Peer Review

Reflection Builds Twenty-First-Century Professionals

Powerful educational experiences arouse interest and curiosity, encourage reflection, and promote learning and growth in people. To this end, educational reformer John Dewey suggests that activity with purposeful reflection in private, public, and in groups supports learning as a “moving force” toward positive change. Using e-portfolios, the Three Rivers Community College (TRCC) nursing program designed scaffolded reflective learning activities that link program learning outcomes with TRCC’s general education core values. Our e-portfolio practices guide students as they integrate the skills and dispositions of critical thinking, safe and competent practice, communication, caring, holism, and professionalism into their development as twenty-first-century professionals.

The opportunity to fully integrate e-portfolio use across our professional degree program offers far-reaching benefits for students, faculty, and our entire college. Weaving a series of reflective e-portfolio assignments into every course in our major, we seek to create a recursive learning sequence, one that gradually deepens students’ identities as successful learners and emerging nursing professionals. That same sequential integration also facilitates faculty learning in our programmatic outcomes assessment process; our e-portfolio-based assessment strategy links general education core values and program competencies and helps our faculty better understand what aspects of our curriculum are working well and what aspects need to be rethought. This active process of inquiry and reflection engages faculty, just as it engages students, and supports learning for both. And this year, the success of this process in nursing has encouraged the college as a whole to advance a similar process for general education and outcome assessment college-wide.

Background

Located in Norwich, Connecticut, TRCC is a midsize commuter college with forty-eight academic degrees and forty-four certificate programs. Educational clusters focus on allied health, advanced manufacturing, energy, hospitality, and information technology. The associate degree (AD) registered nursing (RN) program is one of six nursing programs in Connecticut. Approximately one hundred students are admitted to the program each year. While completing the four semesters of nursing, students have the opportunity to take liberal arts courses towards BSN degrees. TRCC is the only AD RN program in Southeastern Connecticut producing nurses consistently passing the NCLEX licensure exam at above the ninetieth percentile.

TRCCs’ e-portfolio project began in 2004 when we started working with the Connecticut Distance Learning Consortium (CTDLC) and Diane Goldsmith, the consortium’s visionary leader. We initially focused on using e-portfolios as a technology, exploring ways to use CTLDC’s platform. Beginning with one nursing faculty member collaborating with the dean of information technology and a librarian, we implemented e-portfolio use in one course each semester, refining learning activities to develop student abilities. E-portfolio implementation sparked conversations among students and faculty about the technology but also about nursing and reflection and how students develop as registered nurses.

In 2009, as our interest in reflective pedagogy grew, we joined the Connect to Learning’s Making Connections program led by LaGuardia Community College. Monthly face-to-face professional development meetings guided TRCC faculty as we developed our e-portfolio pedagogy (Eynon, Gambino, and Török 2013). We found that the reflective, integrative, and social pedagogies discussed in Making Connections matched our practice-based discipline. When LaGuardia organized the Connect to Learning (C2L) online community of practice, linking Making Connections campuses with e-portfolio innovators nationwide, TRCC was eager to continue the collaboration. As C2L participants we studied the work of multiple theorists, including John Dewey, and other C2L practitioners, applying new insights to our own practice. Dewey’s ideas resonate with e-portfolio practice as he connected experience as both a means and a goal of education. He stated, “We don’t learn from experience, we learn by reflecting on experience.” Building on Dewey’s ideas, Carol Rodgers (2002) expanded the concept of reflection with four descriptors:

  • Reflection as integrative learning
  • Reflection as social pedagogy
  • Reflection as systematic and disciplined
  • Reflection as a process of guided personal change

We found that teaching students to reflect requires carefully crafted prompts and directed questions. We adapted Rogers’ insights to our setting and discipline, introducing TRCC students to e-portfolio technology and the skills and attitudes of self-observation, interpretation, judgment, and planning. Using reflection, our students learn to

  • Report own behaviors
  • Identify own strengths and areas for improvement
  • Connect performance to criteria
  • Identify an approach to learning for new growth

According to the Core Competencies of the nationally acclaimed Nurse of the Future program, twenty-first-century nurses are reflective in action, for action and on action (Nurses of the Future 2010). We marry these professional standards and our TRCC Core Values with the C2L design principles of inquiry, reflection, and integration (Eynon, Gambino, and Török 2014). The iterative process of reflection, formative assessment, revision, and integration helps our students develop the knowledge, skills, and attitudes needed for safe and competent practice in a fast-moving and fast-changing health care workplace.

