May 1998

Writing Across the Curriculum and Critical
Thinking Skills in Nursing 414
May 1998

Michele Turner, who teaches Nursing 414, an elective titled Applying Neuroscience Nursing Principles to Practice, has developed unique ways to enhance both critical thinking and writing skills among her junior- and senior-level nursing students. Many of her ideas were stimulated by material presented at a WSU workshop given by Indiana University Professor Craig Nelson. The following article is her description of three of the assignments she uses to achieve these goals.

Everyone would agree that critical thinking is a transitional process and that our students come to us performing at various levels. As a result, developing projects that enhance thinking can be an educational challenge. Adding the need to develop writing skills magnifies that challenge.

Because higher level critical thinking skills are so important to the practice of nursing, the assignments for this course are designed to transition students along the critical thinking continuum. The higher the level of critical thinking the students obtain, the greater impact they will have on positively shaping the future direction of the discipline. While analysis and application-level multiple choice questions are essential to nursing curriculum in preparing students for practice and for passing the required NCLEX test, in many situations they may limit the development of reflective and creative thought, two essential ingredients to advanced level critical thinking skills.

Higher level critical thinking skills are crucial to the practice of nursing. The higher the level of critical thinking the students obtain, the greater impact they will have on positively shaping the future direction of the discipline.

The "Development of a Concept" assignment assists the transition of thinking for students regardless of the level they begin with. Its major goal is to help students identify and challenge assumptions by forcing them to realize that practice has changed throughout history. Utilizing nursing journal articles, the students are asked to develop an historical review of the evolution of a concept inherent to neuroscience nursing (e.g., cognition, neurogenic pain). They must identify where (what discipline) the concept came from and explore the evolution of the concept within nursing for a minimum of 10 years. Next the student needs to explore how the concept was integrated into patient care throughout its evolution and discuss the future direction of the concept.

Lastly and most importantly, the student must develop questions that ensure the continued evolution of the concept. This assignment not only promotes skeptical thought, but it also allows for inferences and provides for the suggestion of creative alternatives. Students must seek prior approval of their topic.

This ensures that a concept and not a disease is selected and allows for modification of the required nursing journal articles if the choice is a more obscure concept within nursing. The "Development of a Concept" assignment is worth 100 points and accounts for 50% of the course grade.

In addition to this assignment, the students’ own questions are used to stimulate critical thinking. This activity is based on the principles outlined by A. King in "Designing the Instructional Process to Enhance Critical Thinking Across the Curriculum" (Teaching of Psychology, vol. 22, no. 1, February 1995, pp. 13-17). Students are given examples of the generic questions she describes and a list of the critical thinking skills associated with those questions. Throughout the course students are asked to develop and submit their own questions pertaining to the topic to be presented that day in class. These questions stem from assigned readings. I collect the questions at the beginning of class, briefly review them, and then anonymously integrate 4 or 5 of them into the presentation.

Throughout the course I am careful to make sure that all students have an opportunity to hear their questions presented. After a more thorough review of the question, it is returned to the student with written feedback. The presentation for the day, while correlating with the assigned topic and reading, is given by an expert in the area. The presentation is directed toward advanced practice principles and does not duplicate the reading but adds a new dimension to it. The best questions, of course, are those where the experts can find no answers.

A second, non-written component of questioning is the presentation of questions in class by the student. The class syllabus provides the following criteria for obtaining points:

The blending of current text information with the development of questions focused toward the higher end of critical thinking and the vision, intuition and experience of experts set the stage for unlimited enthusiasm and creativity. Both components of the questioning count equally and represent 25% of the total course grade. The assigned distribution of points, coupled with the outlined criteria, has limited the excessive and frivolous asking of questions.

