Reflecting on the use of student portfolios

Article Reflecting on the use of student portfolios Sue Harris, Gina Dolan and Gavin Fairbairn The use of portfolios in nursing has increased during recent years. We reflect upon the design and implementation of a portfolio for pre-registration nursing students in the School of Care Sciences1 at the University of Glamorgan. The portfolio was introduced as the result of the need to address the theory–practice divide and to provide nurse students with the skills to maintain a professional profile upon registration. We also discuss other potential benefits associated with using the portfolio. These include the use of a portfolio as a focus for discussion between the student and their preceptor or personal tutor, a vehicle for the development of reflective skills and a means of assessment. We acknowledge that along with benefits, there are a number of potential problems and limitations in their use, for example, an increase in the workload for the student, preceptor and personal tutor. We include preliminary findings of an evaluation of our portfolio, revealing that both students and staff value the introduction of the portfolio, although currently it is not a high priority in terms of the course as a whole. © 2001 Harcourt Publishers Ltd Introduction Sue Harris MN, BSc, RGN, PGCE (FE), Senior Lecturer, Gina Dolan BSc Econ, MSc, Associate Lecturer, Gavin Fairbairn PhD, MEd, BA, BSc, Dip SEN, PGCE, Professor of Professional Development, School Of Care Sciences, University Of Glamorgan, Pontypridd CF37 1DL, UK. Tel.: +44 (0) 1443 483097; Fax: +44 (0) 1443 483095 (Requests for offprints to GD) Manuscript accepted: 30 November 2000 278 The increasing use of portfolios in nursing has provoked mixed feelings, perhaps because some nurses find it difficult to appreciate their value in facilitating professional development. Therefore, although portfolios are a requirement for reregistration, they still remain as a low priority for registered nurses, many of whom are reluctant wholeheartedly to embrace their use. The introduction of student portfolios as an integral part of pre-registration nursing courses may help to redress this reluctance. For, example, Priest and Roberts (1998) describe the use of portfolios with pre-registration diploma students and Mitchell (1994) describes their use in postregistration training with midwives. Such uses complement the use of portfolios by nurses and midwives, as a means of facilitating professional development after registration. In this article we look critically at some of the reasons for the increasing use of portfolios in nurse education and reflect upon the design and implementation of a portfolio for pre-registration Nurse Education Today (2001) 21, 278–286 doi: 10.1054/nedt.2000.0545, available online at http://www.idealibrary.com on nursing students in the School of Care Sciences at the University of Glamorgan. What is a portfolio? An educational or professional portfolio is a collection, record or set of material or evidence that gives a picture of an individual’s experience in an educational or developmental situation. James (1992) points out that when they were first introduced into secondary schools in 1943, portfolios were intended for use in assessment as an alternative to exams. However, portfolios can be used for a much wider variety of purposes, which is why we believe that they have the potential to be such an important part of nurse education and post-registration development. For example, they can provide a logical presentation of prior learning and experiences that may be considered as evidence of suitability for entry to educational courses, or new job positions. 1 Formerly the School of Nursing and Midwifery © 2001 Harcourt Publishers Ltd Reflecting on the use of student portfolios Alternatively, portfolios may document personal development in a way that is similar to the records of achievement which are now widely used in comprehensive schools (Department of Employment 1991). Why has there been an increase in the use of portfolios within nurse education? In nurse education portfolios are used both as a record of personal development and as a learning tool. Marsh and Lasky (1984) suggest that they can be used to describe learning experiences and provide ‘evidence that concepts and principles from these experiences are being applied in practice’ (p. 195). Portfolios that require students to reflect on the relationship between their theoretical learning and their practical experience can help to bridge the perceived gap between nursing theory and practice2. The use of such a portfolio can facilitate discussion between the student, tutor and clinical preceptor. In our view an even more significant benefit may come from encouraging nursing students to develop their portfolio to meet their individual needs, perhaps maintaining personal reflections in a separate section. Even before the introduction of a personal professional profile as a mandatory requirement for registration and re-registration within nursing in the UK (UKCC 1994), portfolios were frequently cited within the literature of nursing education. For example, Brown (1992), James (1992) and Johnson (1992) all offer guides for the development of nursing portfolios, while Gerrish (1993) and Mitchell (1994) focus on the use of portfolios for assessment purposes. Murray (1994) believes that one reason for the increase in popularity of portfolios in nurse education is the introduction of the Framework and Higher Award of the English National Board for Nursing and Midwifery (ENB 1991). The Welsh National Board for Nursing, Midwifery and Health Visiting Framework for Continuing Education (Welsh National Board for Nursing 1989) has probably exercised a similar influence. 