The Doctorate of Nursing Practice and the Clinical Project: Use of the SQUIRE Guidelines for Project Dissemination and Evaluation

Although the debate about the consequences of the doctorate in nursing practice (DNP) continues, it is without question that the DNP is firmly rooted in the contemporary landscape of our discipline. According to the American Association of Colleges of Nursing website, currently there are approximately 127 established DNP programs in the United States that span 37 states (plus the District of Columbia) with more than 100 additional schools considering starting a DNP program (American Association of Colleges of Nursing, 2010). Distinct from a doctorate of philosophy in nursing, the doctorate of nursing practice is conceptualized as an advanced clinically focused degree. The DNP role includes the synthesis and utilization of empirical evidence to improve nursing practice and patient outcomes. However, the DNP-prepared nurse also has advanced knowledge and skills related to population-based health needs, health policy, and systems management that enable intervention at the organization level (American Association of Colleges of Nursing, 2006). Although not necessarily the totality of the role, the emphasis of the DNP role is to effect health care change at the organization-specific level through strategic intervention that takes into account not only best evidence but also the organization’s strengths, resources, opportunities, and limitations. Over the past decade, much has been written about the DNP role and educational requirements. Furthermore, there is clear consensus that scholarship and scholarly writing are an essential part of the role (Mundinger, Starck, Hathaway, Shaver, & Woods, 2009). As editor of JAPNA, I fully agree with this position. Clearly, the research synthesis, systems analysis, and implementation experiences of our clinical experts are critical knowledge that will importantly contribute to the development of our discipline. However, one issue that has not been addressed in the literature and I believe remains unclear is the format of these written scholarly contributions. Over the past several months, many articles authored by DNP-prepared nurses have been submitted to JAPNA for review. Many, I believe, are reports of work completed as part of the DNP program capstone project in which an organization-specific need is effectively addressed after complex processes of assessment, planning, and intervention. It is my belief that the standard research report format is inadequate to capture the multidimensionality of this work. It is true that one foundational piece of this work is likely to include clinical problem identification, evaluation, and synthesis of relevant research findings that can be effectively reported as a meta-analysis or research synthesis paper. However, the complex assessment of the organizational characteristics, policies, and resources that are used to shape the intervention approach do not neatly fit into the standard research report form. Furthermore, there is likely to be important information related to unanticipated barriers or supports, the revision and tailoring of intervention strategies, mixed patterns of effectiveness, and post hoc evaluation of the processes and the outcomes that do not fit under the standard research report section headings. Just as the study design, sample description, and psychometrics of the measures are essential to adequacy and completeness of the research report, so too the multidimensional components of the implementation process are essential to understanding the relationship between the intervention and outcome within a specific context. After a careful search of the literature, it is my recommendation that JAPNA authors and reviewers use the Standards for Quality Improvement Reporting Excellence (SQUIRE) as guidelines for manuscript preparation and evaluation of agency-specific clinical implementation projects. The SQUIRE Guidelines were developed through a systematic process that included a complex vetting process with input from clinicians, researchers, quality improvement experts, and editors. The guidelines follow the introduction, methods, results, and discussion