Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Nancy Hayward, Ph.D.

Second Advisor

Jean Nienkamp, Ph.D.

Third Advisor

Bennett A. Rafoth, Ed.D.


This qualitative research project places in context the function and use of the textbook in a two-year nursing program at a small liberal arts college in Pennsylvania. Data was collected from focus group interviews of nursing students, individual interviews of nursing students, surveys of nursing faculty, course syllabi, and institutional records. Two questions guided the research: (1) What is the role of the textbook in the undergraduate nursing program at William Penn College?, and (2) How do students utilize the textbook as they train to become nurses? Two groups of nursing students were studied: Level 1 students, who were in their first semester, first year of study, and Level 4 students, who were in the second semester of the second year. This research project, then, utilizes a bookend approach, soliciting responses from students at the beginning and end of the undergraduate nursing program. Analysis of the data indicates that there were no significant differences in the reading and study strategies employed by the two groups for comprehending textbook-based concepts and skills, offering evidence that the same strategies relied upon in entry-level nursing coursework maintain relevance for more advance coursework. In addition, the textbook as a tool for learning maintained or even increased in importance as students progressed through the program. This research concludes that success in the undergraduate nursing program is determined in large part by having the advanced literacy skills needed to transfer textbook-based concepts to multiple choice examinations and clinical situations. Students unable to bridge the gap between academic, textbook knowledge and clinical practice face an insurmountable barrier to their goal of becoming registered nurses. There is a shortage of trained nurses in the United States, and this research offers evidence that efforts to alleviate this shortage must take into account the literacy demands influencing students’ success.