A third assignment that blends critical thinking and WAC is the identification of inaccurate or outdated information in the students’ assigned text. Since state-of-the-art information is outdated before it is fully disseminated, textbook inaccuracies occur in even the most responsible books. Bonus points are given to students who submit, in writing, information provided in the text that is contradictory to newer accepted principles. Students must quote the questionable information, provide the page number, and write a statement about why they believe the information is inaccurate.

Like the "Development of a Concept" project, this assignment also fulfills the critical thinking requirement of reflective thought. An additional means by which it fosters critical thinking growth is by helping the student understand that the best education can do for them is guarantee that "WE WILL BE WRONG."

Notes From Other Programs:
Making Large Lectures Like Seminars at Kent State
May 1998

Given the limits of school resources, large lecture sections of introductory classes seem likely to remain a constant. Thomas R. Hensley and Maureen Rand Oakley of Kent State University have developed several ways for dealing with the problems that go with these classes. The strategies summarized below are drawn from "The Challenge of the Large Lecture Class: Making It More Like a Small Seminar," which appeared in the March 1998 issue of The Teacher, an online publication of the American Political Science Association. In that article, Hensley and Oakley describe their work with an introductory American government course, the largest section of which typically enrolls between 100 and 150 students.

In addition to the lectures, occasional videos and guest speakers typical of a large class, the course also includes a series of six papers and student debates. In a recent semester, the papers addressed the following questions: (1) Is American government dominated by big business? (2) Do political campaigns inform voters? (3) Do we need a strong presidency? (4) Does the government regulate too much? (5) Is capital punishment justified? and (6) Is affirmative action reverse discrimination? After reading a pair of articles on a topic, students were asked to write a two-page paper.

In addition to summarizing both articles on the first page, students then analyze the articles and indicate their position on the issue on the second page. The papers were graded on four areas of concern (quality of the first summary, quality of the second summary, quality of the student’s analysis, quality of the student’s writing). The grading is done by teaching assistants, usually outstanding seniors majoring in political science. They were given detailed guidelines with explicit criteria for each area; in addition, the faculty instructor and teaching assistants graded a series of papers together until there was a high level of consistency. As the authors note, these norming sessions initially take several hours, but less time is required as the teaching assistants become more experienced.

The six debates are linked with these papers. At the beginning of the course, the class is divided into two equal groups and each assigned a teaching assistant. Each group is then further divided into six teams of equal size, usually ranging from 8 to 12 students. Teams from each group are paired and debate their assigned topic on the day the papers are due. At a class meeting prior to the debate, the toss of a coin determines which side the team will take. At that point, voluntary review sessions with the teaching assistant are offered, an offer the authors say most students take.

The full class period is given over to the debate, with teams seated at the front of the classroom and the faculty instructor moderating. During the last 10 minutes of the class, the floor is open for questions from the rest of the class. As the authors note, this part of the meeting is especially lively because the other students are well informed (having just written papers on the topic) and eager to challenge some of the ideas they have just heard.

To conclude the activity, the class determines the winners of the debate on the basis of two criteria: the soundness of the arguments presented (not the position taken) and the breadth of participation by the entire team, with at least 50% participation being required.

Hensley and Oakley report that this approach has been well received. According to questionnaires distributed at the end of the course, 90% of the students agreed to some degree that the papers provided an effective learning experience, 91% said the same of the debates, and 94% agreed that the debates and papers made the course more interesting.

In addition, 87% of the students agreed that the papers and debates had helped to improve their analytical skills. The authors, too, comment that they could observe a marked improvement in the quality of the students’ writing and analytical abilities. They also note that the teaching assistants felt that these activities had been beneficial for them, as well, not only improving their writing skills as a result of grading other students’ papers but also causing them to learn a good deal about American government in the process.

For more detailed information about handling the papers and debates-- including some cautions about potential problems--you can consult the full text of Hensley and Oakley’s article at http://www.apsanet.org/PS/March/hensley.html. Their approach can easily be adapted to a variety of courses and class sizes, and they provide additional strategies for making large lecture classes more like seminars as well.