2 For the sake of consistency, we refer to this as the ‘theory practice divide’ even when authors to whom we refer use the expression ‘theory-practice gap’. © 2000 Harcourt Publishers Ltd As part of these frameworks nurses may obtain credit for what they have already learned by the Accreditation of Prior Learning (APL), and for what they have already experienced, by the Accreditation of Prior Experimental Learning (APEL) in the form of a portfolio. This process of learning has been prominent in further education for many years, yet it is fairly new within nursing. Murray (1994) suggests that, although most nurses favour the portfolio route to gaining recognition for earlier experiences and learning, many of them feel that the guidelines regarding expectations are unclear and that more guidance about compiling a portfolio is necessary. Today portfolios are mainly associated with post-registration nurses. However, this is likely to change as a result of the Fitness for Practice (UKCC 1999b) recommendations, which reinforce the value of using student portfolios to increase the potential of learning from practice. The use of student portfolios in the school of care sciences We introduced the use of portfolios for our preregistration degree and diploma students in October, 1997, as part of an attempt to address the theory–practice divide. In addition we saw the portfolio as a way of helping students to develop the skills to maintain a professional profile upon registration as a preparation for post-registration education and practice (PREP). The process through which we expect our students to go in creating and maintaining their portfolio has many similarities to the uses that Paulson and Paulson (1991) describe. They believe that the student should be actively involved in developing the portfolio: The collection must include student participation in selecting contents, the criteria for selection, the criteria for judging merit and evidence of self-reflection. (p. 60) Although we view an emphasis on students ‘owning’ their portfolios as an advantage in promoting personal and professional development, we are aware that an increase in autonomy for their learning may cause anxiety to some students. To avoid this negative effect as far as possible, we encourage students to view the portfolio as offering them an opportunity to meet their individual needs. Students may thus use the Nurse Education Today (2001) 21, 278–286 279 Reflecting on the use of student portfolios portfolio in a variety of ways. However, in order to enable the development of reflective skills, we emphasize the value of a regular and structured use of the portfolio. Our students are required to make use of their reflections from the portfolio in their summative assignments. We were conscious of the possibility that assessment could detract from the aim that students should have ‘ownership’ of the portfolio, for example, by using it to explore aspects of their professional development. Nonetheless, we decided to incorporate an assessment component. Our portfolio takes the form of a ring binder which allows material to be removed or added as the individual chooses. It is designed as an interactive, flexible manual in which the student is encouraged to reflect, carry out self-appraisals, devise and record what they do in relation to action plans; in these ways they take responsibility for the direction of their own development. The recommendations of Dearing’s report (1997) and the work of Knowles (1975) have influenced the development of our use of portfolios. Dearing recommended that a progress file should be developed that would be ‘a means by which students can monitor, build and reflect upon their personal development’ (p. 3). Knowles makes four assumptions about the nature of the adult learner: 1. The student is self-directed 2. The student’s past experiences are a rich source of learning 3. The readiness to learn develops from life tasks and problems 4. The student demonstrates curiosity and is self-motivated to grow and achieve. The self-directed learner is, therefore, seen as one who diagnoses her/his learning needs, identifies resources for learning and evaluates learning outcomes. Learning is conceptualized as an initiated, participatory, life-long process resulting in an increase in perception and/or change in behaviour. (Knowles 1975, p. 114). Students need structure and support in making their educational journey fruitful and the use of portfolios can help to provide such structure and support. However, to be successful it is necessary to foster a climate in which educators in both the classroom and clinical area positively support the portfolio approach. 