Curriculum Redesign: Improving Writing and Critical Thinking Skills in Doctor of Nursing Practice Programs

Introduction   The purpose of this interactive education session is to present components of the University of Arkansas Eleanor Mann School of Nursing (EMSON) Writing Across the Curriculum (WAC) program. The program focused on strengthening critical thinking and analytic skills of students enrolled in the Doctor of Nursing Practice (DNP) program. To accomplish this goal, EMSON faculty collaborated with the university’s Writing Center (WC) director and reviewed DNP project papers to determine problematic elements that were consistent from the DNP program’s inception. The expectation for the WAC program was that students’ ability to evaluate evidence from research articles, translate evidence into innovations that can be put into practice, and express concepts in written and verbal form would be positively affected by improved writing competence; EMSON faculty would be able to concentrate on main concepts of the DNP proposal and final paper rather than addressing rhetorical and compositional development of writing styleand formatting issues; and the WAC program would enhance students’ critical thinking abilities, positively impacting their clinical experiences. This session will detail the WAC program structure and results of the pilot study, highlight interdisciplinary collaboration, and include strategies for incorporating the WAC program for online and blended programs for multiple disciplines.   Background   The DNP is a terminal practice degree focusing on translational research and implementation science. DNP-prepared nurse practitioners are adept in evaluating research results and creating methods to implement evidence-based innovations into the practice setting. The American Association of Colleges of Nursing (AACN) recommends that nurse practitioners have a terminal doctorate degree upon entry to practice. Since 2004, many universities have adapted their nurse practitioner tracks to meet this requirement. Programs exist for students who have both Bachelor of Science in Nursing and Master of Science in Nursing degrees and multiple practitioner tracks exist for geriatric, pediatric, neonatal, and women’s health. DNP programs are available in all 50 states and the District of Columbia (AACN, 2019).This interactive session is timely and appropriate for the OLC conference as, historically, DNP students have required remediation to address writing weaknesses found in their assignments. Concerns of inept DNP students’ writing skills and ability to synthesize literature were identified by DNP faculty in a 2016 national survey (Dols, Hernandez & Miles, 2016). Nursing faculty erroneously assume that students entering the DNP program possess the writing skills necessary to complete a doctorate program (Stark, Troiano, Knapp, & Johnson, 2012). Solutions for these concerns are relevant to all graduate nursing programs at both the national and international levels. The DNP project and project deliverable are the compilation of learned skills taught throughout the program. Competence with writing is associated with improved critical thinking and analytic abilities aswriting “affords the opportunities to both foster and examine the interrelationship of scientific reasoning and critical-thinking skills within and across disciplinary contexts” (Dowd, Thompson, Schiff, & Reynolds; 2018). The DNP-prepared nurse practitioner drawing upon these skills will be adept at analyzing situations, applying logic, solving problems, and communicating solutions to the appropriate stakeholders.   Writing Across the Curriculum Program Interactive Session   Understanding that writing and critical analysis skills are problematic for many DNP programs, we will discuss how specific components of the WAC design met the DNP programs’ identified areas of concern during the interactive session. After highlighting the WAC program development and initiation at EMSON, we will guide participants in adapting the program to meet the needs of their universities and provide supporting materials electronically for participants. The educational, interactive session is a perfect method to meet the participants’ needs andmost applicable for this type of presentation. The following details the formation and implementation of the WAC program which will be discussed during the session. The WAC program was developed partly in response to an initiative set by the universityProvost in 2019 which called for all departments to improve students’ writing skills. During that time, EMSON graduate faculty placed the writing needs of graduate nursing students as a priority for program improvement. Concept development, integrationof complex ideas, extrapolation from general ideas to address larger concerns, and articulating elements inherent in the DNP project had been previously identified as areas in need for improvement after a thorough evaluation of the EMSON DNP program’s curriculum. Faculty also recognized the need for development sessions to assist them in enhancing students’ writing skills. Representatives from EMSON and the WC met to discuss these concerns and to develop a solution which became the WAC program. The program waspurposefully designed toimprove the learning experience and mature students into proficient writers. EMSON faculty and WC staff collaborated to develop a writing rubric that spanned the entire DNP program and included specific yearly goals, a