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Reflection on Progress Toward DNP Essential I

The American Association of Colleges of Nursing (AACN) describes
eight essentials of doctoral education for advanced nursing practice that help
define the practice doctorate in nursing (DNP) and describe the essential
features of educational preparation for the DNP (AACN, 2006). The first
essential, scientific underpinnings for practice, is fundamental for DNPs
because the scientific base underlies everything that DNPs, and students in
DNP programs, do and seek to do, including achievement of the other seven
essentials. Through this, my first semester of DNP education, I have made
significant strides towards success in this essential.
My phenomenon of interest has evolved through this first semester as I
learned to evaluate its significance, view it through patterns of knowing,
consider it through the lens of grand nursing theory as well as middle-range
and interdisciplinary theoretical perspectives, and finally as I developed a
model which describes my phenomenon inclusive of all these things. The
first version of my phenomenon was a topic of interest: adolescent
pregnancy. I believed that my focus would be on determining ways to
promote contraception adherence in adolescents and so much of my early
work was focused on the concept of adherence and trying to identify
methods and theories to support behavior change strategies for adolescents.
As I did more research and developed the concept of adherence more
completely, I soon realized that adolescent adherence was not the
phenomenon that I was really interested in, in fact the more that I learned,


the more I grew dissatisfied with anything involving adherence since, no

matter how it may be described, it ultimately is about getting others to do
what you want them to do.
I had more impetus to change direction when, at the end of
September, the American Academy of Pediatrics (2014), published a position
statement that guided clinicians to recommend and counsel for long-acting
reversible contraception (LARCs) as first-line methods for adolescents. Since
I work in the field, this directive was not altogether unsurprising to me, as
there have been expert opinion statements and webinars regarding this issue
for some time, however this significantly altered the direction of my
phenomenon because even if I developed a new purpose for a phenomenon,
for example, empowerment of teen contraception users, the
recommendation changes make that, while not entirely irrelevant, certainly
less meaningful. It certainly is still going to be very important to empower
adolescents in their reproductive health choices, but it is possibly more
important that adolescents get the counseling about and access to the
methods that are highly effective, do not require any adherence for efficacy,
and have high user satisfaction.
I decided to shift the focus of my phenomenon to clinicians and their
attitudes and behaviors regarding LARCs. The literature review I completed
shows that many clinicians have negative opinions about LARC use in
adolescents and much of that appears to stem from misconceptions about
LARCs. The literature review demonstrated that my phenomenon is relevant


and significant right now and shows a need for intervention. By pulling in
behavior change theory (directed at clinicians now instead of adolescents)
and information about best practices for clinician performance improvement
interventions, I now have a solid beginning plan for a project.

I think the process of committing to DNP education and what I have

learned even in my short time in the program to date shaped how I handled
the change in my phenomenon. I think in my Masters coursework, if
something significant changed in my area of interest while I was in the midst
of working on it, I likely would have ignored the change and finished what I
was doing because the goals, at least for me, were different. I had fixed
short-term goals: finish a paper, finish the degree, pass a certification exam.
I had no sense that anything I did in my Masters program mattered to
anyone besides me. Even though I knew it would make for more work and a
greater investment of time to really shift my DNP phenomenon of interest, I
could not just ignore the new information because I believe that what I will
do through this project will be significant, perhaps not on a large scale, but it
will be significant in my clinic and hopefully in other school-based/schoollinked health centers across the state.
I was not sure what to think when I embarked on this DNP journey. I
actually had a little ambivalence about the DNP because a few of my peers in
academia do not think it is the right choice for a faculty member. I had
considered research doctorate degrees as well but was concerned about


whether or not I could finish in the amount of time allotted, which was
restricted by my terms of hire. I think I was even guilty of thinking that the
DNP was the lite version of a nursing doctorate. In spite of all these things,
I think that I ended up pursuing the right degree and in the right place.
Everything in the DNP essentials speaks to me, so much of the course work
to date has helped me appreciate the potential of what DNPs can do, and I
feel like I will be instrumental in demonstrating what DNPs can do in the
future. Even when I considered a research doctorate because others thought
it was the right degree, I never thought I would engage in any significant
research, it just has never interested me, but with the types of things that
DNPs can focus on, including practice-based changes, quality improvement,
policy, and advocacy, I feel not only up to the challenge, but really excited
for the future.



American Association of Colleges of Nursing. (2006). The essentials of doctoral education for
advanced nursing practice. Washington, DC: AACN. Retrieved from:
American Academy of Pediatrics. (2014). Policy statement: Contraception for adolescents.
Pediatrics, 134, 1244-1256, doi: 10.1542/peds.2014.2299