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Method simple: An electronic interactive tool helping nursing students prepare for written and oral presentation
Nurse Education Today 43 (2016) 10–14
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Method simple: An electronic interactive tool helping nursing students prepare for written and oral presentation Suzanne Harrison ⁎, Nathalie LeBlanc Université de Moncton, École de science infirmière, 18 avenue Antonine Maillet, Moncton, NB, E1A 3E9, Canada
a r t i c l e
i n f o
Article history: Received 10 November 2015 Received in revised form 20 March 2016 Accepted 18 April 2016 Available online xxxx Keywords: Writing skills Interactive tool Nursing students
a b s t r a c t Background: Developing reflective writing skills is an essential competency in nursing. Nursing schools recognize the importance of promoting scholarly thinking and academic writing amongst their student yet, there is a large gap in the tools and opportunities students receive to help them master these skills during their baccalaureate studies. Method SIMPLE is an innovative and interactive web based tool introduced in first year that can help nursing students prepare university papers both written and oral. Aim of the study: To discover how students learn to use the tool, what barriers affect proper use of the tool, and what role faculty plays in ensuring students' successful use of the tool. The study also sought to explore students' perception in regards to the contribution of the tool to improve their academic work. Research method used: Data was collected using two research methodologies. Method SIMPLE has a built-in satisfaction survey at the end of each of the six modules that provides quantitative and qualitative data about the tool itself. A qualitative descriptive study was chosen to better understand student and faculty's perceptions regarding the tool. Data was collected during three focus groups. Conclusions and recommendations: Students shared their experiences using the tool and talked at length about the importance Method SIMPLE's section “P” which explains in depth how to submit written papers. Participants recognized the benefits of having a web based tool. Results from the built-in evaluation surveys and descriptive analysis of the focus groups data also helped generate three types of recommendations: ways to enhance the tool itself, ways to enhance students' experience when using the tool and faculty's responsibility in helping students learn how to use the tool. © 2016 Elsevier Ltd. All rights reserved.
1. Introduction A lot has been written about the importance of developing academic writing skills in nursing students. In fact, developing writing skills is an essential part of nursing practice (American Association of Colleges of Nursing, 2008). Encouraging these skills helps enhance critical thinking (Naber and Wyatt, 2014) and increases academic success, including practical skills and competencies (Gopee and Deane, 2013; Naidoo, 2013). Bickes and Schim (2010), along with Luthy et al. (2009), mention that as academic skills increase, so can the success rates on a national licensure exam such as NCLEX. Preparing academic papers also provides students with the opportunity to develop their professional identity by reflecting on how their experiences, both theoretical and practical, shape their vision of nursing (Lavelle et al., 2013; Naidoo, 2013). To encourage deeper reflective writing, academic writing skills need to be developed throughout the nursing program, thus supporting WAC, the American movement that encourages writing across the curriculum (Andre and Graves, 2013; Naber and Wyatt, 2014; Troxler et al., 2011; Salamonson
⁎ Corresponding author.
http://dx.doi.org/10.1016/j.nedt.2016.04.008 0260-6917/© 2016 Elsevier Ltd. All rights reserved.
et al., 2010). WAC has also been associated with concepts such as writing through learning (WTL), writing in the discipline (WID), and embedded learning, all of which, according to Luthy et al. (2009) encourage the “production of clear, accurate and relevant writing” which leads to “an essential competency in nursing” p. 54. Despite the many benefits of academic writing, there is a decrease in the support given by universities to develop these skills (Andre and Graves, 2013; Gopee and Deane, 2013; Tarrant et al., 2008; Troxler et al., 2011). Of the programs that exist, most focus on helping student locate, describe, interpret, summarize, synthesize, and critique credible information drawn from the literature (Andre and Graves, 2013; Naidoo, 2013). 2. Academic writing skills: Literature review Recently, two literature reviews were published that looked at how nursing programs encourage writing academic skills, one in Canada (Andre and Graves, 2013) and the other in US (Troxler et al., 2011). Andre and Graves (2013) looked at the websites of 81 Canadian bachelor of nursing programs including collaborative programs but excluding francophone programs and programs for diploma nurses seeking a nursing degree. Almost half (48.1%) did not require English literature
S. Harrison, N. LeBlanc / Nurse Education Today 43 (2016) 10–14
or writing courses and only 4.9% offered academic writing courses specifically geared to nursing students. Andre and Graves (2013) believe that traditional English courses are less than optimal for preparing nursing students to become reflective writers because they are mostly required to write essays and research papers. After analysing 30 different types of writing approaches offered by the various programs in Canada, they concluded that schools of nursing need to have a discipline specific writing course to help develop “discursive knowledge and writing skills” p. 95. The course needs to expose students to APA document style to help students develop an evidence based nursing practice. They also believe that writing courses that are not discipline specific will be less likely to promote learning opportunities. As for Troxler et al. (2011), their review of the literature using three search engines produced 421 records, but after applying elimination criteria such as: articles not including nursing students, articles before 1990 and articles focusing on English as a second language, only nine articles looking at how bachelor of nursing programs teach writing in the US remained. They divided the writing programs in two categories: standalone writing programs and writing programs that span the curriculum. After highlighting different examples of the two categories of programs, they concluded that programs integrating the development of writing skills across the curriculum (WAC) are more effective. In general, they need to include five common elements: - short writing assignments, - training for faculty in offering constructive feedback, - sequencing writing assignments that build on prior learning (scaffolding), - giving samples of successful writing or explaining grading rubrics - and giving drafts with feedback.
