Search

Doctor of Nursing Practice (DNP) programs have focused on competencies needed to deliver comprehensive patient care across settings and time. Endorsed by professional nursing associations, these competencies are typically evaluated through detailed case narratives written by DNP candidates. Beyond competency metrics, the essence of comprehensive care for advanced nursing practice has not been carefully explicated. In this study, a phenomenological analysis is applied to a purposive sample of 12 DNP case narratives to identify the meaning of comprehensive care as transmitted in practice. Clinical assessment precision, diagnostic acumen, and advocacy emerge consistently but only the more audacious nurse practitioners directly challenge health system fragmentation.

The authors propose an interim parallel strategy for the thoughtful inclusion of trained traditional birth attendants (TTBAs) in the maternal and child health (MCH) human resources of low-resource nations to improve safe childbirth. This is in contrast with international policy recommendations that traditional birth attendants (TBAs) be eliminated and replaced by skilled birth attendants (SBAs). Dimensions for critical awareness that should inform global MCH enterprises are identified and elaborated in support of this proposal: omnipresent women’s status, international nursing and midwifery standards, ethnographic values and strategies, local government roles, culturally specific birthing expectations, and the realities of current MCH human resources infrastructures.