Nurse educators are often challenged to find ways to integrate writing instruction into an already saturated curriculum. Strong writing and communication skills are necessary not only to nursing practice in regard to patient care and accreditation, but also to undergraduate students’ overall academic development (Fallahi, Wood, & Austad, 2006). Improvement of student writing ability is a vital component of professional nursing practice, as it is analogous to skills used in clinical practice. For instance, important elements of patient safety are communicated by the nurse to the interdisciplinary team through written venues (electronic and paper); large concepts encountered in patient care need to be organized, modified, and distilled into usable and understandable forms (draft revisions); and students must adhere to national guidelines, standards, and best practices (demonstrated by American Psychological Association [APA] formatting). Despite all of the instructional challenges faced by nurse educators, there are many professional development benefits derived from working with students (Diehl, 2007; McMillan & Raines, 2010). One benefit is that of witnessing burgeoning student confidence when a professional paper is recognized as exemplary. Other benefits to faculty members include improvement of one’s own writing ability by engaging in the editing and grading process, along with satisfaction derived from program and curricular improvements. The purpose of this article is to provide a descriptive data evaluation of a professional writing assignment involving resources derived from campus collaborations.
The original writing assignment referenced in this article is a requirement in the first-semester junior-level Professional Nursing Concepts course. The writing assignment is based on health-related topics for community health promotion, such as healthy aging, childhood obesity, and prostate cancer awareness. The final paper is considered for publication in a weekly community newspaper. The primary goal of the assignment is the enhancement of writing skills, such as articulation of the thesis statement, forecasting major points, evidence of examples directed toward health promotion teaching with clients, and summarization of major points. In addition, a goal of health promotion for members of the community included an Introduction (descriptions of the importance of the topic to college students and members of the community, and prevalence of the disease or condition), Definition of Key Concepts (addressed from a layperson perspective), Prevention and Management of Disease (self-management of disease or condition), Involvement of Health Professions (which treatments or screenings are performed by health professions and community resources), Summary (inclusion of helpful Web sites or organizations), and References (adherence to APA format and acquired from peer-reviewed professional sources that are current within the past 5 years, relevant to the topic, and supportive of the thesis statement). Outcomes are measured by a rubric designed by the primary author (L.R.M.), with assigned values reflecting percentages of the categories listed above and a total of 100 percentage points possible. Additional categories providing credit for documented interface with the campus writing center and librarian collaboration comprise 15% of the total grade. The Introduction, Definitions of Key Concepts, Prevention and Management of Disease, Involvement of Health Professions, and References comprise a summative total of 75%. The Summary category is worth 10% possible points. However, other desirable outcomes include student pride in publication, an outreach opportunity for the nursing school, practical application of learned health-promotion principles for both the students and the community, and increased student self-confidence in writing ability.
Faculty sought areas for improvement identified during the final grading of two separate cohorts’ papers over two previous semesters and during discussions with other faculty members regarding student writing deficiencies in subsequent senior-level evidence-based writing assignments. Faculty concluded that students had deficits in information literacy, grammar, paper organization, and APA formatting. For example, students often cite sources older than 10 years and have poorly developed Internet search skills, relying heavily on Web search engines such as Google™ for information. The relevance of some sources is often questionable.
Among the critical competencies of the professional nurse is the ability to communicate effectively with diverse patient populations. Therefore, it would be helpful for students to practice and develop written communication skills with the help of campus writing experts. As a result, a course assignment incorporating multiple editing, revision, and feedback opportunities in collaboration with these writing experts was piloted in the spring 2011 semester. This threefold strategy included the involvement of campus librarians for information literacy, classroom peers for peer feedback, and graduate and undergraduate student-tutors at a campus writing center for editing and proofreading.
In addition, classroom instruction included approximately 20 to 30 minutes devoted to clarifying the assignment, answering questions, and providing brief tutorials on writing instruction. Tutorial topics included outline construction, editing and proofreading tips, and common APA formatting errors. APA assistance was provided with a PowerPoint™ tutorial on Blackboard™. Students were also provided with published research-based journal articles authored by nursing faculty as exemplars. Two peer review sessions were held in the classroom.
