For the Sake of Argument: Guiding DNP Students to Envision a Clinical Problem

Communication and decision-making in the healthcare workplace often involve finding solutions to ill-structured problems in uncertain, dynamic environments influenced by the competing interests of multiple stakeholders. In this environment, DNPs as nurse administrators and APRN leaders are often compelled to make important decisions based upon evaluating the merit of colleagues’ proposals against some desired organizational or population outcome. Of equal importance, is the DNP’s own capacity to construct a compelling argument or proposal that will drive the organization forward to meet the evolving needs for quality healthcare. Where do we learn the skills necessary to foster this kind of critical thinking in our professional communications? The author suggests that such problem-solving approaches can begin early in the DNP curriculum, when pedagogy is aimed at helping students to clearly identify contemporary problems existing in their practice environments, which will lend themselves to creative, evidence-based solutions. In fulfillment of the AACN Essentials for Doctoral Education, faculty are challenged to create a curriculum that includes the scientific underpinnings that comprise a foundation for nursing knowledge. One useful resource for the delineation of a solvable clinical problem, can be found within the philosophical models of deductive/inductive scientific reasoning. The author suggests that one approach can be found through the thoughtful application of the work of British philosopher Steven Toulmin (2003). Toulmin defined a model for both the analysis and derivation of logical arguments that can be readily learned and applied for use in healthcare systems. This model posits that a substantive argument or problem can be evaluated based on the assumptions it presumes (warrants) and the strength of the evidence base (backing). Several of the social science professions have adapted Toulmin’s model to generate descriptive and normative analysis and solutions to complex or emergent problems. The Toulmin process often provides the DNP student with their first real learning experience in defining the scope and inherent challenges when framing a clinical issue to be the focus of their scholarly translational projects. The author has taught this content as a part of the DNP curriculum in Philosophy of Science and Scientific Underpinnings courses in two Universities. This poster elucidates the teaching-learning activity that was derived from the Toulmin model (2003) for use in these courses. Student problem statement outcomes, which were eventually developed in subsequent research courses as scholarly projects, are presented as exemplars of this process. These illustrations are further analyzed and evaluated for clinical application, as well as their implementation of the Toulmin model elements.