Abstract: The literature review and appraisal assignment is a core foundational component of the writing emphasis course for undergraduate nursing students. The assignment traditionally focuses on navigating databases to locate scholarly research, synthesizing research findings across the literature, and learning APA format. Often, however, students conflate effective writing in the discipline as demonstration of correct APA format. This essay describes a pedagogical innovation that integrates reflective writing and a multimodal infographic component. The changes shift the student focus toward communicating evidence-based, person-centered care, which also promotes metacognition and genre awareness as students connect scholarly literature to culturally congruent care in their future clinical practice.
A primary goal of Writing Across the Curriculum (WAC) at the University of Arizona is to enhance student experiences in required writing-emphasis courses, which apprentice them into their field's unique ways of writing and knowing. This is especially true for community-focused majors in the health sciences, such as Nursing. With the goal of helping students to navigate the ambitious standards of writing in the program and to understand the discipline’s relevance to communities, we (Lateefah and Aimee) describe an approach for supporting nursing students as they navigate writing skill transfer in Nursing Education. Typically, students become attuned to the differences between their general education coursework and the major, especially the transition from MLA format to APA format, which they transition to when writing for the major (Irvin 2010). It can be difficult, explains one nursing major, “you jump into nursing school and it’s APA. And it takes about a year to figure it out” (Mapes and Kimme Hea 2018). To reduce the decontextualized emphasis on APA format in the required writing emphasis course, "Scholarly Inquiry in Evidence-Based Practice," we share how Lateefah revised a major writing assignment to deepen disciplinary understanding. Ultimately, these pedagogical shifts help students move beyond seeing writing as compliance in APA and instead explore scholarly inquiry as it informs real-world, evidence-based nursing practice.
Research in nursing education shows that students improve writing practices as they progress through their program of study and continuously engage in research, evidence-based practice, and information dissemination (Gazza, Shellenbarger, and Hunker 2018). Lateefah recognized that the major writing assignment of her course could foster that development more effectively with a few strategic changes. Historically, the project had been a high-stakes writing assignment accounting for more than a third of the course grade. One priority was to help students navigate the transition to writing in the discipline as more than merely mastering APA formatting (Beaufort 2007; Driscoll et al. 2020; Rounsaville 2012; Yancey, Robertson, and Taczak 2014). WAC scholarship shows that when faculty teach writing as a neutral skill that transfers across the disciplines, they overemphasize format and grammar and omit discussions about how writing enacts disciplinary knowledge (Carter 2007). A disproportionate emphasis on APA format can perpetuate a similar understanding of writing in nursing as only format compliance. However, with adequate faculty development, research shows that faculty learn the importance of connecting disciplinary ways of knowing to professional communication practices (Basgier 2016). In this way, after completing a WAC faculty training at U of A, Lateefah redesigned the major assignment to connect writing to evidence-based, person-centered care nursing practice. These revisions align with two nursing accreditation domains: person-centered care and the application of theory and research-based knowledge (American Association of Colleges of Nursing 2026). Students would learn to understand and apply “Culture Care Diversity and Universality” theory as part of culturally competent care standards (Marion et al. 2016). While certain patient needs are universal, Culture Care Diversity and Universality posits that health practices and beliefs are also inherently diverse across diverse cultures. Effective patient-centered care requires nursing students to navigate this tension, recognizing human commonalities while adapting clinical standards to respect cultural differences. Using the lens of Culturally Congruent Care, students learn to examine patient-centered care as an active, ongoing accounting of a patient’s cultural reality.
The first assignment update integrated reflection. In writing studies, reflective writing is a vital “mechanism for professional development, for professional practice, and for the making of knowledge” (Yancey 2016, 9). Reflection helps students learn to apply theoretical knowledge, a critical skill for new nurses transitioning into the profession (Lindblom et al. 2025). It also increases learning transfer, enhances synthesis of knowledge across various contexts, and sparks metacognition in support of lifelong learning (Beaufort 2007; Gere 2019; Yancey, Robertson, and Taczak 2014). Through reflection, students think critically about the concept of Culturally Congruent Care and to transfer their understanding of this concept to their future clinical practice.