Reflection as a Systematic and Scaffolded Learning Process

In the past two years, the TRCC nursing faculty refined and consolidated a sequential progression of reflections related to nursing program outcomes and general education core values and embedded them into each course of our curriculum. As we used e-portfolios to help students develop professional identities, we also developed our own insights into our assignments, the nursing program, and how students learn. Through faculty inquiry and reflection, we developed an integrated, scaffolded strategy to deepen student learning.

In the first course in our curriculum, Introduction to Nursing Practice, students become familiar with the technology and process of weekly reflections tied to the core values. The purpose is to develop reflective skills and the ability to listen to and incorporate feedback in a systematic and disciplined way. We introduce our beginning students to the concept of a reflective pause, and to rubrics for critical thinking, professionalism, and communication. The day after each clinical experience, students use prompts such as this one to share personal reflections with the clinical instructor:

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? What parts of the implementation of care showed safe competent practice today? What will you do differently, what will you continue? 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?

In response, one of our students wrote

“In the first weeks I wrote what professionalism meant to me: … arrive on time, wear a clean and wrinkle free uniform, ID, stethoscope, and watch. At mid-semester I was questioning ‘Why do I want to be a nurse, this is stressful?’ But after this week I am starting to again see the joy of nursing. I felt like I truly helped my patient. The fact that I am challenged and have to keep learning no matter what is thrown at me really makes me want to be a nurse more and more each day, even if some days are tougher than others.”

Reading these reflections, nursing faculty provide feedback in writing, and in post-clinical conferences. Our goal is to help students take a first step in a recursive process of meaning making, to begin developing the cognitive skills and affective dispositions needed for professionalism, communication and critical thinking.

In Family Health Nursing, a second semester course, students advance their use of e-portfolios. Here the purpose of reflection is to help students connect theory to practice, classroom learning with clinical application, developing the skills of integrative learning:

“I chose this patient to connect to the geriatric presentations for a few reasons. She ties into my group’s presentation of discharge planning and caregiver role strain as well as another group’s topic of polypharmacy…In completing the geriatric presentations, and watching the other groups present their topics, I was able to learn effectively about the care of the elderly. Caring for a geriatric patient in the hospital helped to reinforce this content since I feel that I learn best by actually seeing the situation in person.”

Through experience and reflection, students see the value of listening to others, connecting and applying their learning for integration into practice.

In our third semester course, Nursing Care of Individuals and Families I, our reflective e-portfolio pedagogy focuses students on personal growth. Students now use reflection as a personal guide, deepening their learning and getting them ready to practice as independent practitioners. At this stage, prompts ask students to draw on well-developed reflective skills to recognize the change in their behaviors.

How has your critical thinking changed and developed in regards to direct patient care at the bedside? Please provide two to three specific examples. Consider and reflect on an experience you had in clinical when you realized you applied your theoretical knowledge to your clinical practice.

“I had no idea how complex nursing would be or the level of responsibility it would entail. I remember the words ‘critical thinking’ in the first semester. I guess I knew what those words meant but I really had no idea how they would become an integral part of this new profession I was entering….
Since then things have progressed in terms of the complexity of the information as well as the conditions my patients are presenting with. This semester has truly been transformative for me as a nurse. All of the pieces that I have learned over the semesters have finally started to come together for me as a whole.”

Throughout this course, using multiple practice stories, we persistently encourage deep learning, asking students to take ownership of their professional identities. Sharing knowledge, skills, and new attitudes, our students develop a ‘professional voice.’ Through reflection, they test their ‘voice’ within a safe environment, gaining faculty feedback and a comfort level in sharing written reflections with peers.

In their final semester, in Nursing Care of Individuals and Families II, students record their perceptions and reflect on the effect perceptions have on care. Powerful stories and supportive discussions fill the semester.

“It made me feel sad when a client told me that it meant a lot to him that I treated him like a human being, not like a drug addict…Six years ago my best friend and twenty-three year old brother died of a drug overdose. It completely devastated me…so working with clients who are drug dependent brings a lot of emotion in me. I guess you would call it counter-transference. I have witnessed first-hand the hold drugs can have on someone…. I try to give clients strength to resist so that maybe I can make up for not being able to help my brother.”

