Table 1 Characteristics of the included studies

[2]

2012 (USA)

To determine the perceived feasibility of the eligibility for tenure

being granted to nurses prepared at the level of doctor of nursing practice (DNP)

Internet-

based survey

Faculties and deans (n=65) from a randomly chosen list of doctor of nursing programs from the American Association of Colleges of Nursing

In 61.3 % of the institutions, DNP faculty members were eligible for tenure. 56.25 % of respondents reported that their institutions considered practice in granting tenure. According to 75.4 % respondents allowing DNP faculty eligibility for tenure brings benefits, such as recruitment and retention of faculty, parity with other practice doctorates, and the clinical component that they bring. 41.27 % respondents reported that they have concerns related to allowing DNP faculty eligibility for tenure, such as the fact they are not adequately trained in the research process, and that DNP tenure diminishes the progress nursing has made in academia.

[3]

2019 (USA)

To evaluate mentoring of doctoral students’ work by nursing faculty in DNP and PhD programs

Descriptive study with online survey

Nursing faculty members (n=230; (DNP=177 and PhD=53).

Mentoring is crucial in effective doctoral education. A number of students were identified for effective mentoring (PhD M=3.4, DNP M=4.3). Specific qualification to mentor doctoral students of both programs is required, however only ¼ faculty members received formal training in this regard. Among the factors that would facilitate effective mentoring by faculty are allocation of time, number of students, students’ readiness for doctoral work, better preparation for the mentoring role, and resources which support students’ work.

[5]

2019 (Nordic countries)

To investigate and compare the prevalence of PhD-prepared nurses employed at university hospitals in the Nordic countries, to investigate what functions they fulfil, what research activities they undertake and how they describe their ideal work life

A descriptive cross-sectional study with online questionnaire

PhD-prepared nurses working at a university hospital in one of six Nordic countries (n=166)

The following functions of PhD-prepared nurses working at university hospitals were reported most often:

(a) research,

(b) teaching,

(c) supervision,

(d) administration.

Only part of their time is spent on research. The majority of respondents held a position shared between hospital and university.

[7]

2014 (UK)

To evaluate the quality of doctoral education in nursing in the United Kingdom

A quantitative study with a cross-sectional comparative survey

Doctoral students/graduates (n=97) and faculty (n=37)

The results provide information regarding the program, faculty/staff, resources and evaluation. Staff members were more likely to agree with the statement: ‘your institution values, supports and provides rewards to students for research and scholarly activity’ than students. Staff members were more likely to agree that the emphasis of the doctoral curriculum is consistent with the mission of the university and the discipline of nursing. Staff members think that students have ethical training within the framework of preparation for undertaking research. Students do not agree with this. Students disagree significantly more often with the statement ‘staff members provide students with diverse and challenging learning experiences’ than staff members. Most students reported that the environment and resources, including financial support and the time allocated to support students, were of poor quality. Students rated supervision as excellent. Students rated the overall quality of the program higher than staff members.

[8]

2018 (USA)

To describe development of new competency-based curriculum in quantitative research for PhD nursing students

Mix-method study: assessment of quantitative research methods curricula; survey of PhD students and alumni; interview with program faculty

PhD students (n=127); top National Institute of Health-funded nursing schools with PhD degree programs (n=8)

The study revealed that students are interested in practising with secondary data analysis using large data sets, biomedical informatics data interpretation, an understanding of applied machine learning algorithms, and to improve their understanding of complex database management. Students requested more in-depth statistical courses. All surveyed programs offered a year-long training course in epidemiology and quantitative research methods (some schools offered 2 years of training).

[10]

2015 (USA)

To examine the content of U.S. PhD programs in nursing as communicated on the program websites in 2012

A descriptive design using Web scraping methodology was used

Research-focused doctoral (PhD and DNS) programs in nursing (n=120) in USA

Nearly all programs included statistics/quantitative design, philosophy/theory development and qualitative methods. Only 55 % of programs showed evidence of including nursing inquiry, and 43.3 % included research ethics. Education/teaching was included in 55.8 % of programs, policy in 50 % and leadership in 36.7 %.

