Setting the Stage: International Perspectives on Quality Indicators in Doctoral Programs in Nursing1
Eloita Neves Arruda
2 In this scenario, it is necessary to reconsider the quality indicators
of doctoral nursing education, as one of the essential requirements
for local integration and for the search for the possibilities for
connections on both the local and global levels. Upon proposing
in this study to analyze the quality indicators for doctoral programs
in three countries, the United States, Brazil and Venezuela, we
indicate differences and similarities, and identify issues that
can globally affect education in doctoral programs in nursing. The
choice of these countries, in addition to Brazil, was made because
the organizers of this event solicited a comparative analysis and
because of: 1) the experience of both of the authors in the teaching
of nursing at the graduate-level in Brazil and the experience of
the first author in evaluating graduate courses in the Commissão
de Consultores da CAPES [CAPES Consultants Commission]4;
2) the first author's completion of a doctorate and additional post-doctoral
study in the United States, where the second author also completed
some of her doctoral research through a "sandwich" program; 3) the
participation of the first author in the implementation, as a professor,
of the doctoral nursing program recently created in Venezuela, first
of this kind developed in a South American Spanish speaking country.
These three countries have different realities in terms of their
cultural, social, political, economic and geographic qualities,
which are reflected in the living process, and consequently in the
resolution of internal problems and in the establishment of international
relationships. Historically, the professional insertion of nursing
in each of these societies, its development as a discipline and
its tradition in doctoral programs have been built in different
manners in these three countries. Concerning this tradition, the
history of the education of nurses at the doctoral level in the
United States provides evidence of three stages, beginning with
the doctoral degree in education - EdD (1924-1959), shifting to
doctoral degrees obtained in other fields of knowledge (1960-1969)
and finally implementing different modes of doctorates in nursing
(PhD, DNS, ND)5, since the 1970's (Grace, 1978; Carpenter,
1996), and by 1993, there were 54 such courses (Germain et al, 1994).
In Brazil, the experience is even more recent, considering that
the first doctoral program in nursing was created in 1982. The nation
now has seven operating programs. In Venezuela, the first program
was created in April 1998 through a network among the nation's Nursing
Schools and international co-operation with UFSC. Studies for the
implantation of other programs in Latin American countries are being
undertaken based on inter-institutional partnerships, with the international
co-operation of Brazil, through programs that already have been
established and considered to be of high quality. In this way, the
challenges upon nurses demand a co-operative process of solidarity
in order to confront the changes in the realm of action of educational
institutions in society. These initiatives demonstrate the importance
of joining forces and overcoming weaknesses to survive and advance,
following ethically sustainable ideals to assure that programs offered
meet local and global quality indicators in a complex and competitive
market steered by the process of internationalization and globalization.
Demo (1994) distinguishes two dimensions of the concept of quality,
formal quality and political quality. Formal quality means
the ability to manage means, tools, forms, techniques and procedures
in light of the challenges of development. Among them stand out
management and production of knowledge. Political quality, in turn,
refers to the capacity of the subject in terms of improving oneself
and making history, considering the goals of human society. It is
the basic condition for participation. It is directed at goals,
values and contents. In this sense, knowledge without political
quality looses the notion of ethics and can serve any ideology.
We thus have, on one hand, the most potent tool for innovation,
commanded by the systematic advances of knowledge. On the other,
we have a permanent challenge to discuss, review and redo the historical
sense of innovation or to humanize progress. (Demo, 1994).
For this author, both knowledge and education are the work of
humans and for this reason they are subject to the challenge of
quality. While formal quality concerns the art of discovering, political
quality concerns the art of doing. Thus, the quality assurance focuses
on the challenge of managing the proper tools for making human history.
The formal quality of knowledge and of education is the basic
tool of innovation. As a means, it is guided by the end, which is
political quality. The practice of quality thus refers to the innovative
and humanizing capability of a historic subject, formally prepared
to manage and produce knowledge as a basic force that considers
citizenship and constructive and participative ability above other
factors. (Demo, 1994).
