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A programmatic approach to developing writing embedded in nursing courses

ALTC Fellowship Report

2011

Dr Roger Moni Griffith University

Support for this fellowship has been provided by the Australian Learning and Teaching Council Ltd., an initiative of the Australian Government. The views expressed in this report do not necessarily reflect the views of the Australian Learning and Teaching Council or the Australian Government.

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ISBN 978-1-921856-46-4

2011

A programmatic approach to developing writing embedded in nursing courses 1

Contents

Acknowledgements ......................................................................................................... 2 Abbreviations and terms ................................................................................................. 3 Executive Summary ........................................................................................................ 4 Contexts of nursing ......................................................................................................... 6

Professional contexts .......................................................................................... 6 Griffith Health Group ............................................................................................ 6 The Bachelor of Nursing ...................................................................................... 7 Curriculum change during the fellowship ............................................................. 7

The roles of writing in the nursing curriculum .................................................................. 9 Writing as a literate practice within the curriculum ............................................... 9 Contexts of nursing education and assessment ................................................... 9

Fellowship aims ............................................................................................................ 10 Approach and methodology .......................................................................................... 11 Phase 1: Auditing of documents .................................................................................... 13

KRQ1 Findings ............................................................................................... 14 Section conclusion............................................................................................. 16

Phase 2: Engagement with key stakeholders ................................................................ 17 1. Engagement with the new BN working party ............................................... 17 2. Surveys ....................................................................................................... 22 3. Interviews .................................................................................................... 24 Section conclusion............................................................................................. 39

Phase 3: Capacity building ............................................................................................ 41 1. Professional Contributions to existing projects within the SONM ................. 41 2. Current and future scholarly outputs supported by the fellowship ................ 43 3. Awards ........................................................................................................ 43 4. Seed funds for scholarship of learning and teaching projects around writing

in nursing .................................................................................................... 43 5. The ALTC fellowship EndNote library on Writing in Nursing Education

(WINE) ........................................................................................................ 45 6. Resource book on educating nurses ........................................................... 45 Section conclusion............................................................................................. 46

Outcomes and Recommendations ................................................................................ 47 Milestone events of the fellowship ................................................................................. 48 Links with other ALTC studies in nursing education ...................................................... 50 Evaluation of fellowship ................................................................................................. 51

APPENDIX 1: Quantitative features of written assessment tasks (ATs) in 2008 BN

courses ................................................................................................ 53 APPENDIX 2 Summary of sampling rate of student 2008 assessment data ............... 54 APPENDIX 3 Quantitative features of written assessment tasks (ATs) in revised BN

courses ................................................................................................ 56 APPENDIX 4 Letter inviting Heads of Nursing/Midwifery to participate in online

surveys................................................................................................. 57 APPENDIX 5: Responses of nursing students to online survey on writing .................... 58 APPENDIX 6 Responses of nursing academics to online survey on writing ............... 65 References………….. ................................................................................................... 72


Acknowledgements I respectfully acknowledge the sustained and generous support of the ALTC and Griffith University.

My special thanks go to Ms Cecilia Arrigoni as my intrepid, principal research assistant through the fellowship; and to Ms Lisa Hutchinson for her scholarship and learning-focussed leadership in SONM.

I am also most grateful for the capable assistance of: Louis Alberts for managing the surveys; Professor Nick Buys (Dean of Learning & Teaching, Griffith Health) for ongoing fellowship support; Jo-Anne Clark for research assistance; Professor Patrick Crookes (Chair, CDNM) for survey support; interviewees from Learning Services, Griffith University, SONM and local hospitals; Sylvia Gillard for her efficient management of finances; Professor Kerri-Lee Krause and other Griffith Institute of Higher Education colleagues as learned colleagues; Siobhan Lenihan, (ALTC) for patient support and feedback; Associate Professor Karen Moni for ongoing consultancy and infinite patience; other SONM staff for group discussions and workshops; Professor Elizabeth Patterson (Head of School); Stuart Riddell for research assistance; Professor Marianne Wallis for generous and inclusive leadership; Kathy Watson for the many conversations of encouragement.


Abbreviations and terms

ACNM Australian Nursing and Midwifery Council

AHPRA Australian Health Practitioners Regulation Agency

ALTC Australian Learning and Teaching Council Limited

ANMC Australian Nursing and Midwifery Council

ASKe Assessment Standards Knowledge exchange

BN Bachelor of Nursing

CALD Culturally And Linguistically Diverse

CDNM Council of Deans of Nursing & Midwifery (Australian & New Zealand)

Convenors academics charged with the co-ordination of courses or programs

Course equivalent to a subject; a unit of a program

EEN Endorsed Enrolled Nurse

FYA First Year Advisor

GC Gold Coast campus of Griffith University

GU Griffith University

Heath IDEAS Health Institute for the Development of Education and Scholarship, Griffith University

HoS Head of School

ICT Information and Communication Technologies

IELTS International English Language Testing Score

KRQ Key Research Question

LG Logan campus of Griffith University

LSA Learning Service Advisor

MESS Mark Entry Spreadsheets

MSC courses from the Griffith School of Medical Science

NA Nathan campus of Griffith University

NRS courses from nursing at Griffith University

NSQF National Safety and Quality Framework

OSCE Objective Structured Clinical Examination

PASS Peer Assisted Student Support

Patient synonymous with 'client'

Program sets of courses constituting a degree

RN Registered Nurse

QH Queensland Health

SEWS Student Essay Writing Support

SOAP(IER) Situation-Outcome-Assessment-Plan-(Interventions-Evaluations-Revision)

SoLT Scholarship of Learning and Teaching

SONM Griffith School of Nursing and Midwifery

TAFE Technical And Further Education

The Fellow Dr. Roger Moni

WINE Writing In Nursing Education (EndNote library)


Executive Summary Writing remains the most privileged technology in both academic and professional contexts of nursing. Yet the contrasting purposes of writing in the academic and professional settings risk widening the gap between pre-service education and practice; undermining the students' experience and disempowering nursing academics.

This ALTC fellowship was framed around three questions.

1. What do we know about the ways in which writing is taught and assessed in the existing Bachelor of Nursing (BN) program?

Summative assessment tasks (from 2008) across the existing BN were mapped, illustrating both the value and challenges of assessment from semester one of year one. The predominance of high-stakes, academic essays signalled a need to develop assessment more tuned to the needs of nursing practitioners, and integrated with clinical assessment. Development of writing was unevenly supported across the BN.

Statistical analysis of writing-based assessment tasks in the existing program demonstrated that students' marks for written tasks were the same as, or higher than exams in 80 per cent of tasks. On this basis, writing did not appear problematic for students or nursing staff.

2. What model(s) best describe and guide the teaching and assessment of writing in the BN program?

Through the working party for the revised BN, School of Nursing and Midwifery (SONM) staff were presented with mapped assessment; with the academic literacies model (Lea & Street, 1998) as a way of supporting teaching and assessment practices more likely to bridge the practice-education gap; and with nine questions designed to engage staff in reflection and ongoing discussion.

Through the working party, written assessment in semester one/year one of the revised BN was reduced, and diversified across the new curriculum.

Online surveys of nursing students and academics were distributed to 42 universities via the Council of Deans of Nursing and Midwifery (Australia and New Zealand). Responses were very low but indicated:

self-assessment and peer-assessment were not commonly practised there is a concern from academics about the consistency of marking

writing academics were also concerned about the volume and development of

programmatic writing.

Interviews with Learning Service Advisors (n=4), teaching staff (n=2) and senior nursing managers (n=3) explored academic and professional uses of writing:

staff from Learning Services and (interviewed) nursing staff identified a need for assessment which develops writing proficiency more geared to year levels, and which is delivered more consistently across campuses and courses. This was supported by a needs analysis of consultations with nursing undergraduates, sought from Learning Services.

nursing managers reported on the types of writing currently required of a range of staff, from wards to managerial positions. These might be used to more explicitly support academic writing.


3. How might the capacity of staff be developed to more effectively teach and assess writing in the BN program?

The Fellow is working with the recently established Nursing Learning, Teaching and Assessment Forum (a collaboration between nursing and Learning Services staff) to explore how assessment plans, assessment tasks and consensus moderation can assure academic standards relevant to nursing. This will likely lead to improved assessment tasks and more consistent marking.

An EndNote library of over 300 references to writing has been developed through the fellowship. This library will be made available to all interested parties and through the ALTC website

The fellowship is supporting learning and teaching initiatives from inside and outside SONM, to develop the scholarship of learning and teaching around writing in nursing.


Contexts of nursing Professional contexts Nursing is the science of professional caring and offers opportunities to promote and restore health, to prevent illness and to alleviate suffering. The profession of nursing is complex, demanding and rapidly diversifying in as much as nurses are employed across a very wide range of hospital and community settings which may require specialist postgraduate qualifications (eg Griffith University listed 21 career pathways, http://www.griffith.edu.au/health/nursing/careers). The nursing workforce includes Registered Nurses (RN or Division 1) and Enrolled Nurses (EN or Division 2). The former have Bachelor of Nursing (BN) degrees offered through universities and higher education providers to pre- or post-registered students. Enrolled Nurses have a diploma qualification and may have gained endorsements, ie additional qualifications and specific expertise in an approved area of practice under national law (eg scheduled medicines; nurse practitioner). Competency standards and regulation processes are set by the Australian Nursing and Midwifery Council (ACNM). Eligible graduates apply to the Australian Health Practitioners Regulation Agency (AHPRA) for registration as an RN. From 1 July 2010, AHPRA initiated a new national registration and accreditation scheme for 10 health professions, requiring evidence of at least three months full time equivalent practice in the last five years. Registration categories for nursing students and practitioners are administered by the Nursing and Midwifery Board of Australia. South-east Queensland is Australia‟s fastest growing region (Queensland Government Department of Infrastructure and Planning). To accommodate increasing demands for quality health care, the Queensland Government, through Queensland Health (the largest employer of nurses in the state), is currently building the new 750-bed Gold Coast University Hospital and, over the next three years, expanding the Robina, Pindara, Logan and Redlands Hospitals. Griffith Health Group Griffith University (GU) is one of the country‟s largest multi-campus universities, and as such, the dispersal of academic services, resources and support facilities complicates the provision of equitable standards of education (Scott, Grebennikov & Johnston 2007). The Griffith Health Group is one of the largest such academic groups in Australia, with programs in anatomy, dentistry and oral health, medical science, medicine, pharmacy, nursing and midwifery, physiotherapy and exercise science, human services, psychology, and public health. The group comprises over 5,000 students and almost 400 staff. These programs are delivered mainly at the Gold Coast Campus, but also across the Mt Gravatt, Nathan and Logan Campuses. A shared foundation year is designed to provide Griffith Health students with an understanding of basic science which underpins the interdisciplinary nature of modern health teams. Thus, the health programs are all founded on research approaches, knowledge and practices of science. Learning to write science-informed texts is clearly integral to the thinking and communicative competencies of students enrolled in health degree programs. Thus, the foundation year emphasises the development of writing and other core skills through work-integrated learning curricula with the broad intention that graduates will be better prepared to engage with, and contribute to local and global enterprises. The recently established Health Institute for the Development of Education and Scholarship (Health IDEAS) at GU assists the alignment of expertise and resources with the university‟s strategic priorities around learning, teaching and assessment.

http://www.griffith.edu.au/health/nursing/careers


The Bachelor of Nursing The three-year, 240 credit point, BN degree program at GU commenced in 1990. By 1998, the program operated on three campuses – Nathan, Logan and the Gold Coast, each servicing the needs of distinct demographics. The approximate percentage of students who are first-in-family are 70, 80, 60 at Nathan, Logan and Gold Coast respectively; and these correlate with the Overall Position (OP) which indicates a Queensland Year 12 student's statewide merit-based, rank order position (Lizzio & Wilson personal communication). These campuses are relatively autonomous in learning and teaching which is locally supported on each by a deputy head of school and a program convenor. The BN is located in the School of Nursing and Midwifery (SONM) which is one of 10 schools within the GU Health Group, and the second largest School of Nursing and Midwifery in Queensland. There are multiple entry points into the BN, the most significant alternative pathway (for fellowship activities) being the Endorsed Enrolled Nurses (EEN) who enter the BN in year two, and thus miss out on the strong foundation program. These students have Technical And Further Education (TAFE) qualifications, and are often mature-aged females with extensive professional work experiences. Together with international students (including an overseas-based BN program), these non-traditional-students are potentially at greater risk of leaving the BN. The cutoff OP for enrolment into BN from 2008-2010 was 16. For the same period, the median OPs for Nathan, Logan and the Gold Coast campuses were 10-14, 10-11 and 10-12, respectively. Student enrolments (n~1400 in 2008) are approximately 30 per cent, 30 per cent and 40 per cent across the Nathan, Logan and Gold Coast campuses, respectively. Most students and academic staff (approximately 60 per cent) in SONM are female. As one indirect measure of teaching expertise, only four staff had completed a Graduate Certificate in Higher Education in the period 2003-2010. An internal report within SONM expressed concern that recruiting academic staff at senior lecturer had proven difficult over the last five years; and that there is a decreasing pool of applicants with doctorates. Curriculum change during the fellowship The fellowship spanned approximately 20 months, from March 2009 to October 2010. This was a time of substantial and destabilising change across the higher education sector eg the global financial crisis has important implications for enrolment, resourcing and international collaborations; the Bradley review of higher education (Bradley, Noonan, Nugent & Scales 2008) presaged dramatic expansion and diversification of undergraduate (pre-registration) university education in Australia; and workplace identities is of growing salience as the higher education workforce continues to diversify and age (Hugo & Morriss 2010; Gordon & Whitchurch 2010). Against this backdrop, the SONM at GU addressed additional, more proximate change imperatives – review of the School, institutional quality assurance initiatives to improve student experiences, as profiled in the Course Experience Questionnaire, and planning a major revision to the BN for implementation in 2011. The fellowship made a significant contribution to this last process. Importantly, Griffith nursing graduates will need to develop appropriate professional practices based around all these themes. Writing plays an important reciprocal role in the development of reflective and higher-order thinking (Dexter 2000). In more concrete terms, students will need to master a range of genres and text types suited to diverse professional and social purposes and communication modes (Knapp & Watkins 2005; Luthy, Peterson, Lassetter & Callister 2009). At Griffith University, programs are reviewed every five years to assure continuous


