A fundamental skill needed by both nurses and midwives is that of being able
to provide effective patient or client care. On your university course you will
be asked to write a number of essays that focus on assessing various patient-based
scenarios as part of your preparation for delivering effective care as a nurse
or midwife.
In these activities you will first consider how an essay of this kind could
be structured and presented. You will also explore an approach to the process
of writing one and practise recognising common problems that arise in such essays
written by students of nursing or midwifery.
Activity 1: What are the elements to include in an essay focusing on patient
care?
Look at this example of a typical assignment instruction requiring you to
assess a patient-based scenario:
Discuss in detail the nursing assessment that you would make on a patient
with whom you worked during your nursing practice. Write an essay of 4000
words. Your essay should include reference to:
Any specific considerations concerning the patient's physiological or
psychological status
The intervention and care chosen for the patient
The various approaches that made up your method of assessment
The patient's medical history and the means by which you gathered the
information
Theoretical model/framework referred to (e.g. Roper, Logan and Tierney
model [1985])
Evidence-based reasons for the choice of nursing intervention and care
given to the patient
Relevant documentation concerning the patient as described in the Nursing
and Midwifery Code of Conduct
Any other considerations or influences affecting the patient (social,
cultural, ethical, legal)
An evaluation of the care provided
One approach to this kind of writing task might be to take the different
elements given above for inclusion in the writing and use them as a basis
for creating a framework for the structure of the essay.
You are now going to consider how you might create an outline for the structure
of this essay using this approach.
Study the incomplete outline below, produced by a student,
making a plan for the above assignment. Complete the outline by typing elements
from the list above into the appropriate sections. Then check your answer.
Outline for Assignment
1. Introduction
2. Section 1: Theoretical model/framework referred to +
3. Section 2:
+
+ any other considerations + relevant documentation
Here is one possible outline for the essay
structure:
Outline for Assignment
1. Introduction
2. Section 1: Theoretical model/framework referred to
+ approach(es) used in assessment
3. Section 2: Patient's medical history
+ specific considerations + any other considerations +
relevant documentation
4. Section 3: Choice of intervention and care
+ evidence-based reasons for choice
5. Section 4: Evaluation of the care provided
6. Conclusion
You might choose to use section headings to help guide your reader through
the discussion that your essay contains. The use of section headings can also
help you, as a writer, to address the assignment topic and focus the content
of each section on what is required.
You are now going to choose some appropriate section headings for the essay.
First, consider what makes an effective section heading.
Think about which of the following would be the best
section heading and why. Then check your answer.
Description
Patient's background and history
What are the specific and general considerations
that need to be taken into account concerning this patient?
Patient's background and history would be the best section heading.
While section headings need to be concise and are generally short in length,
they also need to be comprehensive. Description would be too imprecise
as a section heading, since it begs the question description of what? It
gives little useful information to the reader and therefore is less effective
as a section heading.
Similarly, What are the specific and general considerations that
need to be taken into account concerning this patient? is
rather too long to function well as a section heading. In academic writing
it is less common to use rhetorical questions, either as a device within
the body of the writing or as section headings. Moreover, it is not usual
to write section headings that are complete sentences containing active
verbs. It is much more common to use a more complex noun phrase to make
a section heading.
Now study the following list of section headings. Which
of these would be effective section headings to use in a student essay written
in response to the assignment above? Select the tick symbol
next to those that you think would be more effective and the cross symbol
next to any that would be less effective as sections headings. Then read the
comment.
Patient's background and history
Some other considerations about the patient
About the patient
Evaluation of intervention and care given to patient
Evaluation of intervention and care given to patient
A critical analysis of the nursing care provided
Notice how the more effective headings are written as noun phrases and
contain no active verbs; each one also contains and relates several concepts
giving the reader a clear idea of what the section will focus on.
Less effective section headings:
Some other considerations about the patient
About the patient
What I thought about the case
What was effective and what wasn't?