Despite discovering six BN programs that adopt an across the curriculum approach in the US, Troxler et al. (2011) believe that more anecdotal evidence is needed to help determine the efficacy of those programs. In fact, universities offer different programs, which include, but are not limited to, one-on-one tutoring, peer review, writing retreats, English as a second language programs, writing workshops, writing seminars, writing centres, writing tutorials, and writing styles. Some authors believe that by helping students develop writing skills they also develop informational literacy (Andre and Graves, 2013; Bickes and Schim, 2010). Despite the different programs available, several students continue to have a hard time writing; they submit poorly written papers, they have difficulty knowing how to write and how to proceed when writing papers (Andre and Graves, 2013; Bickes and Schim, 2010; Tarrant et al., 2008; Troxler et al., 2011). This can be especially problematic when English is a second language (Salamonson et al., 2010), or a foreign language (Lin and Yang, 2011). Because writing academic papers can be very overwhelming experiences that cause stress and anxiety in students, it's important to use scaffolding to help break down the writing skills (Lin and Yang, 2011; Horstmanshof and Brownie, 2013; Troxler et al., 2011; Tarrant et al., 2008). To encourage reflective writing, universities need to build on prior learning (Tarrant et al., 2008) and their writing programs need to be intensive, directed experiences that are also structured and flexible (Carroll et al., 2013; Stine, 2010; Wichadee, 2010). Salamonson et al. (2010) believe that helping students acquire writing skills takes time and they require detailed feedback, both formative and summative, by trained facilitators, be it peers or faculty (Andre and Graves, 2013; Bickes and Schim, 2010; Gopee and Deane, 2013). A review of the literature for the last five years reveals that universities and colleges are increasingly encouraging the use of technology based formats such as wikis (Carroll et al., 2013; Lin and Yang, 2011; Griffiths and Nicolls, 2010; Wichadee, 2010) and discussion boards
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(Horstmanshof and Brownie, 2013; Stine, 2010) to promote writing skills. However, of all the studies found, only one examined ways to enhance student nurses' writing by using a blended learning approach supported by an electronic aid, e-Support4U, (Horstmanshof and Brownie, 2013). This approach promoted a “community of learning” during clinicals where nursing students used e-communication tools, blogs, wikis, and discussion boards to share and reflect on written assignments. A detailed review of the literature revealed no other studies where researchers or faculty explored the use of web based tools to help nursing students develop academic writing skills. 3. Purpose of the article The purpose of this article is therefore twofold. Firstly we wish to share our francophone school of nursing's experience in creating and evaluating Method SIMPLE: a web based interactive pedagogical tool helping students achieve better success when submitting university papers, both written and oral. Secondly, we will also share results of a qualitative study describing the lived experiences of nursing students and Faculty who use this tool. 4. Creation and evaluation of method simple 4.1. Description of the pedagogical tool Method SIMPLE was created in 2008 by a group of three professors who taught first year courses in the bachelors of nursing program. All were unsatisfied with the old method used to help students present proper academic papers which consisted of them buying, reading and mastering the content of a brief paper document explaining the proper way to present an academic paper loosely based on a francophone adaptation of APA's methodology. Students had no face to face explanations about the document and it was often misplaced or lost causing students to have to return to the bookstore to buy another copy. The web based tool was created to offer students a readily available and interactive tool that they could access at any time. Students are first exposed to Method SIMPLE in their first year Introduction to Health Science class where they learn how to use it and learn about its content. Faculty members in the following years of the program instruct students to refer to Method SIMPLE when they have difficulty preparing oral and written presentations. Method SIMPLE, like other course content is housed on CLIC, a web-based software learning management system
Table 1 Sections present in Method SIMPLE. Title of the module
Content found in the module
S: Sorts of information
Different types, forms, sources, and locations where credible information can be found along with information retrieval strategies (ex. search engines, data bases) Directions on how to collect, analyze, and synthesize the collected information using software such as RefWorks or FLOW Recommendations regarding how to transmit information based on the audience (ex. general public, other healthcare professionals) Requirements when preparing an oral or written presentation/paper. Detailed summary of the APA publication guidelines, PowerPoint presentation suggestions, example of a written letter Examples on how to transmit a clear and precise message that respects the audiences' stage of development (ex. tips regarding Piaget's stages of cognitive development) Revision of the key points when presenting an excellent written paper including a printable checklist
I: Information being communicated M: My audience
P: Path required (written or oral)
L: Language required
E: Excellence
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S. Harrison, N. LeBlanc / Nurse Education Today 43 (2016) 10–14
designed by Desire2Learn. The word SIMPLE is an acronym representing the content of each of the six modules present in the tool (see Table 1). In 2011, four different interactive additions were integrated into Method SIMPLE. These included:
was conducted through invitation emails, brief presentations in nursing courses, and lastly, with the help of student council representatives when student recruitment proved challenging. 5.3. Ethical aspects
- quizzes with formative feedback at the end of each module, using the evaluation function in CLIC - two audio clips in module “M” demonstrating proper and improper use of the SBAR technique as recommended by the Institute for Healthcare Improvement when communicating important information with other members of the health care team (“S”ituation, “B”ackground, “A”ssessment and “R”ecommendations), - three interactive activities in the module “P” (find the errors in a title page, a list of references and French errors in a text), - and two videos in module “P” demonstrating proper and improper ways of giving an oral presentation assisted by PowerPoint.
Although evaluation of the tool is an ongoing process, major changes are planned to coincide with the release of new editions of the APA Publication manual (2010). Minor linguistic and structural corrections where made in 2011 with the publication of the 6th edition. Adjustments to the tool were also based on anonymous feedback received by the users who filled out the electronic surveys at the end of each module. The following section presents more information regarding the results of those surveys.
