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Students’ perceptions on the use of portfolios in pre-registration nursing education: A questionnaire survey
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International Journal of Nursing Studies 43 (2006) 333–343 www.elsevier.com/locate/ijnurstu
Students’ perceptions on the use of portfolios in pre-registration nursing education: A questionnaire survey Mirjam McMullan Faculty of Health and Social Work, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK Received 4 January 2005; received in revised form 11 May 2005; accepted 17 May 2005
Abstract Background: Portfolios encourage both personal and professional development through the process of reflective practice and critical analysis. In clinical placements portfolios are used both as a learning tool and as an assessment tool. Objectives: To determine nursing students’ perceptions on the use and effectiveness of portfolios in their education as well as their perceptions on the use of the portfolio as both an assessment and learning tool in clinical placement. Design: Postal questionnaire survey. Settings: Higher Education Institute in the UK. Participants: 90 first and 84 third year pre-registration diploma of nursing students. Methods: Postal questionnaires were sent to 131 first year and 122 third year students, with a reminder 3 weeks later. The total response rate was 69% (174/253), with a response rate of 69% (90/131) for first year students and a response rate of 69% (84/122) for third year students. Results: Students felt that portfolios were very time-consuming, causing them a great deal of anxiety, and were not very effective in developing and assessing their learning and competence. Using portfolios for both assessment and learning creates a conflict. Any assessment reduces the honesty and learning value of reflective writing and of the portfolio. Additionally, students become increasingly demoralised with portfolio use over time with experience. The study suggested three main linked reasons for this, namely the conflict between using portfolios for both assessment and learning, the design of the portfolio and the amount of support and guidance students feel they receive with their portfolio use. Conclusions: Portfolios can be very effective as an assessment and learning tool, but it is essential that both students and mentors receive clear guidelines on and comprehensive support with their use. They should be designed in such as way that they are relevant, clear and user-friendly for both students and mentors. r 2005 Elsevier Ltd. All rights reserved. Keywords: Portfolio; Assessment; Learning; Reflection
What is already known about the topic?
Corresponding author. Tel.: +44 1752 233831.
Portfolios
E-mail address: [email protected]. 0020-7489/$ - see front matter r 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijnurstu.2005.05.005
provide cumulative information about students’ achievement and progress.
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Portfolios encourage both personal and professional
development through the process of reflective practice and critical analysis. Portfolios are used both for learning and assessment.
What this paper adds
Students find portfolios very time-consuming, caus
ing them a great deal of anxiety, and not very effective in developing and assessing their learning and competence. Any assessment reduces the honesty and learning value of reflective writing and of the portfolio. Students become increasingly demoralised with portfolio use over time with experience.
1. Introduction In nursing education in the United Kingdom, portfolios began to be used to assess clinical competence and learning at the end of the 1980s and the beginning of the 1990s. In 1986 a radical change in nurse education occurred in the form of ‘Project 2000—a new preparation for practice’ (UKCC, 1986). Schools of nursing joined with the institutes of Higher Education resulting in the exploration of different methods of teaching and learning, such as experiential learning and studentcentred methodologies. This in turn led to different ways of assessment, portfolios being one of them. Eventually, in 1996, the English National Board for Nursing, Midwifery and Health Visiting made it compulsory for students to keep portfolios to provide cumulative information about their achievement and progress (ENB, 1996). However, research has shown that the purpose and design of portfolios can vary between different nursing programmes and different Higher Education Institutions (Webb et al., 2002; Endacott et al., 2004). Presently, not only in the UK, but in many countries, portfolios are used in nursing and medical education (Wenzel et al., 1998; Tiwari and Tang, 2003; Pitkala and Mantyranta, 2004). In the Higher Education Institute in this study, portfolios are not only used as a learning tool but also as an assessment tool in clinical placements. Portfolios, in addition to providing carefully selected examples of achievement of learning outcomes, encourage both personal and professional development through the process of reflective practice and critical analysis. Yet, although there has been a lot of theoretical discussion concerning portfolio use, there exists little empirical evidence in the literature regarding students’ perceptions on the use of portfolios (Gerrish et al., 1997). In particular, there is little evidence of whether
students themselves feel that the use of portfolios helps them to develop personally and professionally and whether they feel portfolios are effective in assessing their learning and competence. In addition, little is known whether students’ perceptions on the use of portfolios change over time with experience. This study would like to fill in this gap and concentrate on the students’ perceptions on the use of portfolios in preregistration nursing education.