[11]

2019 (USA)

To assess characteristics and practices of nursing PhD students, the mentoring practices of their advisors, and the likelihood of self-reported career readiness

A nationwide descriptive, cross-sectional study

PhD students (n=380) representing 64 schools

The mean self-rated scientific proficiency score of PhD students was 87.9 ± 13.4 (range: 20–120). A high percentage of students had positive reports of mentorship characteristics of their advisors. Greater readiness for their career was found among students who are older, with a greater number of responsibilities, and who work more hours per week. Mentoring practices were not found to be significant predictors of career readiness. However, having one or more mentor and advisor influenced greater readiness for career.

[12]

2019 (USA)

Understanding doctoral nursing students’ and recent graduates’ expectations of their educational experience related to preparation for an academic career

Descriptive qualitative design

PhD and DNP students and recent graduates (n=24)

Two major themes emerged in the analysis: (1) met and unmet expectations of programs; and (2) equivocal preparation for teaching.

[13]

2015 (USA)

To profile the nursing faculty in the United States teaching in PhD and DNP programs

A descriptive study with an online survey

Nursing faculty (n=554) who teach in PhD and DNP programs in the United States

Faculty who teach only DNP students are more likely to hold a DNP degree, while those teaching only in PhD programs or in both programs are more likely to hold a PhD. Faculty teaching only in DNP programs are more likely to engage in clinical practice. Faculty teaching in PhD programs only or in both programs were more likely to serve as members of doctoral students’ dissertation or project committees, provide academic counselling, mentor students in research, serve as committee chairs, provide informal mentoring to doctoral students, and supervise postdoctoral fellows.

[14]

2018 (China)

To investigate career intentions of nursing PhD students

Online cross-sectional survey

PhD nursing students (n=89)

For most of the PhD students, pursuing a PhD was part of their career plan (73.0 %). Regarding career intentions, most of the students (60.7 %) wanted to work in an educational institution. The most often indicated fields of work after graduation were nursing education (75.3 %) and nursing research (70.8 %), only a few students wanted to work in a clinical setting (16.9 %). Students’ expectations regarding the work role were:

- the opportunity to put their strengths to the fullest use (79.8 %),

- time to conduct research (60.7 %)

- regular office hours for good work-life balance (51.7 %).

[15]

2016 (USA)

To describe the factors influencing the pursuit and completion of doctoral education by nurses intending to seek or retain faculty roles

The quantitative survey

Nurses, current students or recent graduates of doctoral programs (n=548)

Time was an important factor considered when choosing a doctoral program, both by PhD and DNP students/graduates. Time for degree completion was more important for DNP then for PhD students (the sooner the better). Almost all respondents reported that family and job obligations interfered with studying and writing. Nearly all respondents stated that their doctoral education was worth the time commitment. Money was another important factor considered when deciding to enter a doctoral program. Three aspects were crucial here: (a) paying for education, (b) return of investment in the future, and (c) impact on their future salary. Majority of respondents reported that doctoral education was worth money investment.

[16]

2016 (USA)

An evaluation comparing the early-entry option with two more conventional entry points was conducted

Qualitative and quantitative study

Three groups (n=84): (a) early-entry students, undergraduates or immediately upon graduation (n=29), (b) mid-entry students with baccalaureate degrees and at least 1 year of work experience (n=27), (c) delayed-entry students with master’s degrees and 1 or more years of work experience (n=28)

Similarities and differences emerged between students who enter a PhD program in nursing before their baccalaureate degree and students after their baccalaureate degree and after their master’s degree. In qualitative data, among the similarities, three themes emerged: availability of funding, mentors and teaching preparation. Among the differences, two themes emerged: Career decision-making and clinical competence.

In quantitative data, among the similarities, research productivity and faculty position in nursing as post-graduation employment were reported. Among the differences: diversity regarding age and ethnicity of students and progression measures were identified.

[17]

2019 (USA)

To explore the experiences of DNP and PhD prepared faculty on tenure-track in academia through narrative stories

A qualitative narrative design

Doctoral-prepared nurses (n=19) on tenure-track.

Five themes were found:

(1) The ability to develop meaningful partnerships,

(2) A necessity to balance responsibilities,

(3) Destructive criticism is real,

(4) I have value in academia,

(5) Multifaceted coaching to produce achievement.