280 Nurse Education Today (2001) 21, 278–286 What were our reasons for introducing the portfolio? Our decision to introduce the use of portfolios for our pre-registration degree and diploma students resulted from a need to address: ● ● The ‘theory–practice’ divide, in other words the gap that exists between what theory suggests should be done and what nurses do in reality The need to provide nurse students with skills that will enable them to maintain the professional profile that they are required to keep once registered. The theory–practice divide Both the Horder Committee Report (RCN 1943) and the Briggs’ Report of the Committee on Nursing (Briggs 1972) reported on the organization of nursing and specifically referred to this divide as being a negative influence on student nurses’ learning. Very little changed as a result of the recommendations of these reports, which aimed to change the relationship between education and service. Although the reality of the theory–practice divide is widely accepted, there is an ongoing debate about its extent, and also about both causative factors and the effects that it has on standards of care. The divide is often seen as being sandwiched by the two non-overlapping entities of academia and clinical practice. It can be difficult for students to make the link between the theories advocated by academics and those of clinicians, though both are equally relevant. Reed and Procter (1993) believe that this is the essence of the theory–practice divide – the perception that nursing theory is derived from abstract research rather than from practice. A major dilemma of curriculum development in nurse education is the question of whether it should focus on ‘nursing as it is’ or on ‘nursing as it should be’. The move of nursing into Higher Education may be interpreted as endorsing a further move away from the clinical realities to become more immersed in the theory of academia. Mead (1999) argues that this divide does not only apply to nursing, but is also evident in other practice-based professions, including medicine. However, as she points out, being situated within a university environment for the purposes of education and training does not seem to act as a © 2000 Harcourt Publishers Ltd Reflecting on the use of student portfolios negative influence on the status of doctors, or to imply a removal from clinical realities. An appreciation of the importance of the possible effect of the theory–practice divide on student nurses’ socialization is crucial if potential student problems are to be addressed. One common problem that students experience when faced with the reality of life on the wards, is the stress that can arise as a result of being involved in illness and disease. Harris (1992) looked at ways that students cope with such stressful situations. Students identified potential areas for improvement in their preparation for clinical placements, which may assist their coping mechanisms. One student described how she felt this could be achieved: Perhaps a lesson to help us realise the stress of the job, to realise that it is not wrong to feel this way. Perhaps to have a senior sister to tell you about the times that she cried – that it is not wrong to feel this. To see that someone in a senior situation also goes through this-not that they are hand/harsh and don’t feel! (Cited in Harris 1992, p. 61) Rafferty et al. (1996) refer to problems of the kind exemplified by this extract, as a product of the ‘reality shock’ that many students experience during clinical placements. Many attempts have been made to reduce or eradicate the theory–practice divide, but it still prevails. Severinsson (1998) found that a clinical supervision programme for student nurses led to an increase in personal growth and integration of knowledge. In addition, her study suggested that students felt that these perceived benefits and the use of reflection helped to bridge the divide. A portfolio, in which there is a reflective component, may provide a tangible bridge between theory and practice. This has the potential of linking the knowledge student’s gain through clinical experience, facilitated by a preceptor, with knowledge gained in the University. This may also help to reduce the ‘reality shock’ commonly experienced by students. conducted for the UKCC by accountancy firm KPMG has found that there is still a misunderstanding by many regarding their PREP requirements (UKCC 1999a). Payne (1999) also indicated that this survey showed little evidence of meaningful reflection by nurses. Andrews et al. (1998) highlighted the fact that in order to reflect, nurses require highly developed skills in analysis and evaluation, and the assumption that after registration they will have such skills. Including preparation for PREP within the pre-registration curriculum offers students the opportunity to become familiar with portfolio/profile keeping and to develop useful reflective skills. This provides a natural bridge between a school pupil’s National Record of Achievement and their UKCC required professional profile. It also supports the important principle of life-long learning that was so central in Dearing’s report (1997). Potential benefits of the portfolio Having discussed the two main reasons that we had for introducing the use of portfolios with our students we will now consider some other potential benefits their use may bring. The portfolio as a means of facilitating the development of students’ accountability and autonomy Nursing students are adult learners and, in many cases, mature adult learners. Nurse education today emphasizes learning rather than teaching. It also places greater emphasis on increased student involvement in decisions about the curriculum, as well as about individual progress. A student portfolio has the potential to be used as a way of facilitating students as autonomous learners and practitioners