Assessing learning in clinical practice: The structured clinical log of a reflective portfolio

1. Assessing learning in clinical practice: The structured clinical log of a reflective portfolio Stephanie Zettel 2010 CASTL Institute June 3, 2010

2. “Good teaching cannot be reduced to technique; good teaching comes from the identity and the integrity of the teacher” (Palmer, 2007, p. 10)

3. Defining the experience… • Uncertainty – “Unknowing” • Opportunity • Meaning and possibilities • Questioning approach • Critical inquiry

4. “To teach and nurse effectively, we need to know ourselves. This is what we bring to our teaching and nursing partnerships, and it can be a catalyst for provoking caring and social change” (McEldowney, 2003, p. 220).

5. “Emancipatory teaching … fosters a spirit of inquiry, an independence of thought, an ability to question prevailing assumptions, and a confidence with which to meet the complexities of a dynamic health care system” (Myrick & Tamlyn, 2007, p. 301)

6. “The goal of instruction becomes creating an opportunity for learning that integrates content knowledge with knowledge of context” (Forneris & Peden-McAlpine, 2006)

7. Critical Thinking in Practice(Forneris, 2004, as cited in Forneris & Peden-McAlpine, 2006, p. 2) Reflection Time Context Dialogue

9. Critical Thinking is… “Purposeful, self-regulatory judgment that results in interpretation, analysis, evaluation, and inference as well as the explanation of evidential, conceptual, methodical, criteriological or contextual considerations upon which that judgment is based”(Facione, 1990, as cited in Kuiper & Pesut, 2004, p. 383).

10. The Question • What is the effect of a structured clinical log within a reflective portfolio on the assessment of learning (as measured by self-efficacyand critical thinking skills) and competence in the clinical practice of undergraduate nursing students?

11. The Intervention • Narrative Reflective Journaling • “Narrative captures the experience by organizing human actions and events within a composite or real-life experience… Narrative creates understanding by illuminating causal thinking… temporal aspects of the human experience as it changes over time.” (Forneris & Peden-McAlpine, 2006, p. 3)

12. Guided Narrative Reflection Process(Forneris & Peden-McAlpine, 2006) • Describe a story • Guide critical reflection • Consider alternative perspectives • Integrate learning into future practice experiences

13. Self Efficacy • Internality, Powerful Others and Chance (IPC) Scales (Levinson, 1981, as cited in Harvey & McMurray, 1994) • Assesses three aspects of control • Belief in one’s own ability • Role of external factors in controlling life events • Role of chance

14. Competence Self-appraisal with 6-D scale (Schwirian, 1978) Self appraisal with comparison to Benner’s (1984) Novice to Expert behaviours Phenomenological approach to understand how nursing “skills” and behaviours are attained through time, from novice to expert • Leadership • Critical Care • Teaching/Collaboration • Planning/Evaluation • Interpersonal Relations/Communications • Professional Development

15. UNCG (University of North Carolina at Greensboro) Critical Thinking Skills Evaluation Instrument (Sorrell, Brown, Cipriano Silva & Kohlenberg, 1997) • Likert scale on how students perform certain skills (5=independent to 1=unable to perform, even with consistent guidance) • Ability to analyze and interpret • Draws logical inferences • Evaluates and justifies inferences • Deductive reasoning • Inductive reasoning

16. Data Analysis • Correlation of narrative reflective journaling compared to competence, self efficacy and critical thinking skills at students’ various stages of education and practice • Is this relationship significant? • Is it even possible to detect a relationship, given the number of other factors affecting students’ learning?

17. References Bainbridge Frymier, A., Shulman, G., and Houser, M. (1996). The development of a learner empowerment measure. Communication Education, 45, 181-199. Bandura, A. (1997). Insights: self-efficacy. Harvard Mental Health Letter, 13(9), 4-6. Banning, M. (2006). Nursing research: perspectives on critical thinking. British Journal of Nursing, 15(8), 458-461. Boughn, S. (1995). An instrument for measuring autonomy-related attitudes and behaviors in women nursing students. Journal of Nursing Education, 34(3), 106- 113. Conger, M. and Mezza, I. (1996). Fostering critical thinking in nursing students in the clinical setting. Nurse Educator, 21(3), 11-15. Craft, M. (2005). Reflective writing and nursing education. Journal of Nursing Education, 44(2), 53-57. Fonteyn, M. and Cahill, M. (1998). The use of clinical logs to improve nursing students’ metacognition: a pilot study. Journal of Advanced Nursing, 28(1), 149-154. Forneris, S. and Peden-McAlpine, C. (2006). Contextual learning: a reflective learning intervention for nursing education. International Journal of Nursing Education Scholarship, 3(1), 1-18.

18. Harvey, V. and McMurray, N. (1994). Self-efficacy: a means of identifying problems in nursing education and career progress. International Journal of Nursing Studies, 31(5), 471-485. Maynard, C. (1996). Relationship of critical thinking ability to professional nursing competence. Journal of Nursing Education, 35, 12-18. McMullan, M. (2006). Students’ perceptions on the use of portfolios in pre-registration nursing education: a questionnaire survey. International Journal of Nursing Studies, 43, 333-343. Nelson, S. and Purkis, M. (2004). Mandatory reflection: the Canadian reconstitution of the competent nurse. Nursing Inquiry, 11(4), 247-257. Polit, D. and Beck, C. (2008). Nursing research: generating and assessing evidence for nursing practice. Philadelphia: Lippincott-Williams & Wilkins. Ruland, J. and Ahern, N. (2007). Transforming student perspectives through reflective writing. Nurse Educator, 32(2), 81-88. Sedlak, C. (1992). Use of clinical logs by beginning nursing students and faculty to identify learning needs. Journal of Nursing Education, 31(1), 24-28. Sorrell, J., Brown, H., Cipriano Silva, M. and Kohlenberg, E. (1997). Use of writing portfolios for interdisciplinary assessment of critical thinking outcomes of nursing students. Nursing Forum, 32(4), 12-24.

19. Steen Lauterbach, S. and Becker Hentz, P. (2005). Journaling to learn: a strategy in nursing education for developing the nurse as person and person as nurse. International Journal for Human Caring, 9(1), 29-35. Usher, K, Francis, D., and Owens, J. (1999). Reflective writing: a strategy to foster critical inquiry in undergraduate nursing students. Australian Journal of Advanced Nursing, 17(1), 7-12.