Communicating in academic and clinical contexts




information literacy:

a set of skills for searching for, locating, evaluating and using information



Writing academically


Purpose and context


When you write academically or professionally, you write for readers who have a set of expectations about the purpose, structure, style and tone of your writing. At university, lecturers have assumptions and expectations about academic writing. Boud (2001, cited in Kossen, Kiernan & Lawrence, 2013, p. 39) argues that ‘academics have expectations, but fail to articulate them and then, potentially to make judgments about students who fail to demonstrate them’. These expectations relate to a range of writing decisions, which can include issues of:



  • discipline terminology or jargon (clinical nursing language)
  • structure (an essay, report, case study, reflective journal)
  • grammar and expression (word choice, sentence length, punctuation)
  • format (font size, margins, headings, subheadings, paragraphs)
  • tone and style (colloquial or slang language, creative or emotive language, subjective or objective language, formal or informal language, use of first or third person, active or passive voice)
  • sources of evidence (textbooks, subject reference lists or sources, academic texts, journal articles and databases)
  • the appropriate referencing system (APA, Harvard, Oxford), direct or indirect quotes, reference lists or bibliographies
  • submission decisions (hard copy, electronic, portfolio).

You need to know your subject’s expectations about these writing choices.



Case study

A student reflects on how she refined her assignment decision-making during her first semester:




After failing the first assignment, I knew I had to do something different so I asked for help and found out exactly what was required for me to pass the next assignment. There are many things I have learnt from this: first, post to forums as they contain helpful information that is linked to assessment. The most important thing I learnt was to ask for help. I should have done it with Assignment 1 but I was too embarrassed and as a result I failed. This time I admitted I was unclear about what was expected of me and what I had to do. I hope gaining these valuable insights will not only help me in this subject but in my whole time at university.


Critical reflection


What strategies did this student use to ensure she passed her assignments?

Are there other strategies she could have used?

In the clinical context, you will be writing for a number of purposes and audiences. For example, you may be writing notes in patient records that describe your observations of a person’s health status and your actions as a clinician in nursing them. You may also write discharge summaries for patients leaving a healthcare service, or you might develop nursing care plans that you will share with colleagues who are also caring for the patient. In all these situations, it is important to remember that a number of health professionals, as well as members of multi-disciplinary teams, routinely access your notes. Thus you need to ensure your notes are appropriate for and accessible to these multiple needs.


Academic literacy and its structural elements


A range of academic writing tasks exists. One of the most common types is writing an academic argument. This is a well-developed, well-structured and well-supported piece of formal writing that persuades the reader to accept your point of view. There are three main steps to developing an academic argument (see Table 4.1).






academic argument:

a well-developed, well-structured and well-supported piece of formal writing that persuades the reader to your point of view




Table 4.1 The three main steps in academic writing












1 The thesis One clear, concise sentence that provides your viewpoint or argument. Your thesis should provide the reader with your opinion in relation to the question asked or topic provided.
2 Reasons supporting the thesis These reasons become your main points, explaining and/or supporting your thesis. There is one main point per paragraph.
3 Evidence that supports and explains each main point The evidence includes explanations or theory from experts in the subject area – the research base/theory that must be acknowledged or referenced and examples to apply and extend the theory and/or referenced explanation you are using to support your main points.



Source: Adapted from Kossen, Kiernan & Lawrence (2013)

According to Kossen, Kiernan and Lawrence (2013), the first step is developing your viewpoint (your opinion/conclusion/judgement/stance) in relation to the writing task. In academic writing, this is called a thesis or thesis statement.






thesis statement:

your viewpoint in relation to the writing task



Step 2 is the generation of the reasons to support your thesis. These reasons become the main points supporting the thesis.






main points:

the reasons for supporting a thesis statement or the viewpoint you have taken in relation to your writing task



In Step 3, you need to support each main point with evidence. In academic writing, an important form of evidence is expert evidence (or ideas from experts, which you will find in the research literature). You acknowledge these experts by using references (usually in the text, though footnotes or endnotes are sometimes used).






evidence:

the information you have gathered to support each main point



These steps conform to the structure common in academic writing. Table 4.2 cross-references the steps (thesis, main points and evidence) with this structure (introduction, body and conclusion). The thesis statement and overview of main points are included in both the introduction and the conclusion. The body paragraphs each comprise one main point with its supporting evidence.