In higher education, information literacy is defined as a set of abilities requiring individuals to “recognize when information is needed and have the ability to locate, evaluate, and effectively use the needed information” (American Library Association, 2000, p. 2). Information literacy requires that one can:
- Determine the extent of information needed
- Access the needed information effectively and efficiently
- Evaluate information and sources critically
- Incorporate selected information into one’s knowledge base
- Use information effectively to accomplish a specific purpose
- Understand the economic, legal, and social issues surrounding the use of information, and access and use information ethically and legally. (American Library Association, 2000, pp. 2–3)
Nurses should be skilled in information literacy to manage knowledge, mitigate error, and support decision making (Cronenwett et al., 2007). In baccalaureate nursing education, safe patient care is contingent on the ability to navigate patients’ electronic health records, coordinate care, manage care, and evaluate outcomes. Information literacy skills are precursors to nursing students’ capacity to implement evidence-based approaches to clinical practice, as well as fostering the positive patterns of lifelong learning and professional development (Barnard, Nash, & O’Brien, 2005).
There are obstacles and challenges within both higher education and nursing education in the development and application of advanced information skills (Barnard et al., 2005; Dorner, Taylor, & Hodson-Carlton, 2001; McNeil et al., 2003). Such challenges include necessary faculty resources for teaching information literacy (McNeil et al., 2003), the need for curriculum integration (Barnard et al., 2005), and a tiered approach to building student research skills that continue throughout their graduate studies (Dorner et al., 2001).
In our study, focus group meetings with four campus librarians were conducted to develop the 1-hour classroom session devoted to information literacy including teaching effective search strategies for professional-level sources. During these instructional sessions, five students met with one librarian. During these meeting times, librarians also provided assistance with the creation of a thesis statement, along with the pursuit of relevant sources for the topic. The librarians were also involved in the final grading process; a portion of the grading rubric (10%, 10 points) was devoted to the quality of the paper’s sources.
Collaborative learning in the form of peer review is identified as an important component of the writing process (Brammer & Rees, 2007; Gielen, Peeters, Dochy, Onghena, & Struyven, 2010; Rieber, 2006; Xiao & Lucking, 2008). Peer feedback enhances learning for both the provider and the recipient (Gielen et al., 2010) while drawing on cooperative learning skills and improving problem solving abilities (Baumberger-Henry, 2005). Gibbs and Simpson (2004) described several conditions in which feedback from peers is particularly helpful. Effective peer feedback should be sufficient in frequency and detail, focused on students’ performance, timely, appropriate to the assignment, and, lastly, acted upon.
Rieber (2006) suggested several reasons why peer review is an effective tool for writing instruction: Students tend to complete assignments ahead of the due date, review the assignment directions a second time, submit writing of higher quality when they know peers will read their work, and react more positively to peer-driven comments as opposed to instructor comments.
During our project, two peer review sessions were incorporated into class time for 1-hour segments. Peer reviewers used the paper grading rubric as a guide for evaluation. Each student brought two copies of the paper to class; both copies were randomly distributed by the faculty member to classroom peers and returned to the student author at the end of class. Peer reviewers gave both oral and written feedback of the paper drafts to the authors. Students were advised to verify all feedback provided by the reviewers for source document accuracy, such as the APA manual for formatting and the grading rubric and classroom discussions from the course leader. The first peer review occurred 2 weeks into the assignment, and the second occurred 2 weeks later. This left 2 weeks before the final draft was due.
Campus Writing Center
Our university writing center was established in response to Writing Across the Curriculum initiatives in higher education. Writing tutors, who are students employed by the writing center, provide instruction and oversight to students for writing issues, such as grammar and organization. Sessions are requested by the student seeking help and last approximately 30 minutes. Our students received credit (5%, 5 points) on the final paper for one visit to the writing center. Focus group discussions with the campus writing center director were instrumental to establish faculty expectations, along with the goals and objectives, of the writing assignment. One gap in expectations emerged with APA format assistance from the student tutors. Because of the large number of campus academic disciplines that use multiple formatting styles (i.e., Chicago, Modern Language Association, and Turabian), the tutors do not offer format-specific assistance.
