April 2008 Volume 4 Issue 2
Article 2.
PDF File
July 2008 home

Article Title
Academic Writing in Nursing:
Genres, Marking Criteria and Course Design

Author
Julio Gimenez　
Middlesex University, UK

Bio Data
Julio Gimenez is senior lecturer in English for Academic Purposes at Middlesex University (UK). He holds an MA in TEFL from The University of Reading (UK) and a PhD in linguistics from Queen Mary, University of London. He has published in international journals and contributed to various edited collections on his research interests: communication in the workplace, discourse analysis and writing in higher education. He is the author of Writing for Nursing and Midwifery Students (2007), published by Palgrave Macmillan.

Abstract:
This article reports on a two-year research study on academic writing in pre-registration nursing and midwifery at a UK university. For the nursing section of the research, the study surveyed 68 undergraduate students on a BSc nursing programme to identify the most common genres they had to write for their academic assignments. The study also interviewed three content lecturers and analysed the marking criteria used for assessing the identified genres. Based on the results of the survey, the interviews and the examination of the marking criteria, the article presents a taxonomy of the most common genres in pre-registration nursing, examines typical marking criteria, and suggests some guidelines for the design of writing courses for nursing students. It also presents a possible outline for one such course.  

Key words: academic writing in nursing, writing genres, course design

Introduction
Although research on the role of writing in higher education has produced a plethora of studies, journal articles and books (Elander et al., 2006; Lea & Street, 1998; Lillis, 2001; Lillis & Turner, 2001; Read et al., 2001; among others), very little has been researched and published about the nature and dynamics of writing in disciplines like nursing and midwifery.  In nursing, for example, most research and publication efforts have concentrated on post-registration rather than pre-registration writing (cf. Gimenez, 2007; Leki, 2003; Whitehead, 2002). Post-registration publications have almost exclusively examined the new demands of the professionalised roles of registered nurses (Oermann, 2005; Parks, 2001; Tornquist, 1999; Zim & Entwistle, 2002).
   The study reported in this paper explored the nature and issues in academic writing in pre-registration nursing and midwifery. It examined the most common genres students at different levels of a BSc nursing and BSc midwifery programme are required to write, the difficulties they experience in producing them, the criteria by which these genres are marked, and how the students feel they could be best supported to write the required genres successfully (Gimenez, forthcoming). This paper presents a taxonomy of the genres identified in the nursing section of the study, examines the most common criteria for marking these genres, and offers some suggestions on how ESP/EAP teachers can design courses to help nursing students write these genres successfully.      

Genres in ESP/EAP: A theoretical framework
Genres and genre-based studies have been the focus of many publications since the mid-80s. One of the most influential studies has been Miller’s (1984) seminal paper which proposed that genres should be defined by the rhetorical actions they perform rather than by their content or substance. Bazerman’s (1988) work on experimental scientific articles, Yates and Orlikowski’s (1992) examination of the office memo, and Devitt’s (1991) study on genres in tax accounting are just a few examples that illustrate this prolific area of research. 
   Swales’ (1990) book-length analysis of genres in the academic discourse community has probably been the most often-quoted work in ESP/EAP. In this study Swales developed a theory of language use in discourse communities that makes genre its unit of investigation. In his work genre is defined as a typified communicative event with a clearly identifiable purpose and recognised as such by all the members of a discourse community. He mainly focused on research article introductions, pointing out, among other things, that they comprise three moves which he termed CARS — create a research space. But it seems to me that his main contribution to our understanding of genres has been the distinction between moves and steps. Moves are actions writers take to represent a given communicative intent (e.g., establishing the research field), whilst steps are the different options that writers have at their disposal to realise a given move (e.g., claiming the centrality of the topic). Moves, steps and the rhetorical and linguistic elements chosen to realise them are governed by the values and beliefs supported by the writer’s discourse community. Although the term ‘discourse community’ has become ‘a fuzzy concept’ (Hyland, 2006: 313) now under criticism for ignoring diversity and overemphasizing conformity (e.g., Canagarajah, 2002; Prior, 1998), Swales’ work still continues to influence most studies in genre analysis.
   These conflicting views are also reflected in the different theoretical approaches to genre that the field has developed. Flowerdew (2002) suggests that views on genre can be classified into textually orientated and contextually grounded. Textually orientated views examine how communicative purposes are lexico-grammatically and rhetorically realised, applying theories of grammar and discourse to do so. Contextually grounded views, on the other hand, situate genres in the purposes and functions they are created to fulfil and the attitudes, beliefs, and values of the members of the community.
   Other conflicts originate from the pedagogical application of these theories (Johns, 2002). If genres are fluid and in constant evolution, can they be taught in the classroom where they are normally presented as static entities? Are genres to be taught as models to imitate or as texts to be critically contested (Benesch, 2001)? Should we teach ‘macro genres’ (e.g., letters) or ‘subgenres’ (e.g., business letters)? Should we focus on elemental genres (i.e. recurring linguistic patterns) (Martin, 1992)? And most importantly for this study, what genres should we teach and when?
   These general theoretical and pedagogical views of genres have informed the study reported in this paper to a greater or lesser extent. However, by focusing on genres in specific disciplines, namely nursing and midwifery, the study intended to examine the dynamics and complexities of these two disciplinary communities from a narrower viewpoint (Swales, 1998). From a Bakhtinian perspective, the study aimed at analysing genres not as sets of rules, but as ways of conceptualizing reality and interpreting particular aspects of the world in nursing and midwifery. In so doing, the study looked at not only the typical genres but also the members who produce and consume them, as well as the constraints on the production and consumption of the genres (e.g., marking criteria) and the skills (e.g., linguistic and cognitive resources) needed to write them.      