improvement, benchmarking, curriculum renewal and reaccreditation. This process entails appraisal of changes to structure and content, cross-campus consistency, signature experiences, delivery modes and admission requirements, resourcing, and/or professional inputs and accreditation. Program submissions record reviews of the curriculum, a term which includes content-focused disciplinary interests, and the re-positioning of courses and pedagogies (Hicks 2007). Submissions only broadly address summative assessment, by including course assessment plans naming the type of assessment task, length, weighting and alignment with learning outcomes. University policy mandates that course convenors assume responsibility for (course-level) criterion-based, summative assessment detailed in course outlines. Final student grades are approved by faculty assessment boards that deliberate on the overall achievement of students by totaling subscores documented in mark entry spread sheets (MESS). The existing, three-year undergraduate BN degree program was implemented in 2005, themed around the philosophy of solution-focused nursing and with a strong emphasis on critical thinking. It is structured around the need for nurses to first get to know their patients as a basis of assessing and learning about their health problems, to build capacity for patients to adapt to health problems, and then to apply newly learned health knowledge for transitioning their communities. This program received a successful mid-term evaluation by the Queensland Nursing Council (now superseded by the Australian Nursing and Midwifery Council). Between January 2007 and December 2009, Professor Marianne Wallis led a working party to review and revise the curriculum, to be implemented in semester one, 2011. This group included the head of school, and program convenors located at the Gold Coast, Logan and Nathan Campuses, and The Fellow. Curriculum changes were strongly influenced by the proposed National Safety and Quality Framework (Australian Commission for Safety and Quality Healthcare 2009) and the National Patient Safety Education Framework (Australian Commission for Safety and Quality Healthcare 2005). The organising themes upon which high quality care is premised include:

client and family focus

being driven by information and based on evidence

being organised for safety and quality.


The roles of writing in the nursing curriculum

Writing as a literate practice within the curriculum Students, their discipline teachers and teachers from writing centres can have widely differing views about how writing is conceptualised, taught and assessed (Haswell 2008). There have been distinct historical traditions adopted in the USA (writing in the disciplines) and UK (academic literacies; Lea & Street 1998) to writing. Here, I focus on the UK tradition as being more relevant to the curriculum contexts of higher education in Australia. As well, the UK tradition is more appropriate to nursing which has an interdisciplinary curriculum (Mitchell 2005) and therefore adopts a broader view than writing as it appears in separate disciplines (Lea 2004). Writing in nursing could be approached from three perspectives or models based on the influential work of Lea and Street (1998). From case study research in higher education, these authors defined three nested levels, each with distinct implications for how writing is taught and assessed. Study skills: The lowest level equates writing with atomised, transferrable skills (or discrete technical competencies). When students fail to demonstrate these skills in assessment, they are labelled as deficient and in need of remediation to 'fix the skills'. This approach configures writing as technique and separate from the learning of content. It is also likely to marginalise non-traditional students. Academic socialisation: Writing goes beyond the teaching and assessment of writing skills. It equates with being socialised into the academy – writing proficiency is non-problematic as students are acculturated into 'being a university student'. Success in academic writing is supported by teaching and assessment that is explicitly supported through expertise in academic or scholarship skills. This approach ignores disciplinary differences in knowledge making, discourse and practices. Learning to write is presented as generic and transferrable, and taught largely by support staff. Academic literacies: At the highest superordinate level, writing is considered as a social, literate tool for meaning-making which is strongly nuanced by the discipline. Writing becomes problematic in that students need to develop a repertoire of discursive competencies that reflect discipline-based knowledge, identity and power. Learning to write is located where and when learning of content is required. Therefore, this requires embedded teaching and assessment under the direction of disciplinary academics. This three-model framework has been widely used to explore and develop teaching and assessment practices around writing within courses and programs across both disciplines and countries (Alston, Gourlay, Sutherland & Thomson 2008). Therefore, the fellowship adopted the framework as a means to contextualise the roles of writing within the nursing curriculum, and as an established means to engage academic staff in processes of change towards teaching practices that legitimate the disciplinary perspectives of nursing and thus potentially empower staff to act as agents of change. Contexts of nursing education and assessment Nursing education is very demanding on students and academic staff. The nursing curriculum is typically multidisciplinary, and challenges students to master a broad range of disciplinary knowledge from the sciences, sociology, communication, foundations of health, nursing assessment and management, law, ethics and research. Further, nursing students need to be prepared to work in health care


settings that are increasingly diverse, and both technically and culturally demanding, while student cohorts themselves have a wide range of prior academic achievement, age groups, and cultural and linguistic diversity. The design of assessment affords an important key point of leverage in the curriculum. Well-designed writing activities can support language development, deep understanding and critical thinking (Lindblom-Ylänne & Pihlajamäki 2003). The validity of direct assessment of writing is influenced by multiple and complex interacting variables, identified from empirical studies. Murphy and Yancey (2008) include here: the writer and their knowledge of subject, their cultural and linguistic (CALD) background and how they interpret task requirements; markers and their disciplinary, CALD and teaching expertise; contextual factors including the topic, scoring system and whether tasks are timed or not; and features of the writing task eg rhetorical specifications and stimulus material. Extended writing tasks are a major component of nursing curricula, and writing remains a challenge to many students and teaching staff. For example, Brennan (1995) reported that nursing students at both pre-and post-registration stage find writing essays difficult because they are unaware of assessment requirements, the importance of feedback and the processes of writing. For these students, essays are seen as a task and not as a learning opportunity. Ethnographic studies have identified mature females and those from low socio-economic backgrounds as two groups who find essays difficult to understand, alien to their academic identity and difficult to manage logistically (Lillis & Turner 2001).

Fellowship aims This fellowship had three aims:

Aim 1: to investigate what is known about the ways in which writing is taught and assessed in the Bachelor of Nursing degree program.

Aim 2: to build a model to embed the teaching and assessment of writing within and across the BN.

Aim 3: to enhance the teaching and assessment of writing in the BN through engaging university staff with professional development with the model.

The fellowship was framed around three key research questions aligned to the aims:

KRQ1 What do we know about the ways in which writing is taught and assessed in the existing BN program?

KRQ2 What model(s) best describe and guide the teaching and assessment of writing in the BN program?

KRQ3 How might the capacity of university staff be developed to more effectively teach and assess writing in the BN program?


Approach and methodology Approach The central practical idea which was explicitly used when engaging with SONM staff was:

graduating students, by definition, experience programs of study, but no academic teacher can.

The Fellow adopted the stance of Lillis (2001) who, from case studies of non-traditional students in higher education in the UK, called for a re-thinking of student writing in higher education. Lillis uses the models of Lea and Street (1998) as a central framework and aligns them with critical approaches (Ivanic 1999; and Clark, Fairclough, Ivanic & Martin-Jones 1991) in order to question how the diversifying student population can gain access to (and succeed though use of) privileged linguistic capital that characterises mass higher education. The essayist literacy is viewed as the dominant literacy practice reinforced by skills-based writing guides and genre-based approaches to the teaching and assessment that emphasise homogeneity and reproduction of official discourses. Lillis (2001) calls for pedagogies which care based on ongoing collaborative dialogue among novices and teachers, to problematise and unpack both the language and metalanguage of the academy. The Fellow thinks that this is possible only when writing (and other literate practices) are conceptually located within the disciplinary epistemologies and are viewed by staff as practices that are centred around learning viz., these are valued as essential actions of curriculum work. Writing is a technological invention and, like any tool, makes sense and enables purposeful actions when it is situated in well-defined contexts. This describes the practices of a discourse community (Swales 1990). Effective writing is a social practice determined by the cultural contexts in which it is generated and consumed – much more than a contextualised skill set (Street 1984). Thus the types of writing produced and consumed in academic and professional nursing contexts are often different. More importantly, those who produce and consume texts as communicative acts (Knapp & Watkins 2005) need to understand the social and cultural purposes of writing, and use intertextuality (the interdependence of multiple texts; Baktin 1986) as a means for learners to bridge instances of writing that otherwise may be perceived as independent and de novo compositions. In practice, this means that academic teachers need to draw upon their own rich experiences of being a nurse who uses writing for multiple purposes, and use this case knowledge to engage their students such that learning outcomes and assessment support integration of undergraduate and professional nursing experiences. Otherwise, students will rightly be disappointed with their academic education, seeing this as being irrelevant to nursing practice, thus promoting the perception of dual academic and professional cultures that are distinct and disconnected. This perception will likely impact student experiences at university as well as the opinions of graduates – notably those completing the Course Experience Questionnaire at a time when they are likely to view student and professional roles as unrelated. The Fellow disagrees with the view that writing (and other situated social practices) should be listed as graduate skills or attributes. This is particularly unhelpful when graduate writing is assumed to be generic and/or transferrable (Jones 2009). Given that the types and modes of writing continue to serve ever-changing social and cultural needs eg social networking texts; mobile learning), and given the complexity and slowness of applied, high-order learning of „functioning‟ knowledge (Biggs & Tang 2007), and the frequent failure to transfer learning across unfamiliar contexts (Bransford, Brown, & Cocking 2000), it is difficult to see how anything but rule-bound elements of


language might be automatically used across a lifetime of learning. A second but related concern is that „writing as a basic skill‟ relegates it to remedial settings removed from the mainstream curriculum. In short, the teaching of writing becomes the responsibility of those from 'student support services', perhaps anyone else but nursing academics. The investigative activities of this fellowship were informed by ethnographic research techniques. Attempts to understand writing in nursing recognised the perspective of multiple participants immersed in their natural work contexts, and used mixed methods in seeking to describe, analyse and interpret cultural practices within the BN (Gay, Mills & Airasian 2006). This report thus constitutes a combinative, ethnographic casebook (Baszanger & Dodier 1997) wherein the approach entailed empirical observations, open to meaning rather than adopting a priori codified schedules and grounded in the historical and cultural contexts of the SONM. My role was as participant observer – both observing aspects of assessment practices across the three campuses, and engaging with key stakeholders. Some of these interactions were active (assisting with teaching and reviewing progress of interventions led by academic staff based around the Lea & Street models), while others were passive (receiving assessment data on writing). Methodology A mix of methods was adopted throughout the fellowship:

auditing of documents (environmental scan of newspaper articles referring to writing; sampling of major books used throughout the BN program; sampling of assessment tasks around writing; statistical analysis of assessment data from the 2008 BN)

field notes from both The Fellow and Cecilia Arrigoni (research assistant) in the form of observations from engagement with literature, document audits and engagement with university staff including the BN working party

literature searches and construction of an EndNote library around the learning, teaching and assessment of writing, with a focus on nursing

surveys to nursing students and nursing academics from CDNM-registered member universities across Australia and New Zealand

interviews with three key stakeholder groups in nursing: Learning Service Advisors, nursing academics and senior, hospital-based nurse educators.


Phase 1: Auditing of documents

KRQ1 What do we know about the ways in which writing is taught and assessed in the existing (2008) BN program?

Course-level summative assessment in the BN program across Nathan, Logan and Gold Coast Campuses was audited from course outlines in order to:

identify features of written assessment across courses implemented in the 2008 program

create maps of written assessment across the six semesters of the 2008 BN program

record resources used to support the development of writing in courses

determine students‟ writing performances by analysis of variance (ANOVA) statistical analysis of all summative achievements across the existing program in 2008. These data were as marked by course convenors (ie without adjustments by the Assessment Committee). MESS data from Excel spreadsheets were transferred into spreadsheets in GraphPad Prism (version 5). These were then analysed using two statistical procedures: (a) descriptive (column) statistics yielded values for the sample mean, standard deviation, and standard error of the mean and (b) one-way ANOVA with a Tukey multiple comparison, post-test in order to test the null hypothesis that sample means were different from random chance by more than 95 per cent. These baseline data had not been previously generated by the School. These data were sent electronically with permission from the Head of School. Because students were not identified and not at risk, no special ethics approval was required in generating de-identified data for the purposes of improving learning, teaching and assessment (GU Legal Advisors, 23 March 2009).

These results were then:

collated in a report sent of the Head of School and three program convenors

presented to the academic staff (September 2009) as a trigger to broaden conversations about the teaching and assessment of writing in the BN.