Sample and Setting
A one-time convenience sample of junior, full-time, first-semester nursing students (N = 46) enrolled in the Professional Nursing Concepts course were recruited after institutional review board approval was granted. Students completed a paper survey at the end of the semester. The survey response rate was 92%. Participants were from one baccalaureate accredited nursing program located in the southeastern United States, were predominately female, and ranged in age from 20 to 22. All students had limited writing experience in the nursing professional program, although all had completed an introductory foundational nursing course that required brief one-page to four-page assignments using APA format. The survey used quantitative descriptive data, and a spreadsheet data file using Excel™ provided the data for the descriptive results.
The Writing Assignment Resource Evaluation was developed by the primary author to determine the effectiveness of classroom activities devoted to writing improvement, student learning, and the quality of the students’ work (Table 1). Most survey items reflect student perceptions of the utility of the writing resources used while constructing the required paper. These items were developed from extensive literature review and keyword searches (e.g., writing evaluation, program evaluation, partnerships, and collaboration). The instrument variables included evaluation of information literacy instruction, use of the Campus Writing Center, peer review, and following professional paper assignment guidelines. The evaluation criteria included 19 items rated on a 5-point Likert-type scale (strongly agree, agree, neutral, disagree, and strongly disagree). Means and standard deviation values are interpreted through Likert scale scoring based on assigned values of 2 (strongly agree) to −2 (strongly disagree), as shown in Table 2. Item examples included “the activity of reviewing professional paper drafts with the writing tutors contributed to my learning to write the professional paper” and “the librarians demonstrated expertise in finding relevant professional resources.” One item asked participants to indicate the estimated hours spent per week on the assignment. A limitation of the instrument is the lack of outside professional review prior to instrument administration. Projected plans by the primary author include review from outside experts and refinement of instrument questions based on feedback from the campus writing center and librarians.
Table 1: Writing Assignment Resource Evaluation
Table 2: Descriptive Information for the Writing Assignment Resource Evaluation (N = 46)
The descriptive statistics are presented in Table 2. Results from the information literacy subscale indicated that students perceived that collaborating with the librarians was helpful in writing the paper and that their understanding of key concepts and principles of writing a research-based paper was increased. Responses indicated that the classroom information literacy activity was instructive. Responses of strongly agree and agree ranged from 89% to 98%.
One hundred percent of students attended at least one help session with the writing center staff. Some students chose to attend multiple times although no additional points were given for subsequent visits. The campus writing center subscale garnered information about student perceptions regarding the benefit of the collaboration with writing tutors. A favorable response from 63% of study participants indicated that early draft revisions undertaken with tutor assistance contributed to learning. A much wider range of satisfaction with the tutoring sessions was noted, with 50% agreeing that working with the writing center improved their understanding of the principles of professional writing. Two participants responded that they strongly disagree. Eighty-five percent of respondents perceived that the tutors demonstrated expertise in writing, and 89% reported that the tutors were available at convenient times. Seventy-eight percent of respondents perceived the time spent with the tutors was valuable in terms of completing the assignment.
Responses to the peer review subscale indicated that 72% to 85% agree or strongly agree that peer review was beneficial, contributed to learning, and was an effective use of class time. Section 4 responses revealed an average of 4.34 hours spent each week on the writing assignment, with a mode of 3 and a range of 1 to 20 hours. Students reported the greatest challenges were grammar, APA formatting, and writing mechanics (i.e., subject–verb agreement, flow of ideas, organization). Students overwhelmingly (87%) found that classroom time devoted each week to the writing assignment was beneficial.
This evaluation demonstrated that the use of campus writing experts and resources, peer review, and classroom tutorials were beneficial to students writing a professional paper. These findings also demonstrate the efficient use of resources for busy course faculty. The combination of time required of the two faculty members who graded the assignments was 38 to 42 minutes per paper. Providing revision suggestions both in person and electronically in addition to classroom instruction required another 10 hours of time for both faculty members combined. The four librarians spent a total of 2 hours on information literacy instruction and an additional estimated 1 to 2 hours each grading the citations and providing written feedback. Peer review sessions lasted 1 hour, comprising 2 half-hour appointments.
