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ASSESSMENT OF WRITTEN ASSIGNMENTS
In most nursing courses, students complete some type of written assignment. With these assignments, students can develop their critical thinking skills, gain experience with different types of writing, and achieve other outcomes specific to a course. Written assignments with feedback from the teacher help students develop their writing ability, which is an important outcome in any nursing program from the beginning level through graduate study. This chapter focuses on developing and assessing written assignments for nursing courses.
Purposes of Written Assignments
Written assignments are a major instructional and assessment method in nursing courses. They can be used to achieve many learning outcomes, but need to be carefully selected and designed with consideration of the instructional goals. With written assignments students can (a) critique and synthesize the literature and report on their findings; (b) search for, critique, and integrate evidence for nursing practice; (c) analyze concepts and theories and apply them to clinical situations; (d) improve their problem-solving and higher level thinking skills; (e) gain experience in formulating their ideas and communicating them in a clear and coherent way to others; and (f) develop writing skills. Many of the written assignments in clinical courses assist students in thinking through their plan of care and identifying areas in which they need further instruction. Some assignments, such as reflective journals, also encourage students to examine their own feelings, beliefs, and values and to reflect on their learning in a course.
Not all written assignments achieve each of these purposes, and the teacher plans the assignment based on the intended goals of learning. Assignments should meet specific objectives of a course and should not be included only for the purpose of 160having a written assignment as a course requirement. Instead, they should be carefully selected to help students improve their writing skills and achieve course outcomes.
Because writing is a developmental process that improves with practice, writing assignments should build on one another throughout a course and throughout the entire nursing program. Writing a sequence of papers across courses encourages the improvement of writing more effectively than having students complete a different type of paper in each course. This planning also eliminates excessive repetition of assignments in the program. Along the same lines, faculty members should decide the number of written assignments needed by students to achieve the outcomes of a course or clinical practice experience. In some clinical nursing courses, students complete the same assignments repeatedly throughout a course, leading to their frustration with the “paperwork” in the course. How many times do students need to submit a written assessment of a patient? Written assignments are time-consuming for students to prepare and teachers to read and respond to. Thus, such assignments should be carefully selected to meet course goals and should benefit the students in terms of their learning.
Writing in the Discipline and Writing-to-Learn Activities
Writing assignments in a nursing course in which students receive feedback on their writing guides students in learning how to write clearly for varied audiences. The ability to communicate ideas in writing is an essential outcome of a nursing program at all educational levels. The dissemination of new ideas and innovations, outcomes of clinical projects, and findings of research studies and quality improvement projects requires skill in writing. This skill can be developed through formal papers in a nursing course, such as term papers, in which students receive feedback on their writing; this is often referred to as writing in the discipline (Writing Across the Curriculum [WAC] Clearinghouse, 2019a). With formal papers that students prepare in a course, the teacher can give feedback on the content of the paper and also on the quality of the writing (Oermann, 2013; Oermann et al., 2015). The experience of writing a paper and being guided on its development, combined with feedback from the teacher, allows students to develop their skills in thinking through the topic of the paper and how best to communicate their ideas in writing. These assignments are typically completed over a period of time, and both the content and writing skill are assessed. Formal papers also provide an opportunity to learn a reference style, such as the Publication Manual of the American Psychological Association (APA), although this is only one aspect of the assessment (APA, 2010). The goal with written assignments such as formal papers is to learn to write effectively and communicate ideas clearly, not only how to use APA or another writing style.
Formal papers can be divided into smaller writing assignments and sequenced progressively through a course. This makes completion of the paper more manageable 161for students, allows the teacher to assess and provide feedback on each part of the paper, and encourages students to use that feedback for revisions as they are preparing the longer paper. Shorter and carefully planned assignments can be integrated across courses to provide practice in writing. This avoids students preparing a formal paper in one course and having no other written assignments for which they receive feedback on writing in their other courses. Luthy, Peterson, Lassetter, and Callister (2009) suggested that smaller assignments that build on one another are less daunting for students. For example, students might be asked to prepare a paper on a potential safety issue in the clinical setting using the National Patient Safety Goals (The Joint Commission, 2019). The first assignment might be the description of the clinical setting and patient population, an issue they identified with supporting data, and a relevant safety goal. The second assignment might be a literature review related to the safety goal such as the need to communicate important test results to the right person on time, why this is important, and initiatives to improve staff communication. The third assignment might be a description of the initiative they selected for implementation on their unit, their rationale based on the literature and their analysis of the clinical setting, and a plan for implementation and evaluation of outcomes. With each of these written assignments, the teacher can provide feedback, followed by student revision of both the content and writing.
