Doctor of nursing practice (DNP) students enter DNP programs with diverse attributes and experiences and a spectrum of knowledge and skills.1 Students may require assistance with growth of scholarly skills, course selection, life-work-school balance, the transition into a nurse leader, development of competencies outlined in the DNP Essentials,2 adjustment into the scholarly community, and the DNP project process.1 The American Association of Colleges of Nursing does not stipulate a specific approach for advising DNP students.2 Nursing faculty commonly use traditional prescriptive academic advising. With linear directives from an adviser to a student, traditional advising may poorly suit the needs of DNP students.3,4
Founded on the principles of appreciative inquiry,5 appreciative advising (AA) serves as a promising alternative model to prescriptive advising.6 Implemented with undergraduate nursing students to improve retention and performance,7 the model addresses the holistic needs of students.8 The premise of the model is that students have talents and skills that can be nurtured to achieve their goals. The adviser guides the student according to their needs through each of the 6 AA phases (disarm, discover, dream, design, deliver, and do not settle) to facilitate meaningful rapport and empowerment of students' strengths and achievement of their goals.4,6
The disconnect between DNP student needs and established advising approaches contributes to dissatisfaction among DNP program directors and faculty.3 A national survey reported high rates of dissatisfaction with student advising among DNP faculty and program directors.3 Our school of nursing's DNP program quality improvement faculty survey and student course evaluations identified similar problems that indicated a need to redesign our advising model.
We adopted AA as the overarching framework for our DNP student advising model.6 The DNP AA model was specifically designed to address faculty and student needs consisting of 4 major components: advising process aligned with the 6 stages of AA; individual advising; group meetings; and faculty selection, preparation, and workload.4 The purpose of this pilot study was to determine feasibility of providing faculty with an evidence-based, student-centered model to advise students through the rigors of DNP education and improve student and faculty satisfaction with the advising experience. This article describes the findings of the pilot study and discusses future implications.
We conducted a pilot study of the AA model using our full-time DNP cohort that matriculated in fall 2016. The institutional review board approved this project as exempt, nonresearch. Our institution is a private, secular school of nursing on a large, university campus in the southeast United States. In 2016, we had 844 total students across educational levels in our school, 177 in the DNP program. Approximately 60% of DNP students are part time, and 40% begin the program as full time. In the fall 2016, 69 students matriculated into our DNP program. To assess the AA model for feasibility and acceptability from student and faculty perspectives prior to widespread implementation, we piloted this model with 1 full-time cohort.
As part of planning the pilot, we worked with the school administration to negotiate a new workload allocation for advising effort. Faculty members who were teaching in the integrative course series when DNP students usually prepare and execute their DNP project were given 25% workload to teach within the course and advise 4 full-time students through their 4 semester doctoral program. (This 25% workload is a 5% increase from the 20% usual workload allocation for teaching in the course.) After this workload allocation was approved, select faculty members were recruited. Faculty who taught in the DNP project course series and those faculty who had previously advised students and had deep knowledge of the curriculum, program expectations, and common student struggles were asked to participate in the pilot. Those who agreed to participate were oriented to the AA model several weeks ahead of the students' matriculation.
The first author distributed a comprehensive guidebook describing both the AA model and required advising activities across all semesters of the DNP.4 She met with all faculty participants onsite or via video conferencing to discuss expected group and individual advising meetings and their timing and content, common DNP student needs, and relevant campus resources to assist struggling students.4 She then acted as a contact for faculty participants throughout the pilot.
Of 76 DNP faculty, 7 faculty participated in the pilot. Four faculty were DNP prepared, and 3 had PhD degrees. Five (71%) identified as female, consistent with the gender distribution of our DNP faculty. All participating faculty were white. During the pilot, 1 adviser was unable to participate after the first 2 semesters and was replaced by another experienced faculty member.
Twenty-six students matriculated as full time in fall 2016. Twenty-four (92%) identified as female; 19 (73%) identified as white and 7 (27%) as African American; and all resided in the United States. Consistent with other cohorts in our school, 8 students in this cohort moved to part-time enrollment or withdrew from the school and therefore were withdrawn from the AA pilot.