[18]

2014 (USA)

To (1) evaluate admission criteria into PhD programs for direct entry from a bachelor’s degree; (2) ascertain bachelors and masters’ degree nursing students’ perspectives on pursuing a BSN to PhD; (3) clarify factors that influence students’ decision-making processes behind pursuing a PhD

A cross-sectional pilot study

Currently enrolled bachelor’s, master’s, and doctor of nursing practice students (n=606)

Chosen admission criteria into PhD programs from a bachelor’s degree: 5 programs required at least one year of clinical work experience as RN. Other are also: a graduate level statistics course, admissions interview, and grade point averages (GPAs) – which is set on different levels for different programs. 69 % of the surveyed students indicated that they may or definitely would consider a PhD directly after their current program of study. Among the barriers for pursuing PhD study, three emerged in qualitative analysis: cost, time and experience. Among the students’ areas of interest for PhD study, the most often indicated was non-communicable diseases, followed by global health.

[19]

2018 (Canada)

To understand the state of the literature regarding a PhD requirement and the extent to which a PhD supports academic nurse educators in their teaching roles

Integrative review

Peer-reviewed papers n=139

The majority of published works originated in the USA (n=126). Only 33 studies were research-based.

Results are framed in following themes:

(a) What is an effective educator?

(b) What is the current practice for the formal preparation of teachers in higher education?

(c) How is excellence in teaching described?

(d) What conditions influence or have an impact on academic nurse educator preparation for the responsibilities of their roles?

[20]

2019 (USA)

To develop a substantive theory about the perceptions and the attitudes of doctoral nurses regarding their roles

An adapted approach of Strauss and Corbin’s grounded theory methodology.

The semi-structured individual interview and focus group interviews

Doctoral-prepared nurses (n=13) and nursing experts (n=5) with expertise regarding doctoral studies

The core category that emerged was Following the Path – describing respondents’ perspective of the PhD and DNP roles. Additionally, four categories were identified: (1) advancing (perceiving the doctoral role, moving practice forward, influencing); (2) collaborating (working together, building the identity, identifying); (3) transforming (complex health care, changing, choosing roles); and (4) stewarding (building the profession, performing the role, mentoring/growing)

[21]

2018 (Australia)

To understand the experiences of nurses and midwives enrolled in a PhD, explore barriers that PhD students encounter whilst completing the degree, and develop recommendations for support strategies to encourage completion a PhD degree

A mixed methodology, non-experimental design approach

Registered Nurses and Registered Midwives enrolled to PhD program (n=16)

Results regard the following aspects of PhD programs: supervision, feedback, peer support groups, supervisors: expectations/viewpoints, and the PhD journey. Most PhD students give positive comments regarding their supervisors. Feedback received from supervisors regarding submitted work was usually timing, not always consistent, often including conflicting advice, sometimes unhelpful and difficult to understand. Peer group support was not highly rated by the students. More than half of the surveyed students reported that they understand their supervisors’ expectations and viewpoints. Half of the PhD students thought the PhD had been a positive learning curve.

[22]

2011 (UK)

Reports on a national study that sought to investigate the learning expectations and experiences of overseas

doctoral nursing students in the UK.

Semi-structured qualitative interviews

International doctoral nursing students (n=17) representing 9 different countries from 6 different UK universities

Three main categories emerged from the analysis:

(1) A journey of transitions: adjusting to doctoral study in the UK (themes identified: expectations and reality, anxiety and challenge: adjusting to UK academic practices, learning in another language)

(2) A journey of relationships: finding support for doctoral study (themes identified: negotiating the complexities of supervision, peer support, institutional support)

(3) A journey of challenge and a journey of growth (themes identified: an emotional journey, transformation).

[23]

2009 (UK)

To explore student and supervisor perceptions and experiences of the research supervision process within a professional doctorate programme.

An exploratory, descriptive approach

Students (n=15), and

professional doctorate research supervisors (n=5). Additionally, convenience sample of students (n=2) and supervisors (n=2) for one-to-one discussion.

Seven following themes emerged from the analysis:

(a) Supervisor style;

(b) Pragmatism;

(c) Broken discourse: independence;

(d) Broken discourse: facilitation;

(e) Partnership and equality;

(f) Posturing;

(g) Professional issues

[25]

2019 (USA)

To describe DNP and PhD collaboration

in an academic setting

Two examples analysis

Collaborators faculty and collaborators students (n=4)

PhD and DNP faculty members can utilise complementary skill sets in order to prepare projects which are scientifically sound and practically important. Two programs of faculty collaboration may be extended on PhD and DNP students’ collaboration.