Authorization from the university's ethics committee was obtained prior to conducting the study where no changes were required of the research protocol, the data collection tools or consent forms. Clear and informed consent was obtained from each participant prior to beginning the focus group which were digitally recorded. 5.4. Data collection A semi-structured interview guide was used to collect data during three focus groups that were conducted between December 2014 and January 2015. The first focus group was with four nursing students, three female and one male, enrolled in the first and second year of the program (novice users of the tool), the second focus group was with ten female nursing students enrolled their third and fourth years of the program (more experienced users of the tool) and the last focus group was conducted with six female senior and junior Faculty members who adopt the Method SIMPLE in their courses. Participant recruitment of first and second year was particularly difficult, possibly due to an interdisciplinary activity that took place in the same time period. 5.5. Data analysis
4.2. Built-in evaluation results of Method SIMPLE Students and Faculty using Method SIMPLE are encouraged to access a small survey at the end of each module where they can indicate on a Likert scale to what point they agree or disagree with seven evaluation criteria. They are also asked three open-ended questions regarding what aspects were most liked along with what aspects were less useful, and those aspects requiring fixing. Regrettably, only one to 2 % of the almost 2000 users since 2008 chose to fill out the surveys. Despite this small number, the information received helps to partially evaluate the tool and bring about periodic changes, such as those undertaken in 2011. A high percentage of the users (65.2% to 91.3%) were in agreement or total agreement with all seven evaluation criteria, which include: general appearance, ease of use, accessibility, content appropriateness and ease of understanding, pertinent and working links to websites and documents along with successful use of animation. Because the response rate to the online surveys was low and the data gathered was mostly quantitative and evaluative in nature. More information was needed to explore what users felt about their experiences using the tool. The following section describes the efforts taken in 2014–2015 to answer this question. 5. The lived experience of method simple users 5.1. Aims The purposes of this qualitative study were (1) to describe how students learn to use the tool, (2) what barriers affect proper use of the tool, and (3) what role Faculty play in ensuring students' successful use of the tool. The study also sought to explore students' perception in regards to the contribution of the tool to improve their academic work. 5.2. Setting and participants A purposive sampling technique was used to recruit participants as this approach is useful when seeking to increase comprehension in an innovative area of study or to attain a thorough understanding of a multifaceted experience or event (Munhall, 2012). The recruitment process
NVivo 8 software was used to assist in data analysis using Sandelowski's method (2000) for descriptive analysis. Although open to emerging themes and categories in which to classify data, certain themes were predicted based on the structure of the Method SIMPLE tool and questions asked in the semi-structured interview guide. 5.6. Findings During the focus groups, it was expected that feedback would be obtained regarding the lived experience of users with the content covered in each module of Method SIMPLE. However, the vast majority of the comments touched module “P” entitled “Path required”, where students and Faculty members stated that they often refer to the APA methodology. The following paragraphs take a closer look at each of the three focus groups presented in chronological order. The first focus group involved third and fourth year students who stated that they began using Method SIMPLE more seriously during the third year of their program when complex writing assignments were required thus increasing the need to improve their writing skills. Method SIMPLE was described as being a very user-friendly tool that provided them with various examples, especially those related to proper referencing. However, most felt that more reference examples would be beneficial. The participants expressed “It's just the references, there are not enough examples. That's what's missing”. They also mentioned that despite that fact that some of the Faculty openly answered their questions regarding Method SIMPLE, they could be more consistent when giving feedback regarding their student's academic work. In the second focus group, first and second year students expressed being a little overwhelmed by Method SIMPLE at the beginning of their nursing program. Small reflective writing assignments during the first year helped students become more at ease with the tool, although most felt there weren't enough assignments during the first year. One participant said, “I find that when they introduce the method SIMPLE in our 1st year, we learn it, but we don't practice enough¨. Despite the fact that the students found it challenging at the beginning, they stated that the tool was easily accessible and very easy to use. During the focus groups, a participant stated, “Whenever I have a project in a course, I use the method SIMPLE, it is very convenient”. Another participant
S. Harrison, N. LeBlanc / Nurse Education Today 43 (2016) 10–14
mentioned, “You know exactly where to find the information you're looking for, it's convenient and accessible”. Finally, they described the advantages of having a Faculty contact person who would be available at all times to answer questions regarding Method SIMPLE. After discovering the lived experiences of nursing students who use Method SIMPLE, it was time to turn our attention towards Faculty members, especially since some of the students recommendations involved or affected them directly. Similarly to the prior student focus groups, the final focus group with Faculty members started by praising Method SIMPLE for its ease of use and accessibility. Faculty members also confirmed that difficulties with writing skills seem more prevalent during the first two years of the program. To better help the students with their writing skills, they reinforced the need for Faculty to stand together and provide accurate feedback in regards to Method SIMPLE. Lastly, participants in the Faculty focus group noted that method SIMPLE is not always updated and the transfer of knowledge from theory to practice could be optimized. In summary, despite only having four students in the second focus group, their lived experiences as novice users of Method SIMPLE mirrored those of the third and fourth year students. In fact, one of the major strengths raised by the all of the focus group participants were that the tool is easy to access along with being very user-friendly, as also noted by quantitative data from the built-in Method SIMPLE evaluation tool. In addition, the students believed the tool helped them successfully complete their academic papers. They also expressed that Faculty members were open to answering their questions in connection with the APA methodology and Method SIMPLE as a whole. One of the main challenges discussed was the lack of reference examples using APA methodology. Other challenges were the correcting inconsistencies from one professor to another and also from one program to another. Finally, Faculty, along with students, noted that there seems to be a lack of papers requiring the Method SIMPLE following its introduction in the first year of the nursing program. 5.7. Recommendations to improve Method SIMPLE Following the data analysis from the three focus groups, three types of recommendations are formulated; those to enhance the tool itself, those to enhance students' experience when using the tool and Faculty's responsibility in helping students learn how to use the tool. These recommendations can be found in the Table 2. 6. Discussion Naber and Wyatt (2014) present different ways to increase WAC which include the creation and maintenance of a portfolio. Since our school of nursing already requires students to develop an e-portfolio during the entire four years of the bachelor of nursing, this, in conjunction with activities surrounding the use of Method SIMPLE, are great ways to encourage reflective writing. For their part, Gopee and Deane (2013) conducted a qualitative study at a British higher education institution looking at what student experienced when they received help from the writing center. Their
