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REVIEW ARTICLE

The portafolio as an educational tool for training nurses

Mª del Coro Canalejas Pérez^1
1Escuela Universitaria de Enfermería La Paz. Universidad Autónoma. Madrid, Spain

Mail delivery: Paseo de la Castellana 261, 28046 Madrid, Spain

Manuscript received by 28.7.2009
Manuscript accepted by 1.9.2009

Index de Enfermería [Index Enferm] 2010; 19(2-3): 141-146

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Abstract (The portfolio as an educational tool for training nurses)

This article reviews the existing literature on the use of the portfolio for training nurses. Its goal is to identify the following aspects in the studies carried out: the concept and components of the portfolio proposed by different authors, as well as the advantages and disadvantages of its use as a learning and assessment tool. Most of the studies aim to collect student opinion on such tool through questionnaires created for it, so it seems convenient to investigate in future works on the opinion of teachers with experience in its application. The different authors consider the portfolio as an efficient tool for learning generic competences, although some of them stress that it creates insecurity in students and improves teachers' work. As an assessment tool, they state that it is mainly appropriate for the formative assessment, although it would be necessary to improve its validity and reliability.
Key-words: Portfolio/ Competency-Based Education/ Active learning/ Formative assessment/ Literature review.

Introduction

     In the last decade, experiences having as aim the use of portfolio have multiplied as a teaching tool for training students of different disciplines.¹ Although our university school has used this tool as an instrument for learning and assessing competences in two different subjects,^2,3 it seems necessary to study in depth other authors' contribution taking into account its appliance on the future graduate studies. Because of this, a review has been carried out on the existing literature about its application on training nurses with the following goals: (a) describing the concept of portfolio guiding the different experiences. (b) Identifying the components of the suggested portfolio. And (c) analyising the advantages and disadvantages of the portfolio as a learning and assessment instrument that different studies provide.
     To achieve this purpose, the ISI, Medline, Cinahl and Cuiden databases were consulted using as search terms "portfolio" and "nurse training", excluding all the articles referring to the use of portfolio for training postgraduate students and for assessing professionals.
     Although Alexander et al underline the fact that the portfolio started to be used in the nursing schools during the eighties,⁴ one of the first papers found was written in 1992 by Glen and Hight.⁵ With the exception on some article written by a university in Hong Kong⁶ and another one in South Africa,⁷ most of them comment on the experiences carried out in different universities in the United States and the United Kingdom, the latter doing it in collaboration with an Australian university.⁸ In our country the first reference to an experience of such kind is found in a publication from 2004.⁹
     In all these works the aims that different authors set are quite diverse, and sometimes, they do not appear properly formulated. Nevertheless, we could classify these studies according to those aspects of the portfolio on which attention is focused:
     -Studying in depth its theoretical meaning.^5,10-17
     -Describing experiences on the application of the portfolio and asking students their opinion about it.^{2-4,6,9,18-27}
     -Analyzing its usefulness as an instrument of assessment of clinical learning training.^{20,21,24,28-30}
     -Describing the content of the electronic portfolio and commenting experiences on the application of the latter.^31-33
     -Analyzing its reliability and validity as an instrument for assessment.^8,34
     -Revising the existing literature in Nursing about the portfolio.^35-37
     The applied methodology appears in some articles, and we have to remark that only Tiwary and Tang⁶ propose an experimental design of a pretest-posttest control group to compare the effect of the portfolio on the process of learning, whereas the rest of studies are descriptive and in those quantitative data are obtained from opinion questionnaires aimed at students.^{2,3,6,9,18,19,24,26,27} Qualitative data are normally obtained by the creation of focal groups²⁴ or by doing interviews.^26-8,23-25 Except for some studies^{3,6,9,24,26,27,30} using samples consisting of 70-413 students, the rest of surveys carried out this research with a reduced number of students.

Concept of portfolio

     After having selected the different aspects that several authors remark, we can consider the portfolio as a collection of works by the student or of evidences which have been carefully selected and classified in chronological order showing the development of competences in a certain period of time, and allowing the student to discover their inner strengths, weaknesses and learning needs through reflection.

