Hugh McKenna, D. Phil., RN
University of Ulster
Northern Ireland

Introduction
Within the Concise Oxford Dictionary the definition of a Mission is: a journey to undertake a particular task or goal. It also means to propagate a religious faith! The definition of Substance is - essential material. It is also defined as a drug or a toxicant (Thompson, 1996). It is possible that the search for nursing's substance could be a drug for some people ­ a personal obsessive mission!

Shakespeare wrote in Sonnets "What is your substance, whereof are you made that millions of strange shadows on you tend". It is the purpose of doctoral education to remove some of these strange shadows from the sometimes ephemeral substance of our discipline.

This paper proposes to deal with the journey (i.e. mission) of doctoral education and the essential material (i.e. substance) that should underpin such programmes. It will also highlight issues of particular relevance to the UK generally and Ireland in particular.

According to Grace (1978) the progression through doctorate studies for US nurses had three stages. In the early part of the century Ed.D were popular with nurses, later PhDs became more common and more recently DNSc programmes were introduced. In the UK doctoral education for nurses did not go through the first of Graces’ stages, instead it commenced with nurses undertaking PhDs in other fields, for example sociology and psychology. In the late 1970s the number of doctorally prepared nurses (and professors of nursing incidentally) could be counted in single figures. It is only in the 1990s that nurses are undertaking nursing PhDs in what could be perceived as reasonable numbers. Traynor (1997) estimates about 300 PhD nursing theses in the UK.

In 1987 Lash argued that in the US the different types of doctoral programmes in nursing were in fact similar in that each had a theory strand, a research component and an integrative science component. In fact there were so many similarities that it was difficult to tell them apart. This is not the case in the UK.

The British PhD is not taught; rather the student spends 3 years full time or 5 years part time focusing entirely on their research project. During that time the student will be guided by a suitable prepared member of academic staff who will meet the student for supervisory purposes approximately one hour per month. The student does not normally attend any classes, undertake examinations or submit course work. However, they may attend two or three in-house research seminars per year. The entire focus of the PhD is research training culminating in the production of a 100,000-word thesis, which is supposed to make a substantial contribution to the topic area. Topics can be diverse and may not necessarily focus on nursing practice nor issues of immediate relevance to the substance of nursing.

Taught doctorates in Nursing
As we move towards the third millennium much discussion is taking place in Europe concerning the introduction of taught DNSc programmes. There are a number of compelling reasons driving these discussions.

To most people in the UK doctoral education in any field means undertaking a PhD. However most practising nurses perceive PhD study as completely divorced from the real world of practice and not likely to affect them or their patients directly. We must be aware of such perceptions, however ill founded, and pursue strengthening the links between research, theory and practice.

The PhD to date has not been concerned with the substance or soul of nursing. The results of a small qualitative study with Northern Irish PhD students indicated that they knew a great deal about the research literature and their methodology (McKenna, 1996). However, the use of theory as applied to their research or subject area was a matter for the briefest consideration and in the theses discussion about the substantive content pertaining to nursing was conspicuous by it scarcity.

Gortner (1980) warned against this infatuation with science to the detriment of substance. We are nurses, not architects nor engineers, therefore our doctoral programmes should demonstrate that nursing knowledge, nursing scholarship and the essence of nursing has equal weight with research methods and techniques. Furthermore, the scholarly use of research methods and techniques should be focused upon the phenomena of specific interest to nurses and nursing (Donaldson and Crowley, 1978). If not, the substantive content of nursing will get overshadowed by syntax.

Like all science, nursing science is composed of theory + research. In other words Science = Substance + Syntax. Syntax is the tool of nursing science and substance is the product. Having syntax alone will not provide us with science, because substance will be missing.

Currently the UK government is cajoling nurses into a multidisciplinary research culture and into accepting an increasing number of medical tasks and duties. The government is also calling for nurses to demonstrate evidenced-based practice for clinical effectiveness. However, it is difficult to achieve these objectives if nursing is not developed, and nursing cannot be developed if nurses are not developed! Therefore, more than ever before we require a cadre of scholars educated to doctoral level who will focus upon the essence of nursing, its generation and testing. According to Downs (1988) adequate preparation of doctoral candidates is among the most important and pressing educational issues facing nursing today, for it is upon this group of nurses that the profession must depend for the critical and creative study of the science of nursing, its theories and their evaluation.

