Abstract
Introduction
Effective communication is an essential skill for the professional nurse. Previous research demonstrates that nursing students lack skills in written communication, and there is limited time in the nursing curriculum to provide needed instruction. To address this issue, a writing workshop was provided for students at a regional state university.
Methods
Nursing faculty developed and led four identical in-person sessions of the workshop over the course of one semester. Before and after each workshop, students completed the same quantitative survey.
Results
Data indicate that students’ knowledge and confidence of American Psychological Association (APA) format increased significantly as a result of the workshop.
Conclusion
A workshop approach is a useful strategy to address the writing needs of nursing students.
Keywords
Introduction/Background
In The Essentials: Core Competencies for Professional Nursing Education, the American Association of Colleges of Nursing (AACN) (2021) describe 10 domains for nursing, which “constitute a descriptive framework for the practice of nursing” (para. 4). Embedded in these domains is the need for nurses to have strong written communication skills. Specifically, Domain 1: Knowledge of Nursing Practice and Domain 4: Scholarship of Nursing Practice reference the importance of research in the nursing profession.
What Was the Problem?
With these domains in mind, one objective of nursing faculty is to improve undergraduates’ communication skills as they increase their nursing knowledge in preparation for entry-to-practice. This is complicated, however, by the extensive curriculum requirements of pre-licensure nursing programs. The challenge becomes how to teach students written communication skills while also staying focused on other essential learning outcomes.
Why Was It a Priority?
Research indicates that nursing faculty commonly find that writing is a significant challenge for students (Diehl, 2007; Troxler et al., 2011). Despite this fact, writing skills are not often a focus of instruction in undergraduate nursing education (Miller et al., 2015). This is likely related to the significant volume of discipline-specific content that must be covered to prepare students to be successful on the licensure examination (NCLEX-RN).
Summary of What is Known About the Problem
Recent research in this area relates to various strategies that nurse educators have employed to address this problem. Some of the approaches identified are guided instruction (Miller et al., 2015), use of workshops (Derouin et al., 2015), discipline-specific writing education (Mitchell et al., 2017), and strategies to incorporate writing across the curriculum (Hawks et al., 2016).
Workshops, like the ones discussed in this paper, have successfully been used to improve writing skills of both nurses and nursing students (Derouin et al., 2015). For example, Johnson et al. (2007) utilized a workshop approach aimed at developing the technical writing skills of underrepresented and disadvantaged baccalaureate nursing students; use of APA reference style was one of the workshop topics. Nursing students learn APA format for several reasons. APA format teaches students to write using professional standards, to read complex research documents systematically, and to give proper credit to authors for academic advancements (Schwartz et al., 2020). In essence, teaching students APA format helps them become proficient communicators of complex information.
Purpose of the Project
In an effort to enhance the writing skills of nursing students, a writing workshop was developed that addressed a specific weakness noted among students across the program: knowledge and use of American Psychological Association (APA) format. Findings indicate APA workshops improve students’ confidence and ability to use APA format. Based on faculty experiences, a national nursing organization's recommendation, and previous literature, the question being addressed by this research is: Can a workshop approach improve nursing students’ experience, confidence, and knowledge of APA format?
Methods
A quantitative pre-test, post-test questionnaire was developed to measure students’ experience, confidence, and ability in using and understanding APA format. Questions were identical on the pre-test and post-test. While names were not recorded on surveys, each student was given an identification number to put on their survey. Survey participation was voluntary. Pre-test surveys were given immediately prior to the workshop, and post-test surveys were given immediately following the APA workshop.