Other types of writing assignments in a nursing course, such as reflective journals and in-class writing activities, guide students in reflecting on their experiences or learning course content but do not promote development of writing ability. These are writing-to-learn activities: They are typically short and informal, and may be impromptu, but they help students explore their understanding of content and think through key concepts presented in class (Halim, Finkenstaedt-Quinn, Olsen, Gere, & Shultz, 2018; Oermann, 2013; WAC Clearinghouse, 2019b). For example, if students are unclear about a topic presented in class, they can be asked to write down their questions or summarize in their own words key points that they learned in class. The outcome of this type of writing activity is learning, not improving writing skill. The assessment would be formative with feedback on the content, not the writing.
Drafts and Rewrites
Formal papers enable the teacher to assess students’ ability to present, organize, and express ideas effectively in writing. Through these written assignments, students develop an understanding of the content they are writing about, and they learn how to communicate their ideas in writing. To improve their writing abilities, though, students need to complete drafts of papers on which they receive feedback from the teacher.
Drafts and rewrites of papers are essential if the goal is to develop skill in writing (Oermann, 2013; Oermann et al., 2015). Teachers should critique papers for quality 162of the content; organization; process of developing ideas and arguments; and writing style such as clarity of expression, sentence structure, punctuation, grammar, spelling, length of the paper, and accuracy and format of the references (Oermann & Hays, 2019). This critique should be accompanied by feedback on how to improve writing. Students need specific suggestions about revisions, not general statements such as “writing is unclear.” Instead, the teacher should identify the problem with the writing and give suggestions as to how to improve it, for example, “Introductory sentence does not relate to the content in the paragraph. Replace it with a sentence that incorporates the three nursing measures you discuss in the paragraph.” Drafts combined with feedback from the teacher are intended to improve students’ writing skills. Because they are used for this purpose, they should not be graded.
Providing feedback on writing is time-consuming for teachers. Another method that can be used is for students to critique each other’s writing in small groups or pairs. Peers can provide valuable feedback on content, organization, how the ideas are developed, and whether the writing is clear. Although they may not identify errors in grammar and sentence structure, they often can find problems with errors in content and clarity of writing. Students can post sections of their papers or questions about writing online in a discussion forum or prepare papers using collaborative tools such as Google Docs; peers and the teacher can provide feedback and answer the questions. This collaboration benefits not only the individual student writing the paper but also the group as a whole. Peers also can assess writing in small-group activities in the classroom, online, and in postclinical conference if the writing assignment deals with clinical practice. Small-group critique provides a basis for subsequent revisions.
Types of Written Assignments
Many types of writing assignments are appropriate for assessment in nursing education. Some of these assignments provide information on how well students have learned the content but do not necessarily improve their writing skill. For example, structured assignments that involve short sentences and phrases, such as nursing care plans and write-ups of assessments and physical examinations, do not foster development of writing skills nor do they provide sufficient data for assessing writing.
Other assignments such as formal papers can be used for assessing students’ understanding as well as writing ability. Therefore, not all written assignments provide data for assessing writing skill, and again the teacher needs to be clear about the outcomes to be evaluated with the assignment. Many written assignments can be used in nursing courses. These include:
• Term paper
• Research paper and development of research protocol
• 163Literature reviews and integrative reviews
• Evidence-based practice paper in which students critique and synthesize the evidence and report on its use in clinical practice
• Paper analyzing concepts and their application to clinical practice
• Paper comparing different interventions with their underlying evidence base
• Paper on how the content they learned in class and read about in their textbook and articles compares with their experiences in the clinical setting and how it applies to patient care
• Critical analysis papers in which students analyze issues, compare different options, and develop arguments for a position
• Case study analysis with written rationale
• Reflective journals and writing assignments
For clinical courses, written assignments that accompany the clinical practicum are valuable for learning to use evidence-based resources and developing clinical judgment skills. They also provide a strategy for students to analyze ethical issues in the clinical setting and reflect on their personal experiences with patients and staff. Writing assignments such as reflective journals bridge the gap between classroom learning and clinical practice, encourage students to think about practice decisions and evaluate choices, promote self-awareness and professional growth, and provide valuable feedback for faculty in identifying students having difficulty with clinical judgment and other learning needs (Bussard, 2015; Dahl & Eriksen, 2016; Lasater, 2011). Short papers in clinical courses are useful in focusing an assignment on a particular learning outcome and making it easier for teachers to give prompt feedback to students (Oermann, Shellenbarger, & Gaberson, 2018). For example, students might write a one-page paper on an alternate intervention for a patient with evidence for its use, or prepare a short paper on an issue encountered in clinical practice and an alternate approach that could have been used.
