Utilizing an Interdisciplinary Approach to Increase Student Writing Abilities in Doctor of Nurse Practice Programs Sally K. Fauchald Ph.D RN, Heather Bastian Ph.D PII: DOI: Reference:

S8755-7223(14)00083-0 doi: 10.1016/j.profnurs.2014.05.004 YJPNU 834

To appear in:

Journal of Professional Nursing

Received date:

14 October 2013

Please cite this article as: Fauchald, S.K. & Bastian, H., Utilizing an Interdisciplinary Approach to Increase Student Writing Abilities in Doctor of Nurse Practice Programs, Journal of Professional Nursing (2014), doi: 10.1016/j.profnurs.2014.05.004

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ACCEPTED MANUSCRIPT 1 Utilizing an Interdisciplinary Approach to Increase Student Writing Abilities

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in Doctor of Nurse Practice Programs

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Sally K. Fauchald, Ph.D, RN and Heather Bastian, Ph.D

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Department of Graduate Nursing 1200 Kenwood Avenue The College of St. Scholastica Duluth, MN 55811

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218-723-6590 and 218-625-4482

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[email protected] and [email protected]

ACCEPTED MANUSCRIPT 2 Utilizing an Interdisciplinary Approach to Increase Student Writing Abilities in Doctor of Nursing Practice Programs

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The American Association of Colleges of Nursing (AACN) articulates a vision for the

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doctoral-preparation of advanced practice nurses. Programs to educate doctorally-prepared nurses, either with the Doctor of Philosophy (PhD) degree or the Doctor of Nursing Practice

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(DNP) degree, must share high expectations for rigor and scholarship (AACN, 2006). Writing,

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more specifically competence in scholarly writing, is a skill that is needed to advance the profession (Shirey, 2013); moreover, clear and effective communication is critical as a means to

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provide quality health care (Luthy, Peterson, Lassetter, & Callister, 2009). While writing is central to the completion of a higher degree (Jackson, 2009), Shirey (2013) noted “the

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development of systematic teaching/learning approaches that help highly educated nurses to

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effectively convey verbal and written messages” (pp. 138-139) remains unaddressed in scholarship and provided one approach, Strategies, Methods, and Assessment of Outcomes,

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Related to Teaching/Learning (SMART), in an attempt to address this gap. Writing Enriched

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Curriculum (WEC) is another systematic teaching/learning approach focused on writing but differs from SMART in strategies and methods. Additionally, it is grounded in interdisciplinary collaboration.

The project discussed in this paper was modeled on the WEC approach out of the University of Minnesota that combines elements of writing across the curriculum (WAC) and writing in the disciplines (WID). WAC and WID have already successfully been used in baccalaureate nursing programs (Cowles, Strickland, & Rodgers 2001; Luthy et al. 2007). Drawing from WAC and WID, WEC seeks to more purposefully and consciously infuse writing into a program’s curriculum through an intensive interdisciplinary collaboration between a

ACCEPTED MANUSCRIPT 3 department and a specialist in composition and rhetoric who serves as a writing consultant. This paper demonstrates the value of utilizing these kinds of interdisciplinary collaborations to

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Background

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improve the writing and communication skills of graduate nursing students.

The authors teach at a small, regional, comprehensive Catholic Benedictine college that

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enrolls 3,552 students. The Department of Graduate Nursing (DGN) is housed within the School

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of Nursing, one of six schools at the college. The DGN currently supports three programs: a Master’s of Science in Advanced Nurse Practice (MS), a Post-Master’s (MS) Doctor of Nurse

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Practice (DNP), and a Bachelor of Science (BS) to DNP. Within the BS to DNP program, options for study and certification include: (a) Adult/Gerontological Nurse Practitioner, (b)

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Family Nurse Practitioner, and (c) Psychiatric Mental Health Nurse Practitioner. All of these

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programs are delivered in a blended format, consisting of a mix of online and face-to-face courses.

