilize and undertake researchQ (p. 1075). In examining the value of master’s preparation in the clinical setting, Brown (1998) found that graduates most valued research critique and utilization skills, as well as their ability to work cooperatively with others and counsel patients and
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families. Although the importance of research-based graduate nursing education was supported in the literature, no studies were found that describe the end product of this educational outcome or how students master this curriculum component.
Purpose and Questions Given that research is an expected competency of master’s-level education, the purpose of this project was to describe MN students’ completed scholarly projects/thesis. The questions that guided this project were the following: (1) Do MN graduates’ scholarly projects/theses adhere to AACN research expectations? (2) Do MN graduates’ scholarly projects/theses meet program outcomes? (3) Do MN graduates’ scholarly projects/theses adhere to the values as set forth in the program’s mission statement? (4) What method of scholarly inquiry is most used by MN graduates? (5) What population groups are most examined by MN students? (6) What are the outcomes or products of MN graduates’ scholarly projects/theses? (7) Do MN graduates’ capstone projects meet outcome objectives? According to Shultz and Meleis (1988), nursing epistemology is the bstudy of how nurses come to know what they know, what exactly nurses do know, how knowledge is structured, and on what basis knowledge claims are madeQ (p.217). This article attempts to answer the above questions and to determine how research knowledge is structured in one MN program.
Program Characteristics The University of Washington, Tacoma (UWT), was established in 1990 to provide upper division and graduate-level education in the South Puget Sound region to place-bound students who are constrained by geography, employment, and family duties. A Bachelor of Science in Nursing program was initiated in 1992 for registered nurses who sought higher education, and the MN program followed in 1996. The Higher Education Coordinating Board (HECB) of Washington State approved a request for two pathways: (1) Population-Based Provider with specialization in the assessment, planning, implementation and evaluation of health services for groups and communities, and in the formation and analysis of health care policies and (2) Primary Health Care Provider with specialization in the assessment and implementation of personal health services, focusing on the individual and family as client (University of Washington, Bothell and Tacoma, HECB Report, 1994). Although approved for both pathways, the graduate program’s (MN) focus is the population-based provider of care. Because of the place-bound population that UWT serves, the majority of MN students are employed on a full-time basis and they attend school part-time. Classes are scheduled for late afternoons and evenings or 1 day a week to increase access to graduate study for working nurses. The part-time 45-credit program takes 2 years to complete.
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The first curriculum option in the MN program, Communities, Populations and Health, was established in 1996 followed by a second option, Healthcare Leadership and Management, in 1999. The most recent curriculum option is the Nurse Educator that was initiated in 2002. There is also an Independent option in which students are able to blend course work from the above three curriculum options. The MN curriculum was built upon the PEW Health Commission (1991, 1998) competencies that were outlined for advanced practice in graduate education. Graduates are expected to be able to promote and improve health services for diverse populations, assure health care access for individuals, families, and communities, and work in new health settings and interdisciplinary teams to meet the public’s health care needs. In addition to the reports by the PEW Health Professions Commission (1991, 1998), the MN Program also adopted the essentials of master’s education (AACN, 1996) document as the framework for the curriculum. As identified in this document, the core curriculum of graduate education includes research and methods of inquiry, organization and financing of health care, ethics, professional role development, theoretical foundations of nursing practice, human diversity and social issues, and health promotion and disease prevention (pp. 6-12). A matrix that linked these essential curriculum components to individual courses was developed in 2000, and a curriculum review assured the inclusion of these essential components in the MN curriculum. The UWT Nursing Program shares Commission on Collegiate Nursing Education accreditation with the University of Washington School of Nursing on the Seattle campus, as well as outcome objectives. Correspondingly, the UWT MN program promotes the values of scholarly inquiry, discovery, and dissemination of knowledge that are fostered by its parent institution in Seattle. Shared outcomes objectives include the ability of graduates to demonstrate competency in development of inquiry related to practice, education, or administration. There is also the expectation that graduates evaluate the adequacy of underlying knowledge from nursing science, related fields, and professional foundations as it informs advanced practice. In addition, the nursing program supports a UWT campus mission that is dedicated to interdisciplinarity, innovative teaching and scholarship, and mutually beneficial community partnerships, and is committed to diversity. Correspondingly, the program’s mission statement flows from its parent institution and reads as follows: The Nursing Program shares the University of Washington, Tacoma’s mission to provide upper division and graduate education for the diverse citizens of the South Puget Sound region. The Nursing Program supports the interdisciplinary of the UWT campus through teaching and scholarly inquiry. Within the overall mission of the campus, the nursing program focuses on the discovery and
