The nursing profession may question whether the scholarship of application is a strategy for nurses to demonstrate their contributions to patient care. Through nurses’ commitment to scholarly practice and effective patient care, they are prompted to use theory and research to improve nursing practices. As these practice innovations are implemented and evaluated, new knowledge and understanding are developed. By meeting the criteria of scholarship established by Boyer (1990), nurses are able to demonstrate their significant contribution to health care through documentation, peer review, and dissemination.
This form of knowledge production aligns with Boyer’s (1990) expanded view of scholarship and specifically the scholarship of application (i.e., applying knowledge in community and service activities with the outcomes of benefit to the larger community). Nursing has long strived to bring clinical practice, education, and research closer together. This endeavor has raised several questions regarding the scholarship of application:
- Is the enhancement of scholarship of application a strategy to continue closing this gap?
- Why is it important to recognize the scholarship of application?
- What would motivate nurses to contribute to clinical scholarship?
The purpose of this article is to emphasize the importance of clinical scholarship and the scholarship of application; increase discussion among clinical nurses, nurse educators, researchers, and managers; and strategize on the continuing development of clinical scholars.
Recognizing the Scholarship of Application
An expanded model of scholarship (Figure 1), with four domains that frequently overlap, provides a useful framework for considering knowledge production (Boyer, 1990). The four domains of the model include:
- Scholarship of discovery (i.e., the generation of new knowledge or validation of existing knowledge).
- Scholarship of integration (i.e., making connections across disciplines, interpreting known knowledge, and creating new understandings).
- Scholarship of teaching (i.e., creativity in developing innovative teaching materials and the advancement of knowledge on curricular issues and on how students learn).
- Scholarship of application (i.e., applying knowledge in community and service activities with the outcomes of benefit to the larger community).
Expanded model of scholarship (based on the framework by Boyer ).
In the model proposed by Boyer (1990), the scholarship of discovery, teaching, and integration are well documented. However, the scholarship of application is less well understood and perhaps less valued, and therefore requires further clarification.
A lack of consistent terminology exists to categorize the activities that Boyer (1990) linked to the scholarship of application. A literature review identified four terms. Clarifying the nomenclature for the scholarship of application may bring focus to the topic. For instance, scholarship of engagement is used to described the work that occurs when faculty partner with those external to the academy to search for answers and solutions to pressing social, civic, economic, and moral problems (Boyer, 1996; Burrage, Shattell, & Habermann, 2005; Kielhofner, 2005). Similar activities are described as community scholarship by Maurana, Wolff, Beck, and Simpson (2001). Professional scholarship captures the interplay between knowledge and nursing practice using systematic inquiry (Thoun, 2009). The fourth term that aligns with the activities of scholarship of application is clinical scholarship, which is used to describe the scientific methods that identify, describe, and solve clinical problems (Grigsby & Thorndyke, 2011). These four terms describe activities in which knowledge is applied to solve problems, whether in the clinical arena or in a community setting. Given the particular meaning and common use of the term clinical scholarship by nurses, both terms—scholarship of application and clinical scholarship—are used in this article.
Further clarity on the scholarship of application is achieved by examining how service activities develop into the scholarship of application (Acorn & Osborne, 2013; Boyer, 1990). The scholarship of application is true collaboration between the academy and the community that goes beyond outreach to conduct research with the community (Burrage et al., 2005). Dissemination of the results of the service work is vital to determine whether scholarship of application took place (Anderson et al., 2013). The dissemination of outcomes places the information in the public domain, where it is open to review and critique by peers and the wider community.
The knowledge generated through the scholarship of application provides opportunities to strengthen the bonds and bridge the gap between theory and practice. Specifically, when knowledge is integrated in practice, the utility of that knowledge to patient care becomes open for evaluation and scrutiny. Thus, by advancing and promoting the scholarship of application, the full benefits of new knowledge for patient care can be realized. It is important that this scholarship meets the same criteria of scientific rigor as the other forms of scholarship and includes documentation, peer review, and public dissemination (Fincher & Work, 2006; Glassick, Huber, & Maeroff, 1997; Maurana et al., 2001). In this way, the knowledge is open to assessment by academics and the general public.
Examples of the Scholarship of Application
Evidence of achievement in the scholarship of application includes outcomes of work with the community or innovative practice changes occurring in clinical settings. The practice setting is anywhere where nursing is practiced. The following examples can further clarify the types of knowledge production activities that fall under the scholarship of application category:
- Community-based participatory research projects.
- Quality improvement initiatives.
- Patient protocols or practices.
- Clinical practice guidelines.
- Practice innovations.
- Design and evaluation of new care delivery models.
- Policy analysis (i.e., develop, implement, and evaluate policy).
- Patient education materials.
- Outcomes of committee deliberations, such as patient safety or ethics.
Two examples from the nursing literature, pain relief and diabetes control, are provided to illustrate the scholarship of application. Pain relief and diabetes control were chosen as examples because these are two areas where nursing has made significant contributions to knowledge development and innovative practices. An innovative patient care protocol on pain management using ketamine was developed, evaluated, and published by Vaid (2013). The author used published research and knowledge of clinical practice to improve a care process. The criteria of scholarship were met by documenting the work, having the work peer reviewed, and then publishing the results so that the outcomes of the practice change could benefit other clinicians and patients.