  • The introduction provides background information that engages the reader’s interest, the thesis statement and an overview of the main points.
  • The body is made up of a series of paragraphs, with each body paragraph explaining one main point. The body paragraph begins with a first sentence (often called the topic sentence), which states the main point of the paragraph and links it back to the thesis. The remainder of the paragraph provides the evidence supporting this main point.
  • The conclusion provides an overview of the main points, draws conclusions and strengthens the thesis. No new information is included. Generally, the conclusion does not contain references, because references are considered to be evidence – and evidence does not belong in the conclusion (Kossen, Kiernan & Lawrence, 2013).

When you are reading textbooks and journal articles, you will see that academics use this same structure when they write. Understanding this structure can help you to more efficiently find the main points and evidence you need to support your arguments when you are writing your assignments.



Table 4.2 Cross-referencing steps with academic structure
















Steps Structure
Thesis statement
Overview of main points
Introduction
A series of paragraphs, each explaining one main point that is supported by evidence Body
Thesis statement
Review of main points
Conclusion



Source: Adapted from Kossen, Kiernan & Lawrence (2013)

A writing strategy


Understanding the structure of academic writing and its built-in repetition will save you time and energy, as well as help you to focus on what you have to do to complete your academic writing task. The writing process can be made easier by breaking it up into smaller, more manageable steps or activities that you can tick off as you go. According to Kossen, Kiernan and Lawrence (2013), these include finding out about assignment expectations, analysing the writing task, generating a draft plan and beginning the writing process.


Find out the assignment expectations


Having a clear understanding of the task of the assignment, its weighting and how it will be marked is a time-saving strategy because it designates how much effort you will then need to put into each part of the writing process. At university, these sources of information include marking or criteria sheets, rubrics, any sample assignments, lecture and tutorial information, learning centre support, resident fellow support if you are in college, the library, fellow students and your study group or learning circle.


Analyse the task


There are three factors to consider in analysing what you have to do: the task, the content and the limits imposed by the task (see Table 4.3).



Table 4.3 Analysis of the task




















Factor Definition Examples
Content Tells you what the assignment is about What is the subject or topic area the question wants to know about?
Task Tells you what you have to do Usually a verb tells you what to do. Do you have to analyse, describe, define, explain, etc.?
Limits Tells you how to limit the scope or content of the question Tells you what area to focus on; defines the topic further. Is there a particular timeframe, place, book, etc.?



Source: Adapted from Nash (2011) and Klossen, Kiernan & Lawrence (2013)

Analysing the verb or task (what you have to do) leads you to make decisions that determine how you will approach the content. It also gives you clues as to the form or structure of your writing. Some lecturers are not explicit about the meaning of task words, so it is always useful to ask what a task word means. Some of the more common task words are: analyse, argue, compare and contrast, define, describe and evaluate. This process of analysing the task helps you understand it and focus your research, and will ensure you answer the question that has been asked.




Learning activity

There is a great deal of information on the internet about the meaning of task words. Investigate the meanings of task words and write down a definition of each to assist you when you are beginning to write an academic argument.





Generate a draft plan


In generating your draft plan, you need to develop a thesis and the main supporting points.


Develop your thesis

You can try using the wording of the actual task or question, but make sure to turn it into a stance. For example, the question might ask you to analyse a clinical aspect of hand hygiene in a particular context of your choice. Your thesis then might be something like, ‘Using alcohol rubs as a form of hand hygiene is more effective than ordinary hand washing in preventing infection from spreading on cruise ships.’ Another approach is to read the task, then rewrite it. Use words with which you are familiar, then write your own version. When you are writing your assignment, ensure you keep your thesis close by, frequently checking it to make sure you are focused on the assignment question. You need to be aware that your thesis might change as you engage more with the question or topic, and refine it further.