At its best, a doctoral programme is one where knowledge is both discovered and transmitted. In those countries in which nurses have been delayed in gaining admission to doctoral programmes, the development of nursing knowledge has also been delayed. Members of any profession are best able to appreciate the substance of their discipline when they have been educated in a programme where knowledge in their field is being generated, challenged and tested as well as being taught (Lanara, 1994). Nursing has a long way to go, many of those faculty who are managing doctoral programmes in the UK have not undergone an educational process of this nature. In fact the preparation of nurse teachers to date has inadequately prepared them to teach at doctoral level and it is questionable whether those nurses who have a doctorate in another discipline are able and perhaps willing to explore nursing substance.

Doctoral students must be given the opportunity to be taught by talented faculty who are prepared at doctoral level and who are themselves actively involved in generating and evaluating nursing knowledge and scholarship. Faculty's research should be theoretically and philosophically relevant to the phenomena of nursing. A range of staff undertaking unrelated non-cumulative studies in a plethora of topics with no clear focus is not a good milieu for doctoral study.

The development of the nursing theory movement on both sides of the Atlantic is contemporaneous with doctoral education for nurses. Currently there are over fifty 'grand theories' that have served and continue to serve a purpose (McKenna, 1997). However, I am not sure if some of these, which had their origins in the 1950s, are appropriate for dealing with the phenomena nurses will come across in the next millennium. Doctorally prepared nurses can help develop appropriate theories that seek to explain new phenomena. They can also be involved in moving nursing theory from the grand theory level, to mid-range and practice theory levels and in the process forge the link between syntax and substance.

Doctoral scholarship should also benefit the users of nursing services. Lash (1987) stated that nursing cannot thrive unless there is a concerted effort to connect its intellectual activities with the realities of patient care. Practice is the seedbed for theorising - theories are developed in practice and are returned to inform or be tested in practice. A doctoral programme that has the prefix nursing is guilty of a misrepresentation if it ignores the importance of patient care.

Some doctoral programmes are ascending further and further into the Ether. Scholarly productivity needs to be articulated in terms of practice. Working in partnerships with practising nurses is one way of achieving this. In this way doctorally prepared nurses can extend their role from being a discoverer of new knowledge to being an enhancer of knowledge discovering capacities in others.

In 1997 Britain's nurse teachers are finding their career in jeopardy. While they realise that the doctorate degree is the preferred qualification for promotion and tenure, many have not yet advanced beyond bachelor's degree. Most have a primary degree in education and are aware that this may not be adequate for teaching the substantive content of nursing knowledge in the new university-based departments. As a result some are returning to their nursing roots and pursuing a taught Doctorate in nursing. However, though 50% of DNSc applicants at the University of Ulster are nurse teachers, we are careful not to accept those who desire the academic ticket for career purposes, but do not wish to make an obvious contribution to nursing or to patient care.

University of Ulster's DNSc
The first and so far the only DNSc programme in the UK commenced in 1994 at UU. The establishment of this programme was a laborious process that included different layers of stringent validation and review. As alluded to above it was introduced in an effort to provide the much-needed substantive content so blatantly absent from the research doctorate. In other words the intent was to create a doctorate that was different from a PhD in that it is built solidly upon the three foundation stones of practice, theory and research. In her writings Fawcett (1978) refers to the double helix of theory and research. A doctoral programme needs to be permeated by what may be called the triple helix of practice, theory and research - the connecting arms of which elegantly interweave to produce scientific knowledge.

But by its nature scientific knowledge quickly becomes outdated and therefore doctoral education should be about process as well as substantive content. The following assumptions by West (1966) illustrate this perfectly:

1. only a small portion of the current body of knowledge can be taught in the prescribed period of time;

2. much of the knowledge that will be employed in the students' future career is not known today and therefore cannot be taught;

3. not all that is taught is learned;

4. a portion of what is learned will soon be obsolete;

5. of that which is learned, much is quickly forgotten;

6. a small part of what is taught is error (not research based)

(Figure 1 Here please)

The DNSc programme is the cradle for such traits. It incorporates a range of challenging modules. Applicants entering the programme must have a sound base in nursing as evidenced by a good undergraduate degree. Figure 1 illustrates that the programme has three phases. Depending on performance or indeed preference, students can enter or leave the programme at postgraduate diploma level, master’s levels or doctoral level. This provision also acts as a safety net for those students who start the programme but for whatever reason cannot complete it. Of the 20 students who enter the programme annually, one third go onto the doctoral phase while the remainder opt for the Masters qualification.