Concerning the evaluation of quality of university level education
in nursing, our understanding is based upon López and Calderon
(1996). It is seen as a process of permanent analysis of the socio-epidemiological,
political, economic, cultural situation of the nursing professional
practice and of the labor market in health care. The evaluation
of quality can be used to adjust the process of higher education
in nursing, making possible its social legitimacy and relevance,
to the degree that it responds to the needs of the context from
which egress technically, scientifically, humanly and politically
qualified professionals.
These authors (López and Calderón, 1996) go beyond
Demo's (1994) proposal by suggesting the use of three strongly connected
dimensions for the evaluation of university level nursing education:
the socio-political, technical and subjective dimensions. The
socio-political dimension refers to the exogenous demands upon
the educational systems found in the ultimate goal of nursing education:
to produce, reproduce and transmit socially valid knowledge. In
addition, this dimension meets the specific demands of the cultural
system concerning the development of the national identity and of
the development of values, attitudes, and conduct that make possible
the functioning of a democratic, caring and participative society.
This dimension also responds to the demands of the economic system
for the development of capabilities that help those completing their
studies to enter the productive world, including the ability to:
offer scientific support to development; communicate effectively;
work in a team and function productively in a critical and creative
manner.
The technical dimension of the educational system refers
to the technical options that shape the way education is organized
to meet social demands, including: the organization of the program
study, the didactic intervention for production and transmission
of knowledge and ethical, personal and professional values; the
institutional processes – the organizational environment, evaluation
strategies, distribution models of time, space and power –
which allow open discussions in conjunction with intellectual and
ideological diversity.
The subjective dimension refers to the components of the
affective domain of the educational process, expressed by the feelings
of the professor and of the student in relation to: feeling sufficiently
competent, satisfied and motivated to perform their role in the
social and professional environment.
Consequently, upon adopting the perspective of Demo (1994), and
López and Caderón (1996), it becomes clear that we
cannot restrict our understanding of quality to mere formal procedures
or to mere knowledge, keeping in mind that education is not limited
to knowledge. In this way, upon seeking the formal, political and
subjective quality of education we must link theory and practice,
seeking not only to equip ourselves, but above all, to intervene
in reality in an innovative manner in order to transform it.
For these reasons, we can affirm that the evaluation of the quality
of education in doctoral programs in nursing consists in a process
conducted with innovative and humanizing competence. The process
is constructed historically and with the participation of the subjects
who produce knowledge (professors, students and administrators)
and of the subjects who represent those segments that consume the
products and services that we offer society (students, employers
and financing agency). This evaluation should favor and point out
paths to be pursued by an educational system that forms critical
and creative citizens who are capable of indicating historical directions
which are collectively intended. Moreover, a program of excellence
will attract both highly qualified educators and students. In this
perspective, they can contribute to strengthening the nursing discipline
and broaden its interaction with other disciplines, seeking creative
and effective solutions to social problems, considering the growing
complexity of quality in the process of being and living healthy.
An evaluation process of the doctoral programs in nursing will have
to define appropriate quality indicators. This definition is constituted
in a space of ethical and political decision, which should not be
abandoned when it comes to conquering the inalienable right to quality
of education. The conquest of quality is based on one of the challenges
that we encounter, particularly when we suffer countless types of
restrictions and segmentation of a commercial nature.
The other challenge refers to the impossibility of homogenizing
or establishing a unified or universal standard of quality indicators
for doctoral programs in nursing. This is because the quality of
education is defined through the needs of each society in a defined
space and time. It is also determined by the socio-cultural, economic
and political situation of countries, regions and local communities.
In this sense, the search for articulation between doctoral programs
includes the definition of global and international indicators,
considering that the local and national indicators are defined while
maintaining respect for the cultural, political and economic specificities
of the local reality. The process of very rapid transformation to
which societies are submitted must also be considered, requiring
innovation, creativity and permanent revising in the establishment
of quality indicators for doctoral programs in nursing.