A taxonomy of genres in pre-registration nursing
Sixty-eight students on a BSc nursing programme completed a survey which had as its main aim the identification of typical genres in pre-registration nursing and the difficulties associated with writing them.
   Although genres have been traditionally classified by year of study (normally years 1, 2 and 3 in the UK), levels of writing were preferred as students on this programme are required to write different level assignments in the same year of study. For instance, the first year of the programme requires them to write at levels 1 and 2. Level one writing (e.g., care plans) is more descriptive and does not require deploying critical skills. Level 2 demands students to be less descriptive and more critical, whereas level 3 implies writing more argumentative texts and the application of critical skills, as when writing literature reviews. The progression from description to argumentation that students are expected to show in their assignments when moving up levels can be plotted on a cline as shown on Figure 1. 

Figure 1. The descriptive-argumentative cline
(After Gimenez, 2007: 26)

Sometimes a given genre occupies two levels at the same time. For instance, argumentative genres like a review of the literature for the undergraduate dissertation are requested at the end of level 2 and beginning of level 3 of writing.
   Of the 68 students who participated in the study, 21 were writing at level 1, 21 at level 2 and 26 at level 3 at the time of data collection. Data were collected over a period of two years and care was taken to have respondents with a similar profile at each level of writing (e.g., similar demographics, similar previous academic experience, and the like).
   The results of the survey the students completed produced a taxonomy of typical genres by level which is shown in Table 1 below. Cross-tabulating genres and levels is quite useful if one wants to maximise student exposure to the right type of genre at their required level of writing. This has clear implications for course design which will be further explored below.

Table 1. A taxonomy of specific genres by level

As shown in Table 1, some genres such as the care plan are clearly descriptive and thus requested at level 1 of writing. A care plan provides information about the patient’s personal details (e.g., name, date of admission), their medical history (diagnoses, medication and the like) and their hospital history (e.g., their last visit), which make it quite a descriptive written record. Other genres show a more balanced combination between description and argumentation. An article review, for instance, combines both descriptive elements, such as the bibliographical details of the article being reviewed, with evaluative elements like the value of its contributions and the possible gaps it failed to cover. Still other genres are almost predominantly evaluative and argumentative, of which the argumentative essay is a typical example.
   Although no piece of writing can be said to be purely descriptive or entirely argumentative as a combination of the two styles of writing will always be necessary, some genres require facts to be described or listed, such as drawing up a problem list for the care plan, while others involve more evaluative writing, like judging the value of health care policies in argumentative essays. As shown in Table 1 the levels at which the genres are required seem to accompany the progression from description to argumentation (see Fig. 1), which is at the same time supported by the nature of each genre. It seems important to also look at the linguistic and cognitive skills that writing these genres involves and the constraints that students have to overcome in order to produce them. This is discussed in the next section.