Module 1, The Development and Application of Knowledge, deals with what is the substance of nursing, and what are the different ways in which nurses know. Students are provided with epistemological and ontological insights and are involved in seminar work that takes them along the continuum from identifying interesting phenomena in practice to formulating concepts and theoretical propositions. The opportunity is had to explore knowledge of other disciplines so as to identify new paradigms and methodologies that may be brought to bear in generating new nursing knowledge. Coursework for module 1 requires that students undertake a conceptual analysis of phenomena central to their area of interest.

In this module much time is spent in discussing the properties of scholarship and the best way to develop scholarship. As recommended by Meleis (1981), theories are explored epistemologically in relation to their preparadigmatic origins, analytically in relation to their theoretical components and critically in terms of their significance and influence on the discipline of nursing.

Module 6, Taxonomic Domains for Nursing, builds on module 1. Here the students are encouraged to conceptualise, theorise and exploit other paradigms and methodologies in the pursuit of knowledge for nursing. Models of theory building, theory testing and theory evaluation are explored in depth. In module 6 we support Meleis (1981) contention that students must produce quality work that is characterised by theoretical soundness, methodological neatness and an ability to amplify and extend nursing's theoretical propositions.

Module 2, Advanced Techniques for Health Research, and 7 Advanced Research Methods, are concerned with the syntax of nursing. A range of advanced qualitative and quantitative research approaches are examined in some depth. Methods of analysis from various research paradigms are explored.

Module 5 Optional Module, relates to the student's area of practice. It seeks to take the doctoral student beyond what Benner (1984) referred to as expert practice to advanced practice. Benoliel (1977) maintained that scholars and researchers need to be able to move back and forth between the empirical world of nursing practice and the abstract world of theory development. Most of the students are part time and therefore have easy access to the clinical area. This is not to increase clinical expertise but to foster the theory-research-practice linkage necessary for developing nursing science.

These modules are also a challenge to faculty and one that is perceived very seriously indeed. Great care is taken to ensure that the DNSc does not become another series of modules where students master the content so that they can regurgitate it back in end of semester assignments. Such a process is anathema to the independent and creative enterprise that needs to exist if nurses are seeking to extend the bounds of nursing knowledge (Grace, 1978).

DNSc versus PhD
In thirty-five years North American nurses have still not determined to everyones' satisfaction the differences between their research and professional doctorates. At the University of Ulster the problems of differentiation are not so acute. This pluralistic approach to Doctoral education is appropriate at our current stage of nursing development. The programmes complement each other with some PhD students attending modules for the DNSc students and the DNSc students attending seminars led by PhD students. Both degrees are of equal rigour and both are systematically organised in terms of length of programme, supervision and support. Both are concerned with the training of students in research methods, the generation of new knowledge and the presentation of primary research in the form of a dissertation.

The major differences are in the delivery and the goals of the two programmes. The DNSc is a taught degree in which students have to pass a range of examination and coursework milestones. All the students are encouraged to explore the substantive content of nursing knowledge. Furthermore, in the DNSc programme the students learn a wide range of qualitative and quantitative methods whereas in the PhD programme it is possible that students may only study the method they are using in their thesis. In the DNSc there is an emphasis on practice and clinical decision making whereas in the PhD there may be no allusion to practice or patient care.

Future Mission

Postdoctoral career
One recent subscriber to the NurseRes List on the Internet described doctoral programmes as terminal programmes! This perpetuates the myth that once a doctorate is obtained the successful candidate can assume the role of an independent researcher. Doctoral study is best described as advanced scholarly training and the graduate represents an emergent scientist (Meleis 1981). In order for doctorally prepared nurses to sharpen the skills necessary to develop the substantive knowledge base for nursing they have to mature in a culture of postdoctoral scholarship and creativity.