2. Literature review Portfolios are used both for professional and personal development. They are not only used to inform, but also to transform the student. For professional development, portfolios have been introduced as assessment strategies that will integrate theory and practice and thereby address the issue of the theory–practice divide (Gallagher, 2001). After all, on the one hand students acquire knowledge and skills, such as problem solving and critical thinking, from academics, but on the other hand they also acquire and develop the equally important practical skills and experiences from clinicians. However, for professional practice in the ‘real world’ it is important that the two are combined and are able to enhance each other. Theory needs to be applied to practice, resulting in the reinforcement of the learning (Lambeth et al., 1989); but also, through the process of reflection, practice needs to be applied back to theory. A portfolio, through its reflective component, could provide this link between the two and thereby help to reduce the ‘reality shock’ which is experienced by many students when they move into practice (Harris et al., 2001). A recent study by Gallagher (2001) showed that, although the portfolio as an alternative form of assessment was well received by students, the link made between theory and practice was not as strong as anticipated. According to Gallagher, this could be due to the fact that in his study the students had no autonomy in developing their portfolios and that the questions in the study were not sufficiently explicit. On the other hand, in a post-registration study by Murrell et al. (1998), portfolios not only brought theory and practice closer together, but also led to improvements in practice and allowed students to take control of their own learning needs. Murrell et al. (1998) did point out, however, that the size of their study was small and the result could have, therefore, occurred by chance. For personal development, rather than only being a medium providing the product of the student’s accomplishments, a portfolio can also be a catalyst for growth. It is claimed that portfolios will help to assess and promote critical thinking (Wenzel et al., 1998) and that the actual process of developing the portfolio itself can
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lead to an awareness of the student’s own skills, strengths and limitations, as well as giving an indication of his or her developmental needs (Priest and Roberts, 1998). Because of their continuous nature and structure of active involvement, portfolios encourage students to develop self-reflection and to take charge of their own, lifelong learning. They allow students to assume ownership and thereby promote a sense of responsibility. This increase in responsibility might create anxiety in some students, but will encourage them to accept accountability and thereby help prepare them for working practice. Over time, as information demonstrating personal growth is accumulated, portfolios will also help students to increase their feelings of self-esteem and confidence (Wenzel et al., 1998; Harris et al., 2001). However, some authors argue that although portfolios are supposed to stimulate the development of selfawareness, personal growth and independent learning, there is little evidence to support these assumptions (Mitchell, 1994; Cayne, 1995). Reflection is a major component of portfolios as it helps students to learn from experience and practice, thereby helping them to bridge the theory–practice gap (Gallagher, 2001). Through the reflective process students are able to identify gaps in knowledge and/or skills and competence (Grant and Dornan, 2001), but also to reconfirm and document strengths, skills and knowledge (Harris et al., 2001). However, there is a general reluctance by students to engage in self-reflection. The focus on fears and weaknesses as well as strengths may be seen as threatening. They may feel uncertain on how to reflect and not all tutors are necessarily good facilitators of self-reflection (Karlowicz, 2000). Also, as most reflection occurs through the written medium, some students’ writing skills will be better than others (Snadden and Thomas, 1998). Mitchell (1994) found a positive correlation between the writing skills of students and the positive feeling they had about portfolio assessment. In her study, in contrast to the literature, students found that keeping a portfolio contributed little to their self-awareness of strengths and weaknesses and, in some cases, that it even reinforced weaknesses without pointing the way to development. She concluded that this occurred because the portfolios in her study were being summatively assessed, while many discussed in the literature were not. As soon as students know that their writing will be assessed they become very reluctant to express their innermost thoughts and feelings. They see it as an ‘invasion of privacy’ and are inclined to write what they think the assessor wants to read (Woodward, 1998; Scholes et al., 2004). The portfolio becomes assessment-led, resulting in reduction in its learning value (McMullan et al., 2003). Clearly a conflict exists between the summative assessment and the learning, developmental value of the portfolio (Gallagher, 2001). Reflective learning is
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most effective when the contents are personal and ‘owned’ by the student. However, summative assessment tends to lead to alteration of the contents, as students become reluctant to include personal incidents, especially problem areas and difficulties. Yet, these are often the incidents that trigger real learning (Harris et al., 2001). Mitchell (1994) sums this up very well: Problems may arise when portfolios are used for both purposes of learning and assessment. Summative assessment included as a purpose of portfolio use may have a profound effect on the way students contribute to their use. It may also affect their experiences and perceptions of the benefits to themselves of portfolio use. Summative assessment could thus lead to reduced ‘ownership’ and developmental use of portfolios by students. Other problems concerning portfolios are related to their compilation and the ethical issues of privacy and confidentiality (Gannon et al., 2001; Dolan et al., 2004). If the students are not assured of the confidentiality of the portfolio’s content, it will become unreliable as an assessment tool as the entries will often be censored. The issue of honesty in portfolios is another important factor in their use. Gannon et al. (2001) suggest that there is a negative correlation between use of the portfolio as an assessment tool and the honesty of the entries, thereby reducing its validity and credibility. Portfolios have also been criticised both for the amount of time it takes to complete and to assess them (Harris et al., 2001). Students additionally express anxiety about the uncertainty of the nature and amount of evidence to provide in the portfolio (Phillips and Bharj, 1996). This anxiety, together with the time- consuming aspect of portfoliokeeping, will often have a negative effect on student motivation (Mitchell, 1994).