It is interesting to highlight that the AACN indicators were prepared
by nurses to meet the needs for the development of nursing, through
an initiative made by the Schools. Those of CCNEPG were established
by the Universities Council to authorize and give accreditation
to graduate programs, while those of CAPES were created by a government
initiative to monitor the distribution of funds for graduate education
in different areas and currently, as delegated by the Ministry of
Education, serve as parameters to authorize, give accreditation
and periodically evaluate such programs.
Based on a preliminary analysis of the documents we adopted the
five components proposed by AACN for the doctoral program in nursing,
which are: faculty, program of studies, resources, research and
students. Then, we distributed the respective indicators among these
components establishing a comparative analysis between the three
documents.
Faculty The programs in the Latin American countries value both the previous
experience of the doctoral program professors in thesis/dissertation
guidance and teaching in graduate programs and interdisciplinarity,
or that is, the participation in the teaching staff of intellectuals
from other areas of knowledge. They also consider as a quality indicator
the presence of nursing visiting professors and other forms of external
participation, promoting interchange and local, regional, national
and international co-operation. They make explicit the need for
continuous training of the faculty in refreshing and post-doctoral
activities.
We emphasize that Brazil gives importance to the indicator of a
stable and permanent faculty staff which is employed full-time by
the university. In addition to their research activities, the professors
should have regular involvement in teaching activities and guidance
of undergraduate and graduate students. The professors should publish
and deliver papers at national and international scientific meetings,
at an established level of quality and quantity, and they should
have national recognition through participation in committees at
a national and international level and participation in the editorial
board of scientific journals.
One of the indicators considered in the AACN document and not contemplated
by the others refers to the creation by the faculty of "an environment,
in which mentoring, socialization of students and the existence
of a community of scholars is evident".
The indicators concerning faculty, presented above, reveal the
supremacy of the formal/technical dimensions, in detriment to the
political/socio-political dimension. It is important to highlight
that the AACN document considers the political dimension in two
of its indicators regarding faculty, while this dimension is absent
from the other documents. None of the documents consider the dimension
of subjective quality.
We find a need to include indicators that consider aspects of the
political/socio-political dimension related to the attitudes and
behavior of the professors, in order to assure quality of the doctoral
program. We emphasize the ability of the professor to have knowledge
of and influence in graduate and research policies, in order to
contribute to the advance of the nursing discipline. We also include
an openness to the new, a capacity to advance knowledge in a creative
manner, with the courage to dare, innovate and position oneself
in order to be committed to reach a greater capacity to resolve
the improvement of the process of living in society. These factors
also relate to the subjective dimensions which involve motivating
the different actors to understand changes and reach goals; the
feeling of satisfaction faculty have concerning the educational
system activities and the sense of control the person has over the
role he or she is performing.
Program of Studies Concerning the program of studies, we also note the emphasis of
AACN on the following aspects: identification of a core content;
the opportunity students have to deepen previous experiences to
develop their professional role, and the clarity of the requirements
and their sequence in the curriculum.
All three documents include the formal/technical dimension, while
that of the AACN advances in the sense of assuring the knowledge
needed for the insertion and the political performance of the doctor
in nursing in society. Another indicator that is absent that appears
to be of fundamental importance in a globalized world concerns the
flexibility of the curricular structure, and the possibility of
favoring student and faculty exchanges between doctoral programs
in nursing on the local, regional, national and international level.
In this way, in addition to enhancing multiple cultural perspectives,
on the personal/professional level, the exchanges can encourage
co-operation and reciprocity through the articulation of forces
between the co-operating parties and help to reduce particular weaknesses.
Another indicator that we consider to be important concerns the
subjective quality referring to the ontological perspective of education,
to the degree in which this can give priority to the development
of those involved in the educational process.
Resources These indicators are of a formal/technical nature and do not give
priority to the political/socio-political and subjective dimensions.
In our understanding these indicators are not sufficient to assure
quality. Other indicators must be included that allow evaluation
of the autonomy a program has to seek and administer its resources,
as well as to improve the "utilization of the administrative process
in the management of the educational system" (López and Caderón,
1996, p. 06). In the same manner, when evaluating this component
the subjective dimension must be considered, including indicators
that reflect the sense of satisfaction and the motivation of the
different actors to seek resources that continually promote the
improvement of infrastructure.