Requirements for the elaboration of the portfolio. Although its elaboration must be flexible,¹⁷ some authors remark the need of some requirements to be fulfilled in order to make the elaboration of the portfolio an easier task: (a) to provide clear guidelines about the purpose, structure, content and the process of evaluation.^{6,15,17,19,24,31,33,34,36} (b) To offer previous examples of former portfolios, both for students and evaluators.^17,30,33 (c) To present the portfolio as a common enterprise tutor-student,⁴ as a creation and not as the requirement from the lecturer. (d) To pay great attention to its composition, structure, appearance and length for the portfolio not to be excessive for both the evaluator and the students.¹⁷ (e) To previously set the dates for revision^31,33 and to coach both tutors and evaluators³² who must submit a report from once in a while.²⁶ (f) To make the process easier, encouraging the student to select the articles for the portfolio by means of reflection.⁶

Components of the portfolio

     As regards the composition or structure of the portfolios, two tendencies stand out among the recommendations made by different authors:
     -Establishing a section for each competence,²⁹ in which an activity related to the corresponding competence will be described and a reflection on the achieved learning will be provided.
     -Organizing portfolio in three sections: the initial part must contain the personal philosophy and the goals to achieve¹⁸ as well as a learning contract.⁴ The second part will contain reflections on the achievement of results^{8,10,14,25,31,36} showing global growth, not only academic one.³¹ The last part must include evidence supporting the achievement of results and a reflection on the latter,³¹ as well as case studies.²¹
     As regards the evidences the portfolio must contain, Ryan and Carlton³⁸ propose the following classification:
     -Direct evidences: they are elaborated by students themselves and can include the study of cases, videos, photographs, analysis of critical incidents, life stories, care plans, personal philosophy, reflective writings on the practice, specific examples of actions aimed at achieving goals, self assessments.
     -Indirect evidences: they are elaborated by tutors, supervisors and mates so they can include their evaluations or testimonies.

Advantages and disadvantages of the portfolio

     The portfolio as a learning instrument. Most authors emphasize the role of the portfolio as a learning instrument contributing to the development of generic competences [table 1], promoting deep and meaningful learning^2,3,9,18,21 and contributing to increase the student's self-esteem and self-confidence.^{6,11,17,18,22} Several authors underline that this way of learning improves the relationship between the student and their tutor and modifies the role that each of them play, turning them into allies in the educational process.^{2-4,9,18,24,30,31} In relation with this aspect, McMullan comments that the relationship with the tutor conditions the perception the pupil has about the portfolio, and he remarks that a better relationship implies considering it of greater use.²⁶
     Among the inconvenients of this tool we can underline the students' anxiety and insecurity at the beginning of the experience¹ facing such an open activity;^6,26 their difficulty for reflecting and expressing themselves in an appropriate language;^2,9,18 the time required for the elaboration of the portfolio,^{2,3,15,17,22,24,28} and the lack of enough resources to make bibliographic consultations.⁹ Moreover, and contradicting other studies, Dolan et al remark that the students considered that the portfolio had not helped them to establish a connection between theory and practice,²⁴ and Spence et El-Ansari highlight that instead of creative it turns out to be repetitive.³⁰
     The portfolio as a competence assessment instrument. The portfolio is considered an alternative tool for assessing competences which is more effective than traditional tools³⁸ because it can provide evidence of the personal and professional development coming from several sources,^{4,18,23,26,29} which constitutes an accepted way of assessing from pupils' viewpoint since they consider it equitable, global, fair and secure. Despite the general agreement that the portfolio is a useful assessment instrument, some authors consider that this agreement is more theoretical than empirical³⁵ and they point out the need to improve the reliability and validity of this assessment,^{7,8,12,18,29,34} proposing its triangulation as a way of increasing reliability.^8,23,30
     Several authors are critical of the use of portfolio for accumulative evaluation, because they consider that it can condition its elaboration since students tend to not reflect personal incidents or their difficulties^22,26,34 and to express what they think the evaluator wants to read.^24-26,29 In this sense, Web et al comment that quantitative criteria are not adequate for its evaluation and they propose a qualitative approach, since they consider the portfolio an instrument of formative rather than accumulative evaluation.⁵ In the same way, Mcmullan instists that the use of portfolio as an assessment instrument conditions learning, so he doubts about its dual use, and remarks that the portfolio is more necessary as a way of promoting the student's autonomy than as an assessment tool.²⁶ However, Dolan et al point out that, if portfolios are not evaluated, students disregard them because they consider them less important.²⁴
     Authors insist that assessment criteria have sometimes been scarce¹⁰ and that it is necessary to elaborate clear criteria^8,18 which must be shared with the student.^{6,19,21,24-26} Moreover, a proper training for evaluators is considered necessary in order to reduce their anxiety levels about the equity of their assessment.^21,23,25 Several authors express that lecturers have difficulties because of the time required for the revision of individual portfolios,^17,22,24 a reason why they propose to limit the length of the portfolio.
     Although it is generally considered that the portfolio allows the identification of the student's weak and strong points from which learning needs can be established,^18,21,26 we have to point out that Byrne et al highlight that it can offer a distorted image because students emphasize some aspects more than others.¹⁷
     It is also highlighted the fact that the students' learning style and their ability to express themselves can condition the final result.¹⁷ In this sense, McMullan underlines that students with more abilities for reflective writing were less anxious about the portfolio,²⁶ and Tiwary and Tang insist that in order to ensure the success of the project it is necessary to consider in advance if students have the cognitive skills required for the elaboration of the portfolio.⁶

