One of the hardest aspects of essay writing for many students is when and how they should use their own clinical experience in an assignment. Junior students who are excited by their first clinical placements are often eager to describe their experience and senior nurses on master's courses may feel that their wealth of clinical experience should form the focus of essays.
Is clinical practice relevant?
As discussed in previous articles in this series (Fowler, 2020), the foundation of an assignment should be the critical appraisal of relevant evidence-based literature. This is something that the junior nursing student has to grapple with in their initial assignments because the temptation can be to simply describe what happened to a single patient they have nursed.
Lecturers guiding the student often have to repeat and reinforce the need to ‘come from the literature’ not from opinions. Such is the emphasis given to this perspective that many students, and even some lecturers, are left with the ‘rule’ that you should not use clinical experience at all in an academic essay. But nursing is a practice-based profession and we must learn how to incorporate our experience into evidence-based practice.
How not to use clinical experience in an academic essay
A common mistake made by junior nursing students is to write an assignment based on their own opinions, some random clinical observations and a superficial reference to a few articles. This is a formula for failure. A mistake that some qualified nurses make on master's assignments is that they want to use a particular perspective, gained from their experience, as the basis of the assignment, using selected literature to support their opinions—again, a formula for failure. Consider the following example that typifies numerous examples that I have read in assignments. ‘In my experience, post-operative pain can be reduced if the patients are given a good understanding of what is going to happen to them on return from surgery. Smith (2019) agrees with this, as does Jones (2017).’
The student is using their experience to form an opinion and then finding some literature to support their view. The lecturer marking this essay will know that the general sentiments expressed in this sentence have a degree of truth, but that the academic foundation on which they are built is faulty. The student is first expressing an opinion and then finding a couple of pieces of literature to support their view. Consider the more extreme example: ‘Postoperative pain can be reduced if the patients are given a pink crystal to hold for 30 minutes prior to surgery. Smith (2017) agrees with this as does Jones (2019).’
Using clinical experience to comment on the literature
Nursing is a practice-based profession and one of the marks of the developing specialist is the appropriate use of previous experience to inform evidence-based practice. It is important to understand and be able to demonstrate this both in our clinical practice and in our academic writing. The way to do so is to use clinical experience to comment on evidence extracted from the literature.
Consider the following example. The first two sentences were written in part 7 of this series to demonstrate comparative analysis, the final sentence illustrates how you can use your clinical experience to comment on the published evidence.
‘Smith (2015), in a controlled study of 2000 patients and Brown (2016) in a qualitative study interviewing 15 postoperative patients both identified written information as an important factor in their conclusion that preoperative information reduces the experience of pain postoperatively. Interestingly, both of these studies focused on women, whereas a similar, smaller controlled study by Taylor (2016) focusing on male surgical patients found little significant effect on pain reduction. The author's experience of having worked as a charge nurse for the past 5 years on surgical wards for both male and female patients is that both male and female patients who are given appropriate preoperative information appear to have a reduced need for higher doses of analgesia, suggesting that this is a complex multifactorial area requiring further controlled studies.’
You can see from the last sentence above that the student's experience is being used in a similar way to an additional piece of literature. The credibility of the experience is demonstrated, ie 5 years' experience as a charge nurse in surgical wards, followed by the clinical observations, followed by a discussion point. Note that it does not say: ‘Based on my experience, Smith and Brown are right and Taylor is wrong.’ A junior student might add a sentence, saying: ‘In the author's experience during their first student clinical placement on a male surgical ward, I observed that patients were routinely given verbal and written preoperative information relating to postoperative pain experience and several, but not all, patients appeared to find it useful when I subsequently discussed their experience of pain with them.’