Introduction to Reflection and ePortfolio

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Reflection and ePortfolio are “moving forces” developing 21st century professionals. Through an orientation, information literacy assignment and weekly clinical reflections students develop structured and disciplined behaviors. Program outcomes drive the backward curricular design with forward thinking to create graduate registered nurses over four semesters.  In the first semester students are introduced to social pedagogy, reflective practice and use of feedback. Assignments and strategies for implementation in the first semester are given.

Educative experiences are designed to arouse interest and curiosity, encourage reflection and promote learning and growth in people.  John Dewey proposed: activity with purposeful reflection in private, public and groups supports learning as a “moving force” toward positive change.  The TRCC nursing curriculum focuses on the program outcomes and core values when designing scaffolded reflective learning activities. Students are introduced to the program outcomes at the start of this course to gain perspective of where they will be after four semesters of nursing. Students input the program outcomes into their ePortfolio. This sampling of polished practices guides the audience to how students incorporate outcomes and core values of critical thinking, safe and competent practice, communication, caring, holism and professionalism.

In the first required nursing course students are introduced to reflective practice, program outcomes and the ePortfolio platform. In this semester students see how reflection and social pedagogy can become a systematic and disciplined process. Weekly clinical reflection moves them towards positive growth. In subsequent semesters students focus on reflection as integration connecting theory to practice within courses and across the program. Students also identify personal growth as they become a professional. Through artifact review student outcome attainment is assessed.

Orientation to the Technology and Pedagogy

Here are orientation handouts given to students, new staff and faculty. They present the pedagogical component of ePortfolio and reflection.  All receive an account during the orientation session if they do not already have one. Within the platform are videos and handouts to reinforce the technology and its use.  Three Rivers websites are also available to reinforce content and answer questions.

Presented to introduce reflective pedagogy: ePortfolio_orientation-1

Sample outline with links to introduce technology content: N101_Eportfolio_Sample_Start

The Assignments: Information and Technological Literacy

In NUR101 Introduction to Nursing students are introduced to reflection as social pedagogy through connections to peers, faculty and librarians. Pamela Williams and Lillian Rafeldt facilitate this process. Students interact with the librarian and faculty in a class room presentation. The students have the opportunity to practice and reinforce their information and technological literacy skills and then submit an assignment for feedback from faculty, librarians and peers.  The assignment and rubric are given. The assignment corresponds to the college theme of the year—this year it is: “sustainability.” Previous topics were: water, immigration, politics of food, and messages. Students in a commuter school are connected through a theme utilized by all faculty and staff. In the nursing program we connect the academic theme to basic skills. Students may be chosen to present their work at Convocation.

Sample outline with links to introduce information literacy assignment: N101_Info_Lit_EBP

Information and Technological Literacy Assignment and Rubrics:

TRCC_EBP_nursing_library_assignment-1

Student work/ePortfolio examples:

Student samples from information / technologic literacy assignment vary in quality:

Student1SampleCINAHLsearchassignment-1

Student2SampleCINAHLsearchassignment

Student3Sample_CINAHLsearchassignment

Students were asked whether they visited or contacted the librarian after the class session. Higher level rubric scores were seen in those students who did connect to the librarian after class.

The Assignments: Weekly Clinical Reflections

In NUR101 students are also introduced to the process of weekly clinical reflections. They discuss their clinical experience as it relates to core values. This process of reflection guides students to become systematic and disciplined in their work and growth, throughout the program they will continue to reflect on their practice. 

Critical thinking, communication, and professionalism rubrics as well as formative and summative evaluations are available for the student.  These personal reflections are shared with the clinical instructor the next day after clinical has been completed and pause has been taken. Faculty give feedback both in writing and in person meetings. Guidance and feedback also occurs in pre and post clinical conferences where an environment for safe expression is fostered. Students are introduced to a path and the concept of pause for reflections.  A reflective learning rubric also provides guidance. The weekly reflections mirror the core values.

Weekly Reflection and Assessment of the Clinical Experience Assignment

The core values within our program are critical thinking, safe and competent practice, caring, communication, holistic care and professionalism. Consider your experience in clinical this week and answer the following questions.

1. How did you demonstrate critical thinking within the nursing profession today? What was the most difficult part of the nursing process for you?  What was the easiest and why?

2. What parts of the implementation of care showed safe competent practice today?  Did you learn something new related to patient care…what?  Is there anything you would do differently next week?

3. Caring as a professional may be confusing at times.  How did you demonstrate empathy today?  What difficulties did you have with caring in the clinical setting?

4. Communication is another important behavior in nursing.  Who did you communicate with today?  Why?  How?   Was the communication effective?

5. How did you give holistic care today?  Did you care for someone of a different culture, who spoke another language, or had never been in a hospital before?  How did you plan to work with that client?  Was your plan effective?

6. Professionalism reflects integrity, life-long learning, legal, ethical principles, dress codes, timeliness, respect for peers, staff / faculty, joy within nursing and so much more.  How do you see professionalism developing in you?  Is it changing?  How?

Rubric for depth of reflection, students learn to efficiently and productively reflect for their own growth:ExemplaryAccomplishedDevelopingBeginning-1

Students also receive feedback each week on their reflections, actual clinical practice and completion of clinical documentation through a formative evaluation tool: Copy of N101_formative_excel   Course outcome specific tools continue throughout the four semesters.

Students learn how to reflect and faculty guide students to reflect effectively. Sometimes stakeholders perceive reflections as “keeping a historical diary”.  Reflective practice is much more (as identified in the rubric). It is critical for NUR101 faculty to set the stage for deeper learning. In an effort to enhance this process two specific assessment outcomes from faculty and student input were investigated: descriptions of anxiety in student reflections and incomplete reflections.