3. Aims and objectives When reviewing the literature some interesting issues become apparent, such as the conflict that exists between the use of portfolios as both an assessment tool and as a developmental learning tool. According to the literature, due to this dual use, assessment could have a detrimental effect on the developmental learning value of the portfolio, with the result that portfolio use might become assessment-led (McMullan et al., 2003). Another interesting issue is reflective writing, which is a major developmental component of portfolios. The honesty of reflective writing could be influenced by assessment and, in particular, by the fact whether the assessment is summative or formative (Gannon et al., 2001). Additionally the reflective writing ability of the
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students might influence the way students feel about the use and effectiveness of a portfolio as an assessment tool and as a developmental learning tool (Snadden and Thomas, 1998). Other issues concern the support and guidance given to the student regarding portfolio use, the time it takes to complete the portfolio and the anxiety that preparing a portfolio gives the students. All these issues have been raised in the literature, but so far there exists a paucity of empirical studies, particularly quantitative, which have researched these issues further from a student’s perspective. The aim of this study is therefore to obtain students’ perspectives on the process of using a portfolio in their education as well as their perceptions on the use of the portfolio as both an assessment and learning tool in clinical placement. The objectives are to determine whether students feel that the process of using a portfolio helps them in their personal and professional development, whether they feel portfolios are effective in helping them to learn from practice and how effective they feel portfolios are in assessing their learning and competence. In addition, to determine, from a student’s perspective, whether the use of the portfolio as both an assessment and learning tool reduces the learning value of the portfolio and whether students’ perceptions on the use of portfolios change over time with experience.
4. Methodology 4.1. Sample A total sample of 254 pre-registration diploma of nursing students at one UK university were contacted for the study, consisting of one group of first year (n ¼ 131) and one group of third year (n ¼ 122) students. Both groups used portfolios during their education.