Research The indicators mentioned above are inserted in the formal/technical
and political/socio-political dimensions, but do not consider the
subjective dimension, that is, the feeling about their competence,
satisfaction and motivation to conduct and coordinate research programs/groups.
Concerning the political/socio-political dimension, we find that
it is fundamental to establish indicators that evaluate the capacity
of the research programs and groups to work together within a collaborative
research plan that considers themes which are common priorities
among the partners, on a local, regional, national and international
level. In this perspective, we must consider that the research cannot
constitute an end in itself, but must adhere to real social needs.
Students The indicators are consistent with the formal/technical and political/socio-political
dimension but as in the previous component do not consider the subjective
dimension, failing to include the sense of satisfaction of the students
with the educational system and the motivation to commit oneself
and get involved politically in the decisions that affect the profession
and social interests.
It is important to note here the experience in Brazil with the
"sandwich" doctorate, which has increased cultural and educational
exchanges on a national and international levels, by encouraging
interchange between schools and the development of collaborative
research in themes of common interest. We offer as examples the
realization of this program within doctoral programs in Brazil with
countries such as the United States, Canada, France, Sweden and
Italy, among others.
Evaluation For this reason it can be deduced that the quality evaluation of
the doctoral programs in the United States follow a systematic and
continuous plan. We do not have more in-depth information about
the periodicity and form of this evaluation. However, the work of
Germain et al (1994), specifies an interval of evaluation of 5 to
7 years, contradicting the declaration contained in the indicator.
In Brazil, in addition to the evaluation made by CAPES every two
years, the graduate nursing programs at a master's or doctoral level
periodically have promoted self-evaluation of programs, counting
on the participation of national and international external evaluators.
We offer an example of the evaluation experiences that took place
at UFSC (1986;1996) the results of which were widely publicized
to the scientific nursing community.
It is also interesting to register the experience of a process
of quality management of nursing research and education conducted
over three years, with seven National Nursing Schools grouped in
the Asociación Venezolana de Educación Superior en
Enfermeria – ASOVESE [Venezuelan Association of Higher Education
in Nursing], with consultation from WHO/PAHO – Caracas. This
experience led to the work of López and Calderón (1996),
which we utilize as one of the references for quality evaluation.
Thus, the tradition of the doctoral programs in nursing consists
of an important factor to be considered, when seeking local standards
of quality indicators, and they should not be included in global
and international quality indicator standards given that they are
local specificities.
The local/national specificities, detected in this analysis, allow
us to identify both strengths and weaknesses, concerning the aspects
considered in the evaluation of the quality of doctoral programs
in nursing. We can highlight the following points as strengths to
assure quality: the composition of the faculty staff with various
intellectual perspectives, the utilization of interdisciplinarity,
of multi-cultural experiences, and of local, regional, national
and international cooperation. The weaknesses concern those factors
related to: the subjective dimension of the evaluation; reciprocity
in cooperation; development of leadership of the faculty and students
to position themselves politically in decisions and intervene in
reality, based on the interests of the profession and of society;
development of a program of studies and of the research themes that
allow the consolidation of nursing as a discipline, finding paths
to improve the quality of life in society.
Both the strengths and weaknesses are present, in a more or less
accentuated form, in the documents analyzed. For example, we can
cite the documents of the Latin American countries, which, while
they have as a strength the implementation of interdisciplinarity
and are open to collaborative work between disciplines and programs
on the local, regional, national and international realm, they also
have weaknesses in the construction of the nursing discipline. The
reverse seems to be true when we refer to the document from the
United States.
These different perspectives, among others, have at their foundation
the historical, cultural, political and economic tradition which
lead to a diversity of personal and professional experiences which,
when shared globally and internationally, can enrich the nursing
culture and discipline, with impacts for the profession and significant
benefits for society.
