Research Studies and Non-Databased Articles
Of the 80 articles reviewed, 53 described programs and strategies with the primary purpose of improving the writing skills of nursing students and nurses; 27 identified writing improvements as a secondary gain of a program or strategy, such as a case study written report intended for problem-based collaborative learning that also developed students’ writing abilities. Only 28 (35%) of the articles were databased, with most of the articles describing the writing program or strategy but without evaluating its effectiveness in improving the writing abilities of students or nurses.
Among the databased articles, most were descriptive studies that used surveys of student and faculty satisfaction with the writing program or strategy. For example, Cone and Van Dover (2012) offered a professional writing course at no additional cost to all incoming master’s nursing students. On course evaluations, students reported a high level of satisfaction with the course, and faculty also reported “marked improvement” in the quality of student writing (p. 273).
Various studies evaluated student perceptions of following strategies and assignments to enhance writing skills. When provided with multiple resources, students reported that sessions with writing center tutors, including tutor-guided revisions of drafts, contributed to their learning. Collaborating with librarians and in-class peer review were also beneficial. The students’ greatest challenges were grammar, using the American Psychological Association ([APA] 2010) style, and writing mechanics (McMillan & Raines, 2011). Students also reported that annotation (instructor comments written on the graded assignment) informed their next writing assignment (Ball, Franks, Jenkins, McGrath, & Leigh, 2009). Griffiths and Nicolls (2010) described a Web-based learning platform (e-Support4U), which was developed to support students’ academic writing. They used four approaches to evaluate e-Support4U: a self-assessment, data on the extent that students used the writing resources, grades on the writing assignment, and an evaluation blog. The pass rate on the assignment was 100%, and students perceived the platform to be helpful.
To learn more about students’ writing processes, Lavelle, Ball, and Maliszewski (2013) surveyed 169 nursing students, using the Inventory of Processes in College Composition. Students can use this inventory to become more aware of their beliefs about writing and to learn new strategies. Other authors evaluated their own writing programs and strategies by reviewing the grades on writing assignments and using student focus groups and self-evaluations (Bailey et al., 2007; Bickes & Schim, 2010; Carter, 2008; Gimenez, 2008; Peinhardt & Hagler, 2013; Richardson & Carrick-Sen, 2011; Salamonson, Koch, Weaver, Everett, & Jackson, 2010; Shirey, 2013; Tarrant, Dodgson, & Law, 2008).
Four of the databased articles used qualitative analysis to explore nursing students’ writing development and needs (Borglin & Fagerstrom, 2012; Carter & Rukholm, 2008; Crawford & Candlin, 2013; Gazza, Shellenbarger, & Hunker, 2013). A quasi-experimental study that analyzed students’ contributions to an online asynchronous discussion board found that students who posted a larger number of messages demonstrated evidence of using Carper’s (1978) four ways of knowing in their writing, as well as improved critical thinking and writing skills (Carter et al., 2006). Mandleco, Bohn, Callister, Lassetter, and Carlton (2012) used the CLIPS (Computerized Language Instruction & Practice Software) writing assessment tool to measure students’ writing skills before and after a 14-week scholarly writing course. They reported improved mean scores in 12 of 26 assessment categories. Using mixed methods, Martin (2012) reported that graduate students responded favorably to the use of a wiki for creating, reviewing, and editing each other’s work. The wiki assignment provided opportunities for collaboration and peer review.
Several studies explored whether participation in a writing workshop or support program improved publication rates. Across these studies, an increase was noted in manuscript production and publication rates from pre- to post-workshop participation (Rickard et al., 2009; Shatzer et al., 2010; Stone, Levett-Jones, Harris, & Sinclair, 2010). Students also reported that working with faculty provided the most support to write for publication (Dowling, Savrin, & Graham, 2013).
Educational Programs and Strategies for Developing Writing Skills
The 80 articles included in the current review revealed multiple types of writing programs and strategies used in nursing education. These included reports of how faculty integrated writing across the curriculum; writing courses; assignments in a course for improving students’ writing, which were the most common type; faculty behaviors; workshops; and self-directed activities (Table 2).
Types of Writing Programs and Strategies in Nursing Education
Writing Across the Curriculum. The current systematic review included 16 articles that were classified as writing across the curriculum. These articles described writing programs and strategies integrated across nursing courses to provide a continuous process for gaining writing skills and multiple strategies used within the courses for writing improvement. Many of these strategies were intended for students to learn how to write in the discipline and to communicate their ideas effectively to a professional nursing audience. Luthy et al. (2009) described a comprehensive writing program that included foundational writing coursework, writing assignments integrated into courses in the baccalaureate program, grading rubrics for various writing assignments, peer tutoring, and writing seminars for faculty, among other strategies.