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Faced with growing enrollments (an approximate 20 student increase over two years), the

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DGN faculty became increasingly frustrated with the wide range of writing skills of students entering the programs. Caffarella and Barnett (2000) identified that many graduate students do not think or write like scholars or researchers. This is a disconnect with faculty expectations that students will begin programs as proficient writers who will continue to develop. DGN faculty also were frustrated because they did not feel prepared to work with students who had varying and often low levels of preparedness for graduate-level work and writing. Their frustrations were particularly heightened in the online classroom environment where nearly all student-to-student interactions and student-to-faculty interactions occur in writing.

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The WEC Approach

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To address the increasing frustrations of faculty and improve students’ writing abilities in

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the DGN, in spring 2012 the authors undertook an interdisciplinary project that was facultydriven, discipline-specific, and context-specific. As noted above, the project was based on the

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WEC approach that seeks to integrate writing into a department’s curriculum by having faculty

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articulate discipline-specific writing conventions and expectations, evaluate existing curriculum for its inclusion and use of writing, and then develop a plan for integrating writing throughout

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the curriculum (Center for Writing, n.d.). To do so, faculty engage in a three-phase, recursive process in which they create, implement, and assess a writing plan with the assistance of a

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writing consultant (Center for Writing, 2009). The writing plan is the centerpiece of the WEC

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approach, as it “articulate[s] discipline-specific writing expectations, and plans for curricular

Writing, 2009).

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integration of writing instruction, writing assessment, and instructional support” (Center for

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In WEC, all departments and faculty engage in the same process—creating, implementing, and assessing a writing plan—but each plan differs since it is specific to a particular department and faculty population, crafted to meet their mission, needs, students, resources, structures, objectives, etc. Unlike the SMART approach, WEC is not a one size fits all approach to incorporating writing into a curriculum; rather it is a contextually-based approach that responds to local conditions. While one size fits all approaches often are attractive to timecrunched faculty, contextually-based approaches, such as WEC, productively capture and respond to the realities and resources of a specific department, its faculty, and its students (Anson, Dannels, Flash, & Housley Gaffney, 2012).

ACCEPTED MANUSCRIPT 5 The Writing Plan In this section the collaboration between the DGN and the writing consultant to create

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and implement a writing plan over three semesters (Spring 2012, Fall 2012, and Spring 2013) is

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outlined. The writing plan focused on the BS to DNP program and its fifteen core courses that are delivered only in an online format. However, since all three of the DGN’s programs share

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some courses, the post MS to DNP and MS programs were also modified. It is important to note

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before proceeding that the experience with the WEC model provided in this paper is not meant to serve as the definitive way to create and implement a writing plan but rather as an illustration of

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an interdisciplinary and contextually-based approach to incorporating writing into a curriculum. Creating the Writing Plan

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To create the writing plan, data was collected and analyzed to uncover writing

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expectations of faculty as well as areas of concern. Collected data included: sample marked student papers and their corresponding assignments and rubrics; the graduate program handbook;

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syllabi and writing assignments from the fifteen core courses; individual interviews with the

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DGN faculty performed by the writing consultant. Each faculty member also created her own informal writing outcomes statement for the DGN that outlined what writing skills graduates should be able to demonstrate upon completion of their program. From this data, a Writing Outcomes Statement for the Department of Graduate Nursing was created and approved for use; the statement clearly articulated six overarching writing outcomes and provided further detail under each of the six goals (see Appendix A). In addition to this data collection, the DGN faculty and the writing consultant meet three times over the course of the Spring 2012 semester during departmental meetings. These meetings allowed faculty to share their experiences with student writing and their own writing expectations. They also

ACCEPTED MANUSCRIPT 6 allowed the writing consultant to raise topics or issues that were identified during the data collection and analysis process and receive feedback from the faculty as a whole.

