Writing Across the Curriculum (WAC) Educational Strategies to Enhance Graduate/Undergraduate Nursing Comprehension of Pathophysiology

Background. Although much has been written about the value of the ‘flipped classroom’ and 'blended learning' as they pertain to active participation in learning activities, much of today’s didactic classroom learning in nursing education is deeply rooted in traditional passive techniques (Owsten,York & Murtha, 2013; Thai, De Wever & Valcke, 2017; Zacharis, 2015). The use of consistent writing prompts in the discussion of varied problems and topics can serve to expand the breadth and depth of learning, and are used in many university settings and schools (Baepler, Walker & Driessen, 2014). The concept of 'writing to learn' has been shown to improve understanding and performance in a variety of settings, such as engineering (Goldberg, Rich & Masnick, 2014) and human physiology (Bunker & Schnieder, 2015) to expand content knowledge. Given the time constraints involved in the delivery of complex, content rich education in nursing, passive didactic learning represents a missed opportunity for undergraduate nursing students or graduate doctoral students to engage in scholarly writing as a mechanism to enhance learning.

Method. In a university setting, when writing prompts are used in concert with culturally sensitive patient oriented problem scenarios related to complex pathophysiology, nursing students have been shown to more able to integrate application knowledge related to the discipline of nursing. Despite classrooms ranging in size from 28-141 students, randomly assigned student groups of 4-5 were assigned to address four general writing prompts that were further articulated so as to be related to pathophysiology concepts. These prompts are as follows: 1. Identify the relevant information and uncertainties, 2. Explore the interpretations and connections, 3. Prioritize alternatives and implement conclusions, and 4. Integrate, monitor and refine strategies to re-address the problem. Students are asssigned to a patient oriented scenario that represents application of classroom related pathophysiology content. These case scenarios also include human factors related to diseases and conditions, such as health care access, concerns about loss of employment, or other social or economic challenges. In the context of small group dynamics and delegation, students self assign to various sections of the assignment for completion, and then review their own writing, as well as their peers in the group in advance of submission of their written work and in-class oral group presentation. Although students are not allowed to present using powerpoint, they will often use other strategies to improve education to the class.

Although the WAC strategy was initiated in graduate pathophysiology, the opportunity for further development was realized at the senior, then junior level undergraduate medical surgical nursing classes. The writing prompts facilitate student writing that engages the human effect of pathophysiology, and necessitates the review of inter-professional literature. Through an exploration of culture, context, resource availability, health policy and health disparities, students consistently report that they are able to retain knowledge in a context that promotes effective nursing practice. Group presentation of material provides an opportunity to engage an additional touch point of knowledge just prior to unit or comprehensive exams.

Outcomes. Faculty have identified that the students engaged quickly and deeply within the Writing across curriculum group assignments. Student group presentations consistently reflect high levels of scholarship, depth of writing and innovative connections of the core pathophysiology content to societal concerns, such as access to healthcare, processes involved in treatment and policy related to available treatment. Students report in course evaluations that the use of the WAC strategy has deepened their knowledge of course content while providing the opportunity for reflection and attentiveness to the humanistic and holistic nature of problems associated with various diseases and conditions. Through active and engaged learning, students report the ability to synthesize and construct new knowledge, while concurrently reinforcing course content during the group presentations in preparation for examinations and patient care. Regardless of level of student, the presentations have reflected scholarly investment, and have been of consistently high quality. Two faculty members are assigned to grade both written work and oral presentations using a developed rubric that was shared with students at time of assignment.

Conclusion. Multiple touch points of content rich information fosters a deep understanding of course content. Use of Writing across the Curriculum (WAC) strategies have been shown to enhance learning in several university settings. Use of WAC in schools of nursing offers an ability to apply complex and comprehensive pathophysiology knowledge to patient oriented problems faced by nurses in a variety of clinical settings and across multiple levels of undergraduate and graduate nursing education.

Next steps. 1. Evaluate the relationship of the WAC strategy in undergraduate and graduate education to effective scholarly writing within comprehensive capstone projects, 2. Evaluate the effect of WAC strategy on performance in licensure exams such as the NCLEX and nurse practitioner examinations.