Alcione Leite da Silva 3
Abstract The authors compare /contrast
the quality indicators for doctoral programs in three countries,
the United States, Brazil and Venezuela, indicating differences
and similarities, and identifying issues that can globally affect
education in doctoral programs in nursing. Such an analysis is based
on of three documents: that of the American Association of Colleges
of Nursing - AACN (1993); Higher Education Personnel Training Commission-
CAPES (1998), and National Consultative Council of Graduate Studies
CCNEPG (1987). The authors utilize as a framework the concepts of
formal quality and political quality (Demo, 1994) and the sociopolitical,
technical and subjective dimensions proposed by López e Calderon
(1996). The indicators are distributed among the following components:
faculty, program of studies, resources, research, students. Finally,
the authors discuss indicators concerning a plan for evaluation
of quality of doctoral programs in nursing.
KEY WORDS: doctoral education; quality assurance; nursing education
Introduction
In recent decades, the growing complexity of social life and the
broadening of world communication systems have challenged doctoral
programs to continuously seek to improve their resources and processes
in order to insure quality. International economic globalization
presents significant implications for human relations systems, for
technological demands, as well as for quality indicators of the
education process within a profession or discipline which has repercussion
in services offered to society. In this sense, we are challenged
to seek a more global vision to understand with technical perception
and social sensibility the asymmetries created by a world which
is globalize in a heterogeneous manner, creating at all levels both
unions and divisions, alliances and ruptures which demand new analysis
tools and great perception in order to understand their depth. In
this situation, the future of doctoral programs will be influenced
not only by the needs of society, of the profession and by trends
in health systems, as Meleis (1988) points out, but also by our
ability to establish partnerships in the local, regional, national
and international realm, respecting cultural differences, and a
world vision. Nevertheless, this articulation process necessarily
implies that we consider the capacity for group and local integration,
or that is, the reciprocal capacity of members to identify themselves
with the interests, values and goals of the professional group.
Theoretical Reference – Quality Indicators
To think of quality indicators first involves explaining some concepts
related to quality, seeking to anchor these concepts in education.
The concept of quality is associated to characteristics or attributes
essential to a grade of excellence (Davies, 1976). The concept of
quality has evolved in a slow and gradual manner passing from the
notion of quality control, to now reach the concept of a culture
of quality, to define a collective, and differentiated participation
based on solidarity, which is aimed at achieving excellence in results
(Drugg, Ortiz, 1994).
Analysis of Quality Indicators of Doctoral Programs
To analyze the quality indicators for doctoral programs in the three
countries we utilized the following documents: that of the American
Association of Colleges of Nursing - AACN (1993); of the Coordenação
de Aperfeiçoamento de Pessoal de Ensino Superior [Higher
Education Personnel Training Commission] - Ministério da
Educação [Ministry of Education] - CAPES (1998) and;
that of the Conselho Nacional de Universidades [National Universities
Council] / Consejo Consultivo Nacional de Estudios para Graduados
[National Consultative Council of Graduate Studies] - CCNEPG (1987).
The first document establishes indicators for doctoral nursing programs
(PhD, DNS, EdD) in the United States; the second concerns a preliminary
proposal of indicators for a profile of excellence of programs in
health and nursing higher education, without establishing specificities
for doctoral programs, and the third points to indicators for graduate
programs, separately specifying the quality indicators for master's
and doctoral programs in Natural Sciences, Engineering and Social
Sciences.
Concerning the faculty, the three documents detail indicators considering
as requirements that the professors be doctors/researchers in the
program area, and that they have a variety of intellectual perspectives
and are capable of conceiving and implementing research programs,
and maintaining projects in operation with the involvement of students.
The focus given by AACN (1993), which affirmed "that the programs
of research and scholarship continue over time and build upon previous
work", should be highlighted, considering that this constitutes
an important indicator in the development of the nursing discipline.
Considering the second component, program of study, all three documents
affirm that the educational activities be established according
to the area of expertise/scholarship of the faculty, and should
have a strongly based pedagogical perspective, according to the
characteristics of the programs and should be consistent with the
mission and objectives of the program and the major area of studies.