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The writing plan outlined major findings and offered five recommendations for the DGN:

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1) participate in a workshop on the marking and grading of student writing; 2) include direct instruction and support in academic writing in the core courses during

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the first year of the program;

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3) integrate elements of the writing process and peer review throughout the curriculum; 4) restructure the use of discussion board posts and explore other electronic media for

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student interaction in all courses; and

5) incorporate more opportunities to practice reflective clinical practice throughout the

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curriculum (see Appendix B)

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The plan and its recommendations were based on the analysis of the collected data, feedback from faculty at departmental meetings, and a comparison of the core courses and their

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assignments to the newly created Writing Outcomes Statement. This comparison was depicted in

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color-coded chart that highlighted how and to what extent the core course curriculum (including assignments and instruction) currently is or is not meeting the writing outcomes. The chart was created in an EXCEL spreadsheet in which the courses were listed on the vertical axis and the outcomes on the horizontal. The assignments for all courses were reviewed and marked for the outcomes that they met, and this data was inserted into the spreadsheet. Implementing the Writing Plan The plan was implemented over two semesters, Fall 2012 and Spring 2013. During the Fall 2012 semester, the DGN participated in a two-hour, interactive workshop on writing that the writing consultant designed especially for them. During Fall 2012 and Spring 2013, the faculty

ACCEPTED MANUSCRIPT 7 elected to focus their efforts on revising the fifteen core courses to address recommendations 2, 3, 4, and 5 and to better meet the DGN’s writing outcomes. To revise all of the core courses, two

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faculty members, operating as a pair, were assigned to revise one of the core courses and were

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provided with some guidance from the writing consultant. The pairs also met with the writing

each of the recommendations are provided below.

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consultant for one or two informal meetings to discuss course revisions. Concrete examples of

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1. Participate in a workshop on the marking and grading of student writing Providing evaluation and feedback on student writing in DNP programs is perceived to

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be one of the most valuable ways to improve student writing and their understanding of scholarly writing expectations (Caffarella & Barnett, 2000). Yet nearly every faculty member in the DGN

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expressed some level of discomfort with assessing writing during her individual interview.

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Concerns ranged from time management to the quality and efficacy of commenting practices. To address these concerns, the writing consultant developed and led a two-hour interactive

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workshop on assessing writing. Before the workshop, all faculty read and evaluated one student

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paper that served as an example throughout the workshop. During the workshop, commenting practices (including marginal comments, end comments, and minimal marking), grading, and time management were addressed. Faculty then practiced these strategies and techniques with the student paper. The workshop concluded with an open question and answer period, and faculty were encouraged to contact the writing consultant directly for further one-on-one work. 2. Include direct instruction and support in academic writing in the core courses during the first year of the program The comparison of the core course curriculum to the writing outcomes demonstrated that students were expected to know and perform scholarly writing conventions during their first-year

ACCEPTED MANUSCRIPT 8 of study (and subsequent years) without any direct instruction in them. However, as many faculty have observed, students in graduate nursing programs often lack the knowledge, experience,

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and/or confidence to engage in scholarly writing (Caffarella & Barnett, 2000; Kamler &

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Thompson, 2006; Shirey 2013). To expose students to scholarly writing expectations and increase their confidence, the DGN faculty more explicitly integrated direct instruction on

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scholarly writing into their courses, especially those in the first year.

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To introduce or reacquaint students entering the DGN programs with scholarly writing expectations, faculty focused their efforts on revising the first year core courses to more

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explicitly address academic writing expectations and conventions. For example, in one of the first courses students take, students now complete an assignment in which they compare and

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evaluate websites for their credibility and reliability and another assignment in which they

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analyze a scholarly paper to identify and evaluate its use of a thesis statement, evidence, and analysis. In another example, students are told what elements make a good summary and then

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practice summarizing a concept from a required reading. Later courses later also now include

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direct instruction in other kinds of disciplinary writing conventions. For instance, students first encounter grant writing in a course taken near the end of the program. Most student have had limited to no exposure to grant writing, so faculty developed a webinar in which they discuss the purpose of a grant, break down its components, and then analyze a grant together with students. 3. Integrate elements of the writing process and peer review throughout the curriculum The comparison of the core course curriculum and the writing outcomes also demonstrated that no assignments directly required students to draft, revise, proofread, or edit their writing or work with other students to develop their writing. Yet writing is a social act, requiring collaboration among writers and readers to bring meaning to the text and, as such,

ACCEPTED MANUSCRIPT 9 writers benefit from talking with others about writing (and reading) (Bruffee, 1984). Moreover, writing is best understood and taught as a process, not simply a product, through which writers

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discover and develop their ideas (Murray, 1972). As such, students in graduate nursing programs

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benefit from revising and peer support or feedback (Caffarella & Barnet, 2000; Shirey, 2013; Smith & Delmore, 2007).

