Portfolio Learning

Carolyn Emden
Research Education Unit, School of Nursing, Faculty of Health Sciences, Flinders University, Adelaide SA

Diana Hutt
Clinical Facilitator; Casual Lecturer, Aberfoyle Park, SA

Meredith Bruce
Clinical Facilitator, Whyalla Hospital & Health Services, SA

PP: 124

Abstract

This paper describes portfolio projects currently underway within three South Australian settings: an undergraduate general nursing curriculum, a postgraduate perioperative nursing course, and a major general hospital and health service.

The projects share a common interest in achieving an organised, useful means for registered nurses and midwives to demonstrate their competence in accord with contemporary professional standards. Their beginnings in international research and experience is described, and the progress of each project tracked to date. Others wishing to develop similar innovations can follow this decision trail and the advice offered.

Outcomes to date indicate portfolios hold promise for advancing professional nursing and midwifery practice. Research currently underway on the topic is highlighted.

Keywords

portfolio, assessment, learning, nursing, midwifery

Article Text

Portfolio learning/assessment has been used in the field of general education for many years. Indeed, it was described as the 'hottest topic' in student assessment in the early 1990s (Harris and Curran, 1998). Within a student context, a portfolio may be defined as:

… a focused purposeful collection of student work that documents evidence of traditional and nontraditional sources of student learning, progress, and achievements over time. (Wezel et al, 1998: 209)

Research indicates the biggest drawbacks to the success of portfolio learning/assessment are lack of constructive guidance in building a portfolio, and the time required to build and maintain an effective portfolio (Harris and Curran, 1998). Other research has shown the features of a good portfolio are clarity in organisation, cross referencing, evidence of experience, and critical discourse (Wilkinson, 1998) and that further factors influencing portfolio use are writing skills, and ability to reflect and record findings (Day, 1998).

In an extensive review of literature on the topic, Wenzel et al (1998) found there was a gap relating to portfolio use in nursing and subsequently proposed an 'Integrated proficiency-criterion framework'. The framework delineated certain NLN baccalaureate outcome criteria in conjunction with Benner's novice to expert skill levels. Nursing students (in Wisconsin) were responsible for collecting content (evidence) for the portfolio to demonstrate these outcomes were achieved over time. Additionally, Wenzel et al (1998: 212) cited the benefits of portfolio development as including:

… tracking and promoting continuous lifelong learning, the involvement of self-reflection and personal responsibility, learning to value improvements and accomplishments, and developing collaboration among students and faculty.

A further initiative was undertaken by Lettus et al (2001) who created a clinical portfolio assessment option for baccalaureate nursing students in New York. They found it empowered students to 'complete degree requirements in a flexible and comprehensive manner' and a rewarding experience for students and faculty. Writing from Arizona, Bell (2001) proposed the use of portfolios for professional nurses wishing to demonstrate ongoing competence throughout their careers, highlighting that they can serve different purposes such as career changes, additional education or expansion in community areas. More recently, electronic portfolios have been advocated, whereby an electronic template is used by students to 'house' their evidence in an 'accessible, sophisticated format' (Ramey and Hay, 2003).

Nursing and midwifery experience in the United Kingdom endorses the use of portfolios, with references in the literature first appearing in the early 1990s. Storey and Haigh (2002: 47) concluded commitment remains in the UK that 'the portfolio system can be utilised by the practitioner as a dynamic tool to demonstrate that competence is being maintained and developed over time'. This is despite some reported confusion in the UK over a definition of competence and some controversy about competency-based assessment as an assessment approach (Storey and Haigh, 2002). In New Zealand, Thompson and Farrow (1999: 27) reported 'with confidence' after one year of working with a 'workbook portfolio model' that there was a 'clear advance' in mental health students' 'critical thinking, reflection and theory/practice integration'. Also in New Zealand, Gallagher (2001) reported portfolio assessment was used successfully with undergraduate nursing students as an alternative to essays. In Australia, portfolios appear to have received little attention in nursing and midwifery journals, although reference can be found in the guidelines of some Nursing Boards to their use as a means to demonstrate competence, particularly when domain specific competencies are integrated as the framework for the portfolio (Davies and Hamlin, 2003: 28-29). The Australian text Portfolio assessment: a guide for nurses and midwives (Cooper and Emden, 2001) provided the basis for the projects described in this paper.