Interventions
Four identical workshops were offered over the course of one semester. For consistency, the information was presented by the same two nursing faculty members at each workshop. PowerPoint was used to present the content to participants, which consisted of four parts: rationale for using APA format, essential APA paper elements and format, properly crediting works in the text, and constructing the reference list. Workshop days and times varied in an effort to accommodate students’ schedules. Faculty presenters partnered with the university Writing Center staff and enlisted the support of student writing consultants to assist with the workshops. The Writing Center is used by students who seek out help with writing assignments and works based on a peer tutoring model. One or two writing consultants were present and contributed to each session. The sessions were voluntary for students, and interested students signed up to attend one session. Students in this nursing program are required to attend one out-of-class enrichment activity per academic year. The APA workshop counted as that enrichment activity for participants. Therefore, this study is based on a convenience sample of interested nursing majors. There were 175 nursing majors on campus during the spring of 2021. In total, 49 nursing majors participated in the workshops. Of the 49 total participants, there were 34 first-year students, 10 sophomores, and five juniors. No senior participants were included because all senior nursing majors were off campus completing internships. Attendees were predominately female and white and between the ages of 18 and 22 years old, which is reflective of the population of nursing majors at this institution. To be a nursing major, students have to maintain a GPA of 2.75; therefore, all participants in the workshops were in good academic standing.
The 1-hour workshop took place on campus after classes ended for the day, giving students a better opportunity to attend, if they desired. PowerPoint was used to present the information at each workshop. The content consisted of four main parts: rationale for using APA format, essential APA paper elements and format, properly crediting works in the text, and constructing the reference list. Rationale for using APA format included information about scholarly writing, ethical and legal standards, plagiarism and self-plagiarism, and a discussion of the university honor code. Topics covered under the “Essential APA Paper Elements and Format” portion of the presentation included an overview of student papers versus professional papers, required elements of a student paper, heading levels, font, line spacing, margins, and paragraph indentation. Students also learned when to include in-text citations, how to format citations in the body of the paper, how to use direct quotations, and how to cite them. Following the instruction in this portion of the workshop, students were given an opportunity to practice formatting a parenthetical citation and a narrative citation. Lastly, students were given instruction and examples of how to construct a reference list.
Measures
A quantitative survey was utilized to assess students’ experience and confidence using APA format prior to and following the workshop. The questionnaire consisted of a total of 17 items; in addition to the aforementioned self-report items (experience and confidence), 12 questions from the Penn State University Libraries APA Style Quiz were included to objectively assess participants’ knowledge of the content presented. These 12 questions asked students to choose correct APA format from a list of four or five possible options (multiple choice). Permission for use of these items was granted by Penn State University Libraries via e-mail communication. A Likert scale (0–10) was used for the experience and confidence questions. Demographic information (year in the nursing program) was also obtained.
Institutional Review Board Approval
IRB approval (February 23, 2021) was granted prior to any research/workshops being conducted.
Statistical Analysis
Responses from participants were entered into Excel and exported into SPSS 25 for analysis. Descriptive statistics were run to evaluate students’ year in the nursing program and their confidence and knowledge of APA format. Four paired samples t-tests were performed to compare students’ pre- and post-responses to the following: confidence in ability to use APA format in a paper, confidence in ability to cite sources/references in a paper, overall knowledge of APA style, and total APA Style Quiz questions answered correctly.
Results
Using a priori sample size calculation for a minimum total sample size required for a two-tailed hypothesis with a desired statistical power level of 0.8 and a probability level of 0.05, it was determined that the minimum sample size needed per group was 26 respondents (Soper, 2023). In total, 49 participants took pre- and post-surveys on APA style knowledge and confidence during the spring 2021 semester. All 49 participants fully answered survey questions before and after the workshops, resulting in no missing data.
Association Between Interventions and Outcomes
Confidence using APA format was asked on a 0–10 scale. The mean pre-test score for the combined 49 participants was 4.65 (standard deviation [SD] = 2.269) whereas the post-test mean for the same question was 7.18 (SD = 1.845). The paired sample t statistic was 5.95 and the finding was significant at the p < .001 level in a paired samples t-test. Confidence in using APA citations correctly was also asked on a 0–10 scale. The mean pre-test score was 5.78 (SD = 2.094) whereas the post-test score was 7.45 (SD = 1.815). This, too, was a significant finding at the p < .001 level in a paired samples t-test (t = 4.22). Perceived knowledge (experience with APA) was asked on a 0–10 scale. The pre-test mean was 4.71 (SD = 1.958), and the post-test results were a mean of 7.18 (SD = 1.856); this finding was also significant (t = 6.39, p < .001). Reliability for these items was established using a Cronbach's alpha in SPSS. At time 1 for these four questions, the Cronbach's alpha was 0.885, and at time 2 it was 0.898, indicating strong covariance between items and variance in the total score. The 12 questions that asked students to identify the correct APA format/citation out of four or five options was marked as either correct or incorrect. These questions were created by Pennsylvania State University to test student knowledge. Questions and answers can be accessed through the Penn State University Libraries APA Quick Citation Guide (2023).