Faculty members who graded the final drafts noted improvements in paper quality from previous years, especially regarding student selection of relevant sources. Marked improvement in APA format adherence was noted as well. The difficulties encountered by students with grammar and proper citation of sources may reflect the quality of the students’ high school writing instruction, as well as the content of their undergraduate instruction in English composition. For example, in the undergraduate core composition courses, APA formatting is not used, and many assignments are opinion-based rather than research-based.
Librarians expressed enthusiasm for the professional collaboration and partnership experience in post-study feedback sessions. The librarians considered this collaborative experiment to have future outreach potential for other disciplines across campus. The librarians reported that the time spent on evaluating citations was reasonable. However, there was general agreement that the class time spent on citation searches would be improved if more than 1 hour were allotted. Future plans include increasing the number of librarians to decrease the size of the student groups. A scaffolding approach to improving student research skills using the nursing faculty–librarian interdisciplinary approach will be integrated into future classes. This scaffolding approach will require modifications in curricular instruction in an effort to provide benchmarks and evaluate competencies. For example, faculty might consider adding lecture content on information literacy in the prenursing orientation class and competency-based criteria at the senior level.
Several limitations to this study exist. The main limitations include the small sample size and the reliance of student self-perceptions in the measurement of learning outcomes. Due to confidentiality constraints and the risks of identifiable data, the survey was unable to pair the final paper grade with the perceptions of learning. This would have provided a more definitive overall picture of learning outcomes. Variability in student exposure to tutorial content resulted in different exposure of the teaching process for students who attended more or fewer help sessions, thus potentially affecting evaluation outcomes. Furthermore, the timing of the survey administration may have affected respondents’ perceptions. The survey was intended to be administered immediately after the assignment was completed to provide the most current student perceptions before the assignment of grades. However, as a result of delays, the survey was administered 3 weeks later than planned and after grades were assigned. Student grades may have affected perception of learning outcomes. The study sample was limited to one homogeneous cohort from one geographic region; therefore, caution must be used in interpreting the generalizability of results. In addition, the survey instrument had limitations due to absence of psychometric development of reliability and validity statistics, as well as lack of review from a panel of experts.
The following are specific recommendations for the successful use of campus resources in addition to classroom instruction:
- Obtain baseline writing samples from an introductory nursing course to assess strengths and deficits.
- Administer an instrument to measure student perception of writing confidence prior to the assignment and afterward.
- Educate the writing tutors about specific course expectations and requirements to provide consistency.
- Provide additional time for information literacy instruction with the librarians.
- Spend more class time clarifying the assignment requirements in the beginning of the semester.
- Establish a paper due date later in the semester to allow more time for revision.
Health care delivery is becoming increasingly complex, requiring sound clinical judgment, critical thinking, proficiency in information gathering, and effective written and oral communication skills. Our findings demonstrate that student collaboration with interdisciplinary campus experts and peers is time well spent in developing a professional written assignment. Interdisciplinary collaboration with campus writing experts enhances writing instruction while building communication skills with both experts and fellow learners. Writing also involves mastering skills that lay a valuable foundation for graduate study. The mandate for nursing faculty is to find and use the “write” resources.
- American Library Association. (2000). Information literacy competency standards for higher education. Retrieved from http://www.ala.org/ala/mgrps/divs/acrl/standards/informationliteracycompetency.cfm
- Barnard, A., Nash, R. & O’Brien, M. (2005). Information literacy: Developing life-long skills through nursing education. Journal of Nursing Education, 44, 505–510.
- Baumberger-Henry, M. (2005). Cooperative learning and case study: Does the combination improve students’ perception of problem-solving and decision making skills?Nurse Education Today, 25, 238–246.
- Brammer, C. & Rees, M. (2007). Peer review from the students’ perspective: Invaluable or invalid?Composition Studies, 35, 71–85.
- Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J. & Mitchell, P. et al. (2007). Quality and safety education for nurses. Nursing Outlook, 55, 122–131.
- Diehl, S. (2007). Developing students’ writing skills: an early intervention approach. Nurse Educator, 32, 202–206.
- Dorner, J.L., Taylor, S.E. & Hodson-Carlton, K. (2001). Faculty-librarian collaboration for nursing information literacy: A tiered approach. Reference Services Review, 29, 132–140.
- Fallahi, C.R., Wood, R.M. & Austad, C.W. (2006). A program for improving undergraduate psychology students’ basic writing skills. Teaching of Psychology, 33, 171–175.