In the UK nurses are supported to get their doctorates but little thought is put into considering how to support them to develop into mature scientists and future research or clinical leaders. How can doctorally prepared nurses climb the scholarly career ladder when most of the rungs are missing? So it is imperative that those universities with doctoral programmes should encourage graduates to think about career development beyond the doctorate and exposed them to individuals who are pursuing postdoctoral study.

The needs of society, trends in health care systems and the needs of the profession will inevitably influence the future mission of doctoral education. An increased number of doctorally prepared nurses will be required to undertake the myriad of roles emanating from these changes. One of the changes relates to nursing taking its rightful place in higher education.

Nurses in the UK must be careful not to dilute the levels of scholarship in the newly integrated university departments of nursing. Universities must recognise the doctorate as the basic entering degree for academic nurse teachers and for promotion to higher academic positions. The number of PhD programmes for nursing will continue to increase and by the year 2000 other DNSc programmes will emerge within the U.K.

More funding will be needed to support an increase in such programmes. However, it is possible that in times of financial stringency there may be a reluctance to support doctoral study for their staff. We should take cognisance of the words of Cecily Bok ­ if you think education is expensive ­ try ignorance (Oxford Dictionary of Quotations, (1988).

Elsewhere in the world the number of doctoral programmes in nursing is also increasing dramatically. There is however, little cross-frontier contact between these programmes. This is stifling to the growth of our substantive knowledge base. We need to exploit the Internet, video-conferencing and scholarly discussion lists on the World Wide Web. This would encourage what Meleis (1981) calls the invisible college where there is informal communication networks among doctoral scholars in a particular area.

In the UK the move to doctoral education for nurses has its dissenters. These are mostly physicians or nurses who feel that nursing is moving too fast and is leaving behind or debunking what they erroneously perceive to be important knowledge, skills and tasks. However, no person, profession or organisation has the right to fix a boundary to the march of a discipline, no one has the right to say this far you should go and no further. Although our doctoral programmes at the University of Ulster may be embryonic when compared with US programmes, they will continually strive to make a contribution to the substance of nursing.

Conclusion
At the start of this presentation a mission was defined as a journey to undertake a particular task or goal. This journey is ongoing and along it we must collect the essential material or substance of our craft. Doctorally prepared nurses have an obligation to take this journey and search for the substance. There are no reasons left why they should not accept this obligation — only excuses.

References
Benoliel, J.Q. (1977). The interaction between theory and research. Nursing Outlook, 25, 108-113.

Benner, P (1984). From novice to expert. Menlo Pk, Calif, Addison Wesley.

Donaldson, S.D. & Crowley, D.M. (1978). The discipline of nursing. Nursing Outlook, 26, 113-120.

Downs, F.S. (1978). Doctoral education in nursing: future directions. Nursing Outlook. 26, 56-61.

Downs, F.S. (1988). Doctoral education: our claim to the future. Nursing outlook, 36, 18-20.

Fawcett, J. (1978) The relationship between theory and research: a double helix. Advances in Nursing Science. 1(1), 49-62.

Gortner, S. (1980). Nursing science in transition. Nursing research 29, 180-183.

Grace, H. (1978). The development of doctoral education in nursing: an historical perspective. Journal of Nursing Education. 17, 17-27.

Lancaster, E. (1984). Doctoral education in nursing: the Sisyphian concept and Pandora’s box. Critical Care Nursing, 4 , 6-17.

Lanara, V.A. (1994). The contribution of nursing research to the development of the discipline of nursing in Europe. Proceedings from the 7th Biennial Conference. Published by the Workgroup of European Nurse Researchers. Oslo (Jul 3-6) pp33-46.

Lash, A.A. (1987). Rival conceptions in doctoral education in nursing and their outcomes: an update. Journal of Nursing Education, 26, 221-266.

McKenna, H.P. (1997). Nursing models and theories. London, Routledge.

McKenna, H.P. (1996). Views of nurse doctoral students: a phenomenological study. Unpublished paper.

Meleis, A.I. (1981). Nursing Theory and scholarliness in the doctoral program. Advances in Nursing Science. 3, 31-41.

Oxford Dictionary of Quotations (1985). London, Guild Publishing.

Thompson D. ed (1996) The Concise Oxford Dictionary. London, BCA.