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thematic analysis of the interview data revealed similar results to the current Method SIMPLE study. Students identified barriers to writing that included the lack of support and knowledge about writing conventions (i.e. mastering publication styles such as APA). Gopee and Deane (2013) also identified enablers to academic writing, such as feedback and support from Faculty and receiving clear assignment guidelines. Students can benefit from a community of practice when it comes to writing where peer support is offered. Our school of nursing includes volunteering as a rubric in its portfolio but has no formal requirements are made in this regard. To better support students in developing academic writing skills and informational competencies, we could create volunteer opportunities for third and fourth year students who could partner with first and second year students who are learning to write academic papers, thus meeting two objectives with the same initiative. Luthy et al. (2009), along with Griffiths and Nicolls (2010), also support the idea of peer tutoring to help encourage WAC. Luthy et al. (2009) describe their experience at Brigham Young University, revealing that “not only do students become stronger written communicators, but they also tend to understand the course material more completely when required to write about it” p. 59. They believe, like others, that increasing writing skills in nursing students can also help increase success rates in the NCLEX licensure exam (Naber and Wyatt, 2014; Bickes and Schim, 2010). Since Canadian nursing programs are in an infancy stage with the American NCLEX exam (mandatory as of January 2015), Method SIMPLE can not only help increase writing skills, but it might also aid in increasing the licensure success rates of our students. However, research will be needed to either validate or refute this preliminary hypothesis. Tarrant et al. (2008) also conducted a curricular intervention to help increase information literacy skills in post-registration nursing students. Their information management course covered seven course topics that they suggest should start with a first year introductory course and continue via on-going activities afterwards. Our school of nursing does the same thing by presenting Method SIMPLE to students over the course of several weeks in the Introduction to studies in health science course. Afterwards, students are encouraged to access to the tool during the remainder of their bachelor of nursing program because written assignments are regularly asked of them. In addition, Tarrant et al. (2008) also believe that writing activities need to be structured yet flexible. Students in the Method SIMPLE study clearly stated how useful and accessible the tool was. In fact, some improvements have been noted by Faculty in the writing skills of students since the implementation of Method SIMPLE, but the number and complexity of reflective writing assignments needs to be assessed and improved upon, as per student and Faculty requests. Troxler et al. (2011), after reviewing the six nursing programs that integrated WAC also noted, like the students in our focus groups, that inconsistent feedback can create barriers to learning. Training is essential for Faculty. Nursing programs, like the newly interactive additions to Method SIMPLE, need to offer examples of successful writing. In their efforts to counterbalance the dangers of grade inflation associated with using marking rubrics, Bickes and Schim (2010), in their education intervention, offered a four hour workshop to Faculty that included
Table 2 Recommendations for maximizing Method SIMPLE. Tool (method SIMPLE)
Students
- Have direct links to specific information without having to scroll down for information; - Place the checklist for written paper in “P” instead of “E” (excellence); - Provide an example of a excellent paper using method SIMPLE; - Add other examples of references; - Update the tool to reflect changes the latest version of APA.
- Become familiar with the contents of the method SIMPLE in first year; - Commit to good use and master the method SIMPLE; - Learn how and where to get help regarding Method SIMPLE
Faculty members - Become familiar with the method SIMPLE so as to be able to properly supervise students during the process of academic writing; - Adapt academic papers to method SIMPLE elements (examples: title page, references); - Stay congruent when providing feedback on papers and presentations from one course to another, from one year to the next; - Participate in information sessions on method SIMPLE.
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S. Harrison, N. LeBlanc / Nurse Education Today 43 (2016) 10–14
many of the elements that are found in Method SIMPLE: such as common writing mistakes, problems with APA, formatting issues, logical flow of ideas and available resources. Since Method SIMPLE is a readily available electronic tool through all the BN program, its long term benefits to Faculty and students would far outweigh a four hour workshop given by Bickes and Schim (2010). In fact, Method SIMPLE continues to be useful for students in our MN program and they prepare their research protocol, submit their ethics approval request, and eventually write their thesis and/or articles related to their research. When it comes to using technology to help encourage writing skills, Horstmanshof and Brownie (2013), like Wichadee (2010), recognize that wikis and discussion boards offer many advantages because they are flexible, convenient, and their asynchronous nature help students learn at their own pace. Results in both these studies reveal, like data from the internal evaluation of Method SIMPLE and feedback received in the three focus groups, that consistent feedback offered by a trained professional is essential to developing writing skills, but despite having several e-learning opportunities made available to students, this does not guarantee that they will access and use them.
7. Conclusion After conducting the Method SIMPLE study and reviewing the existing literature, we are more convinced than ever of the benefits of the tool created in 2008 to replace a simplified paper document on how to write an academic paper using APA methodology. Since then, the tool has grown and evolved to become so much more. When looking at writing strategies offered by higher education settings around the world, this electronic interactive writing tool created by a small francophone university in Canada has become, in a way, the little engine that could. It is our hope that by sharing our experiences with Method SIMPLE that other nursing programs might be inspired to create their own version of the tool, because reflective writing and the critical thinking required to succeed at it are essential competencies in nursing.
Acknowledgments A research grant of 3000$ was received from the Faculty of graduate studies and research of the Université de Moncton. The Faculty played no role in the study itself or the preparation of this article.