Learning activity

Generate a thesis statement from the following question. You need to write one concise sentence that will reflect your answer to the question and drive your academic argument. When it is completed, check your thesis with a peer for feedback.




Select a common wound type (e.g. diabetic foot ulceration, pressure ulcer, leg ulcer, fungating wound, dehisced surgical wound) and analyse how you would provide care for it in your role as a qualified nurse. It may help to reflect on a patient with this type of wound for whom you have cared.


A possible thesis could be:




The role of a qualified nurse in treating a patient with a pressure ulcer includes the provision of wound hygiene and infection prevention.Note that the patient you choose would become the example you would use as evidence in each of your body paragraphs.


Apply the process you used above to one of your writing tasks this semester.



Develop your main points

Either brainstorm main points from your thesis or research for main points using the recommended texts for the subject. A mind or concept map (see Figure 4.1) can be useful because the relationships between the thesis and the main points can be clarified.




Learning activity

Identify the thesis statement and main points in this article abstract (or summary), then insert them into a mind map. Check your mind map with a peer or colleague.




Healthcare workers’ hands are the most common vehicles for the transmission of healthcare-associated pathogens from patient to patient and within the healthcare environment. Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections (HCAIs), but healthcare worker compliance with optimal practices remains low in most settings.


This paper reviews factors influencing hand hygiene compliance, the impact of hand hygiene promotion on healthcare-associated pathogen cross-transmission and infection rates, and challenging issues related to the universal adoption of alcohol-based hand rub as a critical system change for successful promotion.


Available evidence highlights the fact that multimodal intervention strategies lead to improved hand hygiene and a reduction in HCAI. However, further research is needed to evaluate the relative efficacy of each strategy component and to identify the most successful interventions, particularly in settings with limited resources.


The main objective of the First Global Patient Safety Challenge, launched by the World Health Organization (WHO), is to achieve an improvement in hand hygiene practices worldwide with the ultimate goal of promoting a strong patient safety culture. We also report considerations and solutions resulting from the implementation of the multimodal strategy proposed in the WHO Guidelines on Hand Hygiene in Healthcare.


(Allegranzi & Pittet, 2010, p. 305)



Figure 4.1 Mind map planning Source: Adapted from Kossen, Kiernan & Lawrence (2013).

Find the evidence

You can support your main points with different forms of evidence, which can include theory, research or the research base, and explanation and examples.


Theory is an explanation of why something happens or is important (see Chapter 2). For example, hand washing is important in healthcare because of the theory explaining the chain of infection, and therefore its use in stopping the spread of infection. For example, in a nursing course, beginning nurses not only need to know that they must wash their hands but also why. So students learn Semmelweis’s germ theory (see Hanninen, Farago & Monos, 1983). Semmelweis discovered that the incidence of fever could be reduced significantly by the use of hand disinfection in clinics. He proposed the practice of washing with chlorinated lime solutions while working in a Vienna general hospital, where doctors’ wards had three times the mortality of midwives’ wards.


The meanings attached to theory can change depending on the context. For example, in daily life people refer to unproven ideas and speculation as theories. These sorts of theories provide informal knowledge about the world. Alternatively, formal theories like Semmelweis’s germ theory are more rigorously tested, and therefore have greater authority and credibility (Kossen, Kiernan & Lawrence, 2013). In the sciences, a theory is rigorously tested and is measurable – which means it can be used to explain an experiment or to find out whether something is true and accurate, and can be repeated.


In the academic context, theory is important because it provides a perspective on why we do things or think in certain ways. It is partly why some professions have moved their training from their places of practice or work to the university context, as the theoretical understanding that university provides increases professional standing. For example, nursing moved from the hospitals to higher education in Australia some 30 years ago.