Self-awareness is critical for an effective practicing nurse. It allows the nurse to think critically without bias, remaining patient-centered. This and other reflective tools are powerful when shared with others. Students report they are freeing, and faculty report they provide a window into the students’ perceptions.

In their fourth semester, our senior students also prepare and share written reflections with our first-year students. Sequenced social pedagogy—using e-portfolios as a site for reflective interaction—informs all four semesters: we focus on connections to faculty and staff as resources in the first semester; sharing knowledge with peers in the second; identifying affective ‘ahas’ with ‘safe’ faculty and staff in the third; and, in the fourth, returning to connecting to self and sharing with peers as a graduate entering the profession. The power of this social pedagogy is seen in a first-year student’s statement:

“I wasn’t sure why I was putting my reflections together in a tool and looking back through them until I read a senior’s reflection about what it felt like to be new in nursing and what they could say now. It gave me hope that I would graduate…. I wrote my own reflections differently after that.”

In the same final semester, in Nursing Management and Trends, students’ reflections help them become colleagues, emerging nursing professionals. The first project asks them to demonstrate how they believe they have met the program outcomes. Students select and explain artifacts, including stories, reflections, clinical data forms, process recordings, nursing communication tools, and presentations.

Pick three of the program outcomes and describe and reflect on how you believe you have met the outcome and include one or multiple artifacts, stories and/or digital clips to support your discussion. In your reflection you might discuss how you’ve grown, connected your learning across semesters and to your life. Look at the Integrative Learning Rubric as a guide. Send an invitation to a classmate, myself and another faculty member or advisor.

In this course, students create career e-portfolios that include a resume and “something that will entice a reviewer to interview you.” Students also create an e-portfolio that could be submitted to an educational institution to advance their attainment of a BSN or MSN degree. It incorporates a practice-based research question with an annotated bibliography. One graduating student commented:

“I have figured out what I want to study in my BSN program because I see what I’ve chosen for articles and reflected on over time. I am seeing that this e-portfolio is more than my personal file cabinet…the works are telling me my story.”

Employing reflective and social pedagogy, our systematic, step-by-step e-portfolio assignments support growth and change from the initial semester to graduation, advancing the development of nursing professionals. Students are prepared for lifelong learning, ready to use the profession’s reflective cycle of learning to take intelligent action and learning to think from multiple perspectives and form multiple explanations. Scaffolding of weekly reflections and assignments weave the creation of a nurse who can reflect in a systematic, disciplined, social, integrative, and personal way.

Outcomes Assessment

As we built reflective e-portfolio use into our nursing curriculum, we also began to examine student portfolios for course and programmatic assessment. Examining students’ artifacts, reflections, and e-portfolio designs, we found validation for our work—but also surprises. This important process added life and meaning to student learning and engaged faculty in the effort to deepen our curriculum and our teaching.

Our outcomes assessment process integrated general education core values and program outcomes. Using rubrics calibrated to our scaffolded assignments, we reviewed student work, assessing for critical thinking, information literacy, communication, professionalism, reflection, and integrative learning. This inquiry process supported faculty reflection that highlighted areas where change was needed, and helped develop integrative action plans. In one semester, for example, when we assessed the process recordings stored in student e-portfolios, we found the scores did not reach therapeutic communication levels. Meanwhile, in student reflections, we found that students had expressed discomfort with patient communication. Reflecting on these findings, we decided that students needed additional experiences to develop their communication skills. To “close the loop,” we implemented a set of interventions: faculty development related to process recordings, student exercises in class, and a new clinical experience in a senior center. Similarly, information literacy reviews led us to generate an online module for constructing annotated bibliographies.

Our C2L colleague, Gail Matthews-DeNatale of Northeastern University, has recently described the ways e-portfolio-based assessment helped her faculty collectively design a more integrative curriculum for their program:

The first three to four courses in each concentration have been co-designed by faculty as an integrated suite that takes students through a ‘cognitive apprenticeship’ in the skills, understandings, and capabilities of professionals within the field. They are designed to foster connected learning, in which each course builds upon and complements the rest, and the faculty have a clear understanding of how ‘their’ courses intersect with and reinforce other courses in the program. (2014)

Describing the outcome, Matthews-DeNatale shows how each course has designated ‘a signature assignment,’ each one progressively different but linked—what she calls ‘variation within continuity.’ At TRCC, our experience is much the same; we use ‘signature work’ that varies within reflective continuity and core values to support deeper learning and student success. And our assessment process is deepening our understandings and our capacities to enact an integrative and reflective curriculum for our nursing program.