References American Association of Colleges of Nursing, 2008. The essentials of baccalaureate education for professional nursing practice. Retrieved from; http://www.aacn.nche.edu/ education-resources/BaccEssentials08.pdf. Andre, J.D., Graves, R., 2013. Writing requirements across nursing programs in Canada. J. Nurs. Educ. 52 (2), 91–97. Bickes, J.T., Schim, S.M., 2010. Righting writing: strategies for improving nursing student papers. Int. J. Nurs. Educ. Scholarsh. 7 (1), 1–11. Carroll, J.A., Diaz, A., Meiklejohn, J., Newcomb, M., Adkins, B., 2013. Collaboration and competition on a Wiki: the praxis of online social learning to improve academic writing and research in under-graduate students. Aust. J. Educ. Technol. 29 (4), 513–525. Gopee, N., Deane, M., 2013. Strategies for successful academic writing: institutional and non-institutional support for students. Nurse Educ. Today 33, 1624–1631. Griffiths, L., Nicolls, B., 2010. e-Support4U: an evaluation of academic writing skills support in practice. Nurse Educ. Pract. 10, 341–348. http://dx.doi.org/10.1016/j.nepr. 2010.02.005. Horstmanshof, L., Brownie, S., 2013. A scaffolded approach to Discussion Board use for formative assessment of academic writing skills. Assess. Eval. High. Educ. 38 (1), 61–73. http://dx.doi.org/10.1080/02602938.2011.604121. Institute for Healthcare Improvement, (n.d). SBAR technique for communication: a situational briefing module Retrieved from: http://www.ihi.org/resources/Pages/ Tools/SBARTechniqueforCommunicationASituationalBriefingModel.aspx. Lavelle, E., Ball, S.C., Maliszeewski, G., 2013. Writing approaches of nursing students. Nurse Educ. Today 33, 60–63. http://dx.doi.org/10.1016/j.nedt.2011.10.021. Lin, W.-C., Yang, S.C., 2011. Exploring students' perpections of integrating Wiki technology and peer feedback into English writing courses. Engl. Teach. Pract. Crit. 10 (2), 88–103. Luthy, K.E., Peterson, N.E., Lassetter, J.H., Callister, L.C., 2009. Successfully incorporating writing across the curriculum with advanced writing in nursing. J. Nurs. Educ. 48 (1), 54–59. http://dx.doi.org/10.1080/02602938.2011.604121. Munhall, P.L., 2012. Nursing Research: A Qualitative Perspective. fifth ed. Jones & Bartlett, Sudbury, MA. Naber, J., Wyatt, T.H., 2014. The effect of reflective writing intervention on the critical thinking skills and disposition of baccalaureate nursing students. Nurse Educ. Today 34, 67–72. Naidoo, R.K., 2013. Understanding the processes of writing papers reflectively. Nurse Res. 20 (6), 33–39. Salamonson, Y., Koch, J., Weaver, R., Everett, B., Jackson, D., 2010. Embedded academic writing support for nursing students with English as a second language. J. Adv. Nurs. 66 (2), 413–421. Sandelowski, M., 2000. Focus on research methods: whatever happened to qualitative description? Res. Nurs. Health 23, 334–340. Stine, L.J., 2010. Teaching basic writing in a web-enhanced environment. J. Basic Writ. 29 (1), 33–55. Tarrant, M., Dodgson, J.E., Law, B.V.K.K., 2008. A curricular approach to improve the information literacy and academic writing skills of part-time post-registration nursing students in Hong Kong. Nurse Educ. Today 28 (4), 458–468. http://dx.doi.org/10. 106/j.nedt.2007.08.001. Troxler, H., Jacobson Vann, J.C., Obermann, M.H., 2011. How baccalaureate nursing programs teach writing. Nurs. Forum 46 (4), 280–288. Wichadee, S., 2010. Using wikis to develop summary writing abilities of students in an EFL class. J. Coll. Teach. Learn. 7 (12), 5–10.
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Method simple: An electronic interactive tool helping nursing students prepare for written and oral presentation Suzanne Harrison ⁎, Nathalie LeBlanc Université de Moncton, École de science infirmière, 18 avenue Antonine Maillet, Moncton, NB, E1A 3E9, Canada
a r t i c l e
i n f o
Article history: Received 10 November 2015 Received in revised form 20 March 2016 Accepted 18 April 2016 Available online xxxx Keywords: Writing skills Interactive tool Nursing students
a b s t r a c t Background: Developing reflective writing skills is an essential competency in nursing. Nursing schools recognize the importance of promoting scholarly thinking and academic writing amongst their student yet, there is a large gap in the tools and opportunities students receive to help them master these skills during their baccalaureate studies. Method SIMPLE is an innovative and interactive web based tool introduced in first year that can help nursing students prepare university papers both written and oral. Aim of the study: To discover how students learn to use the tool, what barriers affect proper use of the tool, and what role faculty plays in ensuring students' successful use of the tool. The study also sought to explore students' perception in regards to the contribution of the tool to improve their academic work. Research method used: Data was collected using two research methodologies. Method SIMPLE has a built-in satisfaction survey at the end of each of the six modules that provides quantitative and qualitative data about the tool itself. A qualitative descriptive study was chosen to better understand student and faculty's perceptions regarding the tool. Data was collected during three focus groups. Conclusions and recommendations: Students shared their experiences using the tool and talked at length about the importance Method SIMPLE's section “P” which explains in depth how to submit written papers. Participants recognized the benefits of having a web based tool. Results from the built-in evaluation surveys and descriptive analysis of the focus groups data also helped generate three types of recommendations: ways to enhance the tool itself, ways to enhance students' experience when using the tool and faculty's responsibility in helping students learn how to use the tool. © 2016 Elsevier Ltd. All rights reserved.
1. Introduction A lot has been written about the importance of developing academic writing skills in nursing students. In fact, developing writing skills is an essential part of nursing practice (American Association of Colleges of Nursing, 2008). Encouraging these skills helps enhance critical thinking (Naber and Wyatt, 2014) and increases academic success, including practical skills and competencies (Gopee and Deane, 2013; Naidoo, 2013). Bickes and Schim (2010), along with Luthy et al. (2009), mention that as academic skills increase, so can the success rates on a national licensure exam such as NCLEX. Preparing academic papers also provides students with the opportunity to develop their professional identity by reflecting on how their experiences, both theoretical and practical, shape their vision of nursing (Lavelle et al., 2013; Naidoo, 2013). To encourage deeper reflective writing, academic writing skills need to be developed throughout the nursing program, thus supporting WAC, the American movement that encourages writing across the curriculum (Andre and Graves, 2013; Naber and Wyatt, 2014; Troxler et al., 2011; Salamonson
⁎ Corresponding author.
http://dx.doi.org/10.1016/j.nedt.2016.04.008 0260-6917/© 2016 Elsevier Ltd. All rights reserved.