The research base often includes theory, and is referred to as the ‘literature’, a ‘review of the research’ or a ‘literature review’. It describes research or information already conducted in a particular area and written about by experts in the field. It is the academic convention that if you want to conduct research in an area, you must first consult the research base or literature that already exists in the area. This helps you establish what is known and not known about a given topic. It also shows readers you are familiar with the significant and up-to-date knowledge relevant to your topic. Incorporating the ideas/explanations of subject experts in your paragraphs supports your argument as a form of evidence to explain/support your main points. In fact, many of your textbooks are literature reviews as they report and summarise the findings of research that other people have conducted. Ultimately, referring to the research base in your topic area helps you to establish the credibility of your argument, as it provides expert support (or evidence) to reinforce what you are claiming. Referencing this research base is essential in underpinning the academic credibility. It is not enough to provide this research evidence; you need to say where it came from and when it was printed. Referencing is discussed later in the chapter.


Explanations and examples are also a form of evidence used to support the main point. Examples can be used to explain theory or research. In the writing task, if you are asked to analyse a patient’s disease or given a case study, the examples will stem from or be linked to the thesis statement. For instance, if the thesis is limited to the circulatory system, then the examples need to be linked to (limited to) the circulation system as well.


The more specific the example, the more convincing it will be. Instead of ‘scientists can be effective when communicating with the public’, a more specific example would be ‘Karl Kruszelnicki is an Australian scientist who builds rapport with his audience by giving simple explanations and using humour’ (Kossen, Kiernan & Lawrence, 2013). Instead of the relatively brief example ‘the clinical team would need to seek permission’, a more specific example would be ‘a member of the clinical team would need to seek the patient’s permission before revealing any information the patient had disclosed about their personal circumstances’ (Kossen, Kiernan & Lawrence, 2013). Providing examples also makes your writing richer, and enhances its emotional impact. This is important for motivating the reader to engage with your argument.


Explanations and/or examples help you apply or link the theory or research to practice. If you just include the theory, then your writing may be too descriptive because you haven’t linked the theory or research. For example, by applying Semmelweis’s germ theory to the infection chain on a cruise ship, you are explaining the link between theory and practice, which means your reader has a better understanding of the theory. Explanation needs to relate to either the research evidence or theory used. Through using explanation, the main idea is elaborated and its meaning explained further. For example, the theory of hand hygiene can be explained by providing information about how the infection spreads in a particular context, like an aged care facility or a pre-school. It is also useful to think of the power of examples in assisting you to understand theory. For instance, lecturers use specific examples to help you understand the more complex concepts and theories they discuss.




Learning activity

Have the examples used in this chapter been useful for helping you to improve your academic writing? Explain how.





Begin the writing process


Having collected and developed your thesis, main points and evidence, it is now time to begin writing your paragraphs. Each main point corresponds to one paragraph, and the paragraph’s first sentence should explain this main point. It is important to understand that the main point is neither a quote (either direct or indirect) nor an example. This is because examples and referenced material comprise the evidence that supports the main point. The rest of the paragraph integrates the evidence, including any theory, research and explanation/examples. The next learning activity provides one example of how these elements can be structured in the body of the paragraph.




Learning activity

The following paragraph was written in response to an assignment question that asked: ‘Discuss a clinical aspect of hand washing, making sure to include a context.’ The thesis chosen was, ‘Hand rubbing with a waterless, alcohol-based, rub-in cleanser is more effective than using a regular hand-washing technique with soap and water.’


Your task is to identify the main point and the different forms of evidence used to support the main point, including any theory, research and explanation/examples. Also check whether the referencing is consistently used and conforms to a particular referencing system.