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To help students engage in the writing process, faculty created series of scaffolded

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assignments that prepared students to compose lengthy papers rather than simply requiring students to produce 10-20 page papers with little assistance. As part of the course revisions,

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students now compose shorter 10-15 page papers, but .they also compose proposals, presentations, evidence tables, annotated bibliographies, problem identifications or thesis

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statements, and outlines. Additionally, they receive feedback on these documents before the final

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papers are submitted.

Students also engage with each other as writers, practicing new skills together, writing

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collaboratively, and engaging in peer review, in most courses throughout the core curriculum. In

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several courses, students now work together in groups to practice new skills, such as critiquing a study, and writing tasks, such as composing a critique, before each student composes his or her own work. Peer review also occurs in nearly every course with students providing each other with feedback on proposals, topic selections, outlines, annotated bibliographies, and drafts. Peer reviews are structured to focus on two to three specific questions or writing topics so that feedback is focused and productive. 4. Restructure the use of discussion board posts and explore other electronic media for student interaction in all courses

ACCEPTED MANUSCRIPT 10 The discussion board feature present in many online education platforms provides a space for students to post responses to questions posed and interact with each other in a discussion-like

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format. However, during the interviews, all but one faculty member expressed concern with the

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use and quality of discussion board posts (DBPs). To reduce the reliance on discussion board and encourage different kinds of student interactions, faculty worked to increase the use of other

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electronic media present in online education platforms. Blogs became a space for peer review.

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In some courses, each student has his or her own blog where he or she develops one part of a final paper and then receives feedback from peers on each section. Wikis also provided a place

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for peer review, group writing project, and small group discussion. Webinars allowed for professors and students to have real-time discussions of relevant topics, like scholarly writing

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conventions.

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Additionally, faculty also incorporated tools that are present in word processing software. For example, students are now required to use the “track changes” and “comments” function in

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Microsoft word to document their process of writing a health program evaluation plan in which

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they compose drafts of three different sections of the plan, receive peer and instructor feedback on each one, and then rewrite. They submit the final paper with all of the tracked changes along with a short reflection in which they consider how the revisions earlier in the process helped their writing later in the process. 5. Incorporate more opportunities to practice reflective clinical practice throughout the curriculum The comparison of the core course curriculum to the writing outcomes indicated a minimal presence of reflective clinical practice, which nearly every faculty member identified as central to advanced nursing practice. Mann, Gordon and MacLeod (2009) suggested reflection,

ACCEPTED MANUSCRIPT 11 as a learning strategy, can assist students with integrating and connecting new knowledge with existing knowledge and skills; reflective journals also can be used as a way for students to apply

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course content (Langley & Brown, 2010). In health care, reflection can be used as a strategy to

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determine if the same approach to a clinical problem would be used, or if an alternative approach would have been more beneficial (Leach, 2007). Williams and Taliaferro (2009) further

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suggested that reflection can enhance clinical competence and support lifelong learning by

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assisting the practitioner to think about clinical events, evaluate choices, and identify needs for learning.

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Faculty worked to weave reflection in some form throughout core curriculum so that students encounter it within a wide variety of courses and multiple times. Some of the reflective

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activities were more formal, such as composing reflection essays where they reflect on a

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particular concept, experience, or process. For example, students compose a reflective essay in which they explain management and leadership theories and how they will be integrated into

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one’s own practice Other reflective activities were less formal. For example, in the first

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discussion board posting of a course, students were asked to articulate their first impressions of the role of the nurse practitioner in rural settings. In the last discussion posting of the semester, students were asked what new thoughts they gained regarding the role of a nurse practitioner in rural settings. Preliminary Results Writing can result in further developed skills in critical thinking and reflection, as well as enhanced communication, all of which are imperative for an effective practitioner (Cowles, Strickland, & Rodgers, 2001). This project is still in the process of full implementation since it will take a minimum of three years before the students who began the new coursework at the

ACCEPTED MANUSCRIPT 12 beginning of the program complete the revised curriculum in full. Still, faculty and students have already noted some anecdotal results. These preliminary results appear to indicate that the five

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recommendations from the writing plan have made a positive impact on student writing

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performance.