Conclusions

     Very Few studies have been found in relation with the use of portfolio in nurse training in our country, a reason why it would be appropriate to investigate on the degree of establishment of portfolio in this profession.
     Most studies bring together the students' opinion; therefore it would be interesting to know the opinion of lecturers who are experienced in the use of this tool.
     A large number of studies refer to its use for theoretical learning, so it would be convenient to study in depth its use during clinical practicum periods, in such a way that portfolios collect materials showing each student's "learning to care history".
     The portfolio contributes to generic competence meaningful learning but at the beginning it causes insecurity in the student.
     It is a very comprehensive assessment tool which provides evidences of personal and professional development, although it is necessary to improve its validity and reliability.

References

1. Klenowxki V. Desarrollo de portafolios para el aprendizaje y la evaluación. Madrid: Narcea; 2004.
2. Vera M, Canalejas MC. El portafolio como recurso de aprendizaje e instrumento de evaluación de estudiantes repetidores de enfermería. Educ med 2007; 10(2): 114-120.
3. Canalejas-Pérez MC, Cid-Galán ML, Martínez-Martín ML, Martín-Salinas C. El portafolios como instrumento de aprendizaje y evaluación de competencias en los estudiantes de enfermería. Enferm Clin 2009; 19: 16-23.
4. Alexander JG, Craft SW, Baldwin MS, Beers GW, McDaniel GS. The nursing portfolio: A reflection of a professional. J Cont Educ Nursing, 2002 33(2): 55-59.
5. Glen S, Hight NF. Portfolios: An 'affective' assessment strategy?. Nurse Educ Today 1992; 12(6): 416-423.
6. Tiwari A, Tang C. From process to outcome: The effect of portfolio assessment on student learning. Nurse Educ Today. 2003; 23(4): 269-277.
7. Chabeli M. Portfolio assessment and evaluation: Implications and guidelines for clinical nursing education. Curationis 2002; 25(3): 4-9.
8. Webb CH, Endacott R, Gray MA, Jasper MA, McMullan M, Scholes J. Evaluating portfolio assessment systems: What are the appropriate criteria? Nurse Educ Today 2003; 23(8): 600-609.
9. Olivé MC, Gusiñé F, Pardo A. Evaluación continuada en portafolios, opinión de los estudiantes referente a la experiencia llevada a cabo en la Escuela de Enfermería de la Universidad de Barcelona. [Internet]. Segundas Jornadas Nacionales de la Sociedad Científica Española de Licenciados en Enfermería; 2004. Disponible en:  https://www.scele.enfe.ua.es/web_scele/2_jornad.htm [Consulted: 3/20/2009].
10. Jasper M. The portfolio workbook as a strategy for student-centred learning. Nurse Educ Today 1995; 15(6): 446-451.
11. Wenzel LS, Briggs KL, Puryear BL. Portfolio: Authentic assessment in the age of the curriculum revolution. J Nurs Educ 1998; 37(5): 208-212.
12. Gannon FT, Draper PR, Watson R, Proctor S, Norman IJ. Putting portfolios in their place. Nurse Educ Today 2001; 21: 534-540.
13. Day M. Developing benchmarks for prior learning assessment. part 2: Practitioners. Nurs Stand 2001; 15(35): 38-44.
14. Webb CH, Endacott R, Gray M, Jasper M, Miller C, McMullan M, Scholes J. Models of portfolios. Med educ 2002; 36(10): 897-898.