Prior to the workshop, students got an average of 8.06 questions correct (SD = 1.761), and after the workshop, students got an average of 9.35 questions correct (SD = 1.614). The paired sample t statistic was 3.79, and this finding was significant (p < .001). Cohen's d was used to measure effect size because groups at time 1 and time 2 have similar SDs and are of the same sample size. Cohen's d effect sizes are presented in Table 1. All effect sizes are large with the exception of the APA style questions answered correctly at time 1 and time 2. This effect size is 0.76, and falls between a medium and large effect size. Therefore, the means at time 2 are all at least 0.76 SDs above what they were at time 1.
Paired Sample Means and t-Test of Improvement in APA Knowledge.
Note. p < .05*, p < .01**, p < .001***
Findings from this research were statistically significant and indicate that a workshop approach can be used to improve student writing. Scores for experience, confidence, and ability to use APA format improved after the workshop compared to before the workshop. In programs where little time is available for written communication instruction, APA writing workshops may be the answer for busy faculty and students.
Discussion
While the curriculum for nursing majors is demanding on both students and faculty, learning written communication is essential for long-term success of nursing students. We have bridged the gap between time and learning by offering APA format workshops to our students. Results indicate that students not only learned APA format during these workshops but also boosted their confidence related to writing using professional guidelines. When asked to identify correct APA format in 12 questions, participants got an average of 8.06 correct before the workshop and an average of 9.35 questions correct after the workshop. What is more impressive is how much confidence participants gained during the workshop. Faculty plan to develop topics for future writing workshops based on faculty and/or student-identified needs.
Lessons Learned
Prior to the workshops, nursing faculty were aware of gaps in students’ understanding of APA format. The data collected during these workshops showed that not only were students struggling with the technical aspects of APA format but also with their confidence in their ability to use APA format and citations correctly. A 1-hour workshop significantly improved students’ abilities and confidence in regards to APA format.
Strengths and Limitations
Nursing curricula are content-full and fast-paced, making it difficult to add information, that may or may not be addressed in general education classes, into courses. In alignment with findings from previous research (Derouin et al., 2015), voluntary workshops improve students’ abilities to use APA and their confidence in using APA format and citations. The current study has two major limitations that can be addressed with future research. The sample size of this study was 49 students who self-selected into the writing workshop. Future research would benefit from a larger, randomized sample. Furthermore, the post-test survey was given only once immediately following the workshop. Future research would benefit from an additional post-test survey given several weeks after the workshop to see if students retained their knowledge. Even if specific ideas were not retained, the authors argue that building confidence in using APA format will help students overcome hurdles in future writing projects.
Implications for Practice
These research findings indicate that nurse educators can successfully incorporate writing instruction in the nursing curriculum utilizing a workshop format. This approach serves as an effective alternative to adding this important content to an already content-heavy course. Incorporating campus resources, such as the university Writing Center, can increase the benefits of such workshops to students.
Conclusions
While professional standards for nursing clearly argue that written communication is an essential competency needed for career success, previous research indicates that skill in written communication is something that nursing students struggle to ascertain (Diehl, 2007; Troxler et al., 2011) and faculty struggle to teach given other demands (Miller et al., 2015). Addressing this gap takes creativity and data-driven decisions. Our pilot study indicates that teaching workshops on APA formatting, while partnering with the university Writing Center, works to improve nursing students’ self-ranked experience and confidence of APA formatting and citations while also improving their ability to successfully identify proper APA citations and format.
Footnotes
Acknowledgements
The authors would like to thank Krystle Forlines, DNP, RN of Danville Community College for her contributions to this project.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