The faculty indicated that the grading workshop resulted in more consistency in grading

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and feedback to students. Faculty reached some consensus on how much feedback to offer

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students and realized that with papers that had many issues, addressing all of the issues in the paper with in-depth feedback was overwhelming for students. Faculty stopped correcting APA

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mistakes and referred students back to the APA text to make their own corrections. Faculty have

maintain these early efforts.

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requested an annual grade norming workshop to be facilitated by the writing consultant to

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Another benefit is that the program now begins with clear examples and instructions for writing presented via webinars. These webinars allowed for conversation that clarified writing

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and professional expectations from the onset of the program for both students and faculty. In

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addition to direct instruction in writing expectations, the staged and scaffolded writing assignments incorporated throughout the core courses meant that students were expected to start small, gain experience and skill, then progress to larger assignments. The smaller, staged assignments required less time to grade since mistakes and error were caught early, giving students the opportunity to correct and revise prior to the final submission. This process also resulted in faculty conversations about who was doing what in which course. Faculty discovered that in some early courses, students were expected to write 20 page papers, while in some later courses, the papers were shorter. This knowledge allowed faculty to do a better job integrating new and appropriately designed assignments and creating a better flow of scaffolded work,

ACCEPTED MANUSCRIPT 13 setting reasonable expectations early in the program and then expanding those expectations throughout later courses.

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In many courses students now have the opportunity to read the work of their colleagues

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and provide and receive feedback via blogs or wikis prior to submitting a final paper. Caffarella and Barnett (2000) found that students had little to no experience providing feedback to peers

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about their writing even though they perceived peer feedback to be beneficial to their writing.

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Students have informally commented on the helpfulness of peer feedback and have anecdotally reported to instructors and each other that they are glad to have the opportunity to review others’

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work and learn about the interests of their colleagues. Reflective writing through the use of papers, discussion boards, and journals also are now integrated throughout the program,

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beginning with the first course and continuing into future courses. Over the course of the first

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semester, faculty provided input on an individual’s reflective writing; faculty noted considerable improvement in the reflective writing skills of students as the semester progressed.

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Overall, faculty have noted a perceived improvement in student writing and

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communication, and in end of course evaluation surveys for Fall 2013, students stated they feel more comfortable with writing. While the preliminary and anecdotal results are positive, a formal evaluation plan is currently being developed by a task force of DGN faculty. This plan will develop measures to assess both student writing abilities and student attitudes toward writing as they develop over the course of a program. In addition to these more formal means of assessment, faculty are already performing and responding to informal student feedback through student satisfaction surveys and course evaluations at the end of each semester. To date, faculty have been able to determine what modifications to the new assignments and instructions are needed.

ACCEPTED MANUSCRIPT 14 Conclusion Consistent with the Institute of Medicine (2011) and the AACN (2006), writing and

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communication are recognized as vital skills for nurse practitioners and are skills that can be

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learned (Shirey, 2013). Writing is one skill that needs to be developed in students to meet the charge of AACN and the Institute of Medicine. Moreover, advanced practice nurses prepared at

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the doctoral level need to be able to effectively communicate with colleagues and other health

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care professionals within interdisciplinary teams in order to better impact patient and population health (AACN, 2006). Through the development and implementation of a discipline-specific,

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context-specific writing plan, students in the DGN now have the opportunity to develop and advance their writing skills and become more effective communicators internal and external to

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the health care profession.