[26]

2017 (USA)

To explore attitudes and determinants for effective collaboration among doctoral-prepared nursing faculty

Qualitative study

Four focus groups included faculty members (n=41) who taught in DNP and/or PhD programs.

Five themes emerged:

(a) DNP not well understood,

(b) Confusion surrounding research,

(c) Opportunities for collaboration,

(d) Lack of structural support,

(e) Personal characteristics and attitudes.

[28]

2016 (USA)

To identify barriers and facilitators to academic careers for doctoral (PhD) nursing students

Cross-sectional study

PhD students (n=933)

72.5 % of respondents planned academic careers, and they were more likely to work in teaching or research (71 % vs. 15 %). The average age of students entering doctoral program is 33.9 – for post-baccalaureate level, and 43.4 at the post-master’s level. The first group would graduate in 5.2 years and the second in 5 years. Participating in teaching development activities, receiving financial support and having a faculty member mentor during doctoral education influence students plans regarding future academic careers. 47 % of students who had non-academic career plans switched to academic career plans during their doctoral study.

[31]

2018 (USA)

To explore the unique characteristics of the direct entry BSN/BS-PhD student experience

Descriptive qualitative design. The modified Delphi method was used.

Panel experts (n=4) (current students or recent graduates of BSN/BS-PhD programs).

Four themes were identified as BSN/BS-PhD students experience:

(1) Commitment to science,

(2) Nursing identity,

(3) Exploring prospects,

(4) Balancing family and student expectations.

[33]

2019 (UK)

To examine how

PhD theses in nursing may be categorized, what they study, what theoretical approaches they employ and, to what degree nursing theory is employed as a current theoretical approach.

Descriptive qualitative design

PhD theses (n=61) in nursing science published from

1994–2015, at the University of Edinburgh

Analysis shows that only a few of the PhD theses referred to nursing theory and few used it as their theoretical approach, or as part of the theoretical approach. The vast majority of the theses referred to theories developed by disciplines other than nursing.

[34]

2019 (USA)

To compare dissemination of PhD dissertation research by dissertation format

Retrospective study (1999-2019) – analysis of dissertations (traditional format) and publication dissertation – in PubMed

PhD graduates (n=113)

The majority of PhD graduates employed traditional format for their PhD dissertation (70.8 %). 41.3 % of them had never published dissertation findings in peer-reviewed journal. Those graduates who chose an alternative format for their dissertation, had a higher number of peer-reviewed publications.

[35]

2018 (USA)

To explore the advantages and disadvantages of the traditional format vs. manuscript option for dissertations

among nursing PhD programs in the United States

Cross-sectional census survey

PhD programs in USA (n=79)

Among the programs surveyed, 84 % offered the traditional format and 71 % offered the manuscript option format. The majority of programs (59 %) offered both formats. Among the reasons why programs adopted the manuscript option dissertation format, two were most often indicated: the PhD program faculty supports this kind of dissertation and it may lead to an increase in the transition of student nurse scholars to academic positions. Among the advantages of the manuscript option dissertation format, future career opportunities for students (academic position) were highlighted. Among the disadvantages: challenges with formatting and a lack of writing skills. From programs offering the manuscript format, the majority (61 %) required three manuscripts in order to graduate.

[36]

2018 (Denmark)

To explore different perspectives on the positioning of PhD nurses and how they contribute to clinical nursing practice

A qualitative, explorative interview study

PhD nurses (n=6),

nurse colleagues (n=9) and clinical nurse leaders (n=6)

Nurses with a doctorate see themselves as those who change clinical practice to evidenced-based. Also, their colleagues expect that they will implement research results into practice. Nurses with a doctorate are perceived as important resource, so they should raise the standard of clinical practice by doing useful research. According to study findings, the position of PhD nurses in clinical setting is uncertain and unstable.

[42]

2011 (USA)

To investigate the number of clinical hours required in postmaster’s programs and the types of clinical experiences provided

Prospective, descriptive cross-sectional study

DNP program directors (n=43)

The number of required clinical hours ranged between 0 and 1,000. None of the schools required additional practice hours solely to

supplement previous master’s-level supervised clinical hours. However, 20 % of schools reported having a separate clinical course, 26 % of schools’ clinical hours have end-of-program practice immersion experiences, 38 % used both as supplemental and for end-of-program immersion experiences. Supervision of clinical hours: 45 % responded that they are supervised by DNP faculty, 19 % reported that they are completed independently, 57 % are mentored by a preceptor in the clinical setting.