Such was the backdrop of research and experience to our three South Australian portfolio projects.

Rationale for using portfolio learning/assessment

For individuals

Registered nurses and midwives in Australia must self-declare, or attest by signature, their competence (fitness for practice) at the time of renewing their annual practising certificate with their relevant Board. This raises questions for the individual about the basis on which they make their judgement of personal competence. Signing to one's competence is a serious undertaking that arguably goes to the heart of professionalism and professional practice. Portfolios can be an effective way of demonstrating competence and thus provide a legitimate basis on which registered nurses and midwives can make a judgement of personal competence – and self-declare by signature with a high degree of confidence. They can also be a valuable professional development tool in times of career change.

For employers

Employers of nurses and midwives have traditionally taken the bulk of responsibility for declaring their staff members clinically competent. While this responsibility has now shifted to the individual employee, employers remain highly vigilant of their existing staff members' competence and questioning of new staff members' competence. It is increasingly common for job applicants to be asked to bring their portfolio to the job interview. They may also be asked to leave it for the interview panel to review alongside those of other applicants, after interview. On appointment, the successful applicant may be required, along with other staff members, to present their portfolio from time to time for review - as evidence they are meeting the relevant competency standards of their profession. For example, the Australian Nursing Council Inc (ANCI) National Competency Standards for the Registered Nurse (2000), and the Australian Council of Midwives Inc (ACMI) Competency Standards for Midwives (1998).

For educators

Educators of nurses and midwives not only prepare graduates for initial registration but also ongoing self-regulation and lifelong learning. They seek to provide learning opportunities at undergraduate and graduate levels that will equip their graduates with the knowledge and skills to advance their careers successfully. Teaching the skills of portfolio building within nursing and midwifery university courses can arguably advantage graduates in securing a desired first job as well as maximising their professional development. Importantly, the concept and practice of portfolio building fit with the principles of adult learning. Despite knowledge that adult learners learn best when they have opportunity for experiential learning and self-direction, unfortunately many students continue to report negative learning experiences. In planning curricula, educators need to constantly remind themselves that adults have powerful internal motivations to study, and ability to link what they learn to their own experiences – factors that bode well for success and enjoyment of the portfolio building process.

The projects

Three projects are presented from our personal experiences of implementing portfolio learning/assessment: in an undergraduate bachelor of nursing; in a graduate diploma/master of clinical nursing; and in a major regional hospital and health service. All projects are concerned with the collection of evidence to demonstrate competence, however the purpose of the portfolio within each example varies as does the assessment of the portfolio. The examples are indicators only of how portfolios may be used. For example, the purpose and assessment described are not necessarily restricted to the situations here – approaches may be mixed according to the interests and requirements of individuals and organisations.

1. Undergraduate curriculum

The School of Nursing and Midwifery at Flinders University, Adelaide is currently in the third year of implementing portfolios in the bachelor of nursing – as part of a (at the time) newly accredited curriculum. Prior to this, intensive academic staff discussion and debate occurred about possible approaches to the exercise. All lecturers were provided with a copy of the text Portfolio assessment: a guide for lecturers, teachers and course designers (Cooper, 1999) for their personal reference.

Features of the undergraduate experience

• The prime purpose of the portfolio is for students to prepare themselves for a professional life of self-regulation and lifelong learning. This includes understanding the implications and obligations of belonging to a competency-based profession and readying themselves for self-declaration of competence at renewal of registration.
• Students are introduced to portfolios in the first semester of their bachelor of nursing and progressively guided and encouraged to develop their portfolio building skills over the three years of the course. Students use as their benchmark of competence, the ANCI National Competency Standards for the Registered Nurse (2000).
• The portfolio itself is not directly assessed. However assessment items for various topics in the bachelor of nursing may be suggested/required items of evidence for the portfolios. (This approach does not indicate a disagreement with portfolio assessment per se as much as a recognition of the challenge of assessing the portfolios of a large cohort of students – over 1000 at any given time.)