KRQ1 Findings

1 Features of written assessment across courses implemented in the 2008 program

Summative written assessment tasks in 2008:

were common (20 writing tasks representing seven types of summative assessment)

were commonly designed around 'essays' or 'assignments' accounting for 41 per cent of written assessment;

used various category labels without apparent standardisation of assessment names

were often demanding (modal value = 50 per cent course weighting)

used an explicit grading model ie, criterion-referenced marking with a wide variation criteria and definitions of standards

were unevenly developed across the program, with highest loads in years one and three. In about 40 per cent of year two courses, writing was not summatively assessed

required writing per year level of: 5,500 words (year one), 6,600 words (year two), and more than 11,700 words (year three). These numbers are approximate, being dependent on the availability of data from course convenors. Another way of evaluating written assessment is to compare the actual volume of writing in assessment with that stated in university policy. The latter states that a 10 credit point course should be broadly equivalent to a 5,000 word assignment. On this basis, there was a 53 to 86 per cent shortfall in required writing across the 2008 BN program. However, additional writing is required in the two general elective courses offered in year three eg 2500 to 3000 word assessment as essays, reports, literature reviews, newsletter articles, resource manuals, policy analyses and/or posters. Therefore the shortfall would be significant, but less so in year three courses

unevenly supported the development of academic literacies through formative assessment and a range of summative tasks requiring production of print, oral and multi-media texts ie, some courses used explicit teaching to support the development of academic literacy, others did not

were rarely supported by course documentation emphasising writing-to-learn processes in nursing

were reduced in number compared with 2006 program implementation. This occurred in one-quarter of all courses, with the largest reduction (63 per cent) being in year one courses. Written assignments were replaced by examinations, requiring multiple choice and short answer questions.

2 Maps of written assessment across the six semesters of the 2008 BN

program. The map of written assessment in 2008 (Figure 1) clearly highlights the diversity of assessment and the uneven distribution of substantially challenging tasks for students beginning their first semester at university.

http://www62.gu.edu.au/policylibrary.nsf/AllDocuments/8C13C97616663BA34A256B8F00082CD1?OpenDocument


Portfolio (0.1) 1972NRS

Present (0.2) 1973NRS


Lab man (0.2 -0.3) 1974NRS/MSC

Lab man (0.3) 1975NRS/MSC

Assign (0.5) 2978NRS


Poster (0.4) 3975NRS

Essay (0.5) 1972NRS

Poster (0.3) 1977PBH

Poster (0.25) 2973NR/MSC

Essay (0.4) 2976NRS

Assign(0.5) 3978NRS

Essay (0.6) 3976NRS

Essay (0.5) 1971NRS


Crit Asys (0.4) 2977NRS

Assign (0.3) 2974NRS/MSC


Work book (0.6) 3975NRS

Sem 1 Sem 2 Sem 1 Sem 2 Sem 1 Sem 2

YEAR 1 YEAR 2 YEAR 3

Figure 1. Map of 2008 summative assessment tasks requiring substantial writing.

(Writing under examination conditions is not included) Legend: Assign = assignment; Crit Asys = critical analysis; Lab man = laboratory manual;

Present = presentation.

Fractional numbers indicated fractional weighting of assessment per course eg 0.5=50 per cent weighting

NRS = nursing courses; MSC = medical science courses.


3 Resources used to support the development of writing in courses.

There was evidence for considerable support for writing development in teaching resources. These largely included comprehensive writing guides presented by Learning Service Advisors. The more detailed of these included PowerPoint® slides with deconstructed examples of model essays made available to students through course outlines in Blackboard®. The text Zilm and Entwistle (2002) The SMART Way: Introduction to writing for nurses – which explicitly supports the development of writing for nursing, was referred to in two year one course outlines but not in any 2008 courses. 4 Statistical analysis of all summative achievements across the BN program

in 2008

Most of the student assessment results were included in the statistical analyses (Appendix 1). The overall program sampling rate across the 14 courses was 93±5 per cent, therefore the sample is a strong representation of the course populations. Analysis of assessment results demonstrated that students‟ achievements were consistent within and across the three campuses (for essays, mean ± SD = 66 ± 15 per cent, n=9), and students' marks for writing were the same as or higher than exams in about 80 per cent of cases.

Section conclusion Assessment practices are influenced by institutional and disciplinary traditions, professional requirements and the actions of individual teachers. At a program level, many of the features of assessment regimes that contribute to the 'assessment climate' are likely determined by institutional mandates (Gibbs & Dunbar-Goddet 2009). This includes practices like the variety and volume of assessment, use of explicit criteria and standards, and the alignment of assessment to learning outcomes. Yet, the 2008 delivery of the BN program strongly emphasises traditional essays as a „default genre‟ (Womack 1993). It thus affords students a range and depth of assessment tasks that might be considered as a disciplinary 'signature' (Bond 2007). At face value, course-level assessment data did not identify any particular concerns about students‟ writing achievements. However, these results do not illuminate how teaching staff understand academic literacy in nursing education or how teaching supported success in assessment. As students progress through the BN program, they will likely encounter diverse, even incompatible teaching and assessment practices around writing. The scope of practices within nursing indicates that broadening the range of assessment of writing would be beneficial. These issues, supported by course data profiles, were used as discussion issues with nursing staff.


Phase 2: Engagement with key stakeholders KRQ2 What model(s) best describe and guide the teaching and assessment of

writing in the BN program? This section includes three sources of data collected in the following chronological order: (1) engagement with the working party charged with co-ordinating revision of the BN program and writing the curriculum document; (2) survey responses both students and nursing academics; and (3) themes arising from interviews conducted with GU Learning Service Advisors; nursing academics, and senior hospital-based nurse educators.

1. Engagement with the new BN working party

From January 2007, the working party for the revised BN (commencing in 2011) used institutional evaluation data, national benchmarking, focus group interviews with graduates, and widely consulted industry leaders, other Griffith Health schools, staff and committees to inform the revised BN. The group also sought from The Fellow observations of the existing BN program and suggestions for improvements. In response, a document was constructed, delivered and discussed (1 September 2009). This included a summary of data (above), a developmental programmatic approach to writing in nursing described by Gimenez (2008), two overarching, broadly themed questions and associated observations, plus a series of exploratory questions with which nursing staff might engage. These were then presented to all nursing staff (29 September) as a means to initiate substantive conversations and actions around the teaching and assessment of writing in the revised curriculum. Details of the themed questions and observations follow.

1.1. Broadly themed questions and associated observations Q1. What did our previous curriculum do or not do around the development of

writing and literacy? Observations

nursing staff do have in-house expertise around literacy education

the development of undergraduates‟ writing proficiency across the program is supported through formative learning-teaching activities and resources eg tutorial quizzes, workbooks, support from Learning Services via in-class tuition, and guides to writing

the program supports the development of multi-literacies through the provision of learning opportunities around speaking, listening, reading, writing, viewing and use of multimedia

comparing the program in 2006 and 2008, the number of courses with (summatively) assessed writing – did not change (11 courses), decreased (five courses, all from year one) or increased (one course in year one)

the program seems to afford similar emphasis on writing across the three campuses

the program has a strong emphasis on assessed writing – those courses with assessed writing averaging about 50 per cent weighting

the program has an uneven focus on assessed writing, with an excessive loading in the first semester of year one, and fewest opportunities for students to develop advanced writing skills in year two


assessment uses a limited range of writing genres – with the essay being the most common and over-represented assessment instrument – and apparently non-standardised weighting allocations

the „specified criteria‟ (Sadler 2005) marking model is common, though with variations in use of quantitative and qualitative standards

apart from an increased requirement for writing from years one to three, it is difficult to appreciate (from the course documents) how the current program structure systematically develops writing (and multi-literacy) proficiency

in order to meet the NSQF-themed requirements of the revised program, how writing is assessed will need revision eg inclusion of essential vocational writing genres. This is likely to have implications for how writing is taught and how in-house and service expertise in writing/literacy education is used

the scope of writing practices within nursing (as reported in research literature from nursing education and writing) indicates that broadening the range of teaching and assessment of writing in undergraduate nursing would be beneficial to students, staff and patients.

Both the working party and teaching staff :

expressed concerns about the ability of some students to write effectively, and

wanted to learn more about diversifying written assessment tasks. Q2. Discuss options for how to improve this through the teaching and through

assessment items attached to courses in this curriculum. Observations

academic literacies framework (Lea & Street 1998) was presented

base learning-teaching-assessment activities might be re-configured to align with this framework

A wider range of writing forms (text types) might be explored

design, implementation and evaluation approached through scholarship of learning, teaching and assessment around writing can be supported through the ALTC fellowship.

A set of exploratory questions was generated by The Fellow. These were presented to staff (including members of the new BN working party) on 29 September 2009.

Exploratory questions

What does it mean to become academically literate in nursing?

How will writing be systematically supported through the revised program to include an appropriate balance of developmental, academic and professional discourses?

How does the model for effective communication in nursing accommodate the development of writing such that they also support National Safety and Quality Framework themes?

How will the principles of effective communication in nursing be articulated through the program?

Who are the key academic staff interested in further developing and sustaining a scholarly culture around teaching and assessment of writing?

How might the expertise of nursing and Learning Services staff be more effectively co-ordinated?


What other expertise in Australian nursing is needed?

Are there opportunities to collaborate with other Australian nursing schools that the fellowship can support?

How might an ALTC Exchange site be organised to support the writing needs of staff and students (and possibly employers) in nursing across Australia?

1.2. Course and assessment changes in revised BN program Given that assessment drives much of academic learning and needs to better prepare learners for the workplace (Boud & Falchikov, 2006), the design and implementation of the assessment program in the revised BN will be critical. More specifically, future nursing graduates will not be able to develop and implement these practices if they are not proficient writers – mastering a range of genres and text types suited to diverse professional and social purposes and communication modes (Knapp & Watkins 2005; Luthy et al. 2009). The BN working party submitted the revised program in May 2010. This included substantial year-level changes:

Eight new courses: two in year one; three in year two; one in year three

Three major revisions: two in year one; nil in year two; one in year three

Nine minor revisions: four in year one; two in year two; three in year three.

In response to a range of quality assurance indicators, the revised BN curriculum has more strongly integrated the biosciences with nursing care; has an increased focus on chronic conditions; includes a course on Indigenous health; and extends the clinical practicums from 19 to 22 weeks. Following a mandate from AHPRA, international students with IELTS score less than seven will need to complete a course called English Language and Communication for Health. A map of written assessment was constructed from course assessment plans of the revised BN program (Figure 2). The volume of written assessment in the revised BN appears in Appendix 2. Of note,

the role of writing in the new BN program is clearly very strongly emphasised through summative assessment

essays and assignments dominate the types of written assessment

the workload of written assessment in year one has been reduced from the existing BN program, especially notable in semester one of that year

the workload of written assessment in year two has not changed

the written assessment in year three has diversified, with the introduction of a reflective journal, Blackboard® discussion task, film analysis and teaching plan.


Ref Jour (0.2) 3121PBH

Bb Disc (0.25) 3121PBH

Film Asys (0.3) 3121PBH

eTut (0.1) 1507NRS



Essay (0.4) 2976NRS


Case Study (0.5) 3801NRS






Teach Plan (0.3) 3977NRS



Report (0.2) 2801NRS




Sem 1 Sem 2 Sem 1 Sem 2 Sem 1 Sem 2

YEAR 1 YEAR 2 YEAR 3

Figure 2. Map of summative assessment tasks requiring substantial writing from revised BN.

(Writing under examination conditions is not included) Legend: Assign = assignment; Bb Disc = discussion using L@G; eTut = online tutorial; Film Asys = film analysis; Present = presentation; Ref Jour = reflective journal.

Fractional numbers indicated fractional weighting of assessment per course eg 0.5=50 per cent weighting

NRS = nursing courses; PBH = public health courses.


1.3. Illustrating principles of effective assessment practice How might these changes to assessment in the revised BN be benchmarked? As a contributor to the ALTC-funded National Teaching Quality Indicators Project (Chalmers 2010), Griffith University developed Statements and Quality Indicators of Good Practice in Assessment. Four principles were developed. The shifts in programmatic assessment practices documented here illustrate Principle 4: Assessment policies and practices are planned, implemented, reviewed and improved. Section 4.1 when assessment practices are given consideration in cyclical reviews of

teaching, Programs, Courses and academic units.

This is part of Griffith policy. It is worth noting here that this process places further high demands on nursing educators many of whom may be struggling to balance their need to maintain professional credibility, and at the same time develop both teaching and research scholarship (Boyd 2007). Given also the multi-campus nature of the degree program, the achievements of the working party and SONM staff are commendable.

Section 4.3: when professional development opportunities are provided to staff to assist

them in improving assessment practices.

Professional development is planned as a series of workshops from September 2010. These are being organised by the school-based 'Professional Partnering Forum for Learning and Teaching'. At the time of writing, academic teaching staff from all the three campuses, GU Learning Service Advisors associated with the Health Group, and a staff member from the Griffith Institute for Higher Education are contributors. This change is aligned to GU assessment reform initiated by Professor Royce Sadler.

Section 4.4: when staff participate in professional development activities relevant to

assessment (eg workshops, conferences, relevant literature).

A professional learning community to develop scholarship around assessment reform is being planned. This is supported by seed funds from this ALTC fellowship as a means to sustainably build relevant leadership capacity in the SONM. The process of assessment reform will be documented, leading to scholarly outputs to be disseminated both within the SONM and beyond. This community has the potential to articulate with the ALTC-funded national priorities in health eg the Learning and Teaching Academic Standards (LTAS) project, and could lead to conference presentations, scholarly articles and funding through competitive grants.


2. Surveys

Two cross-sectional surveys were designed to sample demographic data and opinions of nursing students and nursing academics who teach. While the focus of the following is undergraduate nursing, the survey was applicable for midwifery and postgraduate students because it was likely that concerns about the learning, teaching and assessment of writing were similar across cognate programs. Stimulus questions were similar in the two surveys so that opinions could be compared and used by participating institutions as an opportunity for students and staff to develop and share a deeper understanding of what quality writing means when applied to both academic and professional contexts. Common themes, with the number of questions per theme in parentheses, were:

1. demographics (7-8)

2. broad self-perceptions as a writer (2)

3. self-report of university experiences in learning/teaching writing at university (4-5)

4. evaluations of learning/teaching of writing in nursing (12)

5. evaluations of formal assessment of writing in nursing (11).