et al., 2010). WAC has also been associated with concepts such as writing through learning (WTL), writing in the discipline (WID), and embedded learning, all of which, according to Luthy et al. (2009) encourage the “production of clear, accurate and relevant writing” which leads to “an essential competency in nursing” p. 54. Despite the many benefits of academic writing, there is a decrease in the support given by universities to develop these skills (Andre and Graves, 2013; Gopee and Deane, 2013; Tarrant et al., 2008; Troxler et al., 2011). Of the programs that exist, most focus on helping student locate, describe, interpret, summarize, synthesize, and critique credible information drawn from the literature (Andre and Graves, 2013; Naidoo, 2013). 2. Academic writing skills: Literature review Recently, two literature reviews were published that looked at how nursing programs encourage writing academic skills, one in Canada (Andre and Graves, 2013) and the other in US (Troxler et al., 2011). Andre and Graves (2013) looked at the websites of 81 Canadian bachelor of nursing programs including collaborative programs but excluding francophone programs and programs for diploma nurses seeking a nursing degree. Almost half (48.1%) did not require English literature
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or writing courses and only 4.9% offered academic writing courses specifically geared to nursing students. Andre and Graves (2013) believe that traditional English courses are less than optimal for preparing nursing students to become reflective writers because they are mostly required to write essays and research papers. After analysing 30 different types of writing approaches offered by the various programs in Canada, they concluded that schools of nursing need to have a discipline specific writing course to help develop “discursive knowledge and writing skills” p. 95. The course needs to expose students to APA document style to help students develop an evidence based nursing practice. They also believe that writing courses that are not discipline specific will be less likely to promote learning opportunities. As for Troxler et al. (2011), their review of the literature using three search engines produced 421 records, but after applying elimination criteria such as: articles not including nursing students, articles before 1990 and articles focusing on English as a second language, only nine articles looking at how bachelor of nursing programs teach writing in the US remained. They divided the writing programs in two categories: standalone writing programs and writing programs that span the curriculum. After highlighting different examples of the two categories of programs, they concluded that programs integrating the development of writing skills across the curriculum (WAC) are more effective. In general, they need to include five common elements: - short writing assignments, - training for faculty in offering constructive feedback, - sequencing writing assignments that build on prior learning (scaffolding), - giving samples of successful writing or explaining grading rubrics - and giving drafts with feedback.
Despite discovering six BN programs that adopt an across the curriculum approach in the US, Troxler et al. (2011) believe that more anecdotal evidence is needed to help determine the efficacy of those programs. In fact, universities offer different programs, which include, but are not limited to, one-on-one tutoring, peer review, writing retreats, English as a second language programs, writing workshops, writing seminars, writing centres, writing tutorials, and writing styles. Some authors believe that by helping students develop writing skills they also develop informational literacy (Andre and Graves, 2013; Bickes and Schim, 2010). Despite the different programs available, several students continue to have a hard time writing; they submit poorly written papers, they have difficulty knowing how to write and how to proceed when writing papers (Andre and Graves, 2013; Bickes and Schim, 2010; Tarrant et al., 2008; Troxler et al., 2011). This can be especially problematic when English is a second language (Salamonson et al., 2010), or a foreign language (Lin and Yang, 2011). Because writing academic papers can be very overwhelming experiences that cause stress and anxiety in students, it's important to use scaffolding to help break down the writing skills (Lin and Yang, 2011; Horstmanshof and Brownie, 2013; Troxler et al., 2011; Tarrant et al., 2008). To encourage reflective writing, universities need to build on prior learning (Tarrant et al., 2008) and their writing programs need to be intensive, directed experiences that are also structured and flexible (Carroll et al., 2013; Stine, 2010; Wichadee, 2010). Salamonson et al. (2010) believe that helping students acquire writing skills takes time and they require detailed feedback, both formative and summative, by trained facilitators, be it peers or faculty (Andre and Graves, 2013; Bickes and Schim, 2010; Gopee and Deane, 2013). A review of the literature for the last five years reveals that universities and colleges are increasingly encouraging the use of technology based formats such as wikis (Carroll et al., 2013; Lin and Yang, 2011; Griffiths and Nicolls, 2010; Wichadee, 2010) and discussion boards
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(Horstmanshof and Brownie, 2013; Stine, 2010) to promote writing skills. However, of all the studies found, only one examined ways to enhance student nurses' writing by using a blended learning approach supported by an electronic aid, e-Support4U, (Horstmanshof and Brownie, 2013). This approach promoted a “community of learning” during clinicals where nursing students used e-communication tools, blogs, wikis, and discussion boards to share and reflect on written assignments. A detailed review of the literature revealed no other studies where researchers or faculty explored the use of web based tools to help nursing students develop academic writing skills. 3. Purpose of the article The purpose of this article is therefore twofold. Firstly we wish to share our francophone school of nursing's experience in creating and evaluating Method SIMPLE: a web based interactive pedagogical tool helping students achieve better success when submitting university papers, both written and oral. Secondly, we will also share results of a qualitative study describing the lived experiences of nursing students and Faculty who use this tool. 4. Creation and evaluation of method simple 4.1. Description of the pedagogical tool Method SIMPLE was created in 2008 by a group of three professors who taught first year courses in the bachelors of nursing program. All were unsatisfied with the old method used to help students present proper academic papers which consisted of them buying, reading and mastering the content of a brief paper document explaining the proper way to present an academic paper loosely based on a francophone adaptation of APA's methodology. Students had no face to face explanations about the document and it was often misplaced or lost causing students to have to return to the bookstore to buy another copy. The web based tool was created to offer students a readily available and interactive tool that they could access at any time. Students are first exposed to Method SIMPLE in their first year Introduction to Health Science class where they learn how to use it and learn about its content. Faculty members in the following years of the program instruct students to refer to Method SIMPLE when they have difficulty preparing oral and written presentations. Method SIMPLE, like other course content is housed on CLIC, a web-based software learning management system
Table 1 Sections present in Method SIMPLE. Title of the module
Content found in the module
S: Sorts of information
Different types, forms, sources, and locations where credible information can be found along with information retrieval strategies (ex. search engines, data bases) Directions on how to collect, analyze, and synthesize the collected information using software such as RefWorks or FLOW Recommendations regarding how to transmit information based on the audience (ex. general public, other healthcare professionals) Requirements when preparing an oral or written presentation/paper. Detailed summary of the APA publication guidelines, PowerPoint presentation suggestions, example of a written letter Examples on how to transmit a clear and precise message that respects the audiences' stage of development (ex. tips regarding Piaget's stages of cognitive development) Revision of the key points when presenting an excellent written paper including a printable checklist
I: Information being communicated M: My audience
P: Path required (written or oral)
L: Language required
E: Excellence
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designed by Desire2Learn. The word SIMPLE is an acronym representing the content of each of the six modules present in the tool (see Table 1). In 2011, four different interactive additions were integrated into Method SIMPLE. These included:
was conducted through invitation emails, brief presentations in nursing courses, and lastly, with the help of student council representatives when student recruitment proved challenging. 5.3. Ethical aspects
- quizzes with formative feedback at the end of each module, using the evaluation function in CLIC - two audio clips in module “M” demonstrating proper and improper use of the SBAR technique as recommended by the Institute for Healthcare Improvement when communicating important information with other members of the health care team (“S”ituation, “B”ackground, “A”ssessment and “R”ecommendations), - three interactive activities in the module “P” (find the errors in a title page, a list of references and French errors in a text), - and two videos in module “P” demonstrating proper and improper ways of giving an oral presentation assisted by PowerPoint.