The CAPES and CCNEPG documents establish as a quality indicator
the existence of an epistemological base and of research methodologies
corresponding to the specific area of the program. But unlike AACN
document, they fail to consider those aspects of the program of
studies that refer to the development of knowledge and leadership
in nursing, as well as the analytical and leadership strategies
for dealing with social, ethical, cultural, economic, and political
issues related to nursing, health care and research.
Concerning the third component, that is, resources, the documents
indicate that the programs should have physical facilities, libraries,
technical support and computers resources that are easily accessible
to faculty and students, and should receive financial and technical
support from funding agencies and from the university itself for
the development of research programs.
Considering the fourth component, research, the documents identify
as quality indicators the construction of research programs on previous
work, counting on support from funding agencies. However, the AACN
document specifies that the programs must be congruent with the
research priorities in the field and in the communities. The other
two documents, however, emphasize the need for human resources appropriate
to the development of such programs, including the participation
of the faculty and student bodies. The AACN and CAPES documents
establish a variety of mechanisms to insure the elevated quality
of research, such as, peer review, mentoring and consultation. The
CAPES document includes as indicators the appropriateness, scope
and links between the lines of research and research projects in
relation to the major areas of studies. This perspective also considers
the quantity of projects in relation to the size and preparation
of the faculty and the participation of the student body in the
research projects.
Concerning the fifth component, students, we emphasize that there
is not explicit agreement among the three documents. Nevertheless,
concerning the time required to receive a degree, the three documents
determine this to be an indicator, whether by recognizing the need
to define requirements for participation in the course, or by establishing
a maximum limit of four years, or by requiring commitment and dedication
of the student in the course so that he or she can complete the
required studies in the time established. On the other hand, the
CAPES document points to indicators that consider the relationship
between the number of students and faculty, requiring a certain
percentage of professors in relation to the students admitted each
year. The AACN document highlights the establishment of a standard
for productive scholarship collaborating with the professors and
peers in scientific activities that result in the presentation and
publication of papers, which continue after graduation. The CAPES
document, meanwhile, stipulates the publication of articles by individual
students or in partnership with faculty, which seems to reveal the
absence of a tradition on the development of scholarship in comparison
with experience in the United States. In this sense the AACN document
considers the inclusion of activities in the course that prepare
students to assume leadership positions after graduation. Another
indicator present in the AACN document and that of CCNEPG calls
for admission criteria to be consistent with those of the institution.
Although we have not included the evaluation component in the comparative
analysis of the three documents, we believe it is important to make
some comments. The AACN document (1993, p. 3) offers eight indicators
concerning a plan for evaluation of quality of the doctoral programs
in nursing. These indicators highlight the need to include data
(process and outcome), collected from various sources, internal
and external to the program, including: students, alumni, professors,
employers of the graduates, peer groups within nursing and funding
agencies. The evaluation plan, which should be supported by human,
financial and institutional resources, is systematic, ongoing, comprehensive,
focuses on the mission and the objectives of the program and adheres
to the ethical and process related standards of the formal evaluation.
These standards include confidentiality and rigorous quantitative
and qualitative analysis in order to allow the comparison of process
and outcome of the program to the standards of the school/university
and to the selected groups within nursing. In addition the evaluation
plan should periodically offer data that allow to determine certain
standards and trends and recommend future directions for the program,
through feedback to faculty and administrators in order to promote
program improvement.
Final Comments
Given these factors, it is evident that because it was prepared
by nurses, the AACN document considers some specific indicators
not detected in the other two documents as being important for the
development of the nursing discipline. On the other hand, some indicators
presented by CAPES and CCNEPG are not found in AACN, although based
on our experience we know that they are considered in the professional
nursing experience in the United States. This finding led us to
think that the tradition in developing doctoral programs will make
some indicators unnecessary over time, to the degree that they come
to be incorporated in professional life. The same does not appear
to happen with the programs with shorter traditions, which thus
require the specification of these indicators.
Footnotes
References
International Network for Doctoral Education in Nursing
Copyright © 2000-2007 University of Michigan School of Nursing