Notice how the less effective section headings suffer from problems of
being either so general or vague as to convey nothing very helpful to the
reader or being so long that they are unlikely to cover everything that
the section will. Section headings should not be written in too informal
a style or one that is inappropriate for academic writing (e.g. contain
contractions such as wasn't or informal language choice such as
about the patient).
Activity 2: Avoiding common problems when writing a patient-based study
What is the best way to tackle writing this kind of assignment? In this activity
you are going to consider how to approach the task of producing a patient-based
study and learn how to avoid some of the common mistakes that student writers
make when writing them for the first time.
Read each of these comments made by students of Nursing
and Midwifery after receiving back their assignment on a patient-based study
from their tutors. Think about how you would try to avoid this problem arising
in your own work and make a few notes. Then read the comment.
Samantha: My tutor said my essay contained too much description and not
enough analysis.
It is very easy to simply describe a patient-based scenario or a placement
experience that you have had without including any of the critical reflection
that is important for a piece of academic writing.
One solution to this common problem might be to write the descriptive part
of your essay first and then leave it for a while before going through it
carefully and adding critical reflection where you can. When you read through
the descriptive part in order to do this, use the following questions to
help you look at the description in a more critical way:
Why? e.g. Why did I chose this intervention?
How? e.g. How did this choice help to achieve a beneficial outcome?
What? e.g. What did the patient's history tell me that was particularly
significant?
When you have finished writing your assignment, re-read it checking that
at least one third of it involves critical reflection.
Chloe: I didn't know how explicit I should be about where information
came from; confidentiality is important but so is acknowledging sources.
This is a particularly complex issue in the field of Nursing and Midwifery.
It is very important to observe confidentiality rules and particularly not
disclose patients' identities. At the same time, when writing an academic
piece of work you need to acknowledge your sources. However, if you obtained
information used in your writing from an interview with a patient or member
of the medical staff, it is important that you do not refer to them by name
nor give any details that would allow anyone to be able to identify them.
With a little forethought it is usually possible to do this, for example,
the patient can always be referred to in the main body of your writing as
'Patient A' and an interview in your reference list detailed as:
Your name (2005) Transcript of an interview with Patient A at a local
Trust hospital.
Rosa: I wrote my essay like a personal experience but my tutor said there
was too much about me and my feelings about my nursing practice in it.
A patient-based study should be exactly that - patient-based even if the
core material for the writing comes from a placement experience. At the
same time, you do need to include your own perspective and learning in such
a piece of work.
When you write this type of essay try to make the patient the central focus
of your writing and give your own perspective and learning a secondary role,
rather than vice versa. There should be more references to 'the patient'
than to 'I' in the writing overall. Check that this is the case when you
are revising your first draft of the essay and if there is an imbalance,
correct it.
Lee-Ann: I forgot to refer to my own learning outcomes and so didn't
get a particularly good grade for my essay.
It is equally important not to focus solely on the patient and leave out
any reference to yourself. Your nursing placement is intended to be a learning
experience and provides excellent scope for self reflection and further
learning. These points form an important part of what you are expected to
include in this kind of assignment. Self reflection and consideration of
your own learning outcomes must be integrated with the main body of your
writing, which will be patient-centred.
To do this successfully you need to give serious thought to how you are
going to structure your essay and include all the necessary elements in
the right proportions. This will mean writing several drafts of your essay
and reviewing and revising content regularly during the writing stage.
Des: It was difficult to integrate the reflection with the description.
Novice writers quite
often fail to integrate the reflective and descriptive parts of their essays
successfully. They may write essays that are solely descriptive in content
or include separate sections either describing their placement experience
or commenting on their own thoughts about it.
The reflective content of your essay is best weaved in with the descriptive.
To ensure that you have done this, you should check, and if necessary. revise
drafts of your essay. Then read each section of the main body, making sure
that all descriptive content contains critical comment of some kind. Ideally
aim to make about one third of your essay content relate to critical comment
and/or self reflection.