Themes 2 -5 were addressed using a five-point Likert scale. The Flesch Reading Ease for full survey texts was 71-72, indicating that decoding text was easier than plain English. With assistance from Professor Patrick Crookes, Chair of the Council of Deans of Nursing and Midwifery, Australia and New Zealand (CDNM), a covering letter was emailed to all 42 member institutions of the CDNM (Appendix 4). Human ethics submission was approved on 3 May 2010, through GU: reference number GIH/01/10/HREC. Surveys were administered online using the web-based SurveyMonkey® tool. Respondents were presented with full information sheets. No incentives for participation were offered. Surveys opened on 1 May 2010. One month later, interim reports were emailed to the heads of school/department in participating institutions. Implementation and capture of responses was managed by a research assistant. Because responses were slow, a reminder letter was issued through the CDNM on 1 June 2010, and survey period extended to 4 August, when the survey reports were finalised. 2.1 Findings Apart from institutional affiliations, all questions and automated reports for both the student (Appendix 5) and academic surveys (Appendix 6) are reported here. The Queensland University of Technology provided more responses to both surveys than other institutions. Responses were disappointingly low. In addition, many respondents skipped questions, therefore results are to be treated with caution. The main findings for students and academics are reported below. 2.1.1 Students Student responses = 149. However, 46 (31 per cent) did not identify their institutional affiliation. This means that 103 students responded from five universities. Though always speculative, experience of student respondents around the learning, teaching and assessment of writing in their courses follows. Most respondents were young female (<20 yr), native English speakers enrolled in year one or two of nursing. Most enjoy writing as an activity. At university, these students reported that essays and texts requiring description, argument, reviews/critiques and self-reflection are the most assessed types of writing. There was general agreement that these forms of assessment are useful for their career, though not greatly enjoyable. Most agreed that they are taught why assessed writing is important to their career. They


are taught the basic compositional processes of writing including about audience. They are provided with writing exemplars, and write about work experiences. Most are not encouraged and perhaps don‟t learn much about writing from other students. Assessment of writing included both summative and formative. Most reported that they use the services of learning support who teach writing and that academics are important teachers of writing for them. Students see themselves as "good writers". The majority of respondents are successful academic writers who see there marks as being fair. They see that the amount of writing in their courses is appropriate and that assess writing tasks develop logically across their programs. Although they receive feedback from summatively assessed writing, they are not taught to how to use this feedback. Self-assessment and peer-assessment are not commonly required. 2.1.2 Academics Academic responses = 51. However, 22 (49 per cent) did not identify their institutional affiliation. This means that 29 responded from nine universities. The same caveat clearly holds when interpreting the responses from academics. Most respondents were very experienced, mid-aged, female nurses all of whom were L1 English speakers. Teaching experience varied but respondents were teaching widely across both undergraduate and postgraduate programs. Outside university work, most do a lot of writing and enjoy this. Essays and texts requiring description, argument, reviews/critiques and self-reflection are the most assessed types of writing. They see these forms of assessment as being useful for their students and see themselves as being good writers who enjoy and are good at teaching writing to nursing and midwifery students. Respondents reported that they teach writing composition, and how writing is useful for these careers. They teach about audience in workplace settings, provide writing exemplars and use the services of Learning Support staff in teaching writing. While they do learn about the teaching from academics, few writing tasks are formative. Most writing they set is summatively assessed, often using extended tasks, and they understand what good writing is in nursing and midwifery. While they are happy with the marks they give, consistency of marking is of concern. They provide feedback on student writing and teach students how to use this. While self-assessment may be used, peer-assessment is not as commonly used. There is some question about the amount of writing across programs and how writing is logically developed across programs. 2.2 Summary Comparing students' and academics' responses, there is considerable agreement on many issues of teaching and assessment of writing in nursing and midwifery. Most respondents were successful and confident writers themselves. The main issues arising from these surveys are:

self-assessment and peer-assessment are less commonly used

there is a concern from academics about the consistency of marking writing

academics were also concerned about the volume and development of programmatic writing.


3. Interviews

Interviews were conducted with individuals from three stakeholder groups – Learning Service Advisors from GU (four interviews); teaching academics from GU (two interviews); and senior nursing staff large at regional hospitals used by GU students for practicum placements (three interviews). Common themes and questions were selected so that stakeholder views might be compared, consensus issues and priorities around writing might be identified and (beyond this fellowship) appropriately addressed. The common themes explored were:

understanding roles (of interviewees)

the perceived needs of students around writing in nursing

the perceived needs of teaching academics/nurses as employees.

All interview protocols were ethically approved by GU (reference number GIH/01/10/HREC). Rigorous attempts have been made to protect the identity of all volunteering interviewees. The interviews were designed as 45-minute, semi-structured, accompanied by a full information sheet and, upon request, the set of fixed questions. Consent forms were signed at the time of interviews which were conducted by trained research assistants (Ms Cecilia Arrigoni; Ms Joanne Clark) who recorded then and managed the generation of verbatim transcripts. All transcripts were verified by The Fellow by comparing these with the audio files, then verified in turn by each interviewee. Principal themes from transcripts were identified using open (multiple readings), axial (identifying main issues) and selective coding creating superordinate themes (Bogdan & Biklen 1992). The latter are summarised under staff roles, student needs and staff needs at the end of this section.

3.1 Interviews with Learning Service Advisors (LSA)

Learning Services at GU is a structural element of the Division of Information Services. In 2009, this division underwent a major restructuring in which LSAs were allocated to discipline groups within the university, including the Health Group, to which SONM is attached. Prior to this, LSAs worked widely across all five GU campuses, working with both teaching academics and students in nursing. Hence their perspectives on writing were relevant to this fellowship. LSAs were interviewed because they were known to interact with both students and teaching academics and often mediate contrasting perceptions around assessment tasks (Huijser, Kimmins & Galligan 2008). They could draw upon a wide range of first-hand experiences around the learning, teaching and assessment of writing in nursing. Four LSAs at GU volunteered to be interviewed between 31 May and 18 June 2010. All interviewees had worked across the three campuses which offer the BN and had first-hand experience with the needs of both nursing students and teaching staff. The major themes arising from interviews are summarised below.

3.1.1 Roles of Learning Service Advisors

Q1. Please describe your appointment?

All LSAs were female with 1.5 to 10 years experience at GU and employed on either fractional (0.6, 0.8) or full-time appointments (n = 2 respondents).

Q2. Can you briefly describe your main role(s) in Learning Services? The major work of LSA staff is servicing demands to assist writing across a wide, and diversifying, range of genres and conventions within academic writing. This source of support for student writing is widely advertised through pre-orientation and orientations


events each semester. LSAs mainly support student success in academic learning through three forms of contact, all closely coupled to course assessment tasks: (a) face-to-face consultations with students either as individuals, or less commonly, as small groups. Consultations are typically interactive, brief (20-minute) sessions and are now managed through online booking. Students may be mainly seeking assistance with task-related, writing approach strategies eg how to critique.

(b) activity-based workshops on academic writing. This includes weekly workshops catering for larger groups (90-120) of students from multiple degree programs. They are usually 50-minute sessions scheduled outside course timetables during semester one of year one. These workshops are collaboratively organised by First Year Advisors and LSAs, and typically address general academic writing issues eg how to write section introductions, paragraphs and conclusions in essays.

(c) teaching writing in lecture settings. These sessions are sometimes requested by lecturers to support student success on specific assessment tasks in nursing. Sessions may be either regular, timetabled support resulting from lecturer-LSA collaboration or ad hoc requests from lecturers or tutors.

All LSAs espoused a strong professional focus on learning and recognised the increasing diversity of students and staff. Explicit, constructivist and process-oriented pedagogies are used to meet the writing needs of student and support them to become self-regulated learners. They prefer to be proactive and pre-empt the concerns of students and teaching staff around written assessment. They feel underused by nursing academics. Other writing-related activities include contributing to specific institutional initiatives eg a pilot study of SMARTTHINKING®. Q3. Can you describe how the referrals work? Referrals are either organised by students who self-select for writing assistance or by nursing academics who recommend writing support, frequently based around specific assessment issues. Students may bring assessment specifications (instructions, marking schemes) and drafts of their writing for appraisal. With more regular students, a learning plan might be collaboratively developed. Some students are uncertain about why they have been referred. 3.1.2 Needs of students (around writing in nursing)

Q4. In your experiences of working with nursing students at Griffith, what are the

main writing needs of nursing students – can you match needs to groups of students?

Undergraduate nursing students are some of the neediest clients of LSAs. With regard to academic writing, these students may:

self-identify as „poor writers‟ based on their prior academic experiences

question the relevance of assessed topics to nursing practice

not expect the volume of reading set in courses

be weak at analytical (close) reading of academic literature

not understand key instructional words of assessment tasks

not understand how to approach assessment requirements eg how to „unpack the question‟

demonstrate weak analytical skills


how to synthesise and support an argument

not know how to plan their writing

lack control over writing eg in using text moves (transitions)

not understand how to write „reflectively‟

have difficulty with applying referencing conventions

be highly anxious.

Particularly at risk were:

first year students

mature-age students who are TAFE-qualified Endorsed Enrolled Nurses (EENs) entering the BN at the commencement of year two. These students usually have not studied at university and did not benefit from the support structures provided for first year students.

postgraduate students (both domestic and from overseas)

students who identify as Culturally And Linguistically Diverse (CALD).

LSAs reported that nursing students were highly motivated and industrious, and generally strong at:

constructing sentences

describing, summarising and paraphrasing factual content.

Q5. Being more specific about the types of writing in nursing, do you assist students (or staff) with writing any of these (in list provided)?

Answers appear in Table 1. Table 1. Types of writing and relative frequency of assistance provided by

Learning Service Advisors to nursing students

Type of writing Frequency of assistance

types that require description very common

types that require a lot of argument very common

types that require self- reflection very common

essays very common

undergraduate dissertation at Honours level, rarely

journal article reviews or critiques rarely

reports rarely

care plans very rarely

action plans very rarely

progress notes very rarely

portfolios very rarely

resumes no

job applications no

business letters no

memos no

emails for the workplace no


Q6. Regarding the self-help, on-line Academic Writing Tutorial, can you comment on how much this is used and how successful this is helping nursing students?

Users cannot be identified so it is not possible for LSAs to identify uses of this GU-wide resource. There was mention that this resource was going to be linked to course outlines. LSAs recommend this tutorial to nursing students but most LSAs expressed a strong view that a blended approach to instruction (ICT and face-to-face) is favoured both by students and themselves. They saw that face-to-face interaction assisted clarification of task requirements. With the same caveat, interviewees reported value in the online tutorial on academic integrity.

Q7. Now thinking about the undergraduate degree experience of students, (i) What is your understanding of how the writing needs of students changes

across the 3 years?

The common view was that writing requirements should change in a coherent manner across the program. One LSA expressed the well-considered view that semester one of the first year should be about building students' confidence in what they are good at, viz., describing and summarising facts. Instructional focus should be on how to write paragraphs, and use resources; and second semester, moves and the basics of arguments. Year two should emphasise analytical thinking and writing, and more sophisticated compositional strategies to mange the word limit of tasks; and Year three improve editing and reviewing.

(ii) What is your understanding of how the writing abilities of students

changes across the 3 years?

LSAs reported they don‟t see many students as they progress through the BN; and often find the 20-minute consultation too brief to assess abilities. The need for more LSA staffing and nursing resources was expressed.

3.1.3 Needs of teaching staff (around writing in nursing)

Q8. How much of your work is taken up with working with teaching staff from nursing?

LSAs were respectful of the demanding nature of academic work in nursing. They looked forward to closer collaborations around the teaching of writing, and saw these interviews as contributing towards that goal.

Q9. How is this generally organised and implemented?

Prior to the 2009 restructuring, requests from nursing academics were made to an LSA co-ordinator who determined the capacity to service needs. To accommodate campus expansions, schools are now asked to decide on their support needs.

Q10.Can you briefly describe instances where working with these staff has been a

really valuable and rewarding experience for students, academics and yourself?

Most LSAs described strong collaboration with „committed teachers‟ in nursing. These were highly interactive and stemmed from addressing specific issues arising in year one and with mature-age entrants. They drew attention to other successful writing practices across the university and suggested the value in exploring these within the BN.


Interviewees clearly want more collaborations like these, and planned succession management in instances where nursing academics leave the institution eg through an induction of new staff.

Q11.Regarding the learning, teaching & assessment of writing in nursing at

Griffith, are there other issues which you think need to be discussed here or followed-up?

A strong theme across all interviews was the need for:

assessment tasks to be more carefully designed to meet the motivational, cognitive, and writing needs of each year level

nursing academics to develop both shared meaning and standardised use of instructional terms used across the BN

consistent expectations around what constitutes quality sources of information for writing (web sources versus databases)

the need for a re-submission option for written assessment.

Specifically, the LSAs drew attention to the following seven issues:

1. heavily weighted assignments being presented without sufficient consideration for the prior learning experiences of students

2. the excessive cognitive and writing demands placed on first year students eg allocating 50 per cent of a unit's assessment to a short (1500 word) assignment and the anxiety felt by students

3. the need for more explicit scaffolding to support the purposeful development of writing

4. how inconsistent word use in assessment tasks confuses students eg a mismatch of key verbs in the instructions and the criteria sheet

5. the need for teaching staff to agree upon use of databases, and what „writing reflectively‟ means

6. the use of more appropriate diagnostic writing tasks to identify students at risk

7. their ability and willingness to assist nursing academics on all these matters.

