Written Assignments and Clinical Evaluation
Assessments 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.
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 considering 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
(f) develop writing skills
Many of the written assignments in clinical courses assist students in mapping out their plan of care and identifying areas in which they need further instruction. Some assignments, such as keeping 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 having 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, indeed, throughout the entire nursing program.
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.
Drafts and Rewrites
Written assignments enable the teacher to assess students’ ability to present, organize, and express ideas effectively in writing. Through papers and other 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, although, students need to complete drafts of writing on which they get feedback from the teacher.
Drafts and rewrites of papers are essential if the goal is to develop skill in writing (Oermann , 2002, in press). Teachers should critique papers for quality of 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 , 2002).
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. Ellermann , Kataoka-Yahiro , and Wong (2006) have integrated faculty mentoring and the preparation of a draft as part of a writing assignment in a pediatric nursing course.
In that assignment, students meet with their clinical faculty member and brainstorm concepts to include in the paper and how best to present them. This interaction with the teacher as a mentor builds students’ professional communication skills and critical thinking (Ellermann et al., 2006). 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. Peers can assess writing in small-group activities in the classroom, online, and in post clinical 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 teaching plans, do not foster development of writing skills, nor do they provide data for assessing writing.
Wright (2006) commented that assignments such as these are regimented, with limited opportunity to express creativity. Other assignments such as papers on analyzes of theories and critiques of the literature 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
■ Evidence-based practice paper in which students critique and synthesize the evidence and report on its use in clinical practice
■ Paper analyzing concepts and theories and their application to clinical practice
■ Paper comparing different interventions with their underlying evidence base
■ Paper on how the class content compares with what the students read in their textbook and in other sources, and how it applies to patient care
■ Short paper for critical thinking in which students analyze different options, weigh alternatives, consider alternative points of view, analyze issues, and develop arguments for a position
■ Case study analysis with written rationale
■ Journals in which students share their feelings and thoughts with the teacher about their experiences.
For clinical courses, written assignments that accompany the clinical practicum are valuable for encouraging critical thinking and development of problem-solving and decision-making 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. Walker (2006) suggested that writing assignments such as journal writing bridge the gap between classroom learning and a student’s clinical course.
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 , 2006). For example, students might write a one-page paper on an alternate intervention for a patient with a rationale 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
■ Concept analysis paper in which students describe a concept, its characteristics, and how it relates to care of a simulated or an actual patient situation
■ 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 patients
■ Short paper related to clinical practice
■ Teaching plan
■ Nursing care plan
■ Analysis of interactions with individuals and groups in the clinical setting
■ Report of observations made in clinical settings
■ Journal and other writings about personal reflections of patient care experiences and their meaning to students, and
■ 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 their thoughts about the content presented in a face-to-face class or one presented online.
They 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 board. 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 volunteer or be called on to 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 criticism 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 diagnoses, 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 research and other evidence that relates to patient care.
Students also 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 post-clinical conferences
In post clinical 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 practice day. Group writing exercises are effective in post clinical 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, at 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 11.1. 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. The points assigned to the scoring rubric should reflect the importance of the criterion or characteristic (Moskal , 2003). 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 , 2008).
Consistent with other evaluation methods, written assignments may be assessed either formatively (not graded) or summative (graded). With formative evaluation the intent is to give feedback on the quality of the content and writing so that students can further develop their writing ability.
Feedback is of value only if given promptly and with enough detail for students to understand how they can improve their writing. With some assignments, such as reflective journals, only formative evaluation may be appropriate.
Many nursing faculty members are concerned about the amount of time spent giving feedback on students’ technical writing errors, such as grammatical, punctuation, and spelling errors. If teachers focus entirely on assessing the quality of content of written assignments, students will not understand how their technical writing skills affect their ability to communicate relevant and important information.
There is a difference between giving feedback on the quality of technical writing skills and actually correcting errors for students. One method for avoiding the latter approach on a graded assignment is to signify technical writing errors with a particular symbol such as a checkmark, or more specifically, by identifying the type of error, such as “spelling” or “ sp ” and then require students to make the appropriate corrections to improve their scores.
Another approach is to establish a “gateway” criterion for all graded written assignments. For example, the teacher specifies that no more than five grammatical, spelling, and punctuation errors will be accepted; if a paper contains more than the specified number, the teacher stops reading and scoring the paper and returns it to the student author.
The student then corrects the technical errors and resubmits the paper, possibly for a lower overall score. These methods can be incorporated into any scoring rubric that a nursing faculty member develops for written assignments, as previously discussed.
Suggestions for Assessing and Grading Written Assignments
The suggestions that follow for assessing papers and other written assignments do not apply to every written assignment used in a course, as these are general recommendations to guide teachers in this process.
- Relate the assignments to the learning outcomes of the course. Papers and other written assignments should be planned to meet particular learning objectives. All too often students complete papers that may have a questionable relationship to course goals.
- Consider the number of written assignments to be completed by students, including drafts of papers. How many teaching plans, concept papers, research proposals, one-page papers, and so forth are needed to meet the goals of the course? Students should not complete repetitive assignments unless they are essential to meeting course goals or personal learning needs.