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Nurse educators have the responsibility of not only preparing students to be advanced practitioners but also advanced professionals. This project modeled for students the importance

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and value of engaging in interprofessional collaborations among experts from different

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disciplines. Nurse educators benefit when they seek out and engage in collaborations with writing specialists at their institutions to develop their curriculum and assist students in becoming advanced professionals. DNP students also benefit from such collaborations as it helps them to develop the writing and communication skills necessary for professionals in today’s changing workforce.

ACCEPTED MANUSCRIPT 15 Appendix A: Writing Outcomes Statement Writing Outcomes Statement for the Graduate Nursing Program

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By the end of the MS program, students should be able to successfully perform 1-5. By the end of the DNP program, students should be able to successfully perform 1-6.

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1) Analyze and synthesize multiple scientific and scholarly sources from nursing and related disciplines to create a comprehensive review of the literature a. Locate appropriate literature related to an identified topic b. Interpret and evaluate demanding scientific and scholarly readings c. Create clear, concise, and logical summaries of sources d. Establish connections between the sources, identifying similarities and differences, to present a coherent overview of an identified topic

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2) Identify a clear purpose for a writing task and demonstrate that purpose with evidence and analysis a. Develop a clear thesis statement that identifies a discernible purpose b. Effectively integrate appropriate and relevant evidence from scientific and scholarly sources into writing with a balanced use of direct quotation, summary, paraphrasing. c. Analyze evidence to demonstrate its significance and relevance to the thesis statement

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3) Engage in reflective clinical practice a. Critically reflect on one’s evolving role while transitioning from RN to APN/DNP b. Describe, explore, and self-critique the processes involved in independent, clinical decisionmaking c. Apply scientific and scholarly research to clinical practice

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4) Engage in all aspects of writing processes including invention, research, drafting, sharing with others, revising in response to feedback, proofreading, and editing. a. Develop ideas through interaction with others b. Give and receive critical responses to writing c. Critique their own writing in order to revise both global (organization, development, focus, etc.) and local (grammar, usage, format, etc.) concerns 5) Demonstrate academic and disciplinary writing conventions a. Demonstrate mastery of Standardized Edited English b. Properly and responsibly use APA style with no error c. Create paragraphs that have a singular and developed focus d. Demonstrate a logical organization in which paragraphs and sections are explicitly related to each other and remain focused on a purpose e. Compose concise and precise prose 6) Propose, plan, implement, and evaluate an applied research project a. Analyze a current clinical practice to identify a problem and explore that problem in a review of the literature b. Design, describe, and carry out an applied research project that uses appropriate research methods c. Analyze and evaluate a project’s data and results to establish their significance

ACCEPTED MANUSCRIPT 16 Appendix B: Writing Plan for the Department of Graduate Nursing A Summary of the Writing Plan for the Department of Graduate Nursing

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Purpose This document outlines the major findings regarding the Department of Graduate Nursing’s current implementation of writing into their curriculum and suggests recommendations that seek to increase the presence and relevance of writing as well as purposefully sequence writing tasks within their curriculum.

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Methods During the Spring 2012 semester, the curriculum was reviewed and current writing instruction was evaluated. This process included a review of selected marked student papers, the corresponding assignments or rubrics, and the graduate program handbook by the writing consultant; also included were the identification of courses for review, and the collection of syllabi and writing assignments for the identified courses. Faculty members were asked to individually devise a draft of a writing outcomes statement using guidelines and examples. The writing consultant individually interviewed faculty members to supplement the collection of written documents.

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Based on this collected data, the writing consultant created a Writing Outcomes Statement for the Graduate Nursing Programs that faculty revised and approved for use. The writing consultant paired the existing courses and their assignments to the newly created writing outcomes to determine how and to what extent the curriculum currently is or is not meeting the writing outcomes. Findings and Recommendations These findings are drawn from the analysis of the collected materials outlined above. The recommendations are based on elements of composition and rhetorical theory and practice as well as the needs and resources of the Department of Graduate Nursing. Faculty Recommendation: Finding 1 Faculty members indicated that they spend a significant amount of time commenting on, marking, and grading student writing. The writing consultant confirmed that faculty members do spend a significant portion of time on student papers; comments and corrections occur numerous times on each page. The majority of comments and corrections centered on APA format and grammatical errors with relatively few comments engaging the papers’ content. Faculty members reported feeling overwhelmed when grading student writing and stated that they did not believe that they were productively or efficiently using their time. Others indicated that they felt

ACCEPTED MANUSCRIPT 17 uncomfortable commenting and grading student writing in general and needed some direction and instruction.