A second update was for students to compose a multimodal infographic to convey insights from the research for a different context. Yancey, Robertson, and Taczak (2014) argue that remixing the content of a writing assignment to a different context promotes metacognition and genre awareness. Specifically, when invited to adapt their work to a different genre, writers think more critically about which content, organization, and modalities best serve the new context (Tardy, Sommer-Farias, and Gevers 2020). Fostering increased awareness of genre, audience, and purpose, the infographic contributes to student writing development over time (Driscoll et al. 2020; Gere 2019; Yancey 2016).
Taken together, the changes minimize a disproportionate focus on compliance with APA formatting and implement best practices in WAC pedagogy (Bean and Melzer 2021). The subsequently integrated reflection and infographic activities scaffold students to engage more robustly with scholarly literature. This approach models asset-based, culturally sustaining pedagogy (Ladson-Billings 2017; Paris and Alim 2017) because students connect what they learned in the scholarly literature to their future role as nurses and to the communities for which they will care. Both support the tenets of “servingness,” a type of asset-based framework that rejects passive enrollment practices of increased admissions of Latina/o/x students without equal attention to resources for sustained structural and curricular support at Hispanic Serving Institutions (HSIs) (Garcia and Koren 2020; Tinoco 2025). Servingness calls for course content to have an explicit connection to students' lived realities (González 2024). Through the steps of reflection and infographic remix, nursing students connect the findings of secondary research to the real world. In what follows, we overview the course context and the phases of the scholarly literature review assignment. Then, we describe the steps of reflection and the infographic to demonstrate how students engage the research literature more critically, synthesize main ideas, and effectively communicate evidence-based nursing practice.
At U of A the College of Nursing averages approximately 250 student majors annually, and students must earn a minimum cumulative GPA of 3.0 to be admitted. Due to several reasons, such as high demand for certain degree programs and, most egregious, a number of budget cuts, some writing emphasis classes have high enrollment, including Lateefah’s course, which enrolls 65 to 75 students with a single instructor. Beyond first-year writing, unfortunately, there are no campus policies requiring small class size for writing intensive courses in the major; each college stipulates course enrollments. Nursing students complete the writing emphasis course in their junior or senior year; course learning objectives support students' engagement with scholarly literature in the field as demonstrated in a synthesized appraisal of the research studies. The literature review project involves multiple steps to guide nursing students to find and analyze scholarly research. Phase one is a process of inquiry involving topic selection, conducting library research, and finally critically reading by annotating and highlighting articles using Adobe software. Phase two synthesizes information in the literature using a table of findings. During phase three, students develop a narrative summary of the findings, including the major definitions, descriptions, and statistical findings in their sources. Phase four is the focus of this essay.
After the synthesis of literature, phase four is a process for “Summary, Creativity, and Reflection.” Through two sequential components, students critically engage the findings of secondary research. First, in the Reflection Activity, students examine Culturally Congruent Care with attention to how this process might transfer to their future work as a nurse. Then, in the Infographic Activity, students compose an infographic to inform a public audience of their findings.
The Reflection Activity prompts students to reflect on the theory of Culturally Congruent Care as it applies to their role as nurses. The reflection offers a space to process new knowledge and explore its application. Responding to three core questions, students express their ideas in a more personal account:
What did you learn from the readings about Culturally Congruent Care?
How will you incorporate the new knowledge into your practice as a new nurse?
What is the importance of providing culturally congruent care to patients and what is the relationship of culturally congruent care to patient centered care?
This activity fosters metacognition, a process especially valuable for writers “required to work in unfamiliar contexts or with forms with which they are unfamiliar” (Tinberg 2015, 76). Through reflection, students connect their learning directly to patient care, making their thinking legible to both themselves and their instructor.
By embedding reflection into the curriculum, Lateefah has more insight into how students personally internalize the research process and connect it to their future clinical roles. They articulate a variety of relevant themes. Six student reflections illustrate common insights. For instance, the following reflections from two students emphasize active listening and collaborating with patients:
Student # 1
“Culturally congruent care also involves understanding how culture shapes different health behaviors and even their trust in the healthcare system. As a future nurse, I plan to incorporate this knowledge by taking my time to ask meaningful questions about what matters most to each patient and using that to guide my care. I want to have a supportive environment where people feel comfortable expressing their preferences and their concerns. I will also reflect on my own biases, so I can ensure I am respectful, and my care is truly patient-centered.”
