There is a strong relationship between academic writing skills and critical thinking in clinical nursing practice (Jefferies et al., 2018). Clear and effective scholarly writing is a fundamental competency for evidence-based practice and clinical leadership (Rohan & Fullerton, 2019a). Scholarly writing, while central to completion of the Doctor of Nursing Practice (DNP) degree, often is not supported by foundational educational approaches that are designed to develop or enhance the scholarly writing skills of students. In addition, DNP faculty themselves may not be prepared or may lack the confidence to mentor students for doctoral-level writing (Rohan, 2015; Rohan & Fullerton, 2019b).
In the spring of 2016, Stony Brook University School of Nursing faculty held a retreat to identify novel methods to promote evidence-based practice competency across programs (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014; Melnyk et al., 2018; Shellenbarger, Hunker, & Gazza, 2015). Communication competencies were identified as foundational to evidence-based practice competencies. Subsequently, a multicomponent quality improvement project was implemented within the DNP program with the purpose of creating a set of peer-supported interventions that could be embedded into core courses to improve the writing skills of DNP students.
The details of the substantive writing assignment and the “elevator pitch” student peer-reviewed components have been published previously (Rohan & Fullerton, 2019a, 2019b). This article presents the results of a Writing Tutor Round Table intervention. Fifteen of 18 advanced practice nurses who were DNP students asked to be included in this optional after-class workshop. The goals of the Writing Tutor Round Table were to provide students with opportunities to develop self-awareness of their writing confidence and writing challenges, and to improve writing competence.
In the spring of 2016, a writing-enriched curriculum, including intraprofessional writing review (nursing classmate peers) and interprofessional mentorship (individuals from various academic disciplines), was developed with support from the campus writing center. The curriculum was embedded within a core foundational course in the DNP program during the 2018–2019 academic year. The various peer-supported interventions that comprised the entire quality improvement initiative were chosen from among many writing improvement strategies described in the literature because of easy implementation, even by faculty who lacked confidence in providing traditional writing instruction (Hanson & Beaver, 2012; Jefferies et al., 2018; Storch & Tapper, 2009).
Prior work suggests that mentorship, peer support, and the use of commonly spoken language (i.e., determined to be most understandable when read aloud) may be useful tools for improving writing competency (Rohan & Fullerton, 2019b). This evidence and available campus resources were used to develop a Writing Tutor Round Table workshop. The Writing Tutor Round Table was an optional writing workshop during which students received coaching from interdisciplinary student tutors from the campus writing center. The workshop was timed to occur after class during a scheduled on-campus day of the hybrid program and several days before the due date of a high-stakes written assignment. The writing assignment was developed in conjunction with staff at the campus writing center. The writing center tutors who participated in the intervention were given the student assignment prompt prior to meeting with students and used established writing coaching methods to promote scholarly writing (Oermann et al., 2015; Yancey, 2016).
Four writing center student tutors from various disciplines were assigned to assist on the day of the workshop. Workshop faculty made group assignments, with one tutor assigned to three or four DNP students. Each group was moved to a separate room for the mentor-guided group learning activity. Students and their tutor sat together at one table where each student successively received a block of uninterrupted time with the tutor to discuss their draft paper. Other students at the table were asked to listen to the session but not interrupt. The workshop session lasted 60 to 90 minutes. Financial records provided data to determine the direct cost of the intervention, and tutor and student survey data provided evidence for acceptability.
Evaluation of the Writing Tutor Round Table intervention was accomplished with an end-of workshop Qualtrics® student survey that addressed self-awareness of writing skills. The student survey consisted of 11 inquiry items. Ten items were formatted on a 1- to 10-point Likert-type scale and regarded the workshop format, tutor proficiency, and writing self-awareness/self-confidence. The final question was open-ended and asked students to provide general comments. An end-of-workshop written survey also was completed by tutors to gather acceptability data and identify areas for improvement. The tutor survey consisted of six items; four items were formatted on a 1- to 10-point Likert-type scale. Two open-ended queries asked tutors to provide information about common advice offered to the students, most common writing challenges encountered in the session, environment, and format.