by encouraging them to take more responsibility for the direction, progress and quality of their learning, as well as for the development of better study skills. Of course, this may generate anxiety in students who do not wish to take on an increase in Preparation for post-registration education and practice (PREP) Despite the introduction of PREP3 in 1992, a recent survey of 3000 nurses and midwives © 2000 Harcourt Publishers Ltd 3 PREP refers to the UKCC’s requirements for education and practice following registration. Nurse Education Today (2001) 21, 278–286 281 Reflecting on the use of student portfolios responsibility. However, encouraging student nurses to accept accountability can bring benefits. For example, it can help to prepare them for some of the challenges they may face later in their careers. The portfolio as a focus for discussion The relationship between the key players in the student portfolio is crucial because one of its potential strengths is that the portfolio can provide a focus for discussion. Glen and Hight (1992) describe the tutor as a ‘resource’ for the student in reflecting on experiences and subsequent development. They believe that the student and tutor should engage in a critical and collaborative dialogue. Such a dialogue is not assisted if the tutor adopts an authoritarian role (or if the tutor’s role is viewed as authoritarian by the student). The two-way learning process that results from this dialogue also has other clear benefits; for example, Glen and Hight believe that it can facilitate the personal development of the tutor as well as that of the student. In addition to this, we would argue that it should be the tutor’s privilege to be accompanying the student on their developmental journey. The preceptor’s role is to assess the students’ attainment of competence and their ability to relate theory to practice and practice to theory (Statutory Instrument 1989). Taking a wider perspective it would seem that the preceptor is, in fact, the key player in the student’s learning and that using the portfolio as a focus for discussion is one way in which the preceptor/student relationship can be strengthened, leading to a better learning experience for the student. The use of portfolios as a focus for discussion relates to developments in other areas where reflection is used as a means of professional growth. For example, Marland and McSherry (1997) introduced the use of a reflective diary as a way of enabling students to reflect on and learn from their experiences, supported by experienced practitioners following Palmer (1994) they refer to the creation of a ‘practicum’ – a safe and structured environment in which this can take place. They illustrate this process by describing the preceptor’s role in facilitating the analysis of past events by: . . . identifying strategies arising from the new perspective gained, which can enable the 282 Nurse Education Today (2001) 21, 278–286 preceptor and the student to match actual experiences to the achievement of practice based competencies (Marland & McSherry 1997, p. 51) In a small action research study, Marland and McSherry found that the introduction of a reflective diary had the following positive effects: ● ● ● ● ● It enhanced time management between student and preceptor It promoted reflective learning It facilitated the transferability of insights gained in one situation or placement to others It allowed students to ‘see’ how they were progressing on their placement by providing positive feedback It helped the preceptors to relate the student experiences to the Benner Tool (1984) in regular meetings. Marland and McSherry concluded that the use of a reflective diary provided a ‘framework for analysis and discussion’, and formed a link between theory and practice. The portfolio as a vehicle for the development of reflective skills In most student portfolios there is a reflective component. This is essential where a fundamental aim of the portfolio is to provide a vehicle by which students may learn from experience and practice. Reflection on experience needs to be part of a conscious and deliberate strategy aimed at understanding and learning from clinical practice. Interestingly, the UKCC (1999) suggests that, ‘students may keep reflective diaries to describe and analyse their experiences of the process of learning’ (UKCC p. 35). Dearing (1997) also focuses on the way in which opportunities for reflection can ‘help students to become familiar with work, and help them to reflect on such experience’ (p. 2). Boyd and Fales (1983) describe reflective learning as the process of internally examining and exploring an issue of concern, triggered by an experience, in a way that creates and clarifies meaning in terms of self and results in a changed conceptual perspective. Mezirow (1990) emphasizes the relationship between critical reflection and transformative learning, enabling individuals to become more aware and critical of their own and others’ assumptions. © 2000 Harcourt Publishers Ltd Reflecting on the use of student portfolios Critical incident analysis is an accepted approach to reflecting on practice in a systematic way. First used by Flannagan (1954) in the 1940s to train RAF pilots, it has been utilized in nurse education for many years (e.g. Clamp 1980, Cormack 1983, Reed & Proctor 1993). In the School of Care Sciences, students are encouraged to reflect within their portfolio, on critical incidents or