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dissemination of knowledge that promotes health. The curriculum emphasizes and fosters the integration of teaching, inquiry, and service among a community of learners. Partnerships with the community assist the program in providing learning environments in which learners build their skills and knowledge to strengthen their understanding of local, national, and global health issues. In keeping with the above outcome objectives, the MN program requires six credits of methods of systematic inquiry (two research methods courses). Students engage in systematic inquiry by completing a thesis (nine credits) or a scholarly project (six credits). In the scholarly project or nonthesis option, students select a project that is relevant to their practice area and curriculum option and that shows the potential for advancing or changing nursing practice. The scholarly project reflects an integration of knowledge gained from coursework and demonstrates an extension of knowledge within the focused area of inquiry. For both systematic inquiry options (project or thesis), students select a supervisory committee of two to three faculty members. A one-credit seminar is also offered as part of the six credits of scholarly inquiry. In the seminar, students receive assistance in human subjects applications, in writing their proposal, and in forming their supervisory committees. The curriculum includes nine credits of core courses (health policy, access and utilization of health care, and social justice) as well as 12 credits of required work in students’ curriculum option (Communities, Populations, and Health; Healthcare Leadership and Management; and Nurse Educator). There is a 6-credit fieldwork experience, as well as 6 credits of related fields that round out the 45-credit program. The first of three core courses that all students take provides an indepth inquiry into health care access and utilization patterns among diverse populations with an emphasis on management strategies. Another core course focuses on the critical analysis of social inequities and issues as they pertain to health. The third core course examines health policy development within the context of the organizational and political systems. This core coursework provides students with a theoretical foundation that is system oriented, community based, and prevention focused. By contextualizing health and health care from a community and population perspective, students learn to span the boundaries between traditional health care settings and the community. Both the needs and strengths of communities, populations, and systems are addressed. Furthermore, models of health and health care that address chronic care needs are stressed. The two research courses are designed to advance students’ understanding of theoretical frameworks, in-depth research on selected concepts, descriptive and inferential statistics, research design methods, ethical issues in research, data collection, data analysis, including the use of a statistical program (SPSS), and research report writing. At the completion of their first year of study,
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which includes the two research courses, students are then eligible to begin their thesis or scholarly project.
Methodology In order to examine scholarly outcomes of master’s students’ projects/theses, we analyzed the written products of the scholarly inquiry requirement. The sample represented 106 scholarly projects (six credits) and six theses (nine credits) that were completed since the MN program opened in 1996. The authors developed the categories and the research assistant categorized the projects/theses. These categories were then entered into Microsoft Access, a data-management program. The developed categories were the following: method of inquiry (community assessment; literature review; program critique; program evaluation: qualitative, quantitative, and secondary analysis; site evaluation, survey; other; and unlisted), population group (clinical, community), population type (academic, administrative, children, elderly, minority, patient, provider, women, other), and scholarly outcomes (program development, curriculum development, study report [database research], clinical manual, educational materials, health report, paper, proposal, evaluation report, recommendations, and other). In explanation, the subcategory of method of inquiry reflected the various ways by which students approached their inquiry process. The category of population type was defined as being mutually exclusive, with coding based on the emphasis of the literature review. For example, Russian women were coded as bminorityQ if the primary focus was on immigrant status rather than women’s health. The subcategories for population group (clinical, community) were defined as follows: (a) Clinical pertained to the health care environment or an illness. Some examples of clinical groups included the impact of pain in hospice patients, assessing quality of life in patients who had undergone gastric bypass, and clinical testing of patients’ reading levels. (b) Community as a category reflected health care populations, aggregates, or communities. Community examples included fire department disaster preparation, community mapping of adult health care services,
Table 2. Population Type Category
Number
Percent
Patient Children Provider Minority Elderly Women Academic Administrative Other Total
32 18 18 16 11 8 5 2 2 112
28.5 16.1 16.1 14.3 9.8 7.1 4.5 1.8 1.8 100.0
health data tracking in schools, and policy implications of tobacco settlement. The category of scholarly outcomes titled recommendations was further reduced to education, policy, practice, and research.