That nursing undergraduates are particularly needy around writing for assessment was clear from two sources. First, 2008 AUSSE data for GU shows that year one and three students used learning support services at a rate above the national average. Second, there was a consensus among interviewed LSAs. These perspectives were supported by both specific and broad institutional measures. First, The Fellow was given access to de-identified data of the number and basis for consultations about 'academic skills' with Learning Service Advisors in 2008 across the university. Analysis of these found:

Across 25 schools at GU, nursing students had the largest number of

consultations with LSA, accounting for 55 per cent of consultations – most of

which were one-to-one conferences.

Of the 13 reasons given for these consultations (Figure 3), two accounted for

75 per cent – assignment planning and structuring (n=205 consultations), and

'unpacking' assessment questions (n=91 consultations).


Ass

ign p

l/str

Unpac

k Q

Ass

ign P

re-A

sses

s

Ass

ign-P

o Ass

ess

Ref

Rep

ort

Lit Rev

Unsp

ec

Aca

d Std

sOra

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Con M

ap

Per

sonal

Res

earc

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0

50

100

150

200

250

No

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Figure 3. The number of consultations nursing students made with Learning Service Advisors in 2008.

Legend: Assign pl/str = Assignment plan & structuring Unpack Q = Unpacking questions Assign Pre-Assess = Pre-assessment assignment Assign Po-Assess = Post-assessment assignment Ref = Referencing Report = Report writing Lit Rev = Literature Review Unspec = Unspecified Acad Stds = Academic standards Oral = Oral presentations Con Map = Concept mapping


3.2 Interviews with teaching academics from GU Throughout the fellowship, The Fellow interacted with a number of committed teachers from the SONM. Two of these agreed to be interviewed to provide a staff perspective on the learning and teaching of writing in nursing. Interviews were conducted between 21 and 23 June 2009 by Ms Cecilia Arrigoni. The emergent themes from the interviews are reported below. 3.2.1 Roles

Both interviewees were female academics and experienced clinical practitioners (8-14 years). Both had taught nursing in three universities including GU (8-10 years) and worked closely with nursing colleagues across the three campuses 3.2.2 Needs of students (around writing in nursing)

Q1. In your experiences of working with nursing students, what are the main

writing needs of nursing students? The interviewees reported that nursing students mainly need assistance with:

structuring their essay writing (introduction, conclusions, paragraphs, referencing)

how to use literature (to support claims)

poor spelling, sentence structure, not understanding what a paragraph is – these

should be required before enrolling at university

commitments outside university, and emphasis on academic writing reduces time

on clinical content.

Students write well when they:

find topics clearly relevant to nursing practice

come to university with good basic writing skills.

Q2. Where in clinical nursing practice is writing of greatest importance

(ie the sorts of writing in performing the duties of nurses in various work settings)?

“Whilst writing is essential is an essential need in nursing, it‟s more about the ability

to write legibly, legally, clearly – not so much academically” (direct quotation) eg

medication charts and orders

progress notes to record and convey information about patients (eg SOAPIE). This

is often done poorly by students on practicum placements

ICT-based proformas have reduced the quantity of writing required of nurses.

Q3. Being more specific about the types of writing in nursing, can you please identify the types of writing in the new BN program (list provided)?

At the time of interview, the general assessment plan (or schedule) of the revised BN program had been completed but staff had not finalised the details of assessment. One interviewee referred only to the existing BN program; the other provided tentative answers about the revised BN. Answers appear in Table 2.


Table 2. Types of writing in the existing and revised Bachelor of Nursing degree programs, as reported by interviewees

* the interviewee referred to the requirement for professional portfolios in the new AHPRA registration and accreditation scheme.

Type of writing In existing BN In revised BN

types that require self-reflection yes yes

types that require description yes yes

types that require a lot of argument yes yes

journal article reviews or critiques yes yes

essays yes yes

progress notes yes yes,

in OSCEs

reports yes yes

resumes no yes

job applications no yes

undergraduate dissertation yes, Honours yes, Honours

portfolios yes uncertain*

care plans yes possibly

(“…we‟ve moved

away from that in the

clinical area”)

action plans yes unlikely

business letters no no

memos no no

emails for the workplace no no (“…but a good

idea”)

Q4. Now thinking about the undergraduate degree experience of students (ie, across their nursing education – changes, trends, patterns across the program),

(i) What is your understanding of how the writing needs of students changes

across the 3 years?

description is emphasised in year one, developing to analytical writing in year three but we need to teach them how to do that – “I don‟t think we give them the tools to do that”;

many mature-aged students entering from TAFE in year two often need high support in academic writing. These students don‟t value this. A bridging program is offered for them

international students (especially those entering in year three) could be better supported with their writing

students learn more when they link writing to clinical experiences.


(ii) What is your understanding of how the writing abilities of students changes across the 3 years?

writing improves across the three years because the task are more complicated and we don‟t get an increase in fail rates

students improve in critical thinking and reflection

GU Academic Integrity process has helped some students write better.

3.2.3 Needs of teaching staff (around writing in nursing)

Q5. Can you describe your understanding of how writing for nursing practice is taught across the BN program?

in the existing BN,

- year one has too many written assessment tasks

- year two, is heavy on recall but with little writing

- year three has too many written assessment tasks.

A number of excellent learning, teaching and assessment activities across all

campuses were described, some of which are either published examples of

scholarship of learning and teaching, or are being researched currently eg semester

one of year one offers strong writing support is through co-ordinated actions of the

First Year Advisor, Learning Services and Library (Information Services) but after

this, it‟s more dependent on individual course convenors.

Q6. Can we now focus on the revised BN and in particular, the mapping of written

assessment (the interviewer presented maps of written assessment across both the existing and revised BN program. These acted as conversation triggers.),

(i) In terms of a program for improving writing-in-nursing practice, what are the strong points of the new BN?

Only one interviewee had familiarity with the assessment maps.

writing is now integrated across the three years, so students won‟t be 'de-skilled'

the notion that assessment is less 'fixated' on complex essays trying to address all

learning objectives, but more geared to what course convenors want to assess

the new BN has 'promised' to address is having course modules delivered by the

one lecturer, and the same assessment questions across each campus.

(ii) With regards to writing, what are the major changes (improvements and shortcomings) in moving from the previous to the new BN program?

existing BN places heavy demands on written assessment in year one, little writing

in year two, and lots of writing in year three

referring to the mapped written assessment for the revised BN, one interviewee

strongly claimed that the 'Presentation' in year two would, in practice, be replaced

by two examinations and multiple choice questions in order to accommodate

workload for one staff member (presumably a sessional employee).


Q7. I realise that working across campuses can be challenging for staff and

students. To what extent do you think academic staff work together across courses and year levels to address writing within and across the three campuses?

There was agreement from interviewees that:

there is a strong need for more collective effort amongst teaching staff – especially

across the three campuses. This was exemplified by statements like, “…we‟re one

school but we are three islands in that school...I think we‟re going to get better at

this” (direct quotation)

referring to the revised BN, “I don‟t think we have a cohesive development

plan…we‟ll have some major work to ensure that people are on the same page”

(direct quotation)

having the same meaning for common, key instructional words of assessment tasks

– a glossary is being constructed

more assistance for new academics to write better assessment tasks – peer review

of assessment was practiced on one campus. Reference was made to the

increasing difficulty of employing staff with academic experience

the consistency of marking standards needs to be addressed

there is division amongst staff about what writing should entail – both within and

across courses. For example, what types of writing should be included in the BN

program – traditional academic writing only, or non-traditional genres? Differences

also centre around aspirations for nursing education – what balance of 'academic'

(research-based) versus 'humanity of nursing' (practice-based) – and the teaching-

research nexus.

Q10.Can you briefly describe instances where academic and/or Learning Services

staff have worked well with students around the development of writing. Three examples of effective collaboration across campuses were described:

(a) the GU Amber Alert Risk strategy (whereby international students deemed by

course convenors to be 'at risk' of failing based on early assessment results are

referred to Learning Services) was associated with improved writing. Three

qualifiers were added – the process adds to staff workload; not all these students

actually seek professional support; and this support is needed by domestic as well

(b) the relationships between First Year Advisors and Learning Service Advisors is

strong, and positive outcomes are shared at monthly staff meetings

(c) in some year two courses, library staff teach students how to conduct literature

searches and essay writing.

Q8. The ALTC fellowship may set up a website dedicated to writing-in-nursing.

What would you like to see included? The following suggestions were made:

assessment resources geared to the needs of different year levels

assistance with reading comprehension

assistance of verbal and non-verbal communication eg a video of standardised

vignettes was suggested

“how do we use our resources more effectively?” (direct quotation).


Q9. Regarding the learning, teaching & assessment of writing in nursing at

Griffith, are there other issues which you think need to be discussed here or followed-up?

The staff members included various additional comments throughout the interview. The main issues are summarised below:the assessment maps are useful for the teaching staff to guide the planning of future assessment tasks

“…there must be more interesting ways of assessing students than all these

essays” (direct quotation)

the need to assist postgraduate students with their writing, especially international

students

the division of staff beliefs around whose responsibility it is to teach the basic skills

of writing

work-related issues, including: high staff turnover, academic salaries lower in

comparison to clinical salaries, having short-term teaching contracts and increasing

student numbers were also raised as factors negatively impacting on learning and

teaching in the SONM.


3.3 Interviews with senior hospital-based nurse educators Senior hospital-based nurse educators were selected because their duties include support for the professional development of nurses, including how they write in workplaces. More broadly, from their experiences of the interface between academia and a wide range of heath care professionals, they could draw upon a wide range of learning, teaching and assessment issues. Additionally, they were likely to be aware of national and international trends around how writing is addressed within academic and professional nursing.

Letters of invitation were sent to the directors of nursing education at large, Queensland Health hospitals in the cities of Brisbane, Logan and the Gold Coast. All respondents declined but forwarded the names of senior staff who subsequently agreed to be interviewed. Interviews were conducted on hospital campuses between 13-16 July 2010 by a research assistant, Ms Jo-Anne Clark. The results are summarised below.

3.3.1 Roles

Q1. Can you briefly describe the main roles/position duties in your current

position? All interviewees (two female and one male) were full-time, senior nurse educators with 14-23 years of clinical nursing experience; 8-9 years in nurse education; and had been in their current positions for one month to seven years. Among them, they had a mix of other professional experiences – working overseas, TAFE teaching and research in nursing. Their main duties were to support district education programs (12-month graduate transition; transitions to new clinical areas; preceptor; and postgraduate study) and co-ordinate and manage large, undergraduate clinical placements. The latter includes liaising with tertiary institutions (eg developing learning contracts; advise on nursing curriculum issues); matching students with nurse educators and clinical facilitators; and assisting facilitators with the assessment and management of students while on placements. Student intakes were from a number of universities and TAFE colleges but mostly from large, local universities. 3.3.2 Needs of nurses (around writing in nursing)

Q2. Starting with the main types of writing performed by professional nurses,

which of these are required and how important are they in their jobs? All interviewees emphasised that writing permeates all aspects of nursing practice in their hospitals (Table 3). The types of writing generated varied with the role of nurses while the volume of writing increased with seniority. Writing skills were taught in graduate transition programs (in at least one hospital). More senior positions (eg nurse unit managers; nursing directors of education) were described as being more managerial and entailing more types of academic writing eg reports, grants, journal articles.


Table 3. Types of writing performed by professional nurses in hospitals

Type of writing Use of writing in hospitals Targeted authors

types that require

self-reflection

portfolios for new national registration

requirements

graduate transitions program

Kolb‟s learning cycle (Kolb 1984)

all nurses

types that require

description

patient documentation emphasis on facts around direct

patient care; concepts

emphasised at senior levels

types that require

a lot of argument

transitions program

academic study

publications

responses to critical incidents

new graduates

those who specialise

senior levels

journal article

reviews or

critiques

evidence-based practices

journal clubs; continuous

professional development

assignments professional development graduate transitions program

care plans tick-and-flick proformas with provision

for notes (variance reporting)

used daily by ward nurses

action plans appraising performance senior levels

progress notes patient medical records eg SOAP used daily by ward nurses

portfolios AHPRA registration requirements

(introduced 1 July 2010)

all nurses

reports yes senior levels

resumes yes all nurses

letters careers advisory service all nurses

memos yes all nurses, mostly senior nurses

emails for the

workplace

yes all nurses

others job applications two-page letters – QH

employment

performance appraisals senior levels

development plans senior levels

research grants senior levels

polices & procedures senior levels

developing educational resources, eg

(PowerPoint® slides; orientation

programs)

senior levels


Q3. Choosing the most important types of writing, please describe in some detail:

the communicative purpose (what it meant to achieve)

the contexts (when and where it happens)

the intended audiences (who reads it or expected to respond to this).

The significance of writing in the workplaces for all nurses reflected the mandated requirements to systematically document decisions around patient care. Work in hospitals was described as being very busy and permitting little time for extended writing.

Care plans Care plans intended for other nurses at hand-over were described as essential writing tasks to communicate the status of the patient. The care plan was described as a “living document”, recording patient care that has occurred and needs to occur throughout the shift (eight to 12 hours). It is usually written “beside the patient‟s bed” but in practice, is sometimes drafted at the end of shifts. Other health care workers read these care plans to inform their own progress notes for patients. Misinterpretations mainly result from illegible text and ambiguities.