quantitative studies to test statistically these research questions. 4.3. Research instrument The research instrument used for this survey was a postal questionnaire consisting of several sections. Section A provided demographic details such as age, gender and the student’s year of study. The following four sections covered respectively constructs of Personal Development (B), Professional Development (C), Effectiveness of the Portfolio (D) and Portfolio Support and Guidance Received (E). Each of these constructs was made up of 4–7 items that have been raised in the literature, with each item having a five-point Likert response scale, ranging from strongly disagree (1) to strongly agree (5). Likert scales were used in order to determine the strength of the different feelings and opinions held by the students about the use of portfolios. Section F consisted of 10 general statements reflecting research questions raised in the literature. Again, each of these statements had a five-point Likert response scale, ranging from strongly disagree (1) to strongly agree (5). In addition, section F had a question asking respondents if they thought that portfolios, on the whole, were a good thing or not and why. The final section (section G) consisted of an open-ended question offering the opportunity to make any additional comments about the use of portfolios. Face validity of the questionnaire was achieved by review of its format and content by university educators and also through initial pilot testing with second year nursing students (n ¼ 56) who were not included in the main study. Reliability analysis showed that all four constructs in the questionnaire had good internal consistency, with Cronbach’s Alpha Coefficients of, respectively, 0.9, 0.88, 0.86 and 0.89 (Pallant, 2001). 4.4. Research procedure
4.2. Research design The research design chosen for this study was mainly quantitative, with two additional open-ended questions. This approach was chosen partly because the large number of students meant that focus groups or interviews with a smaller sample of students would not have been representative enough of the whole group, but mainly because no previous large-scale correlational survey had been carried out to determine students’ perceptions on portfolio use. The quantitative surveys carried out so far had been of a small scale (n ¼ 30–40) and had been mainly descriptive (Gallagher, 2001). In addition, although the literature had raised some interesting research questions through some small scale quantitative and qualitative studies (Murrell et al., 1998; Gannon et al., 2001), there had been no large-scale
The questionnaires were sent by post to the first year (n ¼ 131) and third year (n ¼ 122) students, with a reminder 3 weeks later. After 8 weeks, at the point of analysis, the total response rate was 69% (174/253), with a response rate of 69% (90/131) for first year students and a response rate of 69% (84/122) for third year students. 4.5. Data analysis The questionnaires yielded both quantitative and qualitative data. For quantitative analysis the statistical package SPSS version 11.5.1 was used. The quantitative data type was either categorical, such as demographic details (section A), or interval (five-point Likert scales, ranging from strongly disagree (1) to strongly agree (5)).
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To form a total score for each construct (sections B to E) the scores of each item in a construct were added together. Both descriptive and bivariate analysis was carried out. Dependent on the purpose of the statistical test and the data type, the bivariate analysis consisted of an independent t-test, a paired sample t-test or a Pearson correlation. To determine the difference between the mean scores between first and third year students the independent t-test was used. The paired-sample t-test was used to measure the same person in terms of his or her response to two different questions rated on the same scale and, finally, to explore the relationship between two continuous variables the Pearson correlation test was used. The qualitative data emerging from the last question in section F and from section G were analysed for recurrent themes (thematic analysis).
Table 1 Participant demographics by year of study
4.6. Ethical issues
they helped them to develop independent learning (mean ¼ 3.39, SD ¼ 1.00, 52% agreed/strongly agreed). Even fewer students (42%) felt that portfolios helped to promote critical thinking (mean ¼ 3.17, SD ¼ 1.03) and only 31% felt that portfolios helped to improve their self-esteem (mean ¼ 2.94, SD ¼ 1.00).
University ethical clearance was obtained for the study. Enclosed with the postal questionnaire was a cover letter informing the students about the study and ensuring anonymity and confidentiality of both the students and their data. Contact details were given in the contact letter in case students required further information before deciding to participate or if they wanted to be kept informed of the results of the study. Students were free to return the questionnaire or not, and could withdraw their data from the study at any time without affecting their relationship with the University. Return of the questionnaire, however, implied consent to participate in the study.