Although evaluation of the tool is an ongoing process, major changes are planned to coincide with the release of new editions of the APA Publication manual (2010). Minor linguistic and structural corrections where made in 2011 with the publication of the 6th edition. Adjustments to the tool were also based on anonymous feedback received by the users who filled out the electronic surveys at the end of each module. The following section presents more information regarding the results of those surveys.
Authorization from the university's ethics committee was obtained prior to conducting the study where no changes were required of the research protocol, the data collection tools or consent forms. Clear and informed consent was obtained from each participant prior to beginning the focus group which were digitally recorded. 5.4. Data collection A semi-structured interview guide was used to collect data during three focus groups that were conducted between December 2014 and January 2015. The first focus group was with four nursing students, three female and one male, enrolled in the first and second year of the program (novice users of the tool), the second focus group was with ten female nursing students enrolled their third and fourth years of the program (more experienced users of the tool) and the last focus group was conducted with six female senior and junior Faculty members who adopt the Method SIMPLE in their courses. Participant recruitment of first and second year was particularly difficult, possibly due to an interdisciplinary activity that took place in the same time period. 5.5. Data analysis
4.2. Built-in evaluation results of Method SIMPLE Students and Faculty using Method SIMPLE are encouraged to access a small survey at the end of each module where they can indicate on a Likert scale to what point they agree or disagree with seven evaluation criteria. They are also asked three open-ended questions regarding what aspects were most liked along with what aspects were less useful, and those aspects requiring fixing. Regrettably, only one to 2 % of the almost 2000 users since 2008 chose to fill out the surveys. Despite this small number, the information received helps to partially evaluate the tool and bring about periodic changes, such as those undertaken in 2011. A high percentage of the users (65.2% to 91.3%) were in agreement or total agreement with all seven evaluation criteria, which include: general appearance, ease of use, accessibility, content appropriateness and ease of understanding, pertinent and working links to websites and documents along with successful use of animation. Because the response rate to the online surveys was low and the data gathered was mostly quantitative and evaluative in nature. More information was needed to explore what users felt about their experiences using the tool. The following section describes the efforts taken in 2014–2015 to answer this question. 5. The lived experience of method simple users 5.1. Aims The purposes of this qualitative study were (1) to describe how students learn to use the tool, (2) what barriers affect proper use of the tool, and (3) what role Faculty play in ensuring students' successful use of the tool. The study also sought to explore students' perception in regards to the contribution of the tool to improve their academic work. 5.2. Setting and participants A purposive sampling technique was used to recruit participants as this approach is useful when seeking to increase comprehension in an innovative area of study or to attain a thorough understanding of a multifaceted experience or event (Munhall, 2012). The recruitment process
NVivo 8 software was used to assist in data analysis using Sandelowski's method (2000) for descriptive analysis. Although open to emerging themes and categories in which to classify data, certain themes were predicted based on the structure of the Method SIMPLE tool and questions asked in the semi-structured interview guide. 5.6. Findings During the focus groups, it was expected that feedback would be obtained regarding the lived experience of users with the content covered in each module of Method SIMPLE. However, the vast majority of the comments touched module “P” entitled “Path required”, where students and Faculty members stated that they often refer to the APA methodology. The following paragraphs take a closer look at each of the three focus groups presented in chronological order. The first focus group involved third and fourth year students who stated that they began using Method SIMPLE more seriously during the third year of their program when complex writing assignments were required thus increasing the need to improve their writing skills. Method SIMPLE was described as being a very user-friendly tool that provided them with various examples, especially those related to proper referencing. However, most felt that more reference examples would be beneficial. The participants expressed “It's just the references, there are not enough examples. That's what's missing”. They also mentioned that despite that fact that some of the Faculty openly answered their questions regarding Method SIMPLE, they could be more consistent when giving feedback regarding their student's academic work. In the second focus group, first and second year students expressed being a little overwhelmed by Method SIMPLE at the beginning of their nursing program. Small reflective writing assignments during the first year helped students become more at ease with the tool, although most felt there weren't enough assignments during the first year. One participant said, “I find that when they introduce the method SIMPLE in our 1st year, we learn it, but we don't practice enough¨. Despite the fact that the students found it challenging at the beginning, they stated that the tool was easily accessible and very easy to use. During the focus groups, a participant stated, “Whenever I have a project in a course, I use the method SIMPLE, it is very convenient”. Another participant
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mentioned, “You know exactly where to find the information you're looking for, it's convenient and accessible”. Finally, they described the advantages of having a Faculty contact person who would be available at all times to answer questions regarding Method SIMPLE. After discovering the lived experiences of nursing students who use Method SIMPLE, it was time to turn our attention towards Faculty members, especially since some of the students recommendations involved or affected them directly. Similarly to the prior student focus groups, the final focus group with Faculty members started by praising Method SIMPLE for its ease of use and accessibility. Faculty members also confirmed that difficulties with writing skills seem more prevalent during the first two years of the program. To better help the students with their writing skills, they reinforced the need for Faculty to stand together and provide accurate feedback in regards to Method SIMPLE. Lastly, participants in the Faculty focus group noted that method SIMPLE is not always updated and the transfer of knowledge from theory to practice could be optimized. In summary, despite only having four students in the second focus group, their lived experiences as novice users of Method SIMPLE mirrored those of the third and fourth year students. In fact, one of the major strengths raised by the all of the focus group participants were that the tool is easy to access along with being very user-friendly, as also noted by quantitative data from the built-in Method SIMPLE evaluation tool. In addition, the students believed the tool helped them successfully complete their academic papers. They also expressed that Faculty members were open to answering their questions in connection with the APA methodology and Method SIMPLE as a whole. One of the main challenges discussed was the lack of reference examples using APA methodology. Other challenges were the correcting inconsistencies from one professor to another and also from one program to another. Finally, Faculty, along with students, noted that there seems to be a lack of papers requiring the Method SIMPLE following its introduction in the first year of the nursing program. 5.7. Recommendations to improve Method SIMPLE Following the data analysis from the three focus groups, three types of recommendations are formulated; those to enhance the tool itself, those to enhance students' experience when using the tool and Faculty's responsibility in helping students learn how to use the tool. These recommendations can be found in the Table 2. 6. Discussion Naber and Wyatt (2014) present different ways to increase WAC which include the creation and maintenance of a portfolio. Since our school of nursing already requires students to develop an e-portfolio during the entire four years of the bachelor of nursing, this, in conjunction with activities surrounding the use of Method SIMPLE, are great ways to encourage reflective writing. For their part, Gopee and Deane (2013) conducted a qualitative study at a British higher education institution looking at what student experienced when they received help from the writing center. Their