Results Of the 112 projects/theses, the method of inquiry most used was literature review (37 [33.0%]), followed by program critique (19 [16.9%]), community assessment (17 [15.2%]), and secondary analysis (11 [9.8%]). When traditional research or empirical methods, which include the categories of qualitative, quantitative, survey, secondary analysis, and program evaluation, are combined, 25% of projects/theses are represented. For a complete description of the 112 projects/theses, see Table 1. For population group, there were 65 (58.0%) community and 47 (41.9%) completed clinical projects/theses. The population type most listed was patient (32 [28.5%]), children (18 [16.1%]), provider (18 [16.1%]), minority (16 [14.3%]), and elderly (11 [9.8%]). Table 2 lists a complete overview of the population type. For scholarly outcomes, the highest numbers were 38 (33.9%) recommendations, 14 (12.5%) study reports, 11 (9.8%) educational materials, and 11 (9.8%) program development. Table 3 reports the complete listing of scholarly outcomes. It is important to note that many projects/theses included multiple recommendations. The 38 recommendations Table 3. Scholarly Outcome
Table 1. Method of Inquiry Category
Number
Percent
Literature review Program critique Community assessment Secondary analysis Qualitative Program evaluation Survey Quantitative Site evaluation Other Unlisted Total
37 19 17 11 8 4 3 2 2 7 2 112
33.0 16.9 15.2 9.8 7.1 3.6 2.7 1.8 1.8 6.2 1.8 100.0
Category
Number
Percent
Recommendation Study report Educational materials Program development Evaluation report Paper Clinical manual Curriculum development Health report Proposal Other Unlisted Total
38 14 11 11 9 9 5 4 2 2 4 3 112
33.9 12.5 9.8 9.8 8.0 8.0 4.5 3.6 1.8 1.8 3.6 2.7 100.0
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were further broken down into practice (26), research (7), education (3), and policy (2). Examples of the outcome categories for the projects and theses are described next.
Discussion The high number of community-focused projects (58%) supports the institutional mission of creating community partnerships and validates a social context (Vinson, 2000). Lindeman (2000) noted that a community-based curriculum is tied to external accountability and this study confirms her thesis. According to Lindeman, ba community-based curriculum is essential because it is the only way we can fulfill our commitment to serve the communityQ (p. 7). An example of a community scholarly project is bClean Air for Kids: Asthma Outreach Worker Evaluation.Q This project was coded as community for the population group, with children the population type, program evaluation the method of inquiry, and program evaluation the scholarly outcome. An important outcome of this project was the evidence it provided about the effectiveness of a communityoutreach worker program that helped families to minimize asthma triggers in the home environments of high-risk children with asthma. As reported in Table 1, the high number of community assessment projects also affirms the campus mission and program’s values. Some selected community assessments were bCommunity Members Creating Change: A Homeless Situation,Q bConducting Youth Forums in a Rural School Setting,Q and bDevelopment of a Sexual Assault Clinic in a Rural Community.Q The high number of practice recommendations (26) validates the potential of these scholarly projects/theses to improve health care outcomes. These end products support practice-related competencies (Ashworth et al., 2001). They also confirm that bthe extraction of knowledge imbedded in practiceQ (Vinson, 2000, p. 40) is the basis for nursing’s epistemology. All of the secondary analyses (11) were practice related and they crossed both clinical and community populations. For example, one clinical analysis looked at bRedicivism in the Emergency Room,Q whereas another investigated bClinical Testing of Patient’s Reading Levels.Q In the community arena, an example was titled bSecondary Analysis of the dCelebrate Seniority SurveyT.Q Although the most common method of inquiry was literature review (33%), these projects met AACN (1996) goals that master’s students should be able to initiate inquiry into comprehensive databases, write and communicate effectively by identifying a clinical problem, demonstrate an understanding of research related to this problem, critically analyze the problem and current knowledge, and develop a strategy for incorporating research. For example, in support of the AACN (1996) research goals for master’s-level students, a literature review project titled bAssessing Quality of Life in Gastric Bypass SurgeryQ was presented at a national research conference. This same project was
published in the Journal of PeriAnesthesia Nursing. For this particular project, in a field in which little had been written, recommendations included the need for a multidisciplinary team approach to support a healthy postoperative gastric bypass lifestyle. This example shows that a clinician who now manages a gastric bypass clinic is proficient in applying research-based evidence to the practice setting. The critical review and implementation of research findings in practice settings has been identified as a key component of graduate education (AACN, 1999). In addition to using researchbased articles from the published literature, MN students also met the challenge of building new theory through their scholarly projects/theses. As noted by Fawcett (1978), there are two types of theory-related research: theory building and theory testing. There were eight qualitative studies, two quantitative projects, 11 secondary analyses, and two surveys that accounted for 25% of the scholarly inquiry methods (Table 1). These initial empirical inquiries have the potential to build nursing theory, as they discover relationships that lend themselves to further study. It is important to note that secondary analyses can facilitate master’s students’ use of the research process without having to collect data independently. Scholarly projects using secondary analyses