Written assignments for clinical learning include:
• Concept map, a graphic arrangement of key concepts related to a patient’s care, which includes a written description of the meaning of the interrelationships
• Analysis of a clinical experience, the care given by the student, and alternative approaches that could have been used
• Paper that examines how readings apply to care of the patient
• Short paper related to clinical practice
• Teaching plan
• Nursing care plan
• Analysis of interactions with individuals and groups in the clinical setting
• 164Report of observations made in clinical settings
• Reflective journal and other reflective writing activities
• e-Portfolio, a collection of projects and materials that demonstrate student learning in clinical practice
In-Class and Small-Group Writing Activities
Not all written assignments need to be prepared by students individually as out-of-class work that is assessed by the teacher. In-class writing assignments provide practice in expressing ideas and an opportunity for faculty and peers to give feedback on writing. For example, students can write a summary of the key content areas presented in a face-to-face class or online. In a concept-based curriculum, they might identify exemplars of a concept that were not included in the class. Students can list one or two questions about the content and give the questions to other students to answer in writing or to post in a discussion forum. The teacher can pose a question about how the content could be applied in a different context and ask students to write a response to the question. In a face-to-face class, several students can read their responses aloud, and the teacher can collect all written responses for later analysis. In an online course, students can post their individual responses for critique by other students. An activity such as this one assists students in organizing their thoughts before responding to questions raised by the teacher and others. Another option is for students to write a few paragraphs about how the content compares with their readings: What new learning did they gain from the class that was not in their readings?
As another writing activity, the teacher can give students short case studies related to the content being learned in the course. In small groups or individually, students analyze these cases, identify possible problems, and develop plans of care, and then report in a few paragraphs the results of their analysis and rationale for their plan. They also can describe in writing how the case is similar to or differs from what they learned in class or from their readings.
These short written activities are valuable at the end of a class to summarize the new content and actively involve students in learning. With any of these activities, students can “pass their writing” to peers whose task is to critique both content and writing, adding their own thoughts about the topic and assessing the writing. The teacher also can review the written work to provide feedback.
Students can work in pairs or small groups for writing assignments. For example, a small group of students can write an editorial or a letter to the editor; develop a protocol for patient care based on the content presented in the lecture and readings for class; and review, critique, and summarize evidence that relates to patient care. 165At the graduate level, students can prepare a manuscript or work through the steps in writing for publication beginning with an outline, preparing a draft, and revising the draft for a final product. These assignments among others encourage acquisition of content and development of skill in writing; they also provide experience in group writing, learning about its benefits and pitfalls.
Writing Activities for Postclinical Conferences
In postclinical conferences, students can work in pairs or in small groups to critically analyze a clinical situation, decide on alternate interventions that might be used, and then write a short paper about their discussion. They can write about their own clinical activities and document the care they provided during that clinical experience. “Pass the writing” assignments work well in clinical conferences because they encourage peers to critically analyze the content, adding their own perspectives, and to identify how writing can be improved. These assignments also actively involve students in learning, which is important during a tiring clinical practicum. Group writing exercises are effective in postclinical conferences as long as the groups are small and the exercises are carefully focused.
Assessing Written Assignments
Papers and other types of written assignments should be assessed using predetermined criteria that address quality of content; organization of ideas; and the process of arriving at decisions and, depending on the assignment, developing an argument. Writing style should also be considered. General criteria for this purpose, which can be adapted for most written assignments, are found in Exhibit 9.1.
Scoring rubrics work well for assessing papers. A rubric is a scoring guide used for the assessment of performance. Rubrics outline the criteria to meet in the paper, or describe the characteristics of the paper and the points allotted for its assessment. Rubrics lead to fairer, more transparent, and more consistent scoring of papers (Fulbright, 2018; Minnich et al., 2018). The points assigned to each criterion or characteristic in the rubric should reflect its importance in the paper. A description and examples of holistic and analytic scoring rubrics were provided in Chapter 6, Short-Answer (Fill-in-the-Blank) and Essay. Rubrics should be given to students before they begin writing so they are clear about how the paper will be assessed. In this way, the rubric can be viewed as an instructional guide and assessment tool (Brookhart & Nitko, 2019). An example of a rubric for scoring papers and other written assignments, based on the general criteria outlined in Exhibit 9.1, is shown in Table 9.1.
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