significant events. Emphasis is placed on a significant event, that is, an event that has some importance to the student, and from which they may learn. This does not mean a ‘life and death’ situation or even a very unusual incident. Some of the examples used to support this are: ● ● ● ● ● Assisting a patient in and out of the bath Talking with a patient during a trip out from the ward Being left alone with worried relatives Giving instructions to a junior student nurse Carrying out a dressing with your preceptor. In order to increase the potential for learning from the critical incidents, students are given a definite structure to support this and appropriate preparation for doing so. Students are also encouraged to share their reflections in small peer groups. This approach is advocated by Reed and Proctor (1993) who have found that sharing experiences has a positive effect on learning. Harris (1998) argues that the socialization process that occurs during a student nurse’s diploma (or now, degree) course, inevitably results in a ‘detached concern’ or ‘professional distancing’ occurring as a way in which stressful experiences may be coped with. Beattie (1991) considers that if students are to be helped to deal with these experiences in a more positive way, they need to be encouraged to learn about themselves, about their feelings, about their own ways of handling significant experiences related to health and illness. Critical incident analysis within the portfolio potentially provides a way of meeting this need. The portfolio as a means of assessment Although they have primarily been used in assessing clinical practice in post-registration courses, portfolios have the potential to be used © 2000 Harcourt Publishers Ltd in assessment in a number of areas. Murrell et al. (1998) found that not only did post-registration portfolios enable theory and practice to be brought closer together, but they could also lead to improvements in practice and facilitate students in taking control of their own learning needs. In their investigation of the use of portfolios in assessment, Glen and Hight (1992) discussed the educational value of portfolios. They decided that portfolios could be assessed by referring to indicators of the professional socialization to which students were being exposed. They adopted criteria that referred to the extent to which students had internalized aspects of the professional ethos of nursing. For example, one of the assessment criteria required students to demonstrate a willingness to respond to change. This approach could enable a summative assessment to be integrated as a useful part of the portfolio. Doing so would have the added benefit of bringing closer the curriculum and the assessment process, giving appropriate emphasis to the importance of the students’ socialization process. Problems and limitations First there are issues which relate to time. For example, since the development of a portfolio can be very time consuming, particularly in the earlier stages, students may neglect it because they consider their work on it to be less important than other parts of the course, such as assignments and exams. This is most likely when portfolios are not formally assessed. Such difficulties may be minimized by helping students to realise how valuable the portfolio can be in their personal and professional development, both as a means of preparation for PREP and as a way of bridging the gap between theory and practice. Also linked to time, is the extent to which tutors and preceptors are committed to the use of portfolios. This can vary, resulting in inequalities between students, some being given more encouragement and support in using their portfolio than others. In a study looking at the role of nurse teachers, Cahill (1997) found that teachers raised concerns about the unequal amount of time given to students; for example, she found that some teachers operated an open Nurse Education Today (2001) 21, 278–286 283 Reflecting on the use of student portfolios door policy, whilst others did not. Problems such as these are difficult to overcome, especially if the portfolio does not have a formal place as part of the course. Other possible problems arise from the antagonism that can exist between the use of portfolios for personal development and their use for assessment purposes. This dual use can cause problems because when they are used well, portfolios are likely to be very personal in nature, especially if they include a diary component. Students may be reluctant to share personal information with their peers or tutors and preceptors. If it is not assessed in its entirety, it is important to explain to students that since they have ownership of the portfolio, they may choose how to use it, and thus if they do not want to share personal aspects within it, that is their decision. Our portfolio is linked to the students’ assessment process at three points during their course through a summative assignment. Whilst this provides a potential link between theory and practice, this inclusion has provoked concerns within the planning team, which are echoed by Mitchell (1994): Summative assessment included as a purpose of portfolio use may have a profound effect on the way students contribute to their use. It may also effect their experiences and perceptions of the benefits to themselves of portfolio use. (p. 43) Summatively assessing portfolios could thus adversely affect the