Similarly, the second example shows how a nurseled intravenous insulin protocol in a medical intensive care unit was effective and safe in reducing rates of hypoglycemia (Khalaila et al., 2011). This example shows how nurses are innovative in developing patient protocols, and when these protocols and their outcomes are brought into the public domain through peer review and publication, they become the scholarship of application.
There are many examples of the scholarship of application in the literature, but there are also many practice changes that are never documented or published. Promoting the scholarship of application can assist nurses to build on the successes of previous practice improvements.
Promoting a Climate of Scholarship
To advance the scholarship of application and the utility of Boyer’s (1990) model, several questions of clarification require discussion:
- What strategies are required to promote scholarship in practice?
- Who are the clinical leaders and champions who will drive and promote scholarship of application?
- How can college faculty, in partnership with their university colleagues, reach their scholarship potential within current models of interprofessional collaborative practice?
- How can the scholarship of application be identified and promoted in nursing to enhance patient outcomes?
- Are nurses in practice engaged in the generation of new knowledge through the scholarship of application but may fail to recognize it as scholarship?
Differentiating scholarly practice from the scholarship of application and explaining how each contributes to knowledge production is important to promote the advancement of the scholarship of application. The hope is that all nurses are engaged in scholarly practice. Nurses engaged in scholarly practice demonstrate clinical expertise and scholarly inquiry, translate research findings into practice through evidence-based decision making, assess the effects of evidence-based practice (EBP), document outcomes of care, and continue the development of best practices to solve clinical problems and improve outcomes (Sigma Theta Tau International, 1999). Nurses engaged in scholarly practice often are viewed as the informal leaders in their work setting. Working with existing supports and organizational structures, nurses can be supported to relay the outcomes of their EBP and knowledge, thus demonstrating their contributions to patient care.
What is needed early in this stage of scholarly practice is guidance to move this work to the scholarship of application toward documentation, peer review, and public dissemination (Figure 2). For instance, the informal nurse leader who is engaged in scholarly practice may suggest opportunities for practice improvements, thus taking the first step in the scholarship of application. To achieve this, informal leaders could connect with an individual in a formalized leadership position for assistance to advance the scholarship of the practice change. Such positions include, for example, clinical nurse leaders who are recognized by the American Association of Colleges of Nursing (AACN, 2007) and clinical nurse specialists, who are recognized by the Canadian Nurses Association (CNA, 2009). Clinical nurse leaders and clinical nurse specialists are RNs who have advanced knowledge and clinical expertise in nursing and promote the use of evidence to provide expert support and consultation to health care team members. Both clinical nurse leaders and clinical nurse specialists provide leadership in the development of clinical guidelines, protocols, and research, as well as in clinical care. Nurses in both formal and informal leadership roles partnering with schools of nursing are central to supporting this shift to the scholarship of application.
Pathway to scholarship of application. Note. CNS = clinical nurse specialist; CNL = clinical nurse leader; EBP = evidence-based practice.
In addition, the EBP committees that exist in many clinical settings can offer organizational support and infrastructure to promote the scholarship of application. An initiative arising from a project management office in a major health care center facilitated successful implementation of EBP projects, leading to changes in care delivery methods (Lavoie-Tremblay et al., 2012). By supporting the additional step of dissemination, this initiative can assist these EBP program changes to evolve into the scholarship of application and provide evidence of nurses’ contributions to patient outcomes.
An organization-wide strategy of using an EBP committee to promote a cultural shift toward a climate of scholarship was described by Mohide and Coker (2005). They suggested a nursing culture that encourages EBP and its impact on client outcomes is “…central to clinical scholarship” (p. 372). The work of this EBP committee included the identification of quality-of-care practices, followed by literature searches, nurse surveys on current practices, implementation of strategies to improve practice, and evaluation of the changes that were made.
These two examples (Lavoie-Tremblay et al., 2012; Mohide & Coker, 2005) illustrate the early phases required for the scholarship of application. Providing support to the final step ensures that practice changes actually yield the desired outcomes and submitting these findings for scrutiny by the scholarly community are essential.
To take the work of clinical nurses a step further into the realm of the scholarship of application, the assessed outcomes of one’s practice are disseminated and brought into the public domain—practices that are at the core of clinical scholarship (Tymkow, 2013). Clinical scholars working to advance a new delivery model or care strategy must approach the process with the same scientific rigor as would be expected for scientists in the laboratory (Grigsby & Thorndyke, 2011). The outcomes are thus open to public scrutiny, debatable, and subject to critique.
