A PCNA Member's Perspective-Why I Enrolled in a Doctor of Nursing Practice Program
Shay A. Schroetter, MSN, RN, ANP-BC, is a nurse practitioner at the Department of Veterans Affairs, Minneapolis VA Health Care System and a DNP student at the University of Minnesota-Twin Cities.
If you have questions for Ms Schroetter regarding her DNP experience, please e-mail [email protected], and your questions will be passed along.
Doctoral education for nurses is not a new concept. In the history of nursing, the following doctoral degrees have been offered: the doctor of education (EdD) since the mid-1920s, the doctor of philosophy (PhD) since the mid-1930s, the doctor of nursing science (DNS or DNSc) and doctor of science in nursing (DSN) degrees since the 1970s, and the doctor of nursing (ND) since 1979.1-3 In 2004, the American Association of Colleges of Nursing (AACN) published a position statement on the doctor of nursing practice (DNP) degree and recommended that the DNP replace the master's degree as the entry level into practice for advanced practice nurses by 2015.1 According to AACN, as of August 2010, 127 nursing schools were accepting students into DNP programs, with more than 100 additional schools in the planning stages of creating a DNP program.4 In 2009, the number of students enrolled in DNP programs were 5165, and the total number of DNP graduates were 660.5 The DNP is not only for those already credentialed, but for students in programs to become clinical nurse specialists, certified nurse anesthetists, certified nurse midwives, and nurse practitioners. It is also an appropriate degree for nurses in public health, administration, and informatics.6
Value of Obtaining a DNP Degree-My Decision to Enroll
During my undergraduate studies, I envisioned myself earning a doctorate degree in nursing and, in fact, always believed that it would be a PhD. Throughout my master's program (2005-2007) and even today, the DNP was a popular, yet controversial topic of conversation. Some believe that the DNP "will detract from the PhD," "slow the development of [new] knowledge in our discipline," and become "another controversial issue" for other disciplines to criticize.3,7
My decision to enroll in a PhD versus DNP program was both personal and philosophical. Ultimately, I understood that these were two different, yet complementary degrees. It is my belief that not only is there room for both research and practice-based doctorate degrees in nursing, but there also is a great need for both. A PhD would have prepared me to be a research scholar, one who would be generating new knowledge within the discipline. The DNP would provide me with the necessary tools and knowledge to narrow the research-practice gap while learning how to generate change within my local, regional, or national health care delivery systems to improve patient care and outcomes.3,8 The DNP (compared with the PhD) has less emphasis on theory and research methodology, but instead emphasizes scholarly practice, practice improvement, improved health care models, evaluation of health care outcomes, and establishing clinical excellence through health policy and leadership.1,9 Considering my career goals-to excel in clinical practice and to educate-the DNP was a better fit.
My DNP Experience (Thus Far)
My post-master's DNP course work has included health care informatics, evidence-based practice, program evaluation, science of nursing intervention, epidemiology, health care leadership, economics, teaching and learning in nursing, health policy, and three seminar courses related to my practice-based scholarly project (DNP project). The end is near, with only three classes remaining until my DNP is complete. It has been an exciting journey to watch my DNP project come to life and to know that I have the potential to improve patient care not only where I work, but also across the nation. Being a DNP student has provided me research and scholarship opportunities to expand my career that I otherwise would not have had. Not only have I gained new knowledge, but also new networks, colleagues, and mentors who will help me to make a difference in nursing.
References:
1. American Association of Colleges in Nursing. AACN Position Statement on the Practice Doctorate in Nursing. Washington, DC: AACN; 2004.
2. Beckstead J. DNP = PhD-light, or old wine in new bottles? Int J Nurs Stud. 2010;47:663-664.
3.Edwardson S. Doctor of philosophy and doctor of nursing practice as complementary degrees. J Prof Nurs. 2010;26(3):137-140.
4. American Association of Colleges in Nursing. Doctor of Nursing Practice Programs. 2010. http://www.aacn.nche.edu/dnp/dnpprogramlist.htm. Accessed August 22, 2010
5. American Association of Colleges in Nursing. The doctor of nursing practice (DNP). 2010. http://www.aacn.nche.edu/media/FactSheets/dnp.htm. Accessed August 22, 2010.
6. Clinton P, Sperhac A. National agenda for advanced practice: the practice doctorate. J Prof Nurs. 2006;22:7-14.
7. Otterness S. Is the burden worth the benefit of the doctorate of nursing (DNP) for NPs? Implications of doctorate in nursing practice-still many unresolved issues for nurse practitioners. Nephrol Nurs J. 2006;33(6):685-687.
8. Loomis J, Willard B, Cohen J. Difficult professional choices: deciding between the PhD and the DNP in nursing. Online J Issues Nurs. 2007;12(1) :16p.