5. Results 5.1. Participants’ characteristics Table 1 shows that most of the first year students (n ¼ 90) were 24 years or younger (39%) and were female (90%). Of the third year students (n ¼ 82), the majority (41%) were in the 35–44 years age group and 89% were female. 5.2. Personal and Professional Development Table 2 shows that, of the 173 students, 74% agreed or strongly agreed that portfolios helped them to take responsibility for their own professional development (mean ¼ 3.78, SD ¼ 0.9), and 60% agreed or strongly agreed that portfolios enhanced their reflective skills (mean ¼ 3.51, SD ¼ 1.05). However, only about half felt that portfolios helped them to become aware of their strengths (mean ¼ 3.25, SD ¼ 0.981, 52% agreed/ strongly agreed) and weaknesses (mean ¼ 3.24, SDF ¼ 0.979, 51% agree/strongly agreed), and that
Year of study First (n ¼ 90) (%)
Third (n ¼ 82) (%)
Age
24 years and under 25–34 years 35–44 years 45–54 years 55 years and over
39 30 23 7 1
16 26 41 15 2
Gender
Male Female
10 90
11 89
5.3. General statements In section F of the survey the students were asked 10 general statements which arose from the literature review. Table 3 shows that students felt that portfolios took a great deal of time to complete (mean ¼ 3.87, SD ¼ 0.893, 73% agreed/strongly agreed) and caused them much anxiety (mean ¼ 3.68, SD ¼ 1.095, 64% agreed/strongly agreed). Only 37% of the students felt they had good reflective writing skills (mean ¼ 3.25, SD ¼ 0.801). A statistically significant negative correlation was found between how good the students perceived their reflective writing skills to be and the anxiety that preparing the portfolio gave them (r ¼ 0.159, n ¼ 174, p ¼ 0.036), with higher levels of perceived reflective writing skills associated with lower levels of anxiety. In addition, as in Mitchell’s (1994) study, a statistically significant positive correlation was found between students’ perceived reflective writing skills and whether they liked the portfolio as an assessment tool (r ¼ 0.189, n ¼ 174, p ¼ 0.012). However, apart from a statistically significant positive correlation between students’ own perceived reflective writing skills and improved confidence (r ¼ 0.162, n ¼ 174, p ¼ 0.032), no statistically significant correlations were found between students’ own perceived reflective writing skills and any of the other personal and professional developmental characteristics, such as independent learning (r ¼ 0.057, n ¼ 173, p ¼ 0.453), awareness of strengths (r ¼ 0.089, n ¼ 174, p ¼ 0.241) and weaknesses (r ¼ 0.018, n ¼ 174, p ¼ 0.818), and
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Table 2 Personal and professional development (n ¼ 173)
Personal Development
Professional development
Strongly disagree/ disagree (%)
Neutral (%)
% Strongly agree/agree
Mean (SD)
Aware of strengths Aware of weaknesses Develop independent learning Value life-long learning Improve self-esteem Improve confidence Responsibility for own professional development
28 28 22
20 21 26
52 51 52
3.25 (.981) 3.24 (.979) 3.39 (1.00)
28 37 32 12
32 32 26 14
40 31 42 74
3.17 2.94 3.15 3.78
Link theory-practice Identify areas where knowledge is good Identify areas where skills are good Identify areas where knowledge is weak Identify areas where skills are weak Promote critical thinking Enhance reflective skills
23 25
26 27
51 48
3.32 (.956) 3.24 (.943)
21
28
51
3.32 (.931)
28
27
45
3.18 (.938)
25
25
50
3.28 (.952)
29 20
29 20
42 60
3.17 (1.03) 3.51 (1.05)
(.974) (1.00) (1.04) (.900)
Table 3 General statements regarding portfolio use (n ¼ 174)
Portfolio takes a lot of time to complete Portfolio causes a lot of anxiety Have good reflective writing skills Difficult reflective writing when summative assessed Difficult reflective writing when formative assessed Like portfolio as assessment tool Like portfolio as learning tool Portfolio both summative and formative assessed increases learning value Portfolio only summative assessed increases learning value Portfolio only formative assessed increases learning value
linking theory and practice (r ¼ 0.054, n ¼ 174, p ¼ 0.478). A possible reason for this is that, for reflective writing to have any developmental learning value, it has to be totally honest. The percentage of students who found it difficult to be critical and honest in their reflective writing was quite large, not only for summative assessment (49% agreed/ strongly agreed, mean ¼ 3.3, SD ¼ 1.01), but also for formative assessment (41% agreed/strongly agreed,
Strongly disagree/ disagree (%)
Neutral (%)
Strongly agree/agree (%)
Mean (SD)
8 20 17 24 26 45 38 42
20 16 46 27 33 31 31 34
73 64 37 49 41 24 31 24
3.87 3.68 3.25 3.30 3.21 2.72 2.86 2.69
35 42
44 46
21 12
2.82 (.858) 2.66 (.788)
(.893) (1.095) (.801) (1.01) (.965) (1.046) (1.024) (.971)
mean ¼ 3.21, SD ¼ 0.965). Analysis showed that on average students found it statistically significantly more difficult to be critical and honest in their reflective writing when this was summatively assessed than when it was formatively assessed (t ¼ 2.576, d.f. ¼ 173, p ¼ 0.011). The very fact that the writing was assessed (whether formatively or summatively) greatly reduced the reflection’s effectiveness, as it became very difficult for students to be critical and honest if their work was