Another strategy for the development of scholarship of application is to encourage peer review among nurses (George & Haag-Heitman, 2011). Peer review in the clinical context is a derivative of the traditional peer review seen when manuscripts are considered for publication. However, within nursing practice, peer review is typically less formal and involves nurses providing feedback and evaluative comments on performance to each other. Peer review in the clinical setting is critical to address variations and inadequacies in the quality of nursing care and to identify exemplary nursing practice. Developing a peer review process with systematic practice-focused feedback can permit timely information to address the impact of nursing care on patient outcomes (George & Haag-Heitman, 2011). Guided by the criteria of scholarship, a peer review process can demonstrate outcomes from nursing practice, which then can be open to a public review process through community dissemination and evolve into the scholarship of application. These experiences in the clinical review processes also can increase nurses’ comfort in the peer review process and thus their confidence in bringing their scholarship forward for public scrutiny.
A community of scholar-practitioners who are engaged in scholarly inquiry in practice is envisioned as necessary for the future of nursing (Ferguson-Paré, 2005). Building this community of scholar-practitioners requires a climate of scholarship where scholarly activities are embraced. Clinical leaders, clinical experts, and clinical scholars are all central to this climate of scholarship (Mannix, Wilkes, & Jackson, 2013). These are the champions of clinical scholarship and the mentors in the development of future scholars. The mentoring of students provides an opportunity for the development of future scholars. Nursing students of all levels, from undergraduate to doctoral preparation, complete course assignments based on their practice experiences. The outcomes of such assignments, or the “deliverables,” frequently include educational materials or program proposals. These outcomes are intended for use in practice settings, thus contributing to the scholarship of application. Extending assignments to meet the criteria of the scholarship of application provides an opportunity for faculty to teach about this type of scholarship and also for students to engage in it.
Capitalizing on Education and Service Partnerships
Many nursing education programs are offered in collaborative models where colleges, universities, and nurses from clinical agencies partner together to deliver baccalaureate nursing education. The opportunity for college and university faculty and practicing nurses to participate in the scholarship of application is one way to enhance scholarship and thus foster greater alignment with an environment of scholarship.
When nursing faculty are engaged in clinical teaching, these settings provide rich opportunities for the scholarship of application. For instance, faculty could capitalize on their ties to the practice setting to seek out opportunities for the scholarship of application. The direct relationships that clinical teachers have with practice settings enable them to be involved in knowledge translation projects to promote EBP. Often, these projects include nursing students as part of this project work. Again, applying the full requirements of scholarship to these projects will enable faculty to promote their work as the scholarship of application. In addition, faculty engaged in this work provide role modeling to the next generation of nurses on how to promote nursing as a scholarly profession.
The Canadian Association of Schools of Nursing (2013) uses the Boyer framework to assess scholarship in their accreditation of undergraduate nursing programs in Canada and internationally. The initiative of the Canadian Association of Schools of Nursing contributes to the promotion of a climate of scholarship within the partnering of college and university nursing programs. This results in schools of nursing moving beyond the focus on research as the sole strategy for knowledge development to a more expanded view of scholarship. Additional actions to promote a broader view of scholarship are seen with academic faculty moving to formally recognize all dimensions of scholarship in tenure and promotion policies. Boyer’s scholarship framework is starting to be integrated into the tenure and promotion criteria of universities, such as Nipissing University (2013) in Ontario, Canada, and the University of Michigan-Dearborn (2013). These are excellent initiatives in building a climate of scholarship.
Implications for Nurses in Continuing Education and Professional Development
Knowledge produced through the scholarship of application can have significant contributions to nursing practice and patient care; consequently, there are implications for nurses in all positions. Carefully building bridges between research, practice, and education can promote a climate of scholarship by strengthening education service partnerships. In addition, creating supportive management and leadership structures and reward systems can enhance the development of this form of knowledge.
One bridging example could involve structuring a learning activity and academic assignment in partnership and consultation with managers and leaders in health care settings to align with the three criteria for the scholarship of application. Students in clinical placement would work with staff nurses, clinical and formal leaders, and the faculty advisor to support EBP innovation. Students could participate in the documentation of the project by assisting in writing literature reviews and the program proposal, or by collecting and analyzing outcome data. The faculty advisor could support the students’ academic development and the initiative by using their knowledge of reviewing the literature, analyzing data, or writing for publication. These efforts work toward meeting the three criteria for the scholarship of application and ultimately improve patient care, the health care community, and nurses’ body of knowledge. Engagement in such projects would help to prepare future generations of scholars, enhance service partnerships, and generate new knowledge through the scholarship of application.
Recognizing and rewarding the scholarship of application is of particular importance to professional disciplines such as nursing, medicine, occupational therapy, and psychology where practice and academia overlap. The current focus on efficiency and effectiveness in health care and nursing’s agenda to demonstrate the contributions of nurses’ work to patient outcomes provides an ideal context for nurses to promote the scholarship of application. In this context, nurses can describe the effects of evidence-based decision making and the contributions that they are making to patient care. The scholarship of application will enable nurses to publicly demonstrate that their care and application of nursing knowledge makes a difference to patient outcomes and is open to scrutiny and evaluation.
The continuing development of a climate of scholarship and nurse scholars will result in a day when the scholarship of application is a part of all nursing practice. This development also will assist nurses to bridge the continuing theory and practice gap that has been an issue in nursing education and practice for some time. Finally, it is proposed that the scholarship of application is necessary to determine the true value and contribution that nurses make to patient outcomes.
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