Introduction
Honoured Participants in this important symposium on Doctoral education in nursing. I have been asked to discuss the topic of "Models of doctoral education in Europe", which is a great honor. My own backgroung is that for more than 8 years I have been responsible for the Doctoral Programme especially for nurses, physiotherapists and occupational therapists in the Faculty of Health Sciences, at Linköping University, but for 6 years I was also responsible for the basic courses in research methods for all the doctoral students at our faculty which includes physicians, biochemists and others doing a PhD. My experience therefore is from a multidisciplinary basis, although in this symposium I will concentrate on doctoral programmes for nurses in Europe.

In preparing for this workshop, it was natural for me to contact several of the representatives of Workgroup of European Nurse Researchers, where I was the Swedish representative during the first five years. One of them is Professor Emeritus Vassiliki Lanara from the University of Athens, who served in the WENR during the same period as myself She gave a most interesting paper at the 7th biennial conference of WENR in Oslo, Norway in July 1994, where she gave a short historical survey of the spiritual and scientific heritage of Europe, relating it to nursing research. As Lanara pointed out, "Research was born in Europe, if first time the methodological specifically in the city of Athens, There men started for the search for truth and thus science and philosophy was born". Also, according to Lanara, modern research also started in Europe, especially with , according to Lanara, the first health scientist, Florence Nightingale.

Europe today has changed, in particular since the liberation of the Eastern bloc after 1991. WHO/Euro consists of 51 member states. In most of those states, however, nursing is not an academic discipline. When we talk about models for doctoral training in Europe, therefore, we could also discuss the situation only in about 15-20 countries. Naturally, my best knowledge of doctoral programmes comes from Scandinavia - but it is also in those countries that the most intensive development has occured during the past 5-10 years. Britain, however, is the country with the longest experience of doctoral training for nurses in Europe.

Methods
In order to prepare myself for this paper, I went through the reports by the representatives of the WENR from 1994-1996 looking especially for information on doctoral programmes for nurses. There are around 20 member countries. The information about doctoral programmes was sparse, although these reports give excellent information on nursing research development in general. At the Oslo meeting in 1994, Dr Alison J. Tierney from Edinburgh gave an excellent review of the development of nursing research in Europe where she listed the number of academic nursing centres in Europe with PhD training for nursing 1993. She estimated this to be 3 5, which, updated today, would equal about 45 by my own rough estimation. However, the countries which are leading the race are the same, namely Britain, Sweden, Finland, Norway, Poland, the Netherlands and Israel in about that order. In order to get some more information I sent a questionnaire to the representatives of 12 member countries in WENR or to a person who had a chair in nursing science excluding the countries I did not have evidence for a doctoral programme for nurses. I asked for a model from at least one university. The countries who responded were: Denmark, Finland, Norway, Sweden, Germany, Greece, Israel, the Netherlands, Poland and United Kingdom (non-respondents were Slovenia and Spain). I had intended to contact the Czeck Republic, but never got that far. I am aware of that I am not covering all Europe - but my intension was as the title of this paper - to discuss some models.

Results
The following pattern emerged among those 10 countries. I will now comment on the 11 questions in the questionnaire:

The first questions concerned the type of doctorate available for nurses. In 8 of the 10 countries a PhD was most common. In Norway the title is Doctor Polit Degree, which equals a PhD in other countries. Sweden has used the title Doctor in Medical Sciences if you belong to the Faculty of Medicine and Doctor of Philosophy if you belong to the Faculty of, Social Sciences. From now on everybody taking a Doctorate within the Medical Faculty will be called Doctor of Medicine in Swedish, which translates it as PhD. In Poland , at least in the two Medical Academies which have had doctoral training for nurses for a long time, namely Lublin and Poznan, nurses will become a Doctor of Natural Sciences, Biological Sciences or Medical Sciences if they belong to the Medical Academy. Otherwise they get a PhD if they go to a University (Medical Academies are separate from Universities).

An important question was the requirements for entering doctoral training in the different countries. Most countries required a Master of Science or equivalent. In Sweden, Israel and the United Kingdom, it is possible to enter with a Bachelor of Science. Four years full-time studies were the most common during the doctoral training period. Six countries had compulsory doctoral courses, this is the case, for example, in all the Scandinavian countries, whereas, in Israel, all the courses are done in the Master's programme. The "standard doctoral courses" consisted of statistics, nursing theory, quantitative methods, qualitative methods and scientific publication. Here I can mention from my own Faculty of Health Sciences that most of the doctoral courses are multidisciplinary. But we have done some of the doctoral courses in cooperation with other Universities, Professor Astrid Norberg and myself , for example, have made an exchange, so that she has had responsability for a course in phenomenological hermeneutics in our department and I have had one in instrument development in her department.

In Great Britain and Israel, students present their doctoral theses as monographs, while in Scandinavia putting together published scientific papers as a book with a summary has become more and more common - at least in the Faculties of Medicine. In Norway, Sweden and Finland, in particular, the doctoral students are able in this way to reach out to an international audience even before their examination. Also our doctoral students are trained to have their manuscripts discussed and questioned in seminars before it is being sent in to a scientific paper for publication.

The examination as such has a different pattern in the 10 countries. As you can see from this table I, the majority of the countries have a public defence with a faculty opponent.

Table I.