- Avoid assignments that require only summarizing the literature and substance of class and online discussions unless this is the intended purpose of the assignment. Otherwise students merely report on their readings, often without thinking about the content and how it relates to varied clinical situations. If a review of the literature is the intended outcome, the assignment should direct students to read these articles critically and synthesize them, not merely report on each article.
- Include clear directions about the purpose and format of the written assignment. The goals of the written assignment—why students are writing the paper and how it relates to the course outcomes—should be identified clearly, and generally the more detailed the directions, the better, for both students and for the teacher grading the papers. If there is a particular format to be followed, the teacher should review this with students and provide a written or electronic copy for their use in preparing the paper. Students need the criteria for grading and the scoring rubric before they begin the assignment, so it is clear how the paper will be assessed.
- Specify the number of drafts to be submitted, each with required due dates, and provide prompt feedback on the quality of the content and writing, including specific suggestions about revisions. These drafts are a significant component of written assignments because the intent is to improve thinking and writing through them. Drafts in most instances are used as a means of providing feedback to students and should not be graded.
- Develop specific criteria for assessment and review these with the students prior to their beginning the assignment. The criteria should relate to the quality of the content; organization of content; process of developing ideas and arguments; and elements of writing style such as clarity of expression, sentence structure, punctuation, grammar, spelling, length of the paper, and accuracy and format of the references. Other criteria would be specific to the outcomes to be met through the assignment. If a scoring rubric is used, it should be shared and discussed with the students before they begin the paper.
- For papers dealing with analysis of issues, focus the assessment and criteria on the rationale developed for the position taken rather than the actual position. This type of assignment is particularly appropriate as a group activity in which students critique each other’s work.
- Read all papers and written assignments anonymously. The rationale for this is the same as with essay testing—the teacher needs to remove potential bias from the assessment process. Reading papers anonymously helps avoid the chance of a carryover effect in which the teacher develops an impression of the quality of a student’s work, for example, from prior papers, tests, or clinical practice, and is then influenced by that impression when grading other assignments . By grading papers anonymously, the teacher also avoids a halo effect.
- Skim a random sample of papers to gain an overview of how the students approached the topic of the paper, developed their ideas, and addressed other aspects of the paper that would be graded. In some stances the assessment criteria and scoring rubric might be modified, for example, if no students included a particular content area that was reflected in the grading criteria.
- Read papers in random order. Papers read first in the group may be scored higher than those read at the end. To avoid any bias resulting from the order of the papers, it is best to read papers in a random order instead of always organizing papers in the same way (eg, alphabetical) before reading them. The teacher also should take frequent breaks from grading papers to keep focused on the criteria for evaluation and avoid fatigue, which could influence scoring papers near the end.
- Read each paper twice before scoring. In the first reading, the teacher can note omissions of and errors in content, problems with organization and development of ideas, issues with the process used for developing the paper, and writing style concerns. Comments and suggestions can be recorded on sticky notes or in pencil in case they need to be modified once the paper is read in its entirety. If papers are submitted online, the teacher can insert comments and suggestions in the paper using the “track changes” or “comments” tools, or by using different-colored highlighting, making it easy to identify the remarks.
- If unsure about the assessment of a paper, have a colleague also read and evaluate it. The second reader should review the paper anonymously, without knowledge of the grade given by the original teacher, and without information about the reason for the additional review. Scores can be averaged, or the teacher might decide to read the paper again depending on the situation. An additional reader also might be used if the grade on the paper will determine whether the student passes the course and progresses in the program. In decisions such as these, it is helpful to obtain a “second opinion” about the quality of the paper.
- Consider incorporating student self-critique, peer critique, and group writing exercises within the sequence of writing assignments. These experiences help students improve ability to assess their own writing: they can “step back” and reflect on their papers, identify where their ideas may not be communicated clearly, and decide on revisions. Students should be encouraged to ask peers to review and critique their work, similar to asking colleagues to review manuscripts and reports. Group-writing activities prepare students for working collaboratively to produce a product, which is similar to nursing practice in real clinical settings.
- Prepare students for written assignments by incorporating learning activities in the course, completed in- and out-of-class. These activities provide practice in organizing and expressing ideas in writing.
Conclusion
Through papers and other written assignments, students develop an understanding of the content they are writing about and improve their ability to communicate their ideas in writing. With written assignments, students can analyze and integrate the literature and report on their findings, analyze theories and how they apply to nursing practice, improve their thinking skills, and learn how to write more effectively.
To improve their writing abilities, although, students need to complete drafts and rewrites on which they get prompt feedback from the teacher on both content and writing. There are many types of papers and written assignments that students can complete individually or in small groups in a nursing course.
Written assignments should be assessed using predetermined criteria that address quality of content, organization of ideas, the process of arriving at decisions and developing arguments, and writing style. General criteria for evaluating papers, an example of a scoring rubric, and suggestions for assessing and grading written assignments were provided.