[43]

2015 (7 countries)

To compare the findings of the quality of nursing

doctoral education survey across seven countries and discuss the strategic directions for improving quality

A descriptive, cross-country, comparative design with an online questionnaire

Deans/schools (n=105), faculty (n=414) and students/graduates (n=1149) from nursing schools in seven countries: Australia, Japan, Korea, South Africa, Thailand, UK and USA

Both faculty and students/graduates rated the overall quality of nursing doctoral education as good to excellent. Among the four domains assessed in the survey, the highest average score was for the faculty domain, followed by the programme, evaluation and resource domains. Faculty assessed the quality higher than students/graduates in three domains (programme, faculty and evaluation).

[44]

2010 (South Korea)

To describe the perceived quality of Korean nursing doctoral education in faculty, students, curriculum and resources

A qualitative research design (focus groups)

Four groups: deans (n=10), faculty (n=7), students (n=7) and graduates (n=6).

Themes emerged with regard to strengths and weaknesses of Korean nursing doctoral education. Among the strengths of the faculty are e.g. recognition of the faculty’s research productivity, ability of the faculty to attract extramural funding, and new research methods delivered by young faculty. Among the weaknesses of the faculty are e.g. teaching courses without content expertise, ageing of the faculty and insufficient faculty with expert knowledge in nursing. Among the strengths of the students are e.g. students with diverse educational and institutional backgrounds and flexible university policy regarding admission. Among the weaknesses of the students are e.g. declined quality of students and decreased number of doctoral applicants. One of the strengths of the curriculum is interdisciplinary courses. One of the weaknesses of the curriculum is a lack of courses to develop core research competencies. Among the strengths of the resources there is e.g. inter-institutional courses with credit transfer. Among the weaknesses of resources there is e.g. a lack of funding support for research.

[45]

2011 (Jordan)

To retrospectively explore: (a) how individuals experienced the doctorate; (b) what they felt they had learned from it; (c) which factors influenced the further development of research activity

Qualitative study

PhD nursing graduates in Jordan who had studied in the UK (n=16)

The following themes emerged from the study:

(a) Difficult discovery journey;

(b) Transformation of oneself;

(c) Passing it on.

[46]

2016 (Denmark)

To create awareness among nurse leaders of what they may need to

consider when integrating nurse researchers as advanced nurse practitioners

(ANP) at PhD level among their staff

A collective case study

ANPs with PhD (n=3) at a large regional hospital in Denmark

Abilities of ANPs with a PhD that emerged from the study: the use of knowledge in practice, clinical thinking and analytical skills, clinical judgment and decision-making skills, professional leadership and clinical inquiry, coaching and mentoring skills, research skills and changing practice. All of these abilities are integrated with the implementation of evidence-based practice.

[47]

2011 (USA)

To identify current admission criteria and academic performance outcomes in nursing PhD programs

Descriptive exploratory design

Nursing PhD programs (n =56).

100 % of programs reported that Graduate grade point average (GPA) is considered in the admission to a PhD in nursing. The most often indicated minimum grade was 3.0. For 91 % of institutions, one or more examples of writing were required as part of the admission process. The most common type was a statement of goals (79 %) and a scholarly project (36 %). 98 % of institutions required a letter of recommendation. Applicant interviews with the faculty were required by 82 % of institutions. 91 % of participants indicated that research match with faculty was considered in the admission process. 6 common academic performance outcomes in nursing PhD programs were identified: comprehensive examination (80 %), ongoing minimum graduate GPA (79 %) of 3.0 (82 %), and a formal dissertation: chapter format (77 %), time to degree attainment (71 %), degree attainment (71 %), and time to candidacy (63 %).

[48]

2013 (USA)

(1) to describe key aspects of DNP program capacity, and (2) describe the potential impact of the DNP on faculty resources in nursing research doctoral programs

A survey

The deans of nursing schools (n=126) offering DNP programs

The average length of time taken for students to finish the MSN-DNP program was reported to be 2.43 years, whilst the BSN-DNP took 3.8 years. 81 % of programs reported the required research course. 79 % of programs required clinical practice in the program, more so in BSN-DNP than in MSN-DNP programs. Also, only 5 % required teaching practice. In 84 institutions, 232 faculty members who had been principal investigator of at least one research grant were employed in the DNP program. Among the 33 reporting institutions which have PhD and DNP degrees, only one reported no faculty overlap.