In response to the varying writing abilities among students in their nursing programs, Gazza and Hunker (2012) developed an evidence-based scaffolding framework to facilitate the development of students’ scholarly writing abilities. Scaffolding is the linking together of multiple teaching strategies to support the development of the scholarly writer. The idea is that as independent writers develop, the scaffold, or support, is decreased and then removed. Writing assignments within courses link to or build on those in subsequent courses; collaboration among nursing faculty ensures that writing benchmarks are met, and students receive feedback from teachers and others and make revisions to their writing assignments.
Another systematic approach to promoting students’ scholarly writing was developed by Shirey (2013) for Doctor of Nursing Practice students, using SMART (Strategies, Methods, and Assessment of outcomes Related to Teaching/Learning). The SMART approach, with multiple writing strategies, was embedded in two courses in the Doctor of Nursing Practice curriculum to build writing capacity. Following implementation of the strategies, the quality of students’ papers improved, and there was an aggregate increase in writing grades of 4.81%. Other authors recommended new models of improving students’ writing skills, including intervening early in a student’s program (Hanson Diehl, 2007) and creating a learning environment that promotes both thinking and writing (Borglin, 2012).
Writing Courses. Eight articles described the use of a writing course as a method of improving students’ writing competency. Writing courses were found to be an effective strategy for improving the writing skills of beginning nursing students (Chu, Perkins, & Marks-Maran, 2012; Mandleco et al., 2012; Tesh, Hyde, & Kautz, 2014), RN-to-BSN students (Smith & Caplin, 2012; Stevens et al., 2014), graduate nursing students (Cone & Van Dover, 2012; Hays, 2005), and English as a Second Language (ESL) nursing students (Chu et al., 2012; Weaver & Jackson, 2011). A writing course can promote confidence in writing and self-expression for nursing students (Young, 2005). In a study by Chu et al. (2012), faculty members presented five sessions to help students develop academic literacy skills. Thirty-six students between their first and second year of the nursing program completed the course; two thirds of the students were nontraditional and 40% were ESL. Students developed increased confidence in their academic writing ability and their understanding of essay criteria.
Writing courses have been developed in collaboration with technical communication faculty (Stevens et al., 2014) and the English department (Mandleco et al., 2012). Online writing courses are a convenient way to share content with students and to enable students to become proficient in lower-level writing skills (e.g., grammar and sentence structure) and higher level skills (e.g., effectively integrating the literature), and they have been implemented as a mandatory requirement for program progression (Cone & Van Dover, 2012; Stevens et al., 2014).
Course Assignments. Another common theme found in the current literature review was the use of nursing course assignments to promote writing development. A total of 24 articles highlighted a range of approaches toward improving student writing through course assignments. These included blogs (Lin & Shen, 2013; Maag, 2005), journaling and reflective writings (Arhin & Cormier, 2007; Binding, Morck, & Moules, 2010; Ruland & Ahern, 2007), short written assignments in clinical courses (Oermann, 2006), and preparation of manuscripts (Bickes & Schim, 2010; McMillan & Raines, 2010; Smith, 2003), among other writing assignments. Several authors highlighted the ability to not only improve writing but also to promote critical thinking and discipline-specific writing skills through course assignments (Carter, 2008; Carter & Rukholm, 2008).
Faculty Behaviors. Another common theme in the current review was the type of strategies that educators used to provide feedback and encourage student participation in writing. Ten articles discussed topics ranging from providing written annotations and positive student feedback on written work (Ball et al., 2009; Ball, 2010; Latham & Ahern, 2013; Parboteeah & Anwar, 2009) to the creation of structured processes and guidelines to assist students with the development of their ideas and promote effective writing skills (Hardy & Ramjeet, 2005; Lavelle et al., 2013; Lee, 2003). Other articles highlighted using partnerships, including student–faculty review (Fowler & Packard, 2009) and volunteers who served as writing tutors for nursing students (Latham & Ahern, 2013).
Workshops and Self-Directed Activities. Seventeen articles described using workshops to help nursing students and nurses to develop their writing skills. This group included a precourse workshop for undergraduate students (Bailey et al., 2007) and writing workshops for graduate students (Chandler, Roberts, & DeMarco, 2005; Dewar, 2012; Heinrich, Neese, Rogers, & Facente, 2004). For practicing nurses, workshops and retreats were used most frequently to promote writing for professional publications. Five other articles in the current review shared professional writing tips or tools that could be used by either students or practicing nurses to improve their writing skills. For example, Clay (2003) offered practical, step-by-step tips for students in gathering literature, developing an essay, creating a reference list, and editing their work.