Effective communication in a clinical environment is essential to the delivery of safe, quality patient care (Emory, Kippenbrock, Lee, Miller, & Reimers, 2017). Communication is an important aspect of the knowledge, skills, and attitudes necessary for nurses (Quality and Safety Education for Nurses [QSEN], 2018). Proficient and competent written communication is an expectation of a safe practitioner (Jefferies et al., 2018) and should be incorporated into their education (Institute of Medicine, 2003). Baccalaureate education program outcomes include preparing graduates to use written communication effectively (American Association of Colleges of Nursing, 2008).
In nursing, proficient writing skills are critical for documenting patient care activities, communicating with interprofessional team members, providing patient education, formalizing protocols and practices (Hawks et al., 2016), and advancing the science of nursing through presentations and publications. Writing activities are vital to clinical practice to develop critical thinking and communication skills (Hawks et al., 2016; Jefferies et al., 2018) and essential for the baccalaureate-prepared nurse. This article explores one college of nursing's (CON) methodology to support development of writing skills among online registered nurses enrolled in the baccalaureate (RN-BS) program. This is achieved through a standardized writing resource module (WRM) incorporated across the curriculum to provide deliberate practice and facilitate writing skill development.
BACKGROUND
The CON is part of a large, public, research-intensive university in the Southeast. The CON has 2,300 students across graduate and undergraduate programs with more than 500 students in the RN-BS program. This program was structured based on extensive feedback and support from clinical partners in the community. Clinical partners, students, experienced nurses, and academic colleagues identified written communication as an essential skill to be included in the program.
The expectation for students to produce high-quality scholarly assignments prompted an assessment of the resources and instruction available. The review identified that a wide variety of resources and teaching strategies were being offered to students without standardization; content and number of resources varied with each course. Faculty discussed the opportunity to standardize the educational process for writing and developed a plan to facilitate student success with the goal of improving scores on standardized rubrics across courses.
To be successful in the online program, students must be able to engage in self-directed learning and organize and structure their academic work. Writing skill development requires deliberate practice for mastery. Kolb's experiential learning theory and deliberate practice are frequently utilized for technical skill development and retention (Kolb, 1984). Experiential learning theory posits that mastery can be achieved by introducing new constructs during a practice experience, reflecting on the experience to bond new to known constructs, and then engaging in deliberate practice. Gonzalez and Kardong-Edgren (2017) describe deliberate practice as a means to significantly improve skill performance and cognitive retention in a continuous cycle.
The application of deliberate practice guided the development of a WRM to facilitate mastery of writing skills among students. Development of standard resources reduces variability among courses and supports content updates. Clapper and Kardong-Edgren (2012) report variations in content and expectations confuse students, making it difficult to recall pertinent information. By providing standard resources and requiring students to practice writing by submitting scholarly papers each semester throughout the curriculum, we hoped to mitigate knowledge decay and facilitate the mastery of writing skills (Gonzalez & Kardong-Edgren, 2017).
INTEGRATION STRATEGY
The decision was made to apply American Psychological Association (APA) scientific communication style standards in developing resources for scholarly writing (APA, 2010). The RN-BS Task Force (TF) appointed an APA/Writing Work Group (WG), consisting of leadership, RN-BS program faculty, and students, to assess current APA/writing-related materials, to identify best resources, and to develop a platform for dissemination among faculty. Student representation was included to obtain their perspective in the development, design, and integration of standardized writing resources.
The first task was to gather APA/writing-related materials (documents, presentations, checklists, and websites) with emphasis on primary source materials. The materials were assessed and collated by topic, and redundant items were removed. A cohesive collection of recommended materials and resources was established using feedback from faculty and students and presented to the TF with a description of the process used to obtain materials. The TF reviewed and approved the materials in detail and charged the WG with the development of an integration and communication plan.
The integration plan was developed utilizing the CON's learning management system (LMS). The APA/WRM, containing the approved standardized resources, resides within the LMS course for integration in all course sections offered each semester. The LMS course is centrally located and allows for periodic revisions based upon feedback from faculty, students, and current best practices (see Supplementary Digital Content, available at http://links.lww.com/NEP/A184, for a table with examples of the standardized content in the APA/WRM).
The requirement to place the module in all courses was communicated by the TF to all RN-BS faculty via email and committee meetings. This was supported by the leadership team. Early adopters requested access to the APA/WRM and imported the content into their courses.
OUTCOMES AND EVALUATION
Short-term outcomes were developed to measure the success of this innovative strategy. Three measures assessed process outcomes related to adoption, utilization, and faculty and student satisfaction: -percentage of courses with written assignments; -percentage of courses containing the APA/WRM; and -percentage of students accessing module resources. It was found that all courses contained written assignments; 50 percent of courses adopted the APA/WRM within the first year; and 60 percent of students had accessed the APA/WRM.
Anecdotal feedback was obtained from students and faculty with positive comments related to the value of the module. Students reported using standardized templates and checklists along with other resources for completing writing assignments. Faculty reported that they regularly referred students to the APA/WRM resources and appreciated the regular content updates.
One year after development and integration, a summary of recommendations was presented to the TF as follows. 1) Continue to monitor compliance to the written assignment standard. 2) Communicate with faculty to promote adoption by all courses and address noncompliance with leadership. 3) Inform students about the purpose and availability of the standardized APA/WRM during program orientation and orientation to individual courses. 4) Further develop and maintain the APA/WRM based upon new evidence and feedback from stakeholders. 5) Design and implement a long-term strategy to measure the impact of the standardized APA/WRM on student writing.
The TF charged the WG with the development and implementation of a process to measure student outcomes over the next year and seek institutional review board approval through the university for future investigation and program evaluation once 100 percent module integration is achieved. A long-term outcome will focus on measuring the impact on student outcomes. Changes will be evidenced by improvements in RN-BS students' written communication skills. To evaluate the effectiveness of the implementation, pre- and postimplementation rubric data, specifically APA style and format, will be reviewed. Application to the university institutional review board will be made for this long-term outcome assessment.
CONCLUSION
Communication is a critical component for providing safe, quality health care services. An essential skill for nurses is effective written communication with health care team members, patients, families, and communities. Baccalaureate education, specifically in the RN-BS program, provides an opportunity to include written skill development as part of the educational content. Deliberate practice was incorporated as a methodology for integrating this content. Based on the assessment, the WG developed a standardized resource module for integration into the program. The development of an APA/WRM demonstrated positive outcomes and the need for further development and evaluation.
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