Progress

Lecturers' experience has been mixed. While it has proved difficult to achieve a common approach to introducing portfolios, or indeed a shared understanding of their value and place in the curriculum, there nevertheless remains a basic commitment to the concept. Students' experience has also been mixed, with topic evaluations indicating a continuum of responses from confusion and dislike of portfolios, to appreciation and inspiration. Particular issues include a reluctance by some students to get started. Within a three-year degree, we consider students can reasonably allow time to develop a positive attitude and a sound set of portfolio building skills.

Our advice to others introducing portfolios (especially where large student and academic staff numbers are involved) is to be tolerant of a diversity of viewpoints and approaches. Experience thus far, and literature reviewed, shows there is no one 'best' way and university students should ultimately prize, and benefit from, a range of different, even conflicting, positions. This is not to suggest lecturers should give up dialogue with one another on portfolio issues; consensus can be a powerful impetus to best practice. (At Flinders, undergraduate bachelor of midwifery students and postgraduate mental health students are also using portfolios in various ways.)

2. Post graduate curriculum

The School of Nursing and Midwifery at Flinders University, Adelaide is currently in the third year of implementing portfolios in the perioperative stream of the graduate certificate/diploma of nursing (perioperative) and the master of clinical nursing. This is occurring as part of a newly developed (at the time) stream curriculum designed around the Australian College of Operating Room Nurses (ACORN) Competency Standards and offered by flexible delivery (on or off campus and on or off line). The number of students and lecturers involved in the strand is small (less than 20 students and principally one lecturer) which enabled a relatively simple process of prior discussion and debate – consultation and planning occurred largely in congenial coffee house surroundings, in contrast to the large orchestrated gatherings required for the bachelor of nursing.

Features of the post graduate experience

• The prime purpose of the portfolio is for students, who are all registered nurses, to demonstrate their competence of the current ACORN Competency Standards within two semesters (one academic year).
• Students are introduced to portfolios from the first day of their course as being integral to their learning and an essential element of successfully completing the course.
• The portfolio is directly assessed. This requires both students and lecturer to be very familiar with the ACORN Competency Standards (the benchmark against which competence is judged), the portfolio building process, how to select evidence for particular circumstances, and how to present a portfolio for assessment.
• Guidelines are available for submission of electronic portfolios, an attractive option for remote students but challenging in terms of ensuring validity of evidence.

Progress

Experiences of both lecturer and students have been intense –in terms of frustration and rewards. Because so much depends on the portfolio (that is, success or failure in the course) it was felt essential to 'get it right'. Yet the lecturer and students were operating in the same ambiguous context as the bachelor of nursing: there is no one 'right' way to go about implementing portfolios. Adding to the challenge, was a further ambiguity of the competency standards themselves.

Initially, students called strongly for more explanation and more direction, especially about how to develop learning objectives from the competency statements, what constituted direct and indirect evidence, and how to compile their portfolios. In the clinical setting, they asked numerous questions about how to gather evidence and what constituted quality evidence. Striking a balance between fostering self-discovery and providing an overload of information became a preoccupation for the lecturer.

The success of the perioperative portfolio initiative is perhaps best judged by the final session conducted by the first cohort of students. The students presented their portfolios to their peers, lecturers and visitors as if they were in an interview situation and were required to speak to their competence as demonstrated in their portfolio. Their thorough grasp of the portfolio concept, innovative and varying approaches to the physical compilation of their portfolios, and professional presentation styles clearly won the respect and admiration of the audience. The difficulty of all that had gone before seemed to fade with the realisation they had produced a successful portfolio and possessed a valuable tool to carry into ongoing professional life.

The second cohort of students provided further challenges due to the introduction of international and distance education students. These students wanted a step-by-step recipe book approach rather than a flexible, individual approach to compiling their portfolio. This, it is theorized, was largely due to English being the international students' second language and the inability of distance students to participate in face-to-face discussion. Despite these challenges for both students and lecturer, the students' final presentation resulted in similar results to the first cohort, although the second cohort was not quite as convinced of the value of the portfolio as the first cohort.