N101Lab

John Dewey highlights phases of reflective thinking

Dewey describes phases of reflective thinking:

(1)   A state of “uncertainty, doubt, hesitation, perplexity, mental difficulty.”

(2)   A process of “searching, hunting, inquiring, in an effort to resolve the uncertainty or dispose of the perplexity.”

(3) A state of “knowing what we are about when we act.”

John Dewey identifies anxiety as a component of reflection. Weekly clinical reflections are submitted to faculty each week. Through these private reflections with the instructor tough clinical issues are discussed. HIPAA (patient confidentiality) principles are emphasized. Students are guided to reflect honestly and constructively on their behaviors and work. To decrease inappropriate amounts of anxiety multiple strategies are in place: advisement / counseling, simulated practice prior to entry into clinical, facilitation of safe environment to disclose created by all faculty, and hiring of national speaker who addressed nursing students’ anxiety in testing and clinical.

Students identified a reason depth was not seen in their reflections. They completed their clinical data form or SIM Chart first, fatigue set in, and reflections were due before they had time to pause, reflect and write. To facilitate depth in writing students are asked to complete their reflections first before completing all of their clinical paper work at home.  They can ask instructors for additional time to complete their work if needed.  They do add to their reflections during the evaluation meeting.

It is clear that a safe environment with time to pause and reflect is needed for demonstrated growth.

Student work/ePortfolio examples:

Students samples of weekly reflections in N101, note the varying time frames of the semester:

Samplestudent1N101Week3ClinicalReflection-1

Samplestudent2N101Week1ClinicalReflection

Samplestudent3N101Week1ClinicalReflection

The importance of continual feedback through evaluations promoted growth in the depth of reflection.  It is noteworthy to say that younger students need additional education related to reflective writing.

Supporting Materials–Can this assignment be used in your program? Look at background information.

Where is the practice used?

  • Course (all sections)
  • Program
    • Professional Majors

Currently 96 students are admitted each year into Three River’s Community College, CT-CCNP (nursing program), 48 are admitted into the N101 Fall section and 48 are admitted into the N101 Spring session.

Reflection as Integrative

Students’ ePortfolio reflections are designed to help them begin to identify the core values as part of their practice. Data reveals integration occurs in subsequent semesters.

Reflection as systematic & disciplined

Students’ ePortfolio reflection processes embody

  • A structured & scaffolded process

Students develop weekly clinical reflections throughout the program. Through this practice, guided feedback and use of the rubrics students progress in content and ability to reflect from simple to complex in a systematic and disciplined way.

Note: Weekly Clinical Reflections are based on the core values and course outcomes. These questions can be changed to match your course / program outcomes. Students appreciate the focus they give.

WeeklyClinicalReflections

Reflection as Social Pedagogy

Students use ePortfolio to share/peer review/ discuss/collaborate, connecting around course work, reflections, plans, goals, stories, and study groups.

  • Sharing their ePortfolios with & getting comments from faculty and librarians

Students submit ePortfolios to faculty and librarians for feedback and development of relationships. This is important because information and technological literacy skills are critical to the development of a 21st century professional RN who can communicate and practice safely and competently.  Further assignments throughout the program reinforce the development of these abilities.

Students also share their portfolios with a colleague in the program.  Interactivity is through the comment feature of the current ePortfolio platform.

Reflection as a process of guiding personal change

Students use ePortfolio for educational and career development, and identity formation, by beginning to articulate the attributes of a professional RN. Data analysis reveals many students do not realize this process is occurring in the first semester but rather see the change in themselves in the third and fourth semesters. Discussion and interaction with previous artifacts encourages this realization.

Sample rubrics used by the General Education Task Force prior to 2014:

Used throughout institution as General Education Rubric, students are familiar with and continue to utilize the principles throughout the program: WrittenCommunicationRubric-1   CriticalThinkingCoverSheetandRubric-Revised-3

 

NUR* K101 8 CREDIT HOURS

INTRODUCTION TO NURSING PRACTICE

Prerequisites: BIO* K211; BIO* K212; ENG* K101.

Co-requisites: BIO* K235 and PSY* K111.

The student will focus on concepts basic to nursing practice. Emphasis is placed on application of the nursing process, communication skills, and nursing practice procedure acquisition. Clinical and laboratory experiences offer opportunities to integrate theoretical principles and demonstrate caring and competence in beginning professional role development. Theory: 60 hours Clinical: 180 hours.

Assignments continue in subsequent semesters to deepen learning:

The skills, abilities and connections continue throughout the program. In NUR102 students use information literacy skills to find and present relevant content and journal article presentations in their clinical medical surgical and maternity rotations. In NUR201 and NUR203 students utilize tools to develop  evidence based practice (EBP) care plans as well as journal article presentations. Throughout the  three pharmacology courses students develop EBP teaching plans and in NUR205 students develop an annotated bibliography. All students and faculty report appropriate application of learned skills.

Students continue to write weekly clinical reflections in all semesters. This is so important for development of clinical reasoning. Here is a sample of what they continue to become, additional students sample will be seen in the NUR201 “AHA” Finding Your Professional Voice post.

SampleStudentN102ClinicalReflections-1

References

Dewey, J. (1938). Experience and education. New York, NY. Macmillian.

Dewey, J. (1938). Logic: The theory of inquiry. New York, NY: Holt.

Eynon, B. (2009). “It helped me see a new me”: ePortfolio, learning and change at LaGuardia Community College. Academic Commons. Retrieved from http://www.academiccommons.org/commons/essay/e-portfolio-learning-and-change

Rodgers, C. (2002) Defining reflection: Another look at John Dewey and reflective thinking. Teachers College Record, 104(4), 842-866.