Student # 2
“I have learned that culture can impact many aspects of healthcare, such as communication, decision-making, and health beliefs. As a nurse, it is my responsibility to understand these differences and work together with my patients to provide them with the care they need and to create a relationship built on trust and respect.”
Both reflections describe the importance of maintaining an open mind, checking personal biases, and continuously clarifying needs with patients. They highlight a mindset of clinical humility by allowing the patient to guide them as caregivers.
Another prominent theme in the reflections is an awareness of how healthcare inequities leave lasting impacts on ethnically or culturally diverse groups. The following examples demonstrate how students understand and how they plan to navigate systemic inequities when building trust with patients:
Student # 3
“As a nurse, I aim to be open to being educated by my patients about their cultural beliefs and how I can best care for them while still respecting their culture.”
“It is greatly important that we take care to show cultural competency when there are so many ethnically and culturally diverse groups that already don't trust the system because it's failed or disrespected them before. Through culturally congruent care, we have the ability to undo previous damage and stigmas surrounding healthcare for minorities while learning from patients, recognizing obstacles specific to them, and incorporating their culture into their care plans.”
Student # 4
“As a future nurse, I plan to incorporate culturally congruent care by assessing each patient's beliefs, preferences, and openness to complementary therapies before implementing pain management strategies. I aim to prioritize patient-centered care by offering options, providing education, and respecting patients' choices and autonomy. By doing this, I can ensure that the care I provide is both culturally appropriate and individualized, fundamentally improving patient comfort, satisfaction, and outcomes.”
Each student considers the effects of systemic inequities on how patients experience care. Student #4, in particular, emphasizes “choice and autonomy” as essential components when caring for communities historically marginalized or stigmatized in medicine.
Finally, students recognize that evidence-based recommendations should align with a patient's individual beliefs to be effective. They reframe cultural integration as a necessity for successful health outcomes, rather than an optional courtesy:
Student #5
“This assignment taught me that providing culturally congruent care involves more than just knowing a patient's background. […] I began to realize that if exercise recommendations are not communicated in a way that respects a patient's cultural framework or attends to her individual concerns, evidence-based recommendations will be useless.”
Student # 6
“Working through these four articles taught me that culturally congruent care is more than just mindfulness of someone's background. It means actually shaping the care I give around whom the patient is, what they have been through, and what matters to them.”
“Going forward, I want to incorporate this into my nursing practice in a few practical ways. First, I plan to slow down and ask patients about their background before teaching or giving instructions, because what works for one patient may feel disrespectful or pointless to another. Second, I want to make a point to pay attention to small things like how I approach a patient, the language I use, and whether I am giving the patient choices, since these details can either build trust or trigger someone with trauma history. Third, I want to remember that I do not have to know everything about every culture to provide solid care. I just have to be willing to listen, ask, and adjust.”
“Culturally congruent care matters because patients are not just a diagnosis on a chart. They have stories, values, and their own unique ways of coping that were built long before they met me. If I honor that, I think patients are more likely to trust me, continue with treatment, and actually receive the benefit of care I will be trained to give.”
Student #6’s reflection is especially illustrative. By rejecting a narrow orientation to patients as “just a diagnosis on a chart,” they offer three actionable insights for practice: the need to slow down, the critical role of language, and the value of patient choice.
Across the responses, students synthesize the principles of Culturally Congruent Care with their emerging visions of real-world practice. Having articulated insights of the theory in their personal reflections, students then transition to the next phase of the assignment in which they communicate insights from their reflection into a visual infographic as we describe in the following section.
After the “Reflection Activity,” students create an infographic that connects the framework of Culturally Congruent Care to the findings of their scholarly literature review. As a form of visual and multimodal communication, an infographic involves the use of images to convey information (Zhao, Peng, and Wu 2024) and may comprise graphics, words, or other images. Increasingly scholarship shows the benefits of doing so. The use of visual communication tools has become a key component in student learning to facilitate better understanding of information (Mardiana-Jansar and Hanafiah 2020). Studies show that students engage with the learning in “memorable and meaningful ways” (Skogsberg and Rice 2023, 88). Related to writing transfer, Yancey, Robertson, and Taczak (2014) theorize that creative redesign is a reseeing of ideas through a “remix.” When students create a remix, the process facilitates their capacity “to incorporate new concepts and practices” (p. 116, emphasis kept). In other words, writers make choices to adapt content from an initial project for a different audience or form, which fosters metacognition. Students address the following as they compose the infographic:
What did you discover in your review of the literature?