To assess the success of this model, we adopted surveys developed by Dr Jessee to assess implementation of AA with undergraduate nursing students and faculty. Reliability and validity of the surveys were not established. We were especially interested in whether the model met students' needs, resulted in high levels satisfaction, and was perceived as a valuable use of time. We adjusted the question wording of the surveys to reflect the doctoral level of education and added a box for free-text comments. The separate faculty and student surveys were sent at the end of each of the 4 semesters in the DNP program using the secure, research-compliant Research Electronic Data Capture (REDCap) platform.9
Data from the surveys were analyzed using basic descriptive statistics because of the small sample size and anticipated lack of statistical significance. Information from the free-text box was analyzed using qualitative content analysis,10 led by the senior author.
Results were downloaded as REDCap reports and screened for completeness and errors.11 On review, a few of the questions translated poorly to doctoral students and faculty. A question regarding study strategies, for instance, may not have been appropriate for DNP students who are focused on papers and projects rather than test taking.
Data screening noted possible miscoding by 1 participant. One participant coded all survey responses as strongly agree in surveys 1 and 4 and coded all survey responses as strongly disagree in surveys 2 and 3. However, the person who served as a contact point for faculty needing help did not verbally report any dissatisfaction with the model. The research team thought that this faculty participant's responses were inaccurately selected; however, we retained these data in this analysis as we were not able to conclusively determine if the responses were in error.
Faculty participation in the survey ranged from 86% to 100% (n = 6-7) across the 4 survey time points. Overall, faculty were pleased with the AA model (Table, Supplemental Digital Content, http://links.lww.com/NE/A520). Qualitative descriptive analysis of the free-text responses had positive comments that the model allowed for early identification of student needs, especially writing or conceptualization of the scholarly practice problem. Participants had several positive comments specifically about the structured group sessions, identifying them as an “investment.”
However, faculty also commented on the time commitment involved in the AA model. Time concerns were by far the most frequent comment. One faculty member perceived that his/her “level of effort and time exceeded that of the student.” The ratio of time spent in proportion to student benefit was also a concern among faculty leaving free-text comments.
Student participation in the survey ranged from 45% to 69% (n = 18-26) across the 4 survey time points. The percentages of students answering positively to selected survey questions are shown in the Table. Overall, students were pleased with the model across the curriculum. The percentage of students who agreed or strongly agreed with positive statements about AA increased across semesters 1 through 3, then decreased in semester 4, a time when surveys may be of lower priority for students. Consistent with the larger trend for all questions about the model, students' perceptions of belonging to the larger scholarly community had low scores at the beginning of the program, peaked in semester 3, then declined in the final semester. Positive responses to the question about whether the AA model met their expectations remained flat throughout the curriculum.
There were 22 free-text comments for analysis. Fifteen of the comments were uniformly positive, stating it was helpful or worthwhile. Students stated the advising process helped them be part of the community, which was important because the program was a blended online program. One student participant stated, “The advisement groups helped to bridge the gaps created from participating in a primarily online doctoral program.” Six students requested additional interaction or scheduled check-ins with their adviser. More in-depth student orientation to the role of the adviser in DNP education was requested by 3 students. There were no negative comments about the model.
This survey highlighted important advisement needs of DNP students. In addition, the survey provided evidence that AA demonstrates promise as a practice for addressing DNP student advisement needs. Survey results indicated that faculty and students shared commonalities in their perceptions of the AA model. Based on the literature,12 as well as their own experiences, faculty are aware of challenges students face during the course of DNP education. Doctoral education often occurs in an uncertain environment and requires rapid student adaptation to new roles and responsibilities.13 Several findings in this study indicate that AA helps to address challenges DNP students often encounter while completing their terminal academic degree.
In undergraduate and graduate programs, students report that a primary goal is to attend classes and make above-average grades.14 In DNP programs, students learn early in the curriculum that pedagogical endeavors outside class are germane to academic success. DNP students realize their doctoral focus is on professional development, as evidenced by portfolio requirements, and their commitment to scholarly project development in a practice setting.15 Students report that transitioning from a traditional classroom focus to more independent learning engagements is often the hardest adjustment to doctoral work.14 This study suggests that DNP students across semesters found AA to be an important component to prepare them for intentional and constructive engagement in completion of their scholarly projects.