9. Marion L, Viens D, O'Sullivan A, Crabtree C, Fontana S, Price M. The practice doctorate in nursing: future or fringe? Top Adv Pract Nurs eJournal. 2003;3(2):8. http://wwwmedscape.com/viewarticle/453247. Accessed August 23, 2010.
PCNA Participates in "Complete Care for Your Heart"
On Saturday, September 11, 2010, PCNA, along with the American Association of Cardiovascular and Pulmonary Rehabilitation, the Association of Black Cardiologists, Mended Hearts, WomenHeart, and program developer, the Society for Cardiovascular Angiography, cohosted "Complete Care for Your Heart," in Atlanta, Georgia. Complete Care for Your Heart is part of a series of regional "Know What Counts" programs designed to educate the public about the many facets of heart disease.
This full-day program began with the free "Future of the Cardiac Care Continuum: Trends in Treatments and Therapies for Optimal Outcomes" CME session in which health care professionals gathered to hear several cutting-edge topics: "Secondary Prevention: Guidelines-Based Strategies for Meeting Risk Reduction Therapies," "Dual Antiplatelet Therapy in Specific Patient Populations," "The Future of Antiplatelet Therapy: Is Patient-Specific Therapy Possible?" and "Optimizing Secondary Prevention: The Role of Cardiac Rehabilitation in the Care Continuum."
Following the morning session, health care providers, policy makers, and patients were invited to attend Complete Care for Your Heart for a free lunch and public forum on issues that impact heart health. This program included information on "Living a Full Life After a Heart Stent: A Patient Perspective," "The Importance of Antiplatelet Medicines for Your Heart Care," "Be Heart Smart: Beating Heart Disease," "Stent Defense: Protecting Your Stent for Optimal Health," "Revitalizing Your Heart: The Benefits of Cardiac Rehabilitation," and "After Treatment: Thriving With Heart Disease."
Program director, J. Jeffrey Marshall, MD, FSCAI, FACC, commented on the importance of the Know What Counts session by saying, "Each of us plays an integral role in the prevention of heart disease and in spreading the message about the importance of caring for your heart. "In forums like Know What Counts, real progress can be made to educate the public and raise awareness about heart disease and adherence to treatment regimens, while also informing physicians and policy makers of their important role in the prevention and treatment of this disease."
PCNA wishes to thank Barbara Fletcher, MN, RN, FAHA, FPCNA, FAAN, PCNA Board of Directors for her morning and afternoon session presentations and Jan McAlister, MSN, NP-C, CLS, FPCNA, Atlanta PCNA Chapter Leader, for her support in program development.
The Damaging Effects of Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is a significantly underdiagnosed condition. Affecting at least 15 million Americans, OSA is linked to inflammatory, metabolic, and hemodynamic dysregulation and is prevalent in people with acute and chronic illnesses. Although difficult to estimate, statistics from the US Department of Health and Human Services and the National Institutes of Health report that 3% to 7% of men and 2% to 5% of women are suspected to have OSA. Obstructive sleep apnea is responsible for 810000 motor vehicle accidents with 1400 fatalities and 15.9 billion health care dollars spent per year. It has been determined that 54% of patients who had a sudden cardiac death have OSA.
Patients with OSA experience significant negative changes to their quality of life including decreased energy for daily activities, lack of vitality for hobbies and recreation, changes in domestic relationships, and suffering social relationships. Cardiovascular nurses must recognize the factors that contribute to OSA and the symptoms presented in patients.
In a recent presentation at an advanced practice nursing conference, Dr Pamela J. McCabe presented relevant guidelines for screening, diagnosing, and treating OSA. What are the best screening strategies? What are the most effective strategies for evaluation and treatment of OSA? Nurses play a critical role in assessment, treatment, support, and encouraging patient compliance in all aspects of care for this damaging illness.
The criterion standard for diagnosis of OSA is polysomnography, which is conducted in a certified sleep laboratory. The testings last at least 6 hours and include a 3-hour trial of continuous positive airway pressure (CPAP) treatment. A simple screening test using the Epworth Sleepiness Scale or the Pittsburgh Sleep Quality Index1 can be performed in the provider's office or in the acute-care setting to identify patients who should be referred.
Once diagnosed, treatment of OSA includes weight management, abstaining from tobacco, limiting alcohol, and mechanical or surgical therapies to reduce airway obstruction. Continuous positive airway pressure is a common and effective treatment when used as directed. However, adherence to CPAP is difficult for patients because it takes time to adjust to the CPAP facial equipment, and it can be disruptive to significant others at bedtime. Factors predicting adherence to OSA treatment include early acceptance, level of daytime sleepiness, active coping strategies, readiness to change, and early monitoring. Early monitoring with sound follow-up plans, ensuring properly fitting facial pressure masks, and education and counseling.