What is known in the literature about the topic?
What is not known about the topic in the literature? (Include ideas for future research on the topic).
What are the implications of the findings from the literature for nursing practice?
To provide resources for multimodal composing, the assignment allows students to use any software program they prefer, including infographic generator tools. Popular generator tools are listed in the assignment directions, such as Piktochart, Venngage, Readymag, Canva, and Easel.ly.
During the infographic, students creatively apply Culturally Congruent Care in a condensed presentation of findings into impactful, public-facing bullet points with attention to font, color scheme, and layout. Three examples (shared with the students’ permission) demonstrate how students engaged in the process and can be found in the online Supplementary Material for this article. One infographic, “Type 2 Diabetes Management: Lifestyle Interventions & Technology,” conveys practices for managing Type 2 Diabetes. Images of glucose monitors, nurse scrubs, and people exercising frame the textual information. The design scheme accentuates the blue color of scrubs, and arrows direct readers to navigate enumerated sections with information about diet, exercise, and monitoring. It concludes with a call for more research about cultural influences and culturally tailored care in Type 2 Diabetes. Another example focuses on serving Veterans with Post Traumatic Stress Disorder (PTSD). Four sections offer bulleted statements that define “trauma-informed and peer-supported care.” The information emphasizes how veterans with PTSD are a cultural group with shared values who benefit from caregivers “who speak their language.” A third example focuses on “Non-Pharmacological Labor Pain Management.” With shades of magenta, pink, and violet, the design evokes décor common in labor and delivery units. Anchoring the title is an image of a baby in the womb. The infographic focuses on the frequent use of epidural anesthesia during childbirth, a care practice that some cultures reject. It presents alternative pain management to provide culturally congruent care during labor. As these examples display, student infographics exhibit the ability to synthesize disciplinary research in multimodal texts with effective organization and visuals in support of a rhetorical purpose. They also provide evidence of student comprehension and meaningful engagement with Culturally Congruent Care.
After several semesters, the changes have improved the learning experience. For Lateefah, the updates have provided more effective assessment of students’ knowledge. The assignment revision has been extremely helpful for gauging students’ understanding of the content through three avenues: their scholarly synthesis of literature, their reflective work, and the infographic. It also appears to be beneficial for helping students display their thinking about, processing, and conveying what they have learned. Students engage the content more substantially as they imagine their future role as nurses. Integrating a Fourth Phase into the traditional literature review assignment supported the following learning goals:
Engage students through varied approaches.
Employ strategies that facilitate the simplification of concepts in ways that make them understandable to students.
Help students to make meaning of Culturally Congruent Care.
Support students on their learning journey.
The assignment updates also minimize the perception that scholarly writing in the field of Nursing is simply following APA format. Instead, students use reflection and a remix to connect disciplinary writing to the real world. Lateefah’s revision enacts several recommendations of culturally sustaining pedagogy, including qualities of meaningful writing projects (Eodice, Geller, and Lerner 2016). Students’ topics are applied to their future work. The infographic provides tools for students to connect to real-world issues. We believe that the two components bolster student engagement and can be adapted to writing courses in any major focused on providing evidence-based care, such as public health, social work, mental health counseling, nutritional science, addiction or rehabilitation services, and physical or occupational therapy.
This writing assignment is divided into four (4) phases with specific directions for each phase. Since phase four is the focus in this writing, the prompt for this specific phase is represented here, and the full assignment is in the Supplementary Material.
Write a short reflection (1-2 paragraphs) on what you have learned about Culturally Congruent Care. In your reflection, describe how you will incorporate this knowledge into your practice as a nurse AND share your thoughts about the importance of providing Culturally Congruent Care to patients.
Create an infographic to summarize your findings from the literature. You may use one of the tools provided in the instructions or a preferred tool of your choosing to create your infographic.
Your final infographic must depict the following four points:
What did you discover in your review of the literature?
What is known in the literature about the topic?
What is not known about the topic in the research literature? (Include ideas for future research on the topic).
What are the implications of the findings from the literature for nursing practice?