Design, implementation, and evaluation of the writing-enriched curriculum received exempt status from the institutional ethics board because the processes were part of ongoing educational quality improvement activities. Per university policy, the exemption allowed publication of deidentified data, including anonymous comments.
The total intervention cost for four tutors to support 15 students was $96 ($12/hour × 2 hours = $24/tutor). Scheduling the workshop at the end of the day assured an adequate number of quiet separate classroom spaces.
Two thirds (n = 10) of the students completed the evaluation survey. Results indicated the majority of the students (90%, n = 9) had become more aware of the importance of writing since starting the DNP program. The majority of students indicated they believed their writing competence was sufficient at the start of the DNP program (70%, n = 7); this changed slightly after completing the workshop (60%, n = 6). The following student comments provided feedback on the workshop format and tutor proficiency:
- I really learned by listening to some of the techniques that were suggested to the other students. It was hard not to be defensive when the work was your own.
- The timing of the workshop just before our papers were due was excellent because I had an almost finished paper and was able to make changes before submitting.
- Occasionally a student asked a question when it wasn't their turn, but it was quick and didn't monopolize the conversation…. I think the tutors appreciated the question as it may have been something that they hadn't thought about themselves.
- The tutors were excellent and made me feel more at ease with my writing.
- I was surprised that we never even talked about APA format…. There was so much else in writing to go over.
- I thought I would be bothered by the onlookers when it was my turn, but it was very supportive between the students. I felt like they were all there to help me.
Each of the four tutors provided evaluation data. The tutors felt prepared to participate in the workshop (average score 9 of 10). They also felt supported by the writing center and the School of Nursing faculty in carrying out the intervention (average score, 8.8 of 10), and they believed they were adequately reimbursed for their time (average score, 8.5 of 10). Tutors provided the following suggestions for optimal environment and format:
- I liked that each of the tutors was in a separate closed classroom without other groups of students nearby.
- My table was a little large for four people…. I had to speak a little louder than I normally speak, and I think it made it harder to feel comfortable for the student I was working with.
- I felt that there was emphasis on tutor comfort and input…. It was an excellent experience and I would be delighted for the opportunity again.
- Being provided with the [assignment] prompt beforehand was a very valuable tool that we don't normally have in most of our tutoring sessions. It would have been even better if we could have had one or two examples of a well-written paper.
- Students seemed more able to recognize their own mistakes from edits that were made on other students' papers. I think they learned best when hearing their colleagues' work read.
Finally, tutors responded with enlightening information about the most common writing challenges encountered in their session and the recommendations that were offered to students:
- The most common challenge I encountered was “awkward” writing. The sentences were too complicated or written in a way that was confusing. I often recommended that the sentence be split into two or three simpler sentences.
- The students had a hard time using my/yours/ours and were replacing these with the third person.
- The most common writing challenges were transitions between ideas. The students seemed to jump from one idea to the next within the same paragraph.
- Some of the students put down their writing before I even looked at their work. I clarified that there was no shame in mistakes—mistakes help us to improve.
The enriched writing curriculum provided an opportunity for students to improve their writing performance. The writing center interdisciplinary peer tutor strategy was perceived by all participants (tutors, students, and faculty) to be an inexpensive and effective method for improving self-perceived writing confidence and competence in DNP students. Our experience with this strategy suggests that a ratio of three or four students to one tutor was optimal compared with smaller or larger groups. However, students may have availed themselves of many self-sought sources of writing support, including independently using the writing center tutors, attending campus workshops, and viewing open-access Internet tutorials, thus limiting what can be said about this particular innovation.
Nevertheless, it can be suggested that interdisciplinary student mentors, such as those employed in a campus writing center, can play an important role in fostering DNP student competency and confidence in writing. In addition, such mentors can provide feedback to faculty for syllabi enhancements to support writing outcomes. These student mentors represent both graduate and undergraduate students, commonly pursuing degrees other than an English, journalism, or humanity degree, and are accordingly writing role models for a range of health sciences students.
The Writing Tutor Round Table intervention was an acceptable, low-cost, low-faculty burden intervention. Well-structured class assignments, supported by “low personal risk” interventions, such as small group peer-review or listening to critique of another person's similar work, are foundational to a writing-enhanced curriculum for adult learners who are building confidence in writing.
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