- Gibbs, G. & Simpson, C. (2004). Conditions under which assessment supports students’ learning. Learning and Teaching in Higher Education, 1(1), 3–31.
- Gielen, S., Peeters, E., Dochy, F., Onghena, P. & Struyven, K. (2010). Improving the effectiveness of peer feedback for learning. Elsevier Learning and Instruction, 20, 304–315.
- McMillan, L.R. & Raines, K. (2010). Headed in the “write” direction: Nursing student publication and health promotion. Journal of Nursing Education, 49, 418–421.
- McNeil, B.J., Elfrink, V.L., Bickford, C.J., Pierce, S.T., Beyea, S.C. & Averill, C. et al. (2003). Nursing information technology knowledge, skills, and preparation of student nurses, nursing faculty, and clinicians: A U.S. survey. Journal of Nursing Education, 42, 341–349.
- Rieber, L.J. (2006). Using peer review to improve student writing in business courses. Journal of Education for Business, 81, 322–326.
- Xiao, Y. & Lucking, R. (2008). The impact of two types of peer assessment on students’ performance and satisfaction within a Wiki environment. Internet and Higher Education, 11, 186–193.
Writing Assignment Resource Evaluation
|Please use the following scale to indicate the response that most accurately describes your opinion.a|
|Information literacy: working with the librarians (topical search, source relevance, finding data and sources)|
| 1. The activity of performing a professional source search contributed to my learning to write the professional paper.||SA||A||N||D||SD|
| 2. Searching for professional sources improved my understanding of the concepts and principles involved in writing this professional paper.||SA||A||N||D||SD|
| 3. The librarians demonstrated expertise in finding relevant professional sources.||SA||A||N||D||SD|
| 4. The librarians were available to me for support, guidance, and questions.||SA||A||N||D||SD|
| 5. Overall, this activity was effective and worthwhile in terms of classroom instruction for learning and advancement to the writing assignment.||SA||A||N||D||SD|
|Campus Writing Center: working with the writing tutors|
| 1. The activity of reviewing professional paper drafts with the writing tutors contributed to my learning to write the professional paper.||SA||A||N||D||SD|
| 2. Working with the Writing Center improved my understanding of the concepts and principles involved in writing this professional paper.||SA||A||N||D||SD|
| 3. The tutors demonstrated expertise in writing principles, editing, grammar, etc.||SA||A||N||D||SD|
| 4. The tutors were available at convenient times for me to obtain support, guidance, and answer questions.||SA||A||N||D||SD|
| 5. Overall, time spent with the Writing Center was effective and worthwhile in terms of paper improvement for learning and advancement to the writing assignment.||SA||A||N||D||SD|
| 1. The activity of peer reviewing of others’ paper drafts contributed to my learning to write the professional paper.||SA||A||N||D||SD|
| 2. The activity of receiving peer review of my paper drafts contributed to my learning to write the professional paper.||SA||A||N||D||SD|
| 3. The classroom peers provided beneficial suggestions in improving my drafts.||SA||A||N||D||SD|
| 4. My classmates were available to me for support, guidance, and questions regarding the writing assignment.||SA||A||N||D||SD|
| 5. Overall, this peer review activity was effective and worthwhile in terms of classroom instruction for learning and advancement to the writing assignment.||SA||A||N||D||SD|
|My expectations of the writing assignment|
| 1. Estimated hours spent per week on this paper was _________.|
| 2. Content (Introduction, Definition of Key Concepts, Prevention/Management and Health Care Professional Involvement) was the most problematic for me in writing this paper.||SA||A||N||D||SD|
| 3. Grammar, American Psychological Association format, and writing mechanics were the most problematic for me in writing this paper.||SA||A||N||D||SD|
| 4. Classroom time each week in the Professional Nursing Concepts course prior to the due date was beneficial to writing the paper.||SA||A||N||D||SD|
Descriptive Information for the Writing Assignment Resource Evaluation (N = 46)a
|Information literacy (working with librarians)|
|Campus Writing Center (working with writing tutors)|
|Peer review (working with peers in class)|
|Expectations of the writing assignment|
| Q1||4.34||Mode = 3, Range = 1–20|