Country	Public defence Fac opponent/s	Only with ex board	Other
Denmark	X
Finland	X
Norway	X
Sweden	X
Germany			X
Greece	X
Israel		X
Netherlands	X
Polen	X
United Kingdom		X

One important questions concerned the characteristic of the scientific tutor (mentor). Eight of the ten countries had a person with a nursing background as the main scientific tutor, but it was also common to have a multidisciplinary person such as a physician or a psychologist as assistant tutor. In the Netherlands it was usually a multidisciplinary person as was also the case in Poland. The situation in Poland is very special. Many nurses have a doctorate as there are Nursing Faculties with Master's programmes in five Medical Academies. In Lublin for example, more than 30 nurses have a doctorate while in Poznan there are at least 15. However you must have a higher degree to be the equivalent of associate professor, in order to be a scientific tutor. We generally demand that in Scandinavia for the main scientific tutors only. My experience is that it is most important for newly graduated nurses with a doctorate to do scientific tutoring at doctoral level, while you have good memories of your own time as a doctoral student.

The financing part is important for most doctoral students. Finland, Germany and Greece reported "usually no special financing". However in Finland posts for research assistants could be arranged after a while. In Scandinavia, however, we have no fees at our universities. Grants and doctoral posts were the most common alternatives in the other countries. In the Department of Nursing Science at Oslo University only candidates are accepted who have their financing for four years. In Sweden, because of the great demands for nurses with a doctorate, especially in the Schools of Nursing, since nursing is an academic discipline, the County Councils have been very generous in providing possibilities for part-time studies. In addition special foundations such as the Vårdalstiftelsen, the sponsor of our Symposium on Priorities in Nursing Sciences in the autumn 1995 in Vadstena, have provided special money for doctoral scholarships for nurses and other paramedicals. Registration of doctoral students could take place any time of the year for half of the countries, while the rest had specific occasions. It could of course vary between different universities within the country.

The last question concerned in which subject the doctoral student was usually registered. This question is difficult to answer, since I have not been able to investigate the subjects in which nurses take their doctorate in the 10 countries. It might still be of interest to look at the answers on this question:

Table II. Questionnaire.

In which subject do your doctoral students usually register?

Denmark	Finland	Norway
Nursing Science	Caring Science	Nursing Science
Sweden	Germany	Greece
Caring Science/Nursing Science	Varies	Nursing Science
Israel	Netherlands	Polen
Nursing/Medicine/Education	Health Sciences	Varies: Clinical Medicine/Sociology/Pediatrics etc
United Kingdom	United Kingdom
Edinburgh	Liverpool
Nursing Science	No special subject

In Scandinavia only nurses who take their doctorates in departments with full chairs (professorships), in for example Caring Science or Nursing Science can take a doctorate in that subject, but many go to other departments where there is a chair in, for example, Pedagogics and then their subject will be that.

Frequency of nurses with a Doctorate in Europe
In the resumé of July 1994 by Alison J Tierney on "Development of Nursing Research in Europe" about 400 nurses (covering 18 countries) were estimated to have a PhD in Europe. Sweden at that time was reported as having 80 with a doctorate and Great Britain more than 100. Today, Sweden has about 160, Finland about 40, Denmark 13, Norway 20 and Island 7-8, which makes 240 in this part of the world alone.

But one question is very important - what does a PhD within the field of nursing lead to?

After the doctoral education
It is not until you have your PhD, that you are a researcher. But this should not be the end. The post-doctoral posts irrespective whether they are in education or in clinical work must be combined with research. In my own case I cot a post within the Swedish Medical Research Council after my doctorate, after an applying with a project on stroke. I was given the possibilty to do full-time research for four years. My successor on the chair in Caring Science at Linköping University, Anna-Christina Ek, got the same type of post. Therefore it is important that our doctoral students accept the thesis - once research, always research. For teachers, in for example Schools of Nursing, who mainly want to have some experience of research, it becomes common, anyway in Sweden and Finland, to end with a Licentiate.

Networking in doctoral education
In the Nordic countries, we are already networking in doctoral education. We have an exchange in research courses, for example, and it is possible to apply for money from a special body called the Nordic Academy for Advanced Study, NorFA. Applications can be made from this body concerning Nordic and Nordic-European Research Courses. These courses are multidisciplinary. I believe very much myself in networking in doctoral training between professions as well as between countries. The work within EU also opens new possibilites within doctoral education and research for nurses.

Summary
Doctoral education for nurses in Europe has been progressing very fast during the 90s especially in the Nordic countries. One important reason is that the basic programmes are becoming academic and incorportated within the universities. The biggest need in many countries is to get more PhD-qualified nurses scientifically equipped for full chairs in Nursing Science in order to lead their own departments and also be primarily responsible for the scientific tutoring. At the same time it is important to have doctoral education for nurses in a multiprofessional set-up. The Nordic School of Public Health, for example, has doctoral training for nurses in the subject Public Health, with a chair in Caring Science. International networking is important - it has progressed very well in the Nordic countries but could be better developed within Europe and with other continents. One good example is the multidisciplinary research course which was arranged in Linköplng University in autumn 1996 on Theories and Concepts within the Caring Sciences with Professor Afaf Meleis from San Francisco, Professor Alan Jette from Boston (a physiotherapist), Dr Sigridur Halldorsdottir, Iceland who has taken her doctorate at Linköplng University and another of our graduates, Dr Chris Henriksson, an occupational therapist, as main lecturerers. The topics discussed by this multidisciplinary group were transition, disablement, activity and suffering. So I would like to end this paper with a picture of the happy course participant and some of their lecturers.

References
Lanara, V. 1994. The contribution of nursing research to the development of the discipline of nursing in Europe. In: Proceedings, Volume I of the 7th Biennial Conference of WENR, Oslo, Norway July 3-6 1994,p 33-46

Tierney, A.J. 1994. The development of nursing research in Europe. Open plenary paper. In: Proceedings 17th Workgroup Meeting, Oslo, Norway 1994, pp 159-185

kod doktmod doc, language revised M Devenney