Work emails These emails were described as happening, “all day – every day”. One interviewee reported receiving 200 emails each day. This form of writing is best when short, succinctly written, factual and meeting clear purposes – the main one being to “maintain open communication”. Emails are often written to a range of ward staff who need to be informed about work issues, the key features being to present accurately, confirm and clarify. For example, emails to inform staff about student placements should contain the name of the facilitator, dates when students begin, and who can attend a proposed meeting. These were descried as being “fairly simple” to write in terms of grammatical requirements.

Q4. How have the types of writing required by nurses changed over time eg use of

technology)?

The introduction of acronyms (eg SOAP and variants) is increasing. This was seen as useful because these heuristics reinforce “best practice for everything”.

Report writing by senior nurses is increasingly required.

Use of ICTs is increasing, around logistics (eg bed transfers) and patient management (eg progress notes in some – but not all – hospitals), reducing the volume of free text. This has been paralleled by 'paper saving' promotions. One interviewee described that ICT use made them “a lot more aware of what you‟re writing because it‟s very clear on the screen…you can edit easily.” Writing in nursing has become more truncated and disjointed, “…it‟s become a bit of a shopping list”. They also reported no strong generational trends in mastering workplace writing supported by ICTs.

Q5. Given the types of writing required of professional nurses, how well do they

write? Interviewees initially answered “very average”, “reasonably well” and “some write very well and some struggle”. For one interviewee, with reference to spelling and grammar, the level of professionalism was reflected in the attention to details in writing at all levels of nursing – systemic problem, “You can infer a lot of reputation issues from a nurse who does not have good grammar or good spelling”.


Policies and procedures, and high-level memos were reported as generally being well written. There is a need for senior level nurses especially to write well eg “…in a legible, cohesive, comprehensive...format”.

Recognising that it is difficult to generalise, the following were reported as needing improvement:

- in the wards, progress notes may contain errors in sentence construction, punctuation and non-standard abbreviations eg SOOB (Sit Out of Bed). Progress notes could be written more clearly by using an action point of view using standardised acronyms eg the Event-the Action-the Response (EAR). In some cases, ward nurses forget to write observations on charts or hand-over sheets

- in the graduate transitions program for recent graduates, a 500-word assignment might be set. In the worst of cases, but in an increasing number of cases, errors include formatting (eg paragraphs), spelling, grammar and failure to adopt appropriate referencing conventions

- poorly written job application letters are the basis for rejection in a competitive workforce

- for some senior nurses, grant proposals may have the same list of writing errors.

Q6. When writing is not completed well, what sorts of actions are usually taken to

remedy this? All interviewees reported being highly vigilant around standards and initiating similar teaching-intensive responses to the reporting of concerns about the quality of writing that might compromise patient safety. Corrective responses included explicit support including the use of mnemonics to structure writing, modelling of high-standard writing and monitoring performance. For one nurse educator, setting high expectations, modelling these for facilitator and students was associated with claims of improved writing in seven months. There appeared to be differences across hospitals in how formally organised this pedagogical action was.

3.3.3 Needs of nursing students (around writing in nursing)

Q7. What types of writing do nursing students do when on clinical placements – the sorts of writing required to perform their duties competently?

There are “lots of writing opportunities” for students while on clinical placements. In these contexts, it includes adding to patient charts (eg fluid and observation charts), care plans and progress notes with all entries monitored and counter-signed by facilitators. Students may be asked to write practice drafts of progress notes for their facilitators. Students will typically also have academic and often reflective writing assignments associated with placements. These will reviewed by facilitators who provide feedback, with occasional re-submission requests. Q8. How well do most students (on placements) write? The answers were, “average…nurses are not great writers”, “…fairly well for the purposes”, and “…reasonably well”. One interviewee explained that, “…they lapse into telling a story…[they] like to tell stories, that's how we learn, by telling stories about this patient-that patient…”. Students must be able to write comprehensive notes in clinical settings. Some struggle with spelling and grammar.


It was expected that students learn to write more appropriately and with greater confidence and self-regulation as they gain further clinical experience. This expectation is coupled to the university teaching and assessment of writing for nursing practice eg completing charts. The writing that students initially bring to placement is of lesser concern than behaviours such as punctuality, time management, clinical skills, managing patients and critical thinking.

Q9. When writing is not completed well, what sorts of actions are usually taken to

remedy this? If students under-perform on placements, they may enter a learning contract involving their clinical facilitator. The student may have to write additional, formative writing eg PowerPoint® presentation, and/or a short, assignment on recent evidence-based practice, relevant to their situation. One interviewee reported that there was “…an unwritten expectation” of the standards of writing they expect in these cases. Students don‟t fail placements solely on the basis of poor writing. One interviewee explained that poor student documentation in progress notes was often associated with failure to know what to write and nervousness. Their corrective teaching response was to ask the student to write their initial notes on a piece of paper, give feedback through collaborative discussion, then the formal entry is made and counter-signed. At that hospital, facilitators receive a two-day workshop as teaching preparation suited for the scope of practice. This preparation deals with adult learning principles and providing feedback. One interviewee commented, “...I suppose it [writing] needs to be developed through the undergraduate training but also is something that we need to keep building on”. Section conclusion The roles of academics and senior nurses around writing Learning Service Advisors. These staff have expertise in the teaching and assessment of writing, and many have considerable experience of working with nursing academics. Their roles can strongly influence both teaching and assessment practices around writing. As a result of recent restructuring, Learning Service Advisors allocated to provide dedicated support in the Health Group are more likely to develop and sustain relationships with academic teaching staff. This provision will particularly assist new academics in nursing. The current and anticipated future demand for advisors outstrips capacity. Nursing academics. Those who teach into the undergraduate nursing curriculum are best positioned, but often not well prepared to support the teaching and assessment of writing in the academy. In recent years, the university has further enhanced professional development for program convenors positioned as leaders in curriculum, assessment and evaluation. However, the role of head of school remains undeniably the most influential on school practices. Uncertainties and tensions around authority and leadership of convenors remain serious obstacles in assuring quality program development and delivery. The impact of local champions around writing in nursing needs to be more evenly strongly supported throughout SONM. Senior nurse educators. These staff are highly mindful of how writing is performed in hospital settings and how patient safety partly depends on the effectiveness of nurses to


write. The roles of these staff obviously impact the quality of learning on clinical placements as well as the continuing professional development of hospital ward nurses. Student needs around writing Learning Service Advisors and nursing academics. The student cohort in nursing is diverse in age, prior academic learning and program enrolment. Learning Service Advisors and nursing academics perceive that many undergraduate nursing students have very high needs around writing. At university, these students struggle with academic writing in a range of genres, particularly with planning and structuring their writing, and need considerable assistance with how they might approach assessment tasks. There is an urgent need for writing tasks to more strongly draw upon nursing scenarios; for nursing students to receive more support for writing within their courses; and for students to understand how writing might develop across the curriculum to support high-order learning in nursing education, and address specific professional needs within diverse workplace settings. Senior nurse educators. Nursing students on hospital placements have many opportunities to write. However, the form of writing was mostly transactional, with emphasis on succinct, accurate and detailed description around patient care. Generally, staff did not expect students to be strong at this form of writing. Most students improved in their writing in hospital settings and there was evidence for well organised learning support. Modelling and one-to-one coaching of writing in the wards was a distinct pedagogical practice. Writing needs of teaching academics and practising nurses Learning Service Advisors. The design and sequencing of written assessment tasks both within courses and across the curriculum require more co-ordination. An explicit list of suggestions was provided to address the sharing of staff expectations and the need for explicit and consistent instruction and assessment around writing. Nursing academics. First-year co-ordination and university-wide supplemental support for writing were successful strategies. However, the concerns of LSAs were echoed by the academics interviewed. Additional concerns were: the need to provide more effective assistance to new teaching staff; to diversify writing across the curriculum; and to more explicitly support the development of writing across the curriculum. The number and type of work-related, industrial issues in nursing education present a complex challenge. Senior nurse educators. Senior nursing staff at hospitals were mindful of how writing in nursing continues to change over time eg with increasing use of heuristics to guide professional actions, and use of ICT. Nurses were generally considered not to be strong at writing, though the ability to write well using discursive forms was important for more senior nursing managers. Effective writing as, bound by rules of traditional grammar, was sometimes perceived as a proxy for professionalism. The ability for nurses to write was viewed as important and, being instrumental to patient safety, was monitored very closely.


Phase 3: Capacity building

KRQ3 How might the capacity of university staff be developed to more effectively teach and assess writing in the BN program?

The Fellow adopted a normative-re-educative approach to foster cultural change within SONM, one which encourages ownership and active collaboration (Cutcliffe 1997). Three means of building capacity and providing leadership around the learning and teaching of writing in nursing were supported through this fellowship: (i) professional contributions to existing project development and implementation within the SONM; (ii) providing seed funds for scholarship of learning and teaching (SoLT) projects around writing in nursing; (iii) providing an EndNote library on aspects of writing (including nursing education) for wide distribution; and (iv) 50 copies of the recent book on educating nurses (Benner, Sutphen, Leonard and Day 2010) will be distributed to SONM staff and key university groups.

1. Professional Contributions to existing projects within the SONM

1.1 SONM Learning, Teaching and Assessment Forum

A school-based 'Professional Partnering Forum for Learning and Teaching' was established in September 2010. The mission of this forum is to promote cross-campus collaboration for the undergraduate nursing and midwifery programs, focused on improving learning, teaching and assessment practices. The principal aim is to bring together like-minded people to network and exchange ideas/examples of good practice in learning and teaching, and advance initiatives to improve the learning experience of students. At the first meeting, on 29 September 2010, Professor Marianne Wallis (SONM) led discussions to:

reach consensus on the name of the forum and establish overarching goals with an action-oriented focus

establish terms of reference (eg frequency of meetings reporting mechanisms to Undergraduate Programs Sub-committee, Health Group Learning &Teaching Committee)

identify assessment reform (including assessment for learning and assessment of learning), SONM-based scholarship of learning & teaching, resource development and enhanced support for new academic staff, as the immediate priorities

plan future forums with workshops up-skilling SONM staff to explore written assessment practices across the existing BN program

plan initiatives for scholarship around our learning, teaching and assessment.

Developing “assessment literacy” (Boud and Falchikov 2006) was a focus of three three-hour workshops in 2010 (29 September, 4 November, 15 December). The Fellow led workshop activities for SONM academics around the assessment of writing within the new BN (and Midwifery) courses using an approach aligned with current university-wide attention on assuring academic achievement standards based on the career work of Professor Royce Sadler and modelled along the Assessment Standards Knowledge exchange (ASKe) approach developed at Oxford Brookes University. Learning Service Advisors also participated in these workshops. Three themes were explored:

1. the extent to which assessment schedules support academic achievement of individual students


2. the extent to which actual assessment tasks determine writing practices that facilitate learning to be a nurse

3. through consensus moderation, appraising the quality of actual student writing to calibrate staff conceptions of quality. From an empirical study in postgraduate nursing, Giddens and Lobo (2008) reported wide variation in marking largely dependent on the level of experience and expertise. This has clear implications for SONM where many teaching academics are inexperienced teachers.

The need to engage SONM staff in workshops to explore their teaching and assessment practices around writing was based on the work of Guskey (2002) who argued that transformational change happens more effectively when behaviours are first altered, rather than thinking – practical experiences of change shape teachers‟ attitudes and beliefs. This approach has been widely used by Michael Fullan (2006).

1.2 Sponsoring travel and accommodation for Professor Roger Watson,

Editor-in-Chief of Journal of Clinical Nursing

The Nursing Practice Development Unit of the Princess Alexandra Hospital organised Professor Watson's visit to deliver a three-day hands-on workshop entitled, Writing for Publication (24-26 November 2010). The workshop was located at the Nathan Campus and was attended by approximately 30 staff from both the Princess Alexandra Hospital and SONM. This sponsorship was organised through Professor Amanda Henderson, a joint ALTC Discipline Scholar in Health, Medicine and Veterinary Science (2010) and ALTC Fellow.

$2700

1.3 The Fellow was invited to be a consultant on a SONM-based project in 2010:

Hutchinson, L, St John, W, Sutherland, K, Mitchell, C, Latimer, S and Symons, G, „Hitting the ground running: Supporting the transition of EEN-RN students in the Bachelor of Nursing‟, Gold Coast campus.

This project had attracted funds from the university. Its main aim was to provide sufficient evidence that a bridging program heavily emphasising writing was successful. This program was piloted in 2010 for TAFE-educated, Endorsed Enrolled Nurses of mature age to transition more confidently and with academic success into year two of the BN program. The Fellow joined team members to implement workshops around transition writing issues. As clear evidence that this project was successful, the bridging program was approved later in 2010 as a new, intensive-mode, elective course to be implemented in the summer semester of 2011. The elective is called Foundation for Success in Nursing Studies.

The fellowship also provided small funds for catering ($246) at the workshops held before the commencement of each semester. 1.4 The Fellow was invited to support a second SONM-based pilot project in

2010:

Hutchinson, L and Fraser, I, „SoNM Student Essay Writing Support (SEWS)‟, Gold Coast campus.

This project targeted the need to develop peers within nursing to help students with essay writing. This complemented the existing PASS system in that it targeted specific forms of writing important in the nursing curriculum. The Fellow was a team member, providing workshops on writing to the student peers (academically successful, year two and year three students) who in turn assisted year one and


year two students with approaching writing tasks. SEWS augments other writing support services in the university such as GU Learning Services and EnglishHELP, but was deemed to be particularly useful for students in that it offered 'just-in-time', contextualised support for students‟ writing endeavours. The program also provided an opportunity for students to develop connections with their peers and be inspired by those who had gone before them.