Patients with OSA are at greater risk of complications when hospitalized. They exhibit a greater risk of respiratory compromise or reintubation and have a more collapsible airway. Because most patients with OSA are morbidly obese, increased adipose tissue affects metabolism of lipid-soluble sedatives and anesthetics, the depressant action of opioids is enhanced, and ventilator weaning may be prolonged. Preprocedure, periprocedural, and postprocedural assessment and management are crucial.
In 2008, the American Heart Association and the American College of Cardiology Foundation published an article entitled, "Sleep Apnea and Cardiovascular Disease." This document outlines the detrimental effects that OSA can have on cardiovascular health including its impact on obese children. Prevalence, treatment strategies, current research of OSA, and all physiological systems are discussed. The article can be accessed on the Internet at http://circ.ahajournals.org/cgi/content/full/118/10/1080.
In summary, health care providers can ensure the best care for patients with OSA by being aware of evidence-based treatment guidelines, reinforcing the importance of evaluation and treatment, identifying patients at high risk for complications, being vigilant observers for possible complications, and by reducing factors associated with complications. We can also advocate for the patient with OSA by participating in changing policies to ensure that patients at risk receive the support they need. Lastly, health care providers should be aware of the key supporting organizations and resources available to patients and their families. Information and support groups can be found at the American Sleep Apnea Association Web site, http://www.sleepapnea.org.
References:
1. Knutson KL, Rathouz PJ, Yan LL, Liu K, Lauderdale DS. Stability of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Questionnaires over 1 year in early middle-aged adults: the CARDIA study. Sleep. 2006:29(11):1503-1506.
Mindless Eating: The Hidden Psychology of Obesity
Time magazine described Brian Wansink's (2007) book, Mindless Eating, as "a fascinating look at the hidden psychology of eating." Rebecca Reeves, past president of the American Dietetic Association, endorsed the book as it "[horizontal ellipsis]explores how our daily food choices contribute to our-and our nation's-increasing girth." Since 1997, Wansink conducted more than 250 studies that explored the motivations to overeat, authored 200 academic articles, and provided more than 200 research presentations. He received a presidential appointment to head the US Department of Agriculture Center for National Policy and Prevention from 2007 to 2009 and is currently the director of the Cornell Food and Brand Lab. His research was conducted in a variety of milieus: movie theaters, office settings, restaurant buffets, military outposts, and most notably a restaurant that he created for research called the Spice Box.
He postulates that individuals engage in overeating because of a multitude of unconscious biological and psychosocial factors. More than 200 food decisions are made each day with only about 10% awareness. He calls it "mindless eating" and indicates in his book that it is strongly impacted by evolution. He writes:
"We are hardwired to love the taste of fat, salt, and sugar. Fatty foods gave our ancestors the calorie reserves to weather food shortages. Salt helped them retain water and avoid dehydration. Sugar helped them distinguish sweet edible berries from sour poisonous ones. Through our taste for fat, salt, and sugar, we learned to prefer foods that were most likely to keep us alive."
From an evolutionary psychology perspective, people will overeat because, simply, food tastes good. Just the sight of chocolate stimulates insulin secretion for an anticipated sugar rush, which ultimately leads to hunger and increased cravings.
Most of Wansink's book is spent on understanding the unconscious biological and visual cues that tell us to stop eating or drive us to overeat. Even when full, individuals continue eating until the package or the bowl is empty. His satiety studies demonstrated that participants felt just as satisfied with smaller portions as larger ones. His work led to the new smaller 100-calorie mini packaging available in grocery stores as a strategy for weight control.
Wansink found that a myriad of factors impact overeating behavior. One study of particular interest demonstrated that individuals ate more when presented with greater variety. Despite all M&M's having the same chocolate flavor, participants ate 43% more when given 10 color choices versus only 7. He provided other examples where individuals kept eating when presented with a variety of food choices. His work may explain why buffets and holiday gatherings are especially vulnerable times for overeating.
Finally, his Web site, http://mindlesseating.org/, provides information and resources to raise awareness regarding unconscious eating influences. Wansink described the 19th century as the century of hygiene, the 20th as the century of medicine, and the 21st will be the century of behavior change. All health care professionals are certainly poised to address the behavior challenges related to obesity. This book offers invaluable insights into individuals' struggles with overeating. Perhaps Wansink summarized his book best when he said, "The best diet is the one that you don't know that you're on."
Section Description
The Journal of Cardiovascular Nursing is the official journal of the Preventive Cardiovascular Nurses Association. PCNA is the leading nursing organization dedicated to preventing cardiovascular disease through assessing risk, facilitating lifestyle changes, and guiding individuals to achieve treatment goals.