extent to which students experience ownership of this important developmental tool; as a result their use of their portfolio could be discouraged. Paradoxically, however, they are also less likely to use their portfolio if it is non-assessed. Conclusion Nursing portfolios are here to stay. We have discussed why we introduced a portfolio into our nursing courses, focusing on the potential benefits it has for our students. As we have already indicated, the reality of nursing in the UK today is that portfolios are a requirement of professional development and re-registration. Focusing on student portfolios, the UKCC recently recommended that: 284 Nurse Education Today (2001) 21, 278–286 The portfolio should be assessed through rigorous practice assessment tools which identify the skills which students have acquired and highlight any deficits which need to be addressed. (UKCC 1999, p. 38) In addition, portfolios are also widely used in other countries, for example in pre- and post-registration nurse education in the USA. Recognizing this increased emphasis on the use of portfolios, it is difficult to understand why they are not more commonly used in pre-registration nurse education. Although we would encourage the use of portfolios, we have acknowledged some problems associated with their use, such as an increase in the workload for the student, preceptor and personal tutor. In order to address potential problems, it is important for us to monitor the ways in which our portfolio is being used. We are currently evaluating the portfolio as part of our commitment ensuring that our students are benefiting from using it. Although we originally intended to investigate whether introducing the student portfolio achieved the intended aims and potential outcomes, we have experienced some difficulties in addressing this. The first stage of our research comprised of semi-structured interviews with students (n = 6) about their use of the portfolio. The results revealed that, although students valued the introduction of the portfolio, the extent to which they use it is very limited. All six students perceived the portfolio as a low priority in terms of the course as a whole, primarily because it is not an assessed part of the course. Focus groups with teaching and management staff (n = 4) validated these interview findings, as students rarely discuss the portfolio with their tutor. As a result it is difficult to conclude whether the portfolio has met the original objectives. In the final stage of the research study a structured questionnaire was distributed to students who were issued with a portfolio. The questionnaire mainly focuses upon usage of the portfolio and how it is perceived. The questionnaires (n = 219) are now being analyzed, and preliminary findings confirm students are not using the portfolio as frequently as we hoped. However, many students feel that a low priority © 2000 Harcourt Publishers Ltd Reflecting on the use of student portfolios is placed on allocating time for using the portfolio during the course. On the basis of these findings we intend to further integrate the portfolio into the nursing course. One way in which this may be achieved is by assessing part of the portfolio. However, we have already acknowledged that, although this will increase usage of the portfolio, it also has limitations. Following the introduction of a Foundation Degree for nursing, recommended by David Blunkett, our portfolio will be further integrated into the course. We hope as a result, the portfolio will become a central rather than a fringe activity. Student portfolios have the potential to be useful in assisting students’ learning and development; they also have the capacity to link clinical experiential learning and theoretical learning, and to help students to deal with the stressful nature of nursing. The process in which students are able to reflect on their development in a structured way may potentially be the most important aspect of the portfolio. However, the way in which portfolios are perceived and utilized by students is influenced by many factors. One of the most significant of these is the emphasis placed upon their ‘usefulness’ by the key players – the student, preceptor and personal tutor. It is also important that, while students are encouraged to take responsibility for their learning, they are given adequate support by tutors and preceptors; without this some students may be reluctant to use the portfolio to its full potential. With a number of colleagues, we are currently planning the next stage in the development of our portfolio use, by translating it into an electronic form which students will access via lap top computers. This may appeal to the students, who are increasingly proficient in IT. The use of networking may also encourage an increase in shared learning experiences. References Andrews M, Gidman J, Humphreys A 1998 Reflection: does it enhance professional nursing practice? British Journal of Nursing 7: 413–417 Beattie A 1991 Curriculum coordination, vol 1, no. 5. National Board for Nursing, Midwifery and Health Visiting for Scotland: 54–59 Benner P 1984 From novice to expert. Addison and Wesley, Menlo Park, CA Boyd E, Fales A 1983 Reflective Learning; key to learning from experience. Journal of Humanistic Psychology 23: 99–117 © 2000 Harcourt Publishers Ltd Brown R A 1992 Portfolio development and profiling for nurses. 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