2. Current and future scholarly outputs supported by the fellowship

2.1 Posters at ALTC Fellows' meetings

Moni, RW 2009, „A programmatic approach to developing scientific writing embedded in Health courses‟, Poster presentation, Sydney, 11-12 February 2009.

2.2 National Conference poster/brief talk

Moni, RW and Arrigoni, C 2009, „What do we know about assessed writing across the Bachelor of Nursing program?‟ Poster presentation, Australian Learning and Teaching Council Assessment Forum, RMIT University, Melbourne, 18 November, 2009. Moni, RW and Arrigoni, C 2009, „What do we know about assessed writing across the Bachelor of Nursing program?‟ Brief talk, Assessment in Different Dimensions: A conference on teaching and learning in higher education, RMIT University, Melbourne, 19-20 November. Moni, RW, Wallis, M, Patterson, E, Tower, M, Barr, J, Fenwick, C, Hutchinson, L and Arrigoni, C 2010, „Exploring Summative Written Assessment in Undergraduate Nursing‟, Griffith University Assessment Project, Promoting Good Practices in Assessment (2009-2010), Nulty, D, Royce Sadler, DR, Moni, RW & Smith, C.

2.3 Poster presentation

Hutchinson, L, and Mitchell, C 2010, „The EEN-BN Transitional Bridging Program: Promoting an equitable transition for students articulating to University from the VET sector‟, Poster presented at 13th Pacific Rim First Year in Higher Education Conference, Adelaide, 27-30 June.

2.4 Planned journal article

Hutchinson, L, St. John, W and Mitchell, C (in preparation), „Floating in a dinghy without a paddle: The transition experience of Endorsed Enrolled Nurses to a Bachelor of Nursing‟.

3. Awards

Certificate of appreciation awarded to Dr Roger Moni in recognition of his

contribution as a Program Coordinator in 2010 of the Student Essay Writing

Support (SEWS) Program. Awarded at the Griffith University Gold Coast campus

on 14 September 2010.

4. Seed funds for scholarship of learning and teaching projects around writing in nursing

As described under KRQ2, The new BN working party (Q2, point 4, p. 20), seed


funds were available to nursing academics who wished to develop scholarship of learning and teaching around any aspect of writing in nursing. Funds were offered on a number of occasions throughout the duration of this fellowship. There was minimal interest. Where there was interest, meetings were arranged and the project designs and funding were shaped to match the requirements of the GU Learning and Teaching Grant level 4 (approximately $5000) with which The Fellow was familiar. The Fellow took the position that he would act as a consultant. In order to offer maximum impact, submissions had to include:

include any writing-related topic of educational value to either nursing students and/or nursing teaching academics

multiple investigators to engage more academic staff

a project rationale with supporting evidence of being fit-for-purpose eg inclusion of results from pilot studies

inclusion of staff professional development based around engaged dissemination

traditional forms of scholarly dissemination eg conferences, journal articles

a mechanism for reporting to the ALTC on future progress – informing ALTC a budget itemising major expenditures

that outputs from funded projects explicitly acknowledge funding through this fellowship

on 19 Nov 2010, the ALTC agreed that Prof Nick Buys (Dean L&T, Griffith Health Group) would oversee as a mechanism for reporting expenditure and outputs from the fellowship. This followed the withdrawal and/or uncertainty of a number of small SONM-based projects around writing.

4.1 Projects which received seed funding from the fellowship in 2010

included:

“Hitting the ground running”: Supporting the transition of EEN-RN students in the Bachelor of Nursing, Gold Coast, Hutchinson, L., St John, W., Sutherland, K., Mitchell, C., Latimer, S. and Symons, G. $2250 Hutchinson, L and Fraser, I, „SoNM Student Essay Writing Support (SEWS)‟, Gold Coast campus. $1224

4.2 Projects with seed funding from the fellowship in 2011 include:

Hutchinson, L and Shaw, J, „Implementation of a peer-facilitated Student Essay Writing Support (SEWS*)‟, Griffith University.

Evaluations of the 2010 pilot study were encouraging but further funds were not available from GU. SEWS complements and synergises the GU Widening Participation Project (WPP) aimed at developing peer-supported study skills for students from economically disadvantaged backgrounds, and will be implemented across all year levels across the university. SEWS* facilitators will be linked in with the WPP training program which is co-facilitated by Learning Services and Student Services.

* The Fellow has suggested to the principal investigator (Ms Lisa Hutchinson) that the word „essay‟ is removed, given the need to generate more diverse forms of written assessment.


5. The ALTC fellowship EndNote library on Writing in Nursing Education (WINE)

An EndNote library (with more than 300 references) on the learning and teaching of writing. This library was developed largely by Ms Cecilia Arrigoni throughout the duration of this fellowship as a resource to be widely distributed through the ALTC website for this fellowship. The aim of the library was to support (or „kick start‟) scholarship of learning and teaching around writing in nursing. The following (21) nursing journals were searched for references to writing:

o Annual Review of Nursing Education

o Australian Electronic Journal of Nursing Education

o Australian Journal of Advanced Nursing

o British Journal of Nursing

o Computers in Nursing

o International journal of nurse education & scholarship

o International Journal of Nursing Practice

o Journal of Advanced Nursing

o Journal of Continuing Education in Education

o Journal of Nursing Education

o Journal of Nursing Management

o Journal of Professional Nursing

o Nurse Education in Practice

o Nurse Education Today

o Nurse Educator

o Nursing Education Perspectives

o Nursing and Health Care Perspectives

o Online Journal of Nursing Informatics

o The Clinical Teacher

o The Journal of Continuing Education in Nursing

o Journal of Clinical Nursing.

In addition, a broad range of hard-copy and online resources have been included. Therefore, the interests of those from nursing and midwifery backgrounds, as well as those interested in the applied research and teaching of writing across the curriculum, have been considered.

6. Resource book on educating nurses Towards the end of this fellowship, The Fellow purchased a copy of the book: Benner, P, Sutphen, M, Leonard, V & Day, L 2010, Educating nurses: A call for radical transformation, The Carnegie Foundation for the Advancement of Teaching, Preparation for the professions, San Francisco, Jossey-Bass. The Fellow introduced this book to SONM staff at the November workshop on assessment reform and recommended that:

academic staff use the book as a common resource to stimulate collaborative conversations; and

that current up-skilling of SONM academic staff around assessment reform would complement these conversations and future projects around scholarship of learning and teaching.


This book focuses on curriculum reform of nursing in the USA. Of particular interest for SONM will be:

a description of global changes to nursing practices that require re-examination of nursing curricula;

the call for change based around nursing programs (the focus on this fellowship);

identification of four needs around the teaching of nurse education:

o shifting from the current transmission of decontextuaised knowledge to teaching for salience, situated cognition and action in specified clinical situations;

o integrating teaching in academic and clinical settings;

o supporting a clinical reasoning and other forms of thinking, not just critical thinking;

o shifting from the current emphasis on socialising forces to professional formation ie the evolving agency, commitments, practice capacities and identification with the standards of quality nursing.

the inclusion of detailed vignettes of exemplary nurse educators (“paradigm cases”).

It is surprising that this book does not explicitly address assessment.

Section conclusion Capacity building entails approaches that target one or more of four levels – bottom-up, top-down, partnerships and community-based (Crisp, Swerissen and Duckett 2000). Activities in the final phase of this fellowship addressed all four of these approaches by:

identifying and supporting „local champions‟ of learning and teaching in SONM. This bottom-up approach enabled these academics to expand teaching and assessment skills as technical expertise, and develop a deeper understanding of how EEN–RN students might be more effectively supported. Through participation in workshops, key individuals in SONM have been able to generate and implement their ideas around writing in nursing;

resourcing (eg the WINE EndNote library; the resource book) and providing educational expertise for SoLT projects. This top-down approach impacts on decision-making around the selection and programmatic sequencing of written assessment tasks across the BN;

strengthening the collaborations among SONM academics, and between these academics and LSAs eg in the workshops of the LTA forum. This partnership approach builds the „network density‟, information exchange and re-focussing of services to better support the teaching and assessment of writing in nursing; and

connecting key leaders in the nursing community. This community-based approach enabled a senior nursing educator and editor of a major nursing journal (Professor Watson) to run writing workshops for nurses from the hospital and university settings.


Outcomes and Recommendations

Major achievements of the fellowship

From KRQ1 (investigating existing teaching and assessment practices around writing):

The evidence base for student academic achievement and assessment practices in the existing undergraduate nursing curriculum has been broadened and enriched.

From KRQ 2 (building relevant models to embed teaching and assessment practices around writing):

These new data samples and the perceptions of key stakeholders were used to affirm the quality of some teaching and assessment practices, and inform the actions of the working party to steer major revision of the BN program.

From KRQ 3 (building capacity around the teaching and assessment practices of writing):

The new data accumulated are currently being used to inform collaborative conversations and workshops around reform of teaching and assessment of writing in the revised BN.

SONM staff willing to lead reform of teaching and assessment of writing in the undergraduate BN were identified and supported through professional and funding activities which will continue into 2011. The fellowship activities were innovative to the extent that they provided ideas, products and services that were adopted by SONM and LSAs to add value to, or transform current practices around assessment of writing (Southwell, Gannaway, Orrell, Chalmers and Abraham 2005). Schwartz, Bransford and Sears (2005) proposed that the goal of change should be “adaptive expertise” – where the commitment to innovation needs to be balanced against the efficiency of routine curriculum delivery. For a focus on writing, nursing academics will need to juggle their skills in interrogating their practices, developing a shared vision and acting upon motivation to improve based on appropriate evidence.

Recommendations

Writing in the curriculum needs to be more explicitly conceptualised to support the formation of professional identity in nursing. This will be better understood by nurse educators after they have calibrated their conception of academic achievement standards. There is considerable interest in how academic literacies underpin formation of identity of undergraduates (Gourlay 2009) as well as teaching academics (Lea & Stierer, 2009).

The 2010 Carnegie report on nursing education should be used by nursing academics to explore how writing can support student learning and the formation of professional identities in the revised BN curriculum.

Ongoing close collaboration with Learning Service Advisors is necessary but not sufficient for nurse academics to develop the learning-focused leadership required.

The nascent community of practice around scholarship of learning and teaching needs to foster learning-focused leadership around writing (and other literate practices) so that nurse academics become more confident and competent writers. This community of practice is currently called the LTA forum however this may change with restructuring on SONM following a school review towards the end of 2010. Regardless, SONM academics need expert educational support to help them apply their rich professional experiences to teaching and assessment in academic contexts, thus close the practice-education gap, and act as a mechanism for developing the writing proficiencies of nursing academics who teach. This support is being provided through the Griffith Institute for Higher education and the Griffith Health Group.


Milestone events of the fellowship The milestone events of this fellowship are summarised chronologically in Table 4.

Table 4. Milestone events of the fellowship

Events 2008 21 July Commence employment at Griffith

26 Nov DVC(A) endorses fellowship around “scientific writing embedded in Health courses”

2009 30 Jan Fellowship described to Acting-Health Group Dean of L&T

25 Feb Fellowship described to Health Group Dean of L&T 3 Mar Employ Research Assistant (0.3) 4 Mar Meeting with Manager of Learning Services 5 Mar Through Office of Health Dean L&T, scoping of schools in

which the fellowship might be based 6 Mar Noted my concerns about Schools buy-in around both (a)

the significance of writing in their curricula and (b) writing as a focus on program (rather than course-level) work

16 Mar Meet with Head of School of Medical Science 23 Mar Meet with Head of School of Nursing and Midwifery –

agree to program level improvement around revision of BN degree program

GU legal clearance to analyse course-level assessment data

Statistical analysis of 2008 assessment results, comparing written with non-written tasks

18 May Interim report submitted to ALTC 24 May Submit statistical analysis of written assessment to SONM 25 May Meet program convenors drafting revised BN; each

convenor taking responsibility for one Year Level 29 May Critical thinking skills and reading / writing identified by

Nursing academics as needing clarification in revised BN 12 June Present fellowship and course assessment analyses to

seven nursing academics from Nathan campus 16 June Meet nursing staff with specific interesting writing – “local

champions for writing” 19 June Invited as consultant on pilot study of EEN-RN Transition

project (Hutchinson) 8 July Finished sampling assessment designs for writing 21 July Informed of excessive student writing requests for Learning

Advisors 22 July Meet with three Learning Advisors about writing needs of

nursing students 5 Aug Meet with five more Learning Advisors 20 Aug Invited to join BN working party as educational consultant 23 Aug Meet with Prof Wallis, Chair of Curriculum Development

Committee; and Head of SONM 1 Sept Meet with working party

Submit and discuss analysis of existing BN curriculum around learning, teaching and assessment of writing, an suggested improvements to inform revised BN program (12-page document submitted by The Fellow)

16 Sept Offer seed funding to support EEN-RN Transition project


22 Sept Meet with working party

Introduced members to ideas and literature (Sadler) about assessment standards and quality design

29 Sept Whole of SONM meeting to dissemination of fellowship findings

6 Oct Offer consultancy and funding support for a Special Interest Group in nursing L&T to support professional development and scholarship of learning and teaching

13 Oct Fellowship EndNote library distributed to nursing staff on EEN-RN project

16 Nov Collaborate with Logan nursing staff around future workshops

17 Nov Meet Prof Patrick Crookes (Chair of the ANZ Council of Deans of Nursing and Midwifery) at RMIT assessment forum

7 Dec Meet with working party

2010 5 Feb Meet with working party; offered the mapping assessment across revised BN to assist assessment reform Recommend Zilm (2009) and Gimenez (2007) as useful reference books to support teaching & assessment of writing in nursing