schedule for faculty development sessions utilizing the EMSON Research Librarian as well as the English department and the Statistical and Analytics department professors, program instruction improvement recommendations to improve critical thinking skills and writing competence in each course, and remediation for students at-risk for not proceeding in the DNP program due to poor writing and articulation efforts. Faculty expressed motivation and buy-in to initiate the WAC program as they felt the end result would allow them to focus on more profound issues in the DNP proposal and final paper instead of acting as “copy editors,” making better use of faculty time and decreasing frustration. The WAC program design promoted equity among students by ensuring every student had access to writing support and an equal opportunity to succeed. Students from varying backgrounds and levels of preparedness used the academic support to address challengesin confidence, skill levels, and barriers to success. In addition, clear articulation of consistent standards across the DNP program promoted inclusion as all students were required to meet the same standards for success throughout all courses. Further, requiring all students to meet with a tutor at least once and submit the tutor’s recommendations to faculty reinforced inclusion. The project design did not force remediation on any student. All students, but especially students for whom English was a second language, had the benefit of an audience for their writing that provided risk-free feedback outside the realm of the grade, with an option to revise and resubmit as desired. Three courses were chosen to participate in the pilot study of the WAC program based on their placement within the program; one course was offered the first semester, the second was offered the fourth semester, and the last course, in which the students write their DNP project proposal drafts, was offered in the tenth semester. Three experienced tutors, who recently completed Master of Fine Arts degrees in Creative Writing and Translation, were selected to work with students for the pilot study. Tutor preparation included review of the program objectives, writing assignments for all courses, DNP Proposal Guidelines, and SQUIRE 2.0 document. Tutors were also enrolled in the course Blackboard shells to facilitate their understanding of course requirements.Faculty informed students about the WAC program the first day of class. Assignments were selected prior to that day, and both the tutors and students were given due dates for submission to the WC. Tutor schedules were posted seven days in advance of appointment availability.Students had three options for tutoring sessions: chat sessions, asynchronous appointments, or synchronous appointments. Students submitted the paper and assignment rubric prior to the due date for an asynchronous session allowing the tutor to evaluate the student’s writing. Upon completion of the review, the tutor emailed recommendations to the student and faculty, ensuring that faculty could track student participation in the program and confirm students were incorporating the recommendations into the assignments prior to submitting them for a grade. Students had the option of submitting the revised paper for additional tutorials, preferably as synchronous sessions allowing for real-time discussion with the tutor. Throughout the writing process, students could use Chat sessions for quick conversations with tutors. Chat sessions required no appointments and could be transitioned to a full appointment as need and time allowed. Integrating the WAC program into the design of the Blackboard shell facilitated student engagement with tutors and tutors’ understanding of course assignments and structure. Embedded links to tutor information, appointment scheduling software, and chat platform facilitated student access. Completed assignments from past students were provided as exemplars for each assignment. Peer review requirements encouraged participation and discussion among students and helped build an engaging classroom climate where students assisted each other with proposal development.   Conclusion   The WAC interactive session will enhance participants’ understanding of how interdisciplinary collaboration and purposeful course structure can improve students’ critical thinking and analytic skills, and will promote strategies for the incorporation of vital concepts into any educational program. The session contributes to the field of nursing education by directly addressing identified areas of concern within DNP programs. Although the session will highlight improvements to the EMSON DNP program, theWAC format can be adapted for any program and will be useful to a wide array of the conference’s attendees.   References   American Association of Colleges of Nursing. 2019. AACN Fact Sheet. Retrieved May 27, 2020 from https://www.aacnnursing.org/News-Information/Fact-Sheets/DNP-Fact-Sheet   Dowd, J. E., Thompson, R. J., Jr, Schiff, L. A., & Reynolds, J. A. (2018). Understanding the Complex Relationship between Critical Thinking and Science Reasoning among Undergraduate Thesis Writers. CBE life sciences education, 17(1), ar4. https://doi.org/10.1187/cbe.17-03-0052.   Stark, S; Troiano, M; Knapp, R & Johnson, B. (March 2012). Scholarly Writing Issues Among DNP Students: Lessons Learned in Writing and Rigor. National Organization of Nurse Practitioner Faculties (NONPF) Annual Conference. Pittsburgh, PA