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…
 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)
Reflection
Time
Context
Dialogue
Self-Regulated Learning Theory
(Kuiper & Pesut, 2004)
Behavioral Self-regulation
Self-monitoring
Self-observation of
performance
Knowledge Work
Thinking Processes
Self-judgment of
improvements
Competence
Self-reactions
Environmental Selfregulation
Of
Skills/Activities
Physical Context
Preceptor/Staff/Patients
Interpretation
Analysis
Inference
Explanation
Evaluation
Metacognitive Selfregulation
Self-evaluation
Self-correction
Of
Goals
Self-efficacy
Knowledge use
Thinking strategies
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).
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?
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)
Guided Narrative Reflection Process
(Forneris & Peden-McAlpine, 2006)

Describe a story

Guide critical reflection

Consider alternative perspectives

Integrate learning into future practice
experiences
Self 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 (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 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?
References
Bainbridge Frymier, A., Shulman, G., and Houser, M. (1996). The development of a
learner empowerment measure. Communication Education, 45, 181-199.
Bandura, A. (1997). Insights: self-efficacy. Harvard Mental Health Letter, 13(9), 4-6.
Banning, M. (2006). Nursing research: perspectives on critical thinking. British Journal
of Nursing, 15(8), 458-461.
Boughn, S. (1995). An instrument for measuring autonomy-related attitudes and
behaviors in women nursing students. Journal of Nursing Education, 34(3), 106113.
Conger, M. and Mezza, I. (1996). Fostering critical thinking in nursing students in the
clinical setting. Nurse Educator, 21(3), 11-15.
Craft, M. (2005). Reflective writing and nursing education. Journal of Nursing
Education, 44(2), 53-57.
Fonteyn, M. and Cahill, M. (1998). The use of clinical logs to improve nursing students’
metacognition: a pilot study. Journal of Advanced Nursing, 28(1), 149-154.
Forneris, S. and Peden-McAlpine, C. (2006). Contextual learning: a reflective learning
intervention for nursing education. International Journal of Nursing Education
Scholarship, 3(1), 1-18.
Harvey, V. and McMurray, N. (1994). Self-efficacy: a means of identifying problems in
nursing education and career progress. International Journal of Nursing Studies,
31(5), 471-485.
Maynard, C. (1996). Relationship of critical thinking ability to professional nursing
competence. Journal of Nursing Education, 35, 12-18.
McMullan, M. (2006). Students’ perceptions on the use of portfolios in pre-registration
nursing education: a questionnaire survey. International Journal of Nursing
Studies, 43, 333-343.
Nelson, S. and Purkis, M. (2004). Mandatory reflection: the Canadian reconstitution of
the competent nurse. Nursing Inquiry, 11(4), 247-257.
Polit, D. and Beck, C. (2008). Nursing research: generating and assessing evidence for
nursing practice. Philadelphia: Lippincott-Williams & Wilkins.
Ruland, J. and Ahern, N. (2007). Transforming student perspectives through reflective
writing. Nurse Educator, 32(2), 81-88.
Sedlak, C. (1992). Use of clinical logs by beginning nursing students and faculty to
identify learning needs. Journal of Nursing Education, 31(1), 24-28.
Sorrell, J., Brown, H., Cipriano Silva, M. and Kohlenberg, E. (1997). Use of writing
portfolios for interdisciplinary assessment of critical thinking outcomes of nursing
students. Nursing Forum, 32(4), 12-24.
Steen Lauterbach, S. and Becker Hentz, P. (2005). Journaling to learn: a strategy in
nursing education for developing the nurse as person and person as nurse.
International Journal for Human Caring, 9(1), 29-35.
Usher, K, Francis, D., and Owens, J. (1999). Reflective writing: a strategy to foster
critical inquiry in undergraduate nursing students. Australian Journal of Advanced
Nursing, 17(1), 7-12.