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thematic analysis of the interview data revealed similar results to the current Method SIMPLE study. Students identified barriers to writing that included the lack of support and knowledge about writing conventions (i.e. mastering publication styles such as APA). Gopee and Deane (2013) also identified enablers to academic writing, such as feedback and support from Faculty and receiving clear assignment guidelines. Students can benefit from a community of practice when it comes to writing where peer support is offered. Our school of nursing includes volunteering as a rubric in its portfolio but has no formal requirements are made in this regard. To better support students in developing academic writing skills and informational competencies, we could create volunteer opportunities for third and fourth year students who could partner with first and second year students who are learning to write academic papers, thus meeting two objectives with the same initiative. Luthy et al. (2009), along with Griffiths and Nicolls (2010), also support the idea of peer tutoring to help encourage WAC. Luthy et al. (2009) describe their experience at Brigham Young University, revealing that “not only do students become stronger written communicators, but they also tend to understand the course material more completely when required to write about it” p. 59. They believe, like others, that increasing writing skills in nursing students can also help increase success rates in the NCLEX licensure exam (Naber and Wyatt, 2014; Bickes and Schim, 2010). Since Canadian nursing programs are in an infancy stage with the American NCLEX exam (mandatory as of January 2015), Method SIMPLE can not only help increase writing skills, but it might also aid in increasing the licensure success rates of our students. However, research will be needed to either validate or refute this preliminary hypothesis. Tarrant et al. (2008) also conducted a curricular intervention to help increase information literacy skills in post-registration nursing students. Their information management course covered seven course topics that they suggest should start with a first year introductory course and continue via on-going activities afterwards. Our school of nursing does the same thing by presenting Method SIMPLE to students over the course of several weeks in the Introduction to studies in health science course. Afterwards, students are encouraged to access to the tool during the remainder of their bachelor of nursing program because written assignments are regularly asked of them. In addition, Tarrant et al. (2008) also believe that writing activities need to be structured yet flexible. Students in the Method SIMPLE study clearly stated how useful and accessible the tool was. In fact, some improvements have been noted by Faculty in the writing skills of students since the implementation of Method SIMPLE, but the number and complexity of reflective writing assignments needs to be assessed and improved upon, as per student and Faculty requests. Troxler et al. (2011), after reviewing the six nursing programs that integrated WAC also noted, like the students in our focus groups, that inconsistent feedback can create barriers to learning. Training is essential for Faculty. Nursing programs, like the newly interactive additions to Method SIMPLE, need to offer examples of successful writing. In their efforts to counterbalance the dangers of grade inflation associated with using marking rubrics, Bickes and Schim (2010), in their education intervention, offered a four hour workshop to Faculty that included
Table 2 Recommendations for maximizing Method SIMPLE. Tool (method SIMPLE)
Students
- Have direct links to specific information without having to scroll down for information; - Place the checklist for written paper in “P” instead of “E” (excellence); - Provide an example of a excellent paper using method SIMPLE; - Add other examples of references; - Update the tool to reflect changes the latest version of APA.
- Become familiar with the contents of the method SIMPLE in first year; - Commit to good use and master the method SIMPLE; - Learn how and where to get help regarding Method SIMPLE
Faculty members - Become familiar with the method SIMPLE so as to be able to properly supervise students during the process of academic writing; - Adapt academic papers to method SIMPLE elements (examples: title page, references); - Stay congruent when providing feedback on papers and presentations from one course to another, from one year to the next; - Participate in information sessions on method SIMPLE.
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many of the elements that are found in Method SIMPLE: such as common writing mistakes, problems with APA, formatting issues, logical flow of ideas and available resources. Since Method SIMPLE is a readily available electronic tool through all the BN program, its long term benefits to Faculty and students would far outweigh a four hour workshop given by Bickes and Schim (2010). In fact, Method SIMPLE continues to be useful for students in our MN program and they prepare their research protocol, submit their ethics approval request, and eventually write their thesis and/or articles related to their research. When it comes to using technology to help encourage writing skills, Horstmanshof and Brownie (2013), like Wichadee (2010), recognize that wikis and discussion boards offer many advantages because they are flexible, convenient, and their asynchronous nature help students learn at their own pace. Results in both these studies reveal, like data from the internal evaluation of Method SIMPLE and feedback received in the three focus groups, that consistent feedback offered by a trained professional is essential to developing writing skills, but despite having several e-learning opportunities made available to students, this does not guarantee that they will access and use them.
7. Conclusion After conducting the Method SIMPLE study and reviewing the existing literature, we are more convinced than ever of the benefits of the tool created in 2008 to replace a simplified paper document on how to write an academic paper using APA methodology. Since then, the tool has grown and evolved to become so much more. When looking at writing strategies offered by higher education settings around the world, this electronic interactive writing tool created by a small francophone university in Canada has become, in a way, the little engine that could. It is our hope that by sharing our experiences with Method SIMPLE that other nursing programs might be inspired to create their own version of the tool, because reflective writing and the critical thinking required to succeed at it are essential competencies in nursing.
Acknowledgments A research grant of 3000$ was received from the Faculty of graduate studies and research of the Université de Moncton. The Faculty played no role in the study itself or the preparation of this article.
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