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

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

Defining the experience…Defining the experience… Uncertainty Uncertainty – “Unknowing”  Opportunity  Meaning and possibilities  Questioning approach  Critical inquiry

“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).

“ 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)

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

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

“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). Critical Thinking is…Critical Thinking is…

The QuestionThe 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?

The InterventionThe 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)

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

Self EfficacySelf Efficacy  Internality, Powerful Others and Chance (IPC) Scales (Levinson, 1981, as cited in Harvey & McMurray, 1994)  Assesses three aspects of control 1. Belief in one’s own ability 2. Role of external factors in controlling life events 3. Role of chance

Competence Self-appraisal with 6-D scale (Schwirian, 1978) 1. Leadership 2. Critical Care 3. Teaching/Collaboration 4. Planning/Evaluation 5. Interpersonal Relations/Communications 6. Professional Development 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

UNCG (University of North Carolina at Greensboro) Critical Thinking Skills Evaluation Instrument 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) 1. Ability to analyze and interpret 2. Draws logical inferences 3. Evaluates and justifies inferences 4. Deductive reasoning 5. Inductive reasoning

Data AnalysisData 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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