Our advice to others introducing portfolios that will be assessed as the basis for successful course completion or other purpose, is to only do so when numbers of students or individuals are low (especially when the initiative is being undertaken for the first time). The process of both facilitation and assessment is highly time-consuming. The assessment of portfolios raises challenging questions about grading and criteria for assessment and these must be addressed; they are covered among other educational issues in the text mentioned earlier (Cooper, 1999) as well as by research currently underway by one of us (DH).

3. Health service setting

The Director of Nursing of the Whyalla Hospital and Health Services (WHHS) made a commitment in 2002 to support nursing staff develop a professional portfolio as evidence of their nursing skills. The Clinical Facilitator was to undertake initial research and lead the project. In collaboration with the publisher and one of the authors of Portfolio assessment: a guide for nurses and midwives, WHHS was established as the first trial site in Australia to develop a 'starter kit' to assist clinicians develop their portfolio. The starter kit was to include all materials and advice needed to produce a portfolio.

Features of the Whyalla experience

• The publisher and author travelled to WHHS to present a prototype starter kit, conducting two workshops targeting senior nurses, clinical nurses and nursing staff who showed enthusiasm for the project. To ensure the project fostered organisational and personal development, it was very important to provide a flexible framework within which participants could work.
• Ten senior nursing staff from the Women's and Children's Health Unit agreed to become the first target group - including registered nurses, midwives and an after hours coordinator. All staff members were given a copy of Portfolio assessment: A guide for nurses and midwives to keep and read prior to the project start date. (Graduate nursing staff 2003 have since been included as an extension of the project group to provide a novice nurse perspective.)
• Key staff who attended the initial workshop were given the task of implementing the project, keeping project principles in mind, such as:
• the organisation would provide support and education to promote successful implementation
• a suitable period of adjustment would be allowed
• target group to identify key issues and strategies to assist in the implementation hospital wide
• staff members to understand that there is no 'organisational hidden agenda'.
• Finding common ground for all nursing staff and providing effective communication was essential. The target group required a clear understanding of the relevance developing a portfolio would have on their nursing practice, a key factor affecting the success of the project.

Progress

As one of the pilot group stated: 'The challenge was to define the purpose of the portfolio, determining what was appropriate and reasonable to expect of nurses and ensuring the whole process did not become so burdensome it was rendered insignificant.'

During the course of the project, the group identified some stumbling blocks requiring further research and clarification. For example, the concept of the portfolio as providing the burden of proof for competence led to much debate; for example:

1. How to provide evidence?
2. What is competence?
3. How does competence vary from novice to expert?
4. Who is sufficiently competent to assess the practice of others? and,
5. Who assesses the assessors?

During the initial introduction of the portfolio, the target group considered a portfolio should focus more on improving the self-development of nurses, rather than providing evidence of competence. It should not be about evidencing one's performance so much as the personal and professional attainment of wisdom. They recommended individuals carefully select what was for showcasing in their portfolios and that a separate private document for personal use and reflection be maintained.

The trial group has remained committed to and motivated about the project, addressing challenges as they arise. WHHS endorses and supports the project trial team and has no doubt the starter kit will evolve to benefit clinicians throughout the nursing profession as a direct result of recommendations from this team. Feedback has been provided to the publisher for the ongoing development of the starter kit.

Advice for getting started

• Become familiar as quickly as possible with a comprehensive source of information about portfolio building, relevant to the Australian context. We suggest Portfolio assessment: a guide for nurses and midwives (Cooper and Emden, 2001). While various people may provide helpful ideas, it remains a personal responsibility to acquire and practise the skills of portfolio building. Read and reread the relevant sections of the text until they make good sense; don't wait for someone else to interpret them for you - follow the advice in the text!
• Link the six-step portfolio building process (Cooper and Emden, 2001) to the particular terminology of the competency standards you are using as a benchmark of competence. For example, if you are using the ANCI Competency Standards for the Registered Nurse you would make the following links:

1. Choose skill areas - ANCI Domains
2. Agree learning outcomes - ANCI Competency Elements
3. Identify learning strategies - your responsibility
4. Identify performance indicators - ANCI Cues
5. Collect evidence - your responsibility
6. Organise the portfolio - your responsibility
   Note that the ANCI 'Cues' do not fully meet the requirements of a performance indicator in that they don't specify the conditions under which you should perform, for example 'at all times'.