Broadening the Use of Integrative E-Portfolio Practice

In the past year, the e-portfolio project at TRCC has catalyzed broader, institution-wide change, helping us progress as a learning-centered college. A confluence of events led to this shift. The nursing program’s successful use of e-portfolios as a tool and pedagogy, resulting in high student retention and NCLEX success rates, was shared with the broader institution. Parallel to this work, the college’s General Assessment Task Force identified an effective paper portfolio process of general education assessment. Our accrediting body, the New England Association of Schools and Colleges, praised the positive work done around general education assessment in some departments, but stressed the need for a broader institutional plan. In this process, it became clear that e-portfolios could serve as connectors between student learning and institutional assessment.

As TRCC develops an institutional assessment plan, we are building on our strengths as a college. E-portfolios serve as a catalyst in these efforts, opening discussions and renewing faculty engagement in outcomes assessment. Nursing faculty and staff enthusiastically share their work and their learning with their colleagues, facilitating forward movement in meeting the teaching, learning, and assessment needs of the college. The nursing program has a receptive and enthusiastic audience; reflective and social pedagogies are already in use in other college programs. In addition, members of the C2L leadership team and other “super users” of e-portfolios from outside of the college have visited, sharing their strategies for success with key TRCC stakeholders. Through an open dialogue with faculty, administrators, and students, we have reached a consensus: e-portfolios will now be used college-wide for general education and programmatic assessment of student learning.

Conclusion

Full integration of an e-portfolio program for outcomes assessment promotes engagement of all stakeholders in teaching and learning. E-portfolio pedagogy links students, faculty, administrators, and the community to “TRCC’s mission as an accessible, affordable, and culturally diverse community college that meets varied educational needs by creating an environment that stimulates learning.” Our nursing students grow and develop as practitioners through a systematic, scaffolded, and recursive reflective process. It is through a similar reflective process, messy at times, that we, as nursing educators, built and continue to nourish our program’s scaffolded ‘signature assignments’ so that they are a foundation in teaching and learning. This process now serves as a model for TRCC’s general education initiative; we are beginning to build college-wide scaffolded assignments, a critical foundation in e-portfolio programs. We look forward to an ongoing, college-wide process of reflection and change as we all grow and develop as twenty-first-century professionals.

NOTE

For more on Connect to Learning, the inquiry–reflection–integration design principles, and other elements of the Catalyst framework, see the Catalyst for Learning: ePortfolio Research and Resources website at: http://c2l.mcnrc.org.

References

Dewey, J. 1944. Democracy and Education. New York: New York Free Press.

Eynon, B., L. M. Gambino, and J. Török. 2013 “Connect To Learning: Using E-Portfolios in Hybrid Professional Development.” In To Improve The Academy 32, edited by J. E. Groccia and L. Cruz. Hoboken, NJ: John Wiley & Sons, Inc.

Eynon, B., L. M. Gambino, and J. Török. 2014 “What Difference Can ePortfolio Make? A Field Report from the Connect to Learning Project.” International Journal of ePortfolio 4 (1).

Matthews-DeNatale, G. 2014. “Are We Who We Think We Are? ePortfolios as a Tool for Curriculum Redesign.” Journal of Asynchronous Learning Networks 17 (4).

Massachusetts Department of Higher Education Nursing Initiative. 2010. Nurse of the Future Core Competencies. Boston: Massachusetts Department of Higher Education. http://www.mass.edu/currentinit/documents/NursingCoreCompetencies.pdf.

Rodgers, C. 2002. “Defining Reflection: Another Look at John Dewey and Reflective Thinking.” Teachers College Record 104 (4): 842–866.

Three Rivers Community College Mission Statement. 2014. http://www.trcc.commnet.edu/President/about/mission.shtml.


Heather Jane Bader is with Lawrence Memorial Hospital; Lillian A. Rafeldt, Nancy Lesnick Czarzasty, Ellen Freeman, Edith Ouellet, and Judith M. Snayd are all of Three Rivers Community College.

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