provided students with the opportunity to engage in the conceptualization or a research problem, pose research questions, complete human subjects applications, conduct and report data analyses, discuss findings, clarify limitations of studies, identify implications for practice, and propose further research. Examples of secondary analyses include bPatient Factors Related to Noncompliance with Urinary Biofeedback Therapy in Female SoldiersQ and bIdentification of Patient and Treatment Factors that Affect Health Outcomes in End-Stage Renal Disease.Q As anticipated, a small number (six) of students completed theses to fulfill their scholarly inquiry requirement. The limited number of theses (six) supports the AACN’s (1996) position that a research thesis is an optional requirement for students in a professional master’s program. An example of one of the six theses is bPractice Patterns for the Type and Frequency of Total Hip and Knee Arthroplasty Follow-up Care: A Secondary Analysis of a Survey of the American Association of Hip and Knee Surgeons.Q This large-scale national study, with the surgeon as the lead author, the MN graduate as a listed author, and a faculty member of the supervisory committee as another author, was also presented at a national orthopedic meeting and published in a leading orthopedic journal. This thesis demonstrated the ability for binterprofessional collaboration in planning and evaluating health programs for populations groups risk related to the specialtyQ (American Nurses Association, 2003, p. 52). The graduate who conducted this research is now involved with large federal and statewide grants and has acquired needed research skills that are used in
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her position. Because of the large data set that was used and the analysis that was involved, the above thesis was one of the two quantitative coded project/thesis. Evaluation reports demonstrate the development of competencies in clinical inquiry that are relevant to health systems and policy (AACN, 1999; Tanner, 1997). As noted, nine projects were coded as evaluation reports. An example of an evaluation report was a project titled bIncarcerated Women and Their Infants: Early Head Start’s First Steps Toward Program Evaluation.Q This community project evaluated the effect of a Head Start Program at the Washington State Women’s Correctional Center. Another community project looked into the bDevelopment of a Project for Gaining Entry into the Local Samoan Community.Q Under scholarly outcomes, two projects categorized as botherQ were Web site development. These projects included developing a Web site for registered nurses seeking overseas experiences (57,000 inquiries) and an information Web site for parents with infants in a neonatal intensive care setting. This application of technology supports nursing’s social policy statement that declares nursing must be a leader in the bdevelopment of new knowledge and technology through researchQ (American Nurses Association, 2003, p. 30). Clearly, the projects/theses reflect not only students’ but also the faculty’s perspectives, worldviews, and areas of expertise (Sparacino, 2000). With faculty expertise in selected areas of community health that include domestic violence, vulnerable populations, health promotion, disease prevention, chronic illness, and health care within and across settings, project analysis makes evident the strong connection between projects/thesis and faculty interest. For example, projects related to domestic violence addressed bDevelopment of a Sexual Assault Clinic in a Rural Community,Q bIntimate Partner Violence: Assessing the Needs of Female Victims,Q and bIntimate Partner Violence Screening.Q Other faculty members with expertise in hospice and palliative care directed projects that addressed bThe Impact of Pain on Hospice Patient’s Quality of Life,Q bThe Emotional Support of the Newly Diagnosed Cancer Patient,Q and bCreating a PACT with Patients and Families to Prevent Experiences of Oppression in the Acute Care Setting at End of Life,Q and bPalliative Care Pathway.Q Finally, a number of projects in emergency nursing and critical care reflected the scholarly background of other faculty. Some of these projects and theses addressed bPhysicians’ Decisions to Write Versus not Write Prescriptions for Automated External Defibrillators for Post-First Myocardial Infarction PatientsQ and bProfessional Characteristics and Skills of Registered Nurses in a Designated Level II Trauma Center.Q The proficiency of the faculty is also demonstrated in research methodologies that were selected. For instance, the number of qualitative projects demonstrates faculty expertise in ethnographic, participatory
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action and other qualitative research designs. One of these faculty members guided a student’s scholarly project that examined bPerceptions and Experiences of Women during the Early Postpartum Period,Q whereas yet another faculty member chaired a project titled bInroads to Outreach in the Mexican American Community of Puyallup and Sumner, Washington.Q This latter student entered a PhD program, carried this same project forward, and she is now the program’s first doctoral candidate. The faculty’s expertise in issues concerning social justice and vulnerable populations surfaced in the number of projects that focused on children (16.1%), the elderly (9.8%), and minority populations (14.3%). Some of these projects addressed cultural sensitivity in printed materials for African Americans with diabetes, evaluated a community care network for elderly Chinese Americans, researched a caregiving project associated with dementia in the Puyallup American Indians, interviewed key informants in the Russianspeaking community, and explored gender-specific issues for incarcerated women. These projects confirmed that graduates’ inquiry took place within a social context (American Nurses Association, 2003; Vinson, 2000) and validated the value of diversity to the mission of the campus and program.