• Make sure you collect evidence pertaining to each of the ANCI Domains (Skill areas). Try to collect evidence pertaining to as many ANCI Competency Elements (Learning outcomes) as feasible and appreciate the ANCI Cues (Performance indicators) may vary according to your particular clinical situation.
• Be sure you understand the difference between direct and indirect evidence (for example, an expert witness statement of competent performance is direct evidence; an extract of a reflective journal entry is indirect evidence).
• Frequently ask yourself: 'What direct or indirect evidence could I provide to demonstrate I have met my learning outcomes?' You will become increasingly aware of the possibilities for different kinds of evidence and how you might present this evidence (check the text for good advice).
• Recognise a portfolio has the potential to become cumbersome to the point of being unmanageable - quality and relevance must take precedence over volume. The idea of developing a public and private portfolio has merit: the private portfolio holds all relevant documentation; the public portfolio holds only those items to be used for a particular occasion (for example, job interview).
• Discuss your portfolio with colleagues. It can be very helpful to swap portfolios with a colleague. Ask one another: Is this portfolio clearly presented? Can I follow the parts of the portfolio: the Table of Contents, the Table of Evidence, the Commentaries, the Evidence itself? Is the portfolio clearly linked to the relevant competency standards? Is it easily handled (not bulky or items falling out)? How could the presentation of this portfolio be improved if I wished to use it at a job interview?

Conclusion

Portfolio learning and assessment is firmly established in international nursing and midwifery arenas. Based on our experiences, we are persuaded portfolio learning/assessment holds promise for Australian nurses and midwives. It is founded on well-documented educational principles and is a logical accompaniment to innovations underway in the nursing and midwifery professions concerning competency-based education and self-regulation. Portfolio learning and portfolio assessment are interrelated concepts and practices that sustain and foster one another. Together, they are intended to develop critical thinking and personal responsibility, raise confidence and generate empowerment. They focus on quality experiential learning and on outcomes related to the self-regulating professional nurse and midwife. Clearly, based on the literature and on our experiences, there is scope for research. One of us (DH) currently has research underway that addresses two of the most cited ambiguities about portfolios: the definition of competence and how to grade evidence for the purpose of assessment. The findings of this research (in relation to perioperative nursing) will be published when available. Meanwhile, we hope the ideas and experiences shared here are helpful and contribute to necessary ongoing debate about approaches to developing portfolios. Certainly, portfolios appear in keeping with the fast and unpredictable demands challenging health professionals today-requiring 'flexible and critical thinking, an ability to face ambiguity and complex systems, and the capability of going through different roles during one's career' (Ben-Zur, Yagil and Spitzer, 1999).

We conclude with a student's comment:

'I have gained invaluable insight through this portfolio. It has really shaped my learning through reflective practice and I have been able to demonstrate each ACORN competency with a high level of credibility. Compiling a portfolio has enhanced my understanding of perioperative nursing and I am now providing a more knowledgeable, comprehensive and proficient level of care to all perioperative patients.' (Leanne)

Acknowledgements

We wish to recognise the vision of Professor Judith Clare and Mr Jim McMenemy for launching portfolios for nurses and midwives at Flinders University and Whyalla Hospital and Health Services respectively. We thank Trudi Cooper, and Terry Love from Praxis Education, for valuable advice and unstinting support throughout. Dr Ysanne Chapman is thanked for her enthusiasm for portfolios and sustained support to Flinders first year bachelor of nursing students. And most importantly, we thank all the students and staff members who, together with us, have bravely entered the world of portfolios (including Leanne Thompson for allowing us to quote from her portfolio).

View references

Navigate: Archives | Contents | Top of page

Search

Translate

Related Publications from eContent Management