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seen by anyone with any authority or power. Students feared that anything they wrote might be used against them: Reflection is meant to be a personal experience. Can a student really and truly reflect on one’s mentor, personal tutor and lecturer’s attitude, especially if they are unhelpful? The student will be crucified on the wards and in University. I have seen it happen and help from anyone is rare! My reflections are personal. Why should it be judged formatively and summatively? (Third Year Student) Only 24% of respondents agreed or strongly agreed that they liked the portfolio as an assessment tool (mean ¼ 2.72, SD ¼ 1.046) and 31% agreed or strongly agreed that they liked the portfolio as a developmental learning tool (mean ¼ 2.86, SD ¼ 1.024). The difference between the two was found to be statistically significant (t ¼ 2.459, d.f. ¼ 173, p ¼ 0.015), with on average students liking the portfolio more as a developmental learning tool than as an assessment tool. Because of the dual nature of this portfolio, we were interested in determining whether assessment interfered with the learning value of the portfolio and whether this depended on the type of assessment. We, therefore, asked students whether having the content of their portfolios only summatively, only formatively or both summatively and formatively assessed increased its learning value. The percentage who actually felt that assessment increased the learning value was very low (21% agreed or strongly agreed that the learning value of the portfolio increased if the assessment was only summative; mean ¼ 2.82, SD ¼ 0.858), while 24% agreed with this if the assessment was both summative and formative (mean ¼ 2.69, SD ¼ 0.971) and 12% agreed or strongly agreed if the assessment was only formative (mean ¼ 2.66, SD ¼ 0.788). No matter which combination of assessments was used, very few students felt that assessment increased the learning value of the portfolio. There was a statistically significant difference in the increase in learning value that students felt they would
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get whether the content of their portfolio was only summatively or only formatively assessed (t ¼ 2.204, d.f. ¼ 173, p ¼ 0.029). Students felt that if there had to be an assessment of their portfolio content they would prefer only summative assessment (mean ¼ 2.82, SD ¼ 0.858) to only formative assessment (mean ¼ 2.66, SD ¼ 0.788), especially for their clinical skills: It [portfolio] would have more meaning for me if goals were clearly defined with feedback from mentors and tutors plus grades that would encourage learning and motivate me to get the most out of my practiceySummatively assessed—gives you an idea on how you are doing and gives a sense of achievement. (Third Year Student) It is interesting that students on average would also prefer only summative (mean ¼ 2.82, SD ¼ 0.858) to having both summative and formative assessment (mean ¼ 2.69, SD ¼ 0.971), although the difference was not statistically significant (t ¼ 1.462, d.f. ¼ 173, p ¼ 0.145). 5.4. Support and Guidance Table 4 shows that only 32% of the students (n ¼ 174) felt they received clear guidelines on the purpose of the portfolio (mean ¼ 2.75, SD ¼ 1.124), 33% were clear on which evidence they needed to include in their portfolios (mean ¼ 2.72, SD ¼ 1.141) and 21% were clear on how much evidence they needed to include in their portfolios (mean ¼ 2.46, SD ¼ 1.046). When it came to receiving support and guidance on how to use the portfolio only 13% felt they received this (mean ¼ 2.19, SD ¼ 0.933) and only 6% reported having regular feedback sessions (mean ¼ 2.01, SD ¼ 0.829). The amount of support and guidance students received greatly influenced the amount of anxiety students felt about the preparation of their portfolios (see Table 3). We found that a large percentage of students (73%) felt that portfolios took a great deal of time to complete (mean ¼ 3.87, SD ¼ 0.893) and that preparing them was very stressful and caused them
Table 4 Support and Guidance Received (n ¼ 174)
On purpose of portfolio Which evidence to include How much evidence to include How to use the portfolio Regular feedback sessions
Strongly disagree/ disagree (%)
Neutral (%)
Strongly agree/agree (%)
Mean (SD)
47 50 61 71 77
21 17 18 16 17
32 33 21 13 6
2.75 2.72 2.46 2.19 2.01
(1.124) (1.141) (1.046) (.933) (.829)
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much anxiety (64% agreed/strongly agreed, mean ¼ 3.68, SD ¼ 1.095): They [portfolios] take a lot of time and cause a lot of anxiety wondering whether we are putting the right or enough content into them. (First Year Student) It was, therefore, not surprising to find a statistically significant positive relationship between the time it took students to prepare portfolios and the amount of anxiety that preparing a portfolio gave them (r ¼ 0.577, n ¼ 174, po0.0005), with higher levels of time associated with higher levels of anxiety. Additionally, the more anxious the students became, the less they liked the portfolio as an assessment tool (r ¼ 0.179, n ¼ 174, p ¼ 0.036). However, support and guidance received on how to use the portfolio statistically significantly reduced the anxiety that preparing a portfolio gave students (r ¼ 0.19, n ¼ 174, p ¼ 0.012) and statistically significantly improved the way they felt about the portfolio as an assessment tool (r ¼ 0.404, n ¼ 174, po0.0005) and as a learning tool (r ¼ 0.367, n ¼ 174, po0.0005). This was also clearly reflected in the statistically significant positive correlation found between the support and guidance construct on the one hand and the personal development (r ¼ 0.406, n ¼ 173, po0.0005) and professional development constructs (r ¼ 0.4, n ¼ 174, po0.0005) on the other. The more support and guidance students felt they received with their portfolios, the more they felt that the process helped them with their personal and professional development.