Conclusions This initial analysis of MN students’ scholarly projects/ theses is limited by the coding categories. For example, it was difficult to differentiate among the codes titled: program critique, program evaluation, and site evaluation. It was also challenging to conclude whether some projects belonged in the quantitative or secondary analysis category, as these projects all included descriptive and sometimes inferential statistics. A scrutiny of the coding categories by the Master of Nursing Committee (MNC) determined that the quantitative category assumes the categories titled survey and secondary analysis. This same group of faculty members proposed that site evaluation be included in the community assessment code. The MNC also developed a coding sheet that chairs complete at the time of the students’ graduation. These codes are now entered into a database that maintains an up-to-date record of the students’ scholarly projects/ theses. The MNC plans to provide clearer definitions of the population types as well as continued clarification of the coding categories. Nonetheless, this initial analysis of the scholarly projects/thesis at one MN program determined which method of inquiry was most used, what population groups were most frequently studied, and what outcomes were proposed. At this particular educational institution, MN students demonstrated their ability to integrate the theoretical and empirical literature as it related to diverse community and clinical health care practice settings, as well as population groups. More importantly, this retrospective analysis of MN graduates’
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scholarly projects/theses did provide conclusive evidence that the program adheres to the AACN’s (1996, 1999) expectations, meets program goals, and supports the campus mission. Most importantly, the implications of these results go well beyond faculty interests and outcome objectives. Given that a program’s mission statement is the most important guiding document that it possesses, these results support the value of this document, as well as its underlying philosophical beliefs, in shaping the curriculum (Johnson, 2006). As noted by Johnson (2006), a mission statement defines a program’s uniqueness, describes the population that it serves, influences faculty roles, and accounts end-of-program outcomes. Thus, in curriculum development, a program’s mission statement points the way forward or becomes the road map by which students advance through the program. The philosophical beliefs that are embedded within the mission statement also define the important values that the program upholds. For instance, if social justice and equality for all individuals regardless of class, race, and economic background are important philosophical beliefs, they are then woven into the curriculum. At the end of their educational journey, students will complete courses that address health disparities and inequalities, and they should also work with individuals who are considered a vulnerable population. For the above reason, this program analysis serves as an example for other nursing programs within other academic institutions. Although at the outset of this project the open scrutiny of students’ work and the supervising faculty’s input was somewhat arduous, many benefits were gained. Specifically, before this analysis was conducted, there was no clear picture of the depth and breadth of students’ scholarship, nor was there a way to assess the overall content of their scholarly projects. It was also unknown whether or not students’ projects were adhering to the values as set forth in the program’s mission statement. In other words, there was no overall, collective scrutiny of MN students’ capstone work and culminating projects. Thus, this collective analysis of the MN students’ scholarly projects for the first few years of a new program’s existence described the program’s accountability to improve health care outcomes and to form partnerships within the community that it serves. It offered health care outcomes from the perspective of a population-based health expert (Radzyminski, 2005). Moreover, the quality of the students’ work validated end-of-program objectives that address competency related to the development of inquiry. Thus, another benefit to this analysis was assuring that outcome objectives were being met. The program uses a Scholarly Inquiry Scale in which faculty members rate a student’s individual project at the end of their program. Although the Scholarly Inquiry Scales asks faculty to evaluate students’ projects in relationship to outcomes objectives, this form does not capture the content of the projects or ascertain whether or not a
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project builds on the program’s mission. Another weakness that was uncovered was a place to note the interdisciplinary nature of a student’s project. With the mission supporting interdisciplinary work, a statement that captures this question will be added to the newly developed Scholarly Outcome Evaluation Checklist (coding sheet). Therefore, the analysis we conducted in this project serves as a quality improvement activity whereby the faculty ascertains congruence among its mission, philosophical beliefs, and student outcomes. When conducting a similar analysis, further questions that can be examined are as follows: What does the mission statement say about the population that it serves? Do graduate students’ scholarly projects/theses build on the program’s mission? Are the end-of-program objectives congruent with the curriculum? What courses are in place to reach these terminal objectives? Do students’ scholarly projects/theses reflect the terminal outcomes? With an acquired graduate degree as an indicator of a higher level of professionalism (Wynd, 2003), the untold benefits may extend far beyond this current analysis. The greatest outcome of all may be a nurse who is empowered by the educational process—one who finds new worth and value in his/her profession.
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