[49]

2013 (USA)

To uncover the lived experience of developing as a scholarly writer

Qualitative – hermeneutic

phenomenology

Students

enrolled in their first semester of coursework in a PhD in nursing (n=10).

Themes uncovered:

(a) Coming to know about scholarly writing,

(b) Shifting thinking in order to write scholarly,

(c) Giving birth: the pain and the pleasure of scholarly writing,

(d) Putting all of the pieces together into the final product.

[50]

2012 (USA)

To describe the resources available for research support in schools of nursing with doctoral degree-granting programs

Descriptive survey design, the online survey

The deans of nursing

schools (n=120) offering doctoral degrees.

75 % (from 116 programs) reported having a research office within their institution, and 76 % of these schools provided information about their budget. The average budget for the research office in years 2008-2009 was $350,000. Among the major goals of the research office, the following were reported: to increase of the amount of external funding obtain (92 %), promote scholarly work including publications (90.8 %), and promote collaborative research with other disciplines (88.5 %). Among the most often indicated activities of the research office were: grant development (100 %), grant assembly (92.9 %), grant budget development (90 %), research seminars (90 %), and statistical consultation (84.3 %). With regard to the personnel of the research office, 97.1 % employed a research office director/dean, 78.3 % a grant administrator and 74.3 % statisticians.

[51]

2012 (USA)

To examine trends in the process, timing, and methodology of comprehensive and

qualifying examinations in nursing doctoral programs in the United States

Exploratory, descriptive cross-sectional

Study with online survey

Administrators from research-focused doctoral programs (n=45) from 27 states across the country

According to 47 % of respondents, the most common method of doctoral comprehensive/qualifying examination was a written take-home test, with 2/3 reporting subsequent oral examination. 24 % of respondents reported using a form of the traditional written, on-site examination, with few follow-ups involving an oral defence. 20 % of programs implemented requirement for a written publishable paper with follow-up oral defence of the paper. As 67 % of programs reported, the examination was developed by a PhD program committee or special examination task force.

[52]

2018 (USA)

To examine how the effects of environmental

stressors predict the students’ intent to leave their current program of doctoral study

A descriptive survey design

PhD and DNP students (n=835)

Two types of stress were identified that significantly predicted students’ intention to leave:

(1) Stressors related to program issues, primarily relationships between the student and the faculty/advisor. When program stressors rise also the intent to leave rises.

(2) Stressors related to support issues, specifically from the family/friends. When family support declines, intent to leave rises.

[53]

2017 (Iran)

To explore the challenges of the acceptance of the role of a clinical educator by PhD-graduated nurses who are faculty members.

Qualitative exploratory study with semi-structured, face to face interview

Sample (n=13): 8 PhD graduates in nursing, 3 heads of departments of nursing, 1 educational vice chancellor of a nursing school, and 1 nurse

One main theme emerged in the analysis: “Identity threat” with 5 categories:

(a) expectations beyond ability,

(b) lack of staff’s relies on a PhD graduate’s performance,

(c) poor clinical competencies,

(d) doubtfulness,

(e) obligation

[54]

2019 (USA)

To identify common experiences voiced by the DNPs who have returned to school for the second nursing doctoral degree.

Qualitative research study using a heuristic, descriptive phenomenological approach

DNPs (n=12) who have returned to school in pursuit of a PhD in nursing

Three themes were uncovered from the analysis:

(1) wanting to know something more;

(2) social-individual tension;

(3) challenges faced to transformational learning.

[55]

2019 [55] (Sweden)

To investigate what registered nurses (RNs) with a PhD working in a clinical practice experience in terms of their role, function and work context.

Qualitative design, with semi-structured interviews

Registered nurses (RNs) with a PhD (n=13)

One concluding theme was formed: “Having the competence and desire to improve clinical nursing, but facing barriers”, and 19 sub-categories grouped into 4 categories:

(a) striving to develop nursing care, with or without support;

(b) being present in clinical nursing care as an intentional strategy;

(c) contributing to the development of evidence-based nursing (EBN);

(d) supporting and enabling nursing education and competence development.