SD ¼ 1.064). When it came to the effectiveness of portfolios in assessing learning and competence, only 26% felt that portfolios were very effective in assessing learning (mean ¼ 2.79, SD ¼ 0.966) and 24% in assessing competence (mean ¼ 2.78, SD ¼ 0.939). However, the results did show that increased support and guidance statistically significantly improved students’ feelings about the effectiveness of the portfolio (r ¼ 0.483, n ¼ 173, po0.0005), with higher levels of overall support and guidance associated with higher levels of overall portfolio effectiveness. When third year students results were compared with those of first year students, the former were much less positive about the use of portfolios in their nursing education. Compared with first year students, they felt that the portfolio helped them statistically significantly less with their professional development (t ¼ 2.103, d.f. ¼ 172, p ¼ 0.037) and was overall statistically significantly less effective in helping them to prepare for and to learn from practice and in assessing their competence and learning (t ¼ 2.472, d.f. ¼ 171, p ¼ 0.014). Additionally, compared with first year students, third year students felt they received statistically significantly less support and guidance with portfolio use (t ¼ 2.150, d.f. ¼ 172, p ¼ 0.033). Regarding portfolio design, students complained that they were too big and bulky and that the language used was very repetitive and confusing to both students and mentors. In addition, some learning outcomes were not appropriate to particular practice placements, and students felt that they ended up concentrating more on getting everything ‘signed off’ rather than learning more about their placement areas and clinical skills:
5.5. Portfolio Effectiveness The level of support and guidance given to students with their portfolios also influenced their feelings about its effectiveness. Table 5 shows that when respondents (n ¼ 173) were asked how effective they felt portfolios were, the majority did not seem to think they were very effective. Although 42% felt that portfolios were very effective in helping them to learn from practice (mean ¼ 3.10, SD ¼ 1.079), only 29% felt that they helped them to be prepared for practice (mean ¼ 2.76,
Most assessors don’t understand what is needed. It took me a while myself to know how much and which evidence is neededyThe way things are worded is confusing, surely they could be better worded so it doesn’t take half an hour to know what they mean. They repeat quite a bit alsoyTo fulfil the criteria for completing a portfolio, students waste valuable time finding sometimes irrelevant information to include as evidenceyIn my experience they cause unnecessary worry and added pressure. (Third Year Student)
Table 5 Effectiveness of the portfolio (n ¼ 173)
To prepare for practice To learn from practice Assessing learning Assessing competence
Strongly disagree/ disagree (%)
Neutral (%)
Strongly agree/agree (%)
Mean (SD)
48 30 42 43
23 28 32 33
29 42 26 24
2.76 3.10 2.79 2.78
(1.064) (1.079) (.966) (.939)
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6. Discussion Portfolios are used both for personal and professional development at both pre- and post-registration levels in nursing education in the UK. According to the literature, they encourage students to enhance their reflective skills (Grant and Dornan, 2001) and help them to become aware of their strengths and weaknesses (Priest and Roberts, 1998). They help students to take responsibility for their own professional development and promote critical thinking (Wenzel et al., 1998). In addition, they help students to develop independent learning and increase their feelings of self-esteem and confidence (Harris et al., 2001). Although in our study they did help students to enhance their reflective skills and to develop a sense of responsibility for their own professional development, when it came to stimulating the development of self-awareness, independent learning, critical thinking and self-esteem, support for these assumptions from a student perspective was not as strong as anticipated, confirming Mitchell (1994) and Cayne (1995) results. A possible reason why students in our study reported that portfolios helped them to enhance their reflective skills but not their critical thinking skills, even though critical thinking is an important component of reflection, could be due to the amount of support and guidance students feel they receive with their portfolio use. If students, as the students in this study reported, do not receive ongoing support and guidance and regular feedback sessions on how to use the portfolio and on how to reflect, their reflective skills will remain shallow and the deeper critical thinking skills will not develop sufficiently. Additionally, our study found that third year students were more disillusioned with the use of portfolios than first year students. The findings suggested three main linked reasons for this, namely the amount of support and guidance students feel they receive with their portfolio use, the design of the portfolio and the conflict between using portfolios for both