Common marking criteria
An important consideration for both students and writing lecturers, especially for those teaching discipline-specific genres, is how the genres are going to be marked by the content lecturers. Marking criteria are an important source of information which indicates what expectations content lecturers have (Gimenez, 2007). Thus an examination and discussion of the meaning of the criteria will help students produce more effective genres.
    In the context of the study reported in this paper, three content lecturers, each teaching at a different level, were interviewed to discuss, among other things, the common criteria used to mark the genres identified in Table 1 above. Based on their answers and an examination of the criteria provided to students in their handbooks, Table 2 was designed to illustrate the most common criteria by level. The criteria specific to content or the learning objectives of the modules have not been included in the table.

Table 2. Most common marking criteria by level

The shaded cells in Table 2 show the specific criteria for each of these levels as well as the complexity of the requirements, level 3 being the most complex and comprehensive of the three. This has implications for learners, writing lecturers and course designers who need to decide on content — what their courses should focus on — as well as gradation issues. These will be more thoroughly dealt with below. 

Course design: Some pedagogical considerations
Some considerations which relate to course design can be made on the basis of the results presented above. These considerations concern content selection and gradation.  
   One of the typical questions course designers face is what to include in their courses. When designing a discipline-specific writing course, it seems imperative to first know what genres students are going to be asked to write as to avoid including content which is only tangentially related to their needs. Thus, a taxonomy of genres such as the one presented in Table 1 above can make the selection of content more effective. This taxonomy can also be used to plan pre-writing and writing tasks normally associated with the different genres. Taking care plans as an example, students may be asked to examine the verbs that are linked to writing them as a pre-writing activity. At level 1 of writing, verbs such as ‘describe’, ‘list’, and ‘summarise’ can be used to elicit students’ knowledge of the semantic properties of these verbs and how they compare. At level 3, a discussion of verbs such as ‘review’, ‘critique’ (cf. criticise), and how they are used in academic writing may prove a stimulating way of introducing students to more advanced writing. A further task may involve students working with web-based corpora to identify how these verbs are commonly used and their most typical grammatical patterns. Still another pre-writing task may request students to match each of these verbs with a section in the genre they are examining.
   In the case of care plans, the pre-writing tasks described above can be followed by different genre-based activities. For instance, students can be provided with examples of written genres to analyse not only their communicative purposes (e.g., to record information about the plan of care for a patient), but also how the purposes are rhetorically organised, that is, their moves and steps, and how these are linguistically realised (e.g., ‘will + be able to’ for the goal setting section: ‘patient with a stroke will be able to communicate his basic needs in two months’). At a more macro level, students can discuss the attitudes and beliefs of the nursing community as encapsulated in the genre being analysed. In the case of care plans, students can discuss how the positivist epistemology embraced by the community materialises in the style of care plans, which tends to be impersonal and shows many examples of ‘passive constructions’ (e.g., ‘patient has been diagnosed with breast cancer’).
   It is also important to mention here that different level tasks should incorporate discussions of the marking criteria used to evaluate the genres so as to raise students’ awareness of what they need for producing efficient genres. These criteria represent institutional rules that students have to either accept or challenge, depending on the approach to writing that they and their writing lecturer have agreed to follow. In either case, marking criteria represent constraints that students will have to overcome.  In using marking criteria like the ones presented in Table 2 above, writing lecturers should call the students’ attention to the fact that a criterion like “Work neatly presented and easy to read” needs to be unpacked. What do phrases like ‘neatly presented’ and ‘easy to read’ actually mean? It is only when they understand exactly what it takes to write a given genre that students will be able to produce it effectively. As Hyland (2006: 35) puts it, “Learning about genres does not preclude critical analysis. In fact it provides a necessary basis for critical engagement with cultural and textual practices.”  Ideally, students should unpack these terms in a session that brings their content and writing lecturers together. Alternatively, students can interview their content lecturers to find out more about what the criteria represent for them. 
   Closely related to content selection is content grading. It could be rather demotivating for students to be taught genres they still do not have to produce, let alone genres they have already been requested to write. Identifying the right levels at which each of the genres in the writing course should be introduced to students will allow the writing lecturer to provide students with the right type of support so that they can write their assignments more effectively. Grading in this sense refers to organising how and when the ‘pool’ of genres will be delivered to students. A more traditional approach to grading refers to the act of ranking contents from easy to more difficult. In this respect, the cline presented in Figure 1 can guide the writing lecturer. In general terms, descriptive genres are easier to produce than those which require students to use critical and argumentative skills, and so it seems sensible to grade contents following the ‘descriptive-argumentative’ cline. This consideration points to the importance of following a scaffolding principle, by which linguistic and cognitive skills needed to write easier genres are deployed in producing more difficult ones as mentioned above in relation to article reviews. These selection and grading principles are central to course design as the suggested outline in the next section intends to show.