The side effects of rubbing with a waterless alcohol-based, rub-in cleanser are rarer than the side effects caused by using soap and water. Hand washing with plain soap can cause skin dryness, cracking and irritation, especially if living in a cold, dry climate (Rhinehart & Friedman, 1999). Some people, for example, find their dermatitis is exacerbated in winter especially if washing with harsh soaps. However the cleanser-rub has far fewer side effects. According to Widmer (2000, p. 140) a ‘database of 3500 HCWs generated over 10 years did not identify a single case of documented allergy to the commercial alcohol compound in use, which resulted in an estimated incidence density <1:35,000 person-years’. Widmer (2000) also maintains that allergies to alcohol are rare and could only be caused by emollients and other compounds added to the alcohol. Many organisations now provide their employees with waterless, alcohol-based rub-in cleansers, which points to the efficiency and lack of side effects being experienced with these types of products. It is important for nurses to be informed about the side effects of all products, especially those that are used frequently.



The next section discusses strategies you can use to locate the evidence you need to support your thesis statements.


Information literacy


Information literacy is the ability to search for, locate, evaluate and use the information needed (Eisenberg, 2008).


Searching and locating sources of information to use as evidence


Information literacy relates to your ability to locate the evidence to support the argument you are writing. If you are a student, your university library is the most appropriate source of information about this literacy. So, rather than provide information here that is not contextualised to your particular higher education institution, we encourage you to investigate your own library site. Most libraries provide online sources of information as well as classes (on campus and online) that have been devised to assist you to develop the skills of information literacy. This is a crucial aspect of academic literacy, and it is important that you empower yourself in its use.



Case study

Students’ reflections reveal the library practices that students found surprising:



  • The most surprising thing I have learnt about the library is the virtual availability and the ability for books to be posted out wherever you are; great flexibility. The role the library plays within the university is in learning development, whether that be self-directed (access information through books, e-articles) or group study sessions or workshop groups.
  • I have found the library tutorials to be very helpful. I have been quite nervous to use the online library as I have found them quite difficult to use in the past, however after watching the tutorials and going through a few activities I am feeling more confident about using the library. The tutorials are so helpful in showing how to find a particular article, book or video. I will definitely be referring back to these in the future! The library is definitely of extreme importance in university study and it is hugely helpful when referencing as you can be sure that information you find is genuine, as opposed to what can be found on the internet!
  • One of the most surprising things I have discovered about libraries in university study is just how vital they are to academic work! No more ‘just Googling’ opinions and following them! I also have been surprised at how thoroughly searching a library for a certain topic can greatly change the way you actually view your assignment. What may have seemed a clear-cut answer before you started researching now looks much more complicated once you have actually taken the time to search the library.
  • One of the most important aspects for me about using libraries is how it forces you to organise what you’re doing before actually getting your information. To enter in correct keywords and get useable articles, you first have to have a general idea of what your topic is, be able to expand it into various keywords and phrases, and be able to decide which articles are relevant and which articles are not, even before you start the real researching! So libraries play a much bigger part in achieving success in uni than I ever gave them credit for in the past!
  • I have studied previously and was surprised by the number of tutorials available to assist. I found that the tips and hints for researching, as well as searching in the library catalogue were of the most benefit. I’ve been overwhelmed at the sheer volume and different types of information, but feel much more confident now that I can perform succinct and relevant searches when required. Finally, my biggest surprise is the availability of library staff to provide assistance. I suppose from my high school days with a grumpy ‘shushing’ librarian, I have always had some trepidation in asking for help. I now know that there is no need to hesitate with the librarians only a phone call or an email away.
    One of the most surprising things I found out about the university library is how accessible everything the library has to offer is for online and external students too. I love the fact that I can access databases 24/7 – given I work shiftwork, my study hours are a little varied. I feel like a great deal of effort has gone into making you feel as though you have the same opportunity for information as students who can physically attend the library. It is essential to have academic studies to support your own statements or theories as part of academic writing. Now all I have to do is practise navigating by myself.

Critical reflection

Jan 30, 2017 | Posted by in NURSING | Comments Off on Communicating in academic and clinical contexts
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