How confident are you in your ability to write academic essays? If you are a student nurse in your first year of training then your answer will depend largely on your previous success, or not, in GCSEs, A levels and the equivalent. If you entered nursing via an alternative route that had less emphasis on traditional academic preparation, then your confidence in writing an essay that draws on referenced literature will probably be much reduced. Even if you were quite strong at school or college work, you may find the transition to self-directed degree study quite difficult. If you are a qualified nurse with a pre-registration diploma or degree, returning to university study to complete a post-registration master's degree, you may still have reservations about your ability to re-engage with academic writing. If you are confident of your ability to communicate nursing theory and its application to clinical care, then this series of articles is probably not for you! However, my experience of teaching nurses, from first-year students to specialist nurses undertaking PhDs, is that very few are confident in their academic writing skills.
Academic ability versus academic writing
For most nurses who struggle with academic skills, it is usually not their innate academic ability that is the problem, but the lack of specific skills required to research the question and then communicate valid findings in a reliable way. For student nurses, this is about understanding where the body of nursing knowledge lies, be that the literature, protocols or clinical practice, how to access it and then communicate those findings. For the experienced nurse undertaking a post-registration degree, it is about dusting off library skills, getting to grips with different IT, exploring the knowledge base relevant to, but outside, pure nursing, understanding the relevance and use of clinical experience and, finally, mastering the skills of writing a long essay that communicates knowledge, experience and innovative ideas.
What ‘sister says’
When I trained as a nurse, it was in pre-university and pre-diploma or degree days; the ward sister or the medical consultant was the source of knowledge. Students quickly learned to develop their nursing skills according to what ‘sister says’: ward sisters and ward routines were the source of knowledge and authority. As nursing research and evidence-based protocols developed and began to inform nursing practice in the 1980s, the source of knowledge moved away from this and included ‘what the literature says’. Nurse training was underpinned at diploma level, validated by a university system that stressed the importance of referencing published materials as the source of authority. As the scientific base and the wealth of nursing-related literature increased over the next 20 years, student nurses were required not just to refer to the literature, but to demonstrate their discussion and critical review of a body of knowledge based on valid and robust evidence; this was reflected in the move to make nursing an all-graduate profession in the early 2010s. In what ways has this transition from ‘sister says’ to the ‘literature says’ changed the way we inform our practice?
Has our ability to apply knowledge to clinical practice changed?
To inform clinical practice and develop clinical expertise, a nurse needs to take various aspects of evidence, evaluate its appropriateness and then apply it to a specific patient or clinical situation. This was true when I was a student nurse and the source of knowledge was the ward sister. It is equally true today when the source of knowledge is more literature-based. What has changed is the origin of the knowledge. In my student days it was probably 85% ward sister and 15% text books. Today it is more like 40% clinical staff and 60% evidenced-based literature. To inform clinical practice, we need to assess the validity and reliability of the knowledge, both clinical- and literature-based, evaluate it and then apply it to clinical care. The difficulty that nursing has over the pure biological science healthcare professions, such as pharmacy and medical sciences, is that a significant proportion of nursing practice draws from the social sciences concerned with feelings and interactions. When a patient is in pain, we know we can draw upon the science of pharmacology and pain administration protocols, but it is only our observation of experienced staff and our own experiential learning that guides us as to when to hold a hand, sit by the bedside or ask about the patient's worries regarding family or pets. Communicating this interaction of hard biological science, evidence-based protocols and the application of softer caring skills is a difficult, yet important, part of academic writing for the nurse. How do we write an essay that justifies the possible benefits of holding a patient's hand, when there are no randomised controlled trials to support its application?
This forthcoming series will explore all the practicalities of planning an essay, managing the literature, developing structure and content, but it will not lose sight of this important principle of incorporating holistic clinical nursing care into academic writing.