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

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

• Stephanie Zettel
• 2010 CASTL Institute
• June 3, 2010

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

• Uncertainty Unknowing
• Opportunity
• Meaning and possibilities
• Questioning approach
• Critical inquiry

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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).
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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)
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The goal of instruction becomes creating an
opportunity for learning that integrates content
knowledge with knowledge of context (Forneris
Peden-McAlpine, 2006)
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Critical Thinking in Practice(Forneris, 2004, as
cited in Forneris Peden-McAlpine, 2006, p. 2)
Reflection
Time
Context
Dialogue
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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).
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The Question

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

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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)

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Guided Narrative Reflection Process (Forneris
Peden-McAlpine, 2006)

• Describe a story
• Guide critical reflection
• Consider alternative perspectives
• Integrate learning into future practice
  experiences

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Self Efficacy

• Internality, Powerful Others and Chance (IPC)
  Scales (Levinson, 1981, as cited in Harvey
  McMurray, 1994)
• Assesses three aspects of control
• Belief in ones own ability
• Role of external factors in controlling life
  events
• Role of chance

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Competence

• Self-appraisal with 6-D scale (Schwirian, 1978)

• Self appraisal with comparison to Benners (1984)
  Novice to Expert behaviours

• Leadership
• Critical Care
• Teaching/Collaboration
• Planning/Evaluation
• Interpersonal Relations/Communications
• Professional Development

• Phenomenological approach to understand how
  nursing skills and behaviours are attained
  through time, from novice to expert

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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 (5independent to 1unable to perform,
  even with consistent guidance)
• Ability to analyze and interpret
• Draws logical inferences
• Evaluates and justifies inferences
• Deductive reasoning
• Inductive reasoning

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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?

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