15. Bowers SP. The portfolio process: questions for implementation and practice. Coll Stud J 2005; 39(4): 754-758.
16. Billings D, Kowalski K. (2005). Portafolioss learning. J Contin Educ Nurs, 36(4), 149-150.
17. Byrne M, Delarose T, King CA, Leske J, Sapnas KG, Schroeter K. Continued professional competence and portfolios. J Trauma Nurs. 2007; 14(1): 24-31.
18. Karlowicz K. The Value of Student Portfolios to Evaluate Undergraduate Nursing Programs. Nurse Educ. 2000; 25(2): 82-87.
19. Gallagher P. An evaluation of a standards based portfolio. Nurse Educ Today 2001; 21(5): 409-416.
20. Williams J. The clinical notebook: Using student portfolios to enhance clinical teaching learning. J Nurs Educ. 2001; 40(3): 135-137.
21. Lettus MK, Moessner PH, Dooley L. The clinical portfolio as an assessment tool. Nurs Adm Q. 2001; 25(2): 74-79.
22. Harris S, Dolan G, Fairbairn G. Reflecting on the use of student portfolios. Nurse Educ Today 2001; 21(4): 278-286.
23. Williams M. Assessment of portfolios in professional education. Nurs Stand 2003; 18(8): 33-40.
24. Dolan G, Fairbairn G, Harris S. Is our student portfolio valued? Nurse Educ Today 2004; 24(1): 4-13.
25. Scholes J, Webb C, Gray M, Endacott R, Miller C, Jasper M, McMullan M. Making portfolios work in practice. J Adv Nurs 2004; 46(6): 595-603.
26. McMullan M. Students' perceptions on the use of portfolios in pre-registration nursing education: A questionnaire survey. Int J Nurs Stud 2006; 43(3): 333-343.
27. Nairn S, O'Brien E, Traynor V, Williams G, Chapple M, Johnson S. Student nurses' knowledge, skills and attitudes towards the use of portfolios in a school of nursing. J Clin Nurs 2006; 15(12): 1509-1520.
28. Tracy SM, Marino GJ, Richo KM, Daly EM. The clinical achievement portfolio: An outcomes-based assessment project in nursing education. Nurse Educ 2000; 25(5): 241-246.
29. Schaffer MA, Nelson P, Litt E. Using portfolios to evaluate achievement of population-based public health nursing competencies in baccalaureate nursing students. Nurs Educ Perspect 2005; 26(2): 104-112.
30. Spence W, El-Ansari W. Portfolio assessment: practice teachers' early experience. Nurse Educ Today 2004; 24(5): 388-401.
31. Ramey S, Hay L. Using Electronic Portfolios to Measure Student Achievement and Assess Curricular Integrity. Nurse Educ 2003; 28(1): 31-36.
32. Skiba D. E-portfolios, Webfolio, and E-dentity Promises and Challenges. Nurs Educ Perspect 2005; 26(4): 246-47.
33. Corbett-Pérez S, Dorman S. Electronic portfolios enhance health instruction. J Sch Health 1999; 69(6): 247-249.
34. Kear ME, Bear M. Using Portfolio Evaluation for Program Outcome Assessment. J Nurs Educ. 2007; 46(3): 109-113.
35. Ball E, Daly W, Carnwell R. The use of portfolios in the assessment of learning and competence. Nurs Stand 2000; 14 (43), 35-38.
36. McMullan M, Endacott R, Gray MA, Jasper M, Miller CM, Scholes J, Webb CH (2003). Portfolios and assessment of competence: A review of the literature. J Adv Nurs 2003; 41(3): 283-294.
37. McCready T. Portfolios and the assessment of competence in nursing: A literature review. Int J Nurs Stud 2007; 44(1): 143-151.
38. Ryan M, Carlton KH. Portfolio applications in a school of nursing. Nurse educ 1997; 22(1): 35-39.