16 Feb Maps of assessment across revised BN program distributed to working party

5 Mar Offer to assist with assessment reform 8 Mar Update Head of School on fellowship progress 30 Mar Approach Prof Crookes for support with distributing online

surveys to students and academic staff in nursing – support given

13 April Through ANZ Council of Deans of Nursing and Midwifery, distribute letter on invitation to 42 universities to participate in online surveys

24 April Received GU ethics approval 1 May Online surveys open 12 May Interviews commence 14 May Assessment maps redistributed to working party 24 May Interim report on surveys emails to participating universities 1 June Re surveys, reminder letter sent to 42 universities 2 June Suggest Learning Services-fellowship joint support for

writing workshops at Logan 15 June Provide seed funding to support the pilot transition of

“Hitting the ground running” (EEN-RN students at Gold Coast campus)

First meeting to provide feedback on a Logan proposal to develop a project on reflective journaling in nursing – project not pursued by nursing staff

21 June First meeting to develop Logan project (Modelling Effective Writing) across three universities – project not pursued by nursing staff

1 July Surveys stopped 20 Aug Resources and workshop support for proposed L&T Forum

in nursing (via Lisa Hutchinson) 29 Sept 1. Inaugural meeting of L&T Forum (Wallis & Hutchinson)

2. Offer fellowship support for documenting/publication of change processes


1 Oct Write case study as part of the Griffith Good Practices in Assessment project (Nulty, 2009-2010) for internal distribution

21 Oct Commence discussions to support mentoring of nursing staff around their own writing (Henderson & Billet)

19 Nov Meet with Dean L&T, Health (Buys) to manage remaining funds

22 Nov Agreement form ALTC to pool and transfer remaining funds to Office of Dean L&T, Health

15 Dec Third workshop with SONM L, T &A Forum

Links with other ALTC studies in nursing education

This fellowship adds to the educational information about nursing education in Australia. It complements the following recent or current ALTC-funded studies selected because they address literacy issues, assessment and/or leadership in nursing education:

The Learning and Teaching Academic Standards (LTAS) Project

Professor Amanda Henderson and Associate Professor Maree O‟Keefe. ALTC Discipline Scholars

The development of an undergraduate nursing competencies assessment tool for use across Australian universities (CG7-523)

Lead Institution: University of Wollongong Partner Institution(s): The Council of Deans of Nursing and Midwifery (Aust &

NZ), Curtin University, Queensland University of Technology, University of Technology, Sydney, University of South Australia

Project Leader: Professor Patrick Crookes

Developing a model for interprofessional learning during clinical placements for medical and nursing undergraduate students.

Dr Heather Alexander and Professor Amanda Henderson (Griffith University) Type: 2007 ALTC Teaching Fellow

Leading engagement of academic and clinical communities for learning.

Professor Debra Creedy, Dean of Health at Griffith University and Professor Amanda Henderson, Nursing Director, Education, Princess Alexandra Hospital

Supporting student transition to a futures-orientated professional identity

Fellow: Professor Ieva Stupans (University of New England) Type: 2009 ALTC Teaching Fellow

Practical leadership for developing and sustaining first year learning

environments that facilitate the success of a diverse student population.

Professor Keithia Wilson (Griffith University) Type: 2010 ALTC National Teaching Fellow


Evaluation of fellowship A brief self-evaluation is based on reviewing the major contexts, inputs, processes and products of this fellowship based in the SONM (Stufflebeam 2000). Contexts

Soon after being awarded this fellowship, the context for the fellowship changed when The Fellow accepted a new appointment at Griffith University. This change of institution was accompanied by a move from teaching bioscience to academic staff development. These two major shifts of work focus provided a considerable challenge to how the fellowship was adapted, as well as delaying the commencement of fellowship activities;

The principal educational need of SONM was to revise the BN around the organising themes of high quality patient care (p.10). This matched well with the intent of the fellowship to explore, problematise and sustainably support teaching and assessment practices around writing; and

The fellowship period coincided with the mandatory re-accreditation of the BN and an extraordinary, major performance review of the SONM. The latter impacted negatively on academics and likely decreased their engagement with the fellowship activities.

Inputs

Most of the fellowship activities were integrated with the school-based inputs into curriculum reform. The Director of the Griffith Institute for Higher Education generously recognised fellowship activities as part of core professional development. As such, the fellowship provided SONM academics with additional support for the mandated revision of the BN program;

The framework of Lea and Street (1998) presented three models of writing. In conceptualising effective writing as more than complying with the rules of traditional English grammar, it affirmed many existing teaching and assessment practices. However, the model of academic literacies which requires staff to articulate how writing in the academy might better develop professional identity was clearly a greater challenge and not achieved during the fellowship;

The budget was sufficient to support activities in all three phases. There were funds remaining at the end the fellowship because staff commitment to a number of capacity-building projects was withdrawn. It is hard not to see this as a missed opportunities;

The need to improve the teaching and assessment of writing in nursing became more apparent throughout the fellowship. The global analysis of summatively assessed writing in the BN did not identify particular needs of students or academics. Survey results pointed to the opportunity of introducing more self-and peer-assessment. Interviews with various stakeholders confirmed widespread concerns for the consistency with which written assessment in the BN was designed, and delivered across the three campuses.

Processes

The major fellowship activities included document analyses, the meetings of the working party, surveys, interviews, workshops, project support and resource development. All correspondence around the fellowship was recorded and from this, milestone events were identified (Table 4). The low engagement of universities in the international surveys was unexplained and particularly


disappointing. By contrast, findings from the surveys were informative about practices around writing and this report will hopefully support the much needed collaborations among stakeholders. Local champions of learning and teaching in nursing were identified and strongly supported by the fellowship. Direct engagement of nursing students was not an essential aspect of the fellowship but again, the findings might be used by convenors, LSAs and hospital nurse educators to shape conversations with students.

The fellowship was very ambitious. The Fellow started with a focus on using data as a conversation trigger, assuming that change would follow vision and that the process of change might be roughly linear ie, the outcomes of each phase of the fellowship would inform the next. In contrast, Fullan (2006) draws upon large-scale empirical studies to argue that successful educational change foregrounds action, skills development and capacity building over vision, persistence and flexibility over quick fixes and that change is usually neither rational nor linear. This may in part, explain the slow rate of engagement and change in SONM over 18 months of the fellowship.

The process of engaging SONM staff was impeded by an entrenched culture that fosters separation between many of the experienced, research-focused, senior academics and inexperienced, teaching-focused, junior academics. Thus, writing in undergraduate nursing at GU remains excessively focussed on the need for skills remediation, and academic discourses with restricted engagement of students in the formation of professional identities and capacities. Leedham (2009) offers ways in which academics might design and implement diverse, “non-traditional” forms of written assessment.

Products

The three main aims of the fellowship were not addressed in the order stated – auditing did proceed first, but SONM staff did not readily engage in the second phase of conceptual model building by SONM academics. This focus on abstract ways of understanding how writing supports becoming a nurse required considerable a deep reflection and knowledge how writing might be coherently developed across the existing BN program. This aim has yet to be achieved. The third aim of capacity building occurred earlier than expected because some SONM staff were already focussed on SoLT

The existing curriculum work of many SONM academics has been too strongly centred around both the sub-themes of course and campus. This threatens the coherence with which the revised BN is taught and assessed.

The university has recently engaged SONM to address issues of leadership around learning, teaching and assessment. These will likely facilitate the broadening of the fellowship‟s impact. However a recent ALTC-funded project around academic leadership and the roles of course co-ordinators indicates the often negative interplay among reform, work practice changes, managerialism and leadership capacity (Jones, Ladyshewsky, Oliver and Flavell 2009). Adaptive organisational change is neither trivial not rapid.

A number of SoLT projects will further explore student writing in the revised BN from 2011. This should synergise with the activities of the Health IDEAS.

Planned and new SoLT projects receiving support from this fellowship will also build a quality evidence base to direct teaching and assessment innovations, engage more SONM staff, support career prospects around the teaching duties of academics on SONM.

The Writing In Nursing Education (WINE) EndNote library and the Carnegie book reforming nursing education are resources that can foster writing-focused collaborations within and beyond GU.


APPENDIX 1: Quantitative features of written assessment tasks (ATs) in 2008 BN courses

* not all course details were available. However, data include most courses with substantial

emphasis on writing. SD= standard deviation.

Year Level

Number of courses*

(from total)

Number of written ATs

Word length of ATs

(mean± SD)

Total word length of

written ATs

1

4/8 4 1375±250 5500

2

3/8 3 2167±289 6550

3

5/5 5 2340±422 11700


APPENDIX 2 Summary of sampling rate of student 2008 assessment data

GC = Gold Coast; LG = Logan; NA = Nathan campuses.

Campus

(sample size relative to enrolment)

COURSE GC GC (off site) LG NA

1971NRS 168/197 ---- 127/146 137/152

1972NRS 179/200 ---- 115/124 150/163

1977NRS 158/177 ---- 125/133 131/140

1976NRS 136/165 ---- 111/115 121/126

2973NRS ---- ---- 155/177 161/170

2974NRS ---- ---- 133/137 126/137

2976NRS 175/190 ---- 133/143 138/145

2977NRS 198/210 40/45 154/171 158/170

2978NRS 189/217 ---- 169/182 153/169

3971NRS 163/167 ---- 112/122 110/120

3975NRS 146/150 ---- 100/101 101/106

3976NRS 173/182 16/19 109/110 132/138

3978NRS 150/151 ---- 96/98 98/102

3979NRS 125/151 ---- 92/95 99/103

The calculated sample rates (mean ± SD) for each Year Level were:

(i) Year 1 courses: 91±4 per cent, ranging from 82-97 per cent; four courses with 29 assessment tasks (plus the exit levels of achievement per course), represented by essays, portfolios, OSCEs and exams; with the breakdown per campus as GC: 87±3 per cent, LG: 93±4 per cent; NA: 93±2 per cent.

(ii) Year 2 courses: 93±3 per cent ranging from 87-99 per cent; from five courses 36 assessment tasks (plus the exit levels of achievement per course), represented by essays, assignments, pass/fail clinical assessment tools and exams; with the breakdown per campus as GC: 91±4 per cent; GC (off campus): 89±0 per cent; LG: 94±4 per cent; NA: 93±2 per cent.

(iii) Year 3 courses: 95±5 per cent, ranging from 84-100 per cent; five courses with 43 assessment tasks (plus the exit levels of achievement per course), represented by assignments, workbooks, posters, presentations, tutorial participation, pass/fail clinical assessment tools and exams; with the breakdown per campus as GC: 94±7 per cent; GC (off campus): 84±0 per cent; LG: 97±3 per cent; NA: 94±3 per cent.


The calculated sample rates (mean±SD) were from each campus:

o GC: 91±6 per cent from 12 courses

o GC (off campus): 87±3 per cent from 2 courses

o LG: 95±4 per cent from 14 courses

o NA: 94±3 per cent from 14 courses.


APPENDIX 3 Quantitative features of written assessment tasks (ATs) in revised BN courses

* not all course details were available. However, data include most courses with substantial emphasis on writing. SD= standard deviation.

Year Level

Number of courses*

(from total)

Number of written ATs

Word length of ATs

(mean± SD)

Total word length of

written ATs

1

5/8 5 1950±622 9750

2

5/6 7 1543±574 10800

3

5/5 6 2083±492 12500


APPENDIX 4 Letter inviting Heads of Nursing/Midwifery to participate in online surveys.

23 April 2010

Dear Colleague

I am inviting your School/Department to participate in an online survey study to be conducted across all

Schools of Nursing/Midwifery in Australian and New Zealand universities. This study is part of my Australian

Learning and Teaching Council Fellowship, entitled:

A programmatic approach to developing writing embedded in Nursing courses.

By participating in this study I hope your students and staff can develop and share a deeper understanding of what

“quality writing in Nursing” means when applied to both academic and professional contexts. These exchanges

might be both local and international.

As context, Nursing/Midwifery graduates need proficient writing skills adaptable to diversifying professional

and social contexts, communication modes and purposes. A key research question is: What do we know

about the ways in which writing is taught and assessed in the existing undergraduate Nursing & Midwifery

degree programs?

There are two surveys – one for undergraduates at all year levels, the other for academics who teach into

undergraduate courses. Both surveys will sample perceptions around the learning, teaching and assessment

of writing in and across their courses/subjects. The surveys are anonymous; will be available during May (but

may need to be extended into June); take 10-15 minutes to complete; institutional data will be treated in

confidence and returned to you during July-August; pooled data across institutions will be released on an

ALTC-sponsored website called Writing in Nursing Education but without linking data to institutions. This study

has Ethics approval from Griffith University.

If you wish your School/Department to participate in this study, can you please:

(i) email me, indicating that your School/department will participate in these surveys, and

include the number of students and staff who might access to the surveys (so that return rates can be

calculated), and

(ii) invite your students and staff to participate by completing the survey accessed at following URL

addresses,

STUDENTS www.surveymonkey.com//NursingMidwifery_students

ACADEMICS www.surveymonkey.com//NursingMidwifery_Academics

If you wish to know more, please do not hesitate to contact me (email is best).

Sincerely

Roger

Roger W. Moni PhD, BEdSt

Australian Learning and Teaching Council Teaching Fellow

Griffith Institute for Higher Education

Griffith University, Brisbane 4111, Australia

Email: [email protected]

Tel: (+617) 373-56815

http://www.surveymonkey.com/NursingMidwifery_students

http://www.surveymonkey.com/NursingMidwifery_Academics

mailto:[email protected]


APPENDIX 5: Responses of nursing students to online survey on writing


APPENDIX 6 Responses of nursing academics to online survey on writing

(institutional affiliations have been removed)


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