Students also need support accepting themselves as nurse leaders and scholars. Impostor syndrome is a widely recognized but poorly understood phenomenon in doctoral education.16 Doctoral students describe the impostor syndrome as feeling they do not belong in a doctoral program. Impostor syndrome characterized by inescapable feelings of self-doubt, insecurity, and duplicity, despite evidence to the contrary.17,18 These feelings are especially disturbing for students during their first year of doctoral work. Many elements of AA are found to be beneficial in ameliorating effects of impostor syndrome, for example, breaking the silence about it, accentuating students' positive characteristics, and visualizing success, all touchstones of AA. Over 4 semesters, this study found that AA assists students to identify their personal strengths and fosters realistic expectations for academic success, which are identified as beneficial interventions for impostor syndrome.17
DNP students, by necessity, often manage numerous multidimensional roles including student, family, work, and social life. Successfully completing the DNP project competes heavily for the time that other life roles frequently demand. Clearly, completion of the DNP project is the ultimate product that indicates success in a DNP program. Various aspects of multiple role demands often distract students as they are trying to conceptualize, implement, analyze, and disseminate critical findings of the DNP project. This survey highlights the importance of AA in helping students develop plans to navigate multiple role stressors they encounter in the DNP program. The AA approach seems to be most effective in supporting students to manage role stressors during the second and third semesters when critical conceptual, implementation, and analytical involvement are required for scholarly project progress.
Mentoring is an important form of professional development,19 and mentorship is especially valuable for students in doctoral programs. A consistent key feature of AA is the mentoring model relationship that develops between students and faculty.6 Providing realistic encouragement, taking a long-range view of student growth, and assisting students to visualize their destinations are mentor characteristics that were referred to by students and faculty in this survey. The power of effective faculty mentoring is critical as DNP students begin to think differently about practice situations and open their minds with more breadth and depth to consider different perspectives and solutions about clinical practice challenges.
This survey and report clarify that DNP students have important advisement needs. According to the literature and faculty experience, those needs are frequently unaddressed or inaptly managed. On the basis of the survey findings, much work needs to be done in conceptualizing the advisement needs of DNP students along with the application and evaluation of advisement strategies.
Because DNP advisement is a relatively unexplored area, specific recommendations for AA at the doctoral level are not well understood. Without sound advisement guidelines, based on empirical data, fidelity to an advisement intervention is always questionable. While much is known about undergraduate advisement, work needs to be accomplished to determine the best AA practices for doctoral faculty. Adapting recommended AA ideas to doctoral advisement shows initial promise in helping to address many academic needs of DNP students. However, we did not monitor faculty fidelity to the AA principles and practices. AA is a new undertaking for faculty, and it is reasonable to expect that they would appreciate follow-up and support as they learn and use the principles of AA.
A time commitment is required of faculty to successfully engage in AA. Students, in general, found AA to be a valuable use of their time. Conversely, almost 40% of faculty reported that AA was not a valuable use of their time. Because AA is a new innovation that involves additional learning and mastery, the low reports of AA serving as a valuable use of time are understandable. More work needs to be done within the faculty learning community to allow faculty to learn how to manage AA time commitment effectively and recognize the reward payoffs, such as student success, for time that is committed to advising students. In addition, the faculty workload provided for the effort involved may need further calibration.
The dose and timing of AA interventions for doctoral students need further exploration. For example, AA interventions that promote a sense of belonging to the scholarly community may need to be strengthened and targeted for both early and latter segments of the student's DNP program. In addition, clarification of student expectations about advisement needs to be identified and clearly defined. AA was originally designed to meet the expectations of undergraduates. Doctoral students may have different expectations about their advisement needs compared with undergraduates.
As faculty, we understand that transitioning and adapting to the challenges of doctoral education are often unexpected and sometimes daunting for students. Faculty can add AA to their repertoire of strategies for helping students acclimate to doctoral scholarship and practice. Our students have made a serious commitment to succeed in the highest rank of academia. It is the responsibility of faculty to develop and assess methods to help DNP students succeed in their quest for scholarly excellence. AA has promise to support students adjustment to the rigors of DNP education and is deserving of further exploration.
The authors thank Dr Mary Ann Jessee, for sharing her prespecialty AA materials. Dr Jennifer Bloom is acknowledged for allowing the authors to use the Appreciative Advising Inventory.
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