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Recommendation 1 A workshop on the marking and grading of student writing would benefit the nursing faculty as a means to introduce faculty to commenting and marking strategies, including marginal comments, end comments, and minimal marking, as well as time management techniques. These strategies and techniques would assist in decreasing the time that faculty spend commenting on student work while increasing the value and productivity of the time that is spent and the comments that are made.

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Curricular Recommendations Finding 2 The comparison of the curriculum to writing outcomes showed that nearly all courses ask students to meet writing outcomes 1 and 2. However, students appear to be provided with little to no instruction in terms of how to meet the outcomes. Faculty indicated that students struggle to meet outcomes 1 and 2 during their first years of study and throughout subsequent years. Given the population and nature of the program (with the majority of students returning to academia after several years in professional settings), this is a common situation.

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Recommendation 2 During their first year of study, students need more support and direct instruction in meeting outcomes 1 and 2; this will provide a foundation and practice in academic writing for those who need it most and a refresher for those who might need it less. Assignments during this first year can be broken down into separate assignments that provide more direct practice in academic writing skills. Finding 3 The comparison of the curriculum and writing outcomes revealed that the current curriculum does not address most aspects of writing outcomes 4. Additionally, the curriculum does not appear to show or teach students how to engage in the writing process or critique their own writing. Other aspects of outcome 4 are being met only through discussion board posts where students respond to other students’ ideas but not necessarily their writing. Recommendation 3 The writing process should play a more active and visible role throughout the curriculum. Courses undertaken during year 1 of the program would most explicitly incorporate and require elements of the writing process with less explicit and fewer requirements during years 2 and 3.

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Finding 4 All but one faculty member expressed concern with the use and quality of discussion board posts (DBPs). Concerns included the quality of student writing in the posts, the lack of student engagement with the prompts and with each other, the quality of student responses to each other’s posts, the unclear purpose or role of DBPs within courses and the program, and the heavy reliance on DBPs as part of the curriculum. Many also indicated that DBPs are not achieving or encouraging interaction between students. The comparison of curriculum to writing outcomes confirms that DBPs do take on the bulk of student work and interaction throughout the program. A review of discussion board post assignment also reveals that DBPs serve a limited and formal purpose: students are generally expected to post "mini-academic papers” and respond to two other students. DBPs also do not appear to directly contribute to final projects.

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Recommendation 4 Extending the uses of DBPs and restructuring the role that DBPs play in the program would benefit faculty and students. DBPs can also serve less formal purposes, allowing students to interact with each other and explore ideas in less structured ways and can be used to engage the writing process. DBPs can serve more purposes, especially as places of exploration, and be less formal in terms of APA format and other academic conventions. The curriculum would benefit from creating different kinds of assignments outside of DBPs that encourage student interaction. Experimentation with other mediums, such as blogs, wikis, and journals is another option for encouraging more productive student engagement with course material and each other.

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Finding 5 The comparison of the curriculum to the writing outcomes indicated a minimal presence of outcome 3. Engage in reflective clinical practice. This outcome is reflected only minimally during the curriculum and intermittently throughout the program. Recommendation 5 Reflective clinical practice, especially self-reflection and self-critique, should be more consistently incorporated throughout the curriculum so that students can meet writing outcome 3. Journaling is a practice that encourages self-reflection and would help students engage in reflective clinical practice. Similarly, a separate and required self-reflection component could accompany the final applied research projects. Conclusion During the Fall 2012 and Spring 2013 semesters, the Graduate Nursing Faculty and writing consultant will work together to implement the recommendations listed above or adapt the recommendations so that they best serve the faculty, students, and program.

ACCEPTED MANUSCRIPT 19 References

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