How to Interpret a Nursing Essay Question.

Nursing essay questions are typically focused on key areas of clinical practice, either in relation to the needs of a client, or to an area of practice. Most nursing questions ask students how to respond to particular scenarios. As such, the student needs to identify the key words in the essay question, and ensure that their answer contains reference to the key words.

Some questions require the student to use a reflective model to review their own practice, or the practice involved in a particular case. Ideally, the student should identify the model, and structure the essay around the sub-headings or concepts contained within that model. Most essay questions will also require the student to make good use of the evidence surrounding a topic or area of practice. Therefore, the student is expected to use a range of sources of primary literature to answer the question. Primary literature would include primary research articles, review articles, debate and discussion articles, and articles which provide case studies or reflections on practice. Some attempt should be made to comment on the quality of the literature relating to the topic. Evidence can include not only evidence about clinical issues, such as drugs or treatments, but also evidence surrounding key elements of nursing care, governance, nursing philosophies and models, and even nurse education.

To discuss an area of practice is not simply to present the evidence for and against the theories and practice points shown in the literature, it is to explore it from all angles. Nursing practice is based on concepts of health and illness, interprofessional working, medical versus social models of health and health care, governance and care planning, and management. Therefore, interpreting the question involves identifying what elements of practice are required to be examined. Usually, a nursing question asks the student to explore the concept, or treatment, its application, its implications, and, crucially, elements of the role of the nurse. Identifying these, and making recommendations for practice, drawing conclusions about practice, and recommending areas for future research, are key to answering a nursing essay question.

In addition to these framework concepts, nursing essays are very much related to the concept of professionalism, and to the ethics of nursing care and practice. Professionalism is enshrined in the publications of the nurse’s governing body, which depends on which country the nurse is practising in. It is also enshrined in the ethics and philosophies of nursing. Current trends in nursing can be seen in the choices made about research methodologies, and in reactions to government documents, policies and strategies. Therefore, a good nursing essay will include reference to relevant policies and strategies, but will (usually) link these to the patient-centred models that dominate nursing care.

Nursing questions must be interpreted in the light of the assessment, which is usually based on the module or unit of learning, the area of practice, such as community nursing, paediatric nursing, surgical nursing, elderly care, or the like, and usually relates to some of the concepts and ideas described above. But more than anything, interpreting the question means answering the question as set.

• Using a model of reflection that you have come across, such as Gibbs, Johns, Schon or Borton, reflect upon a practice experience from your last clinical placement. Provide a summary of the situation, case or critical incident, and also provide a rationale for choosing this topic as the focus of your reflection. Identify the areas of professional practice that relate to your role as a nurse, and critically evaluate your actions and those of your professional colleagues. Develop a plan to improve practice in relation to the experience and what you have learned from reflecting on it.
• Critical issues in nursing practice – using case studies to explore evidence-based practice. Using a case study derived from your own clinical practice experience, explore the provision of care for an adult with complex health needs. Outline your assessment of their needs, and include as an appendix a full care plan to meet their needs. Provide a rationale for your care plan, and a proposed timescale for evaluation. Evaluate the evidence base for practice in relation to the identified care needs, and in the light of this, critically analyse the care provided in relation to quality, patient-centredness and best practice.
• Evidence for nursing practice. Identify one aspect of nursing practice in relation to the acutely ill adult which you wish to investigate. Carry out a literature search and identify two articles of primary research which relate to this aspect of nursing practice. Carry out a full critical analysis of the quality of these articles, using a recognised framework for analysis, and in the light of research theories, identify the value of the studies for applying to your sphere of practice. Identify any problems or challenges in implementing this evidence into practice.
• Interprofessional working for nursing practice. Identify the healthcare/multidisciplinary team involved in the care of a patient of your choice, and indicate what the purpose of their involvement would be. Outline the professional responsibility and sphere of practice of each professional, and discuss the areas of practice where their roles (and yours) might overlap, exploring the potential consequences of this. Discuss the issues and challenges surrounding interprofessional communication and working in relation to the identified patient. Identify any strategies or guidelines which can be used to improve interprofessional communication and collaborative working, and evaluate these in relation to the patient and the healthcare context.
• Management in nursing the acute adult. In relation to your current placement, identify a nurse who acts in a leadership or management capacity, and outline their role and the clinical context. Analyse their role, actions and responsibilities in the light of leadership and management theories, with specific reference to accountability. Relate this analysis to the role of the nurse and the Nursing and Midwifery Council rules and codes of conduct. Identify the strengths and weaknesses of their leadership or management activities, and make recommendations for improvement.