Course design: A suggested outline
One of the implications that has resulted from the study reported here is the need for a more targeted approach to teaching academic writing to nursing students (Gimenez, forthcoming). As far as possible, this has been implemented not only in the design of teaching materials but also in the design and organisation of the courses now offered. Table 3 below shows a possible outline for a course in writing for nursing students. It is to be noted that each stage may take one or more teaching sessions, depending on the level and needs of the students and the time and resources available to the writing lecturer.

Table 3. A sample course outline

Conclusion
This paper has reported on the results of a study that looked at the nature of academic writing in pre-registration nursing. It focused on the genres that students on a BSc in nursing are asked to write for their assignments and the typical criteria used to mark them. Based on the analysis of the genres and the criteria, the article has made some suggestions for designing writing courses for nursing students and offered an outline of the contents and activities for one such course.

References
Bazerman, C. (1988). Shaping written knowledge: The genre and activity of the experimental article in science. Madison: University of Wisconsin Press. 

Benesch, S. (2001).Critical English for academic purposes.  Mahwah, N.J.: Lawrence Erlbaum.

Canagarajah, A. S. (2002). A geopolitics of academic writing.  Pittsburgh: University of Pittsburgh Press.

Devitt, A. J. (1991). Intertextuality in tax accounting: Generic, referential, and functional. In C. Bazerman & J. Paradis (Eds.), Textual dynamics of the professions (336-357). Madison: University of Wisconsin Press.

Elander, J., Harrington, K., Norton, L., Robinson, H., & Reddy, P. (2006). Complex skills and academic writing: A review of evidence about the types of learning required to meet core assessment criteria. Assessment and Evaluation in Higher Education, 31(1), 71-90.

Flowerdew, J. (2002). Genre in the classroom: A linguistic approach. In A. M. Johns (Ed.), Genre in the classroom: Multiple perspectives (91-102). Mahwah, N.J.: Lawrence Erlbaum.

Gimenez, J. (2007). Writing for nursing and midwifery students. Basingstoke: Palgrave.

Gimenez, J. (forthcoming). Beyond the academic essay: Discipline-specific writing in nursing and midwifery. Journal of English for Academic Purposes.

Hyland, K. (2006). English for academic purposes: An advanced resource book. Oxon: Routledge. 

Johns, A. M. (Ed.). (2002). Genre in the classroom: Multiple perspectives. Mahwah, N.J.: Lawrence Erlbaum.

Lea, M., & Street, B. (1998). Student writing in higher education: An academic literacies approach. Studies in Higher Education, 11(3), 182-199.

Leki, I. (2003). Living through college literacy: Nursing in a second language. Written Communication, 20, 81-98.

Lillis, T. (2001). Student writing: Access, regulation, desire. London: Routledge.

Lillis, T., & Turner, J. (2001). Student writing in higher education: Contemporary confusion, traditional concerns. Teaching in Higher Education, 6(1), 57-68.

Martin, J. R. (1992). English text: System and structure. Amsterdam: Benjamins.

Miller, C. R. (1984).Genre as social action.Quarterly Journal of Speech, 70, 151-167.
Oermann, M. (2005). Writing for publication in nursing. 2nd Ed. Philadelphia: Lippincott Williams & Wilkins.

Parks, S. (2001). Moving from school to the workplace: Disciplinary innovation, border crossing, and the reshaping of a written genre. Applied Linguistics, 22(4), 405-438.

Prior, P. A. (1998). Writing/disciplinarity: A sociohistoric account of literate activity in the academy. Mahwah, N.J.: Lawrence Erlbaum.

Read, B., Francis, B., & Robson, J. (2001) Playing safe: Undergraduate essay writing and the presentation of the student voice. British Sociology of Education, 22, 387-399.

Swales, J. (1990). Genre analysis. Cambridge: Cambridge University Press.

Swales, J. (1998). Other floors, other voices: A textography of a small university building. Mahwah, N.J.: Lawrence Erlbaum.

Tornquist, E. M. (1999). From proposal to publication: An informal guide to writing about nursing research. New York: Prentice-Hall.

Whitehead, D. (2002). The academic writing experiences of a group of student nurses: A phenomenological study. Journal of Advanced Nursing, 38(5), 498-506.