assessment and learning. Regarding support and guidance, for the use of portfolios to be successful the literature argues that it is essential that students receive clear guidelines on their purpose, content and structure (Gannon et al., 2001). Additionally, students will require ongoing support and guidance on how to use portfolios, with regular feedback sessions to know that they are on the right track (Grant and Dornan, 2001). In our study, the students overall did not seem to feel they received enough support and guidance with their portfolio use. This greatly influenced how they felt about the portfolio as an assessment and learning tool. They felt that portfolios were very time-consuming, causing them a great deal of anxiety, and were not very effective in assessing their learning and competence. However, our
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study did show that for portfolio use to be successful clearly ongoing support and guidance is essential, as this will reduce the anxiety that preparing a portfolio give students, and improve the way they feel about the effectiveness of the portfolio as an assessment and learning tool and the use of portfolios for their personal and professional development. However, for portfolios to be successful, it is important that both students and mentors in practice receive support and guidance with their use. Mentors are often very busy and may not have enough time to devote to students. Additionally, like students, mentors find portfolios very time-consuming and stressful, mainly due to the large amount of paperwork, which in many cases is repetitive, unclear and not always appropriate to that particular practice placement. If mentors do not understand how to use portfolios and cannot themselves provide support, guidance and feedback to students, the latter will become demoralised and the value of portfolios will be diminished. Concerning portfolio design, our results indicate that at present they are designed in a way that actually reduces their overall learning value and that of the placement. Students feel that they end up concentrating more on getting signatures than on learning about their placement areas and clinical skills. Yet, to be able to know that they are competent to practise, they do want to continue to obtain placement feedback and assessment, especially of their clinical skills. However, the mode of assessment should be clear to both students and mentors, relevant to practice and not too numerous. A suggestion was made by some students that the portfolio should contain a summative assessed clinical skills list to motivate them and promote safer practice. In addition, instead of chasing up signatures for learning outcomes that were not always achievable, students would prefer mentors to write a formative report at the end, and perhaps in the middle, of the placement, which would include their strengths, weaknesses and any skills achieved. This would give them more thorough feedback and would improve their sense of achievement. Having mentors writing only one or two sets of progress reports would also reduce the time-consuming nature of portfolios for them, thereby giving them more time to spend with students. According to the literature, a key feature of the portfolio is that it contains evidence of achievement of learning outcomes (Crandall, 1998). To demonstrate learning for the owner, it is essential that the portfolio does not just contain a collection of evidence, but also shows how the student reflects on these items. Developmental learning is achieved through reflection and by applying practice back to theory so that the gap between the two is reduced (Girot, 2000). In our study, only 51% of students felt that the use of portfolios helped them to
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link theory and practice, 42% that the process of using portfolios helped them to learn from practice and only 31% liked the portfolio overall as a learning tool, thereby confirming Gallagher’s (2001) finding that portfolio use does not strengthen the link between theory and practice as much as anticipated. A probable reason for this arose through our qualitative analysis. Students felt that the portfolio appeared to focus more on theory and academic skills of writing than on practical clinical skills, thereby actually increasing the gap between practice and theory. Although reflection does help to link practice to theory, it does this through academic writing. What students really are nervous about in placement, and require feedback on, is practical clinical skills and their application of theory to practice. However, they feel that the emphasis of the portfolio is too much on theory and academic reflective writing, and this does not acknowledge enough the importance of clinical skills. Without this students may qualify as nurses but still not be sure that they have the necessary clinical skills. Additionally, although students like the process of reflection to help them link practice and theory, the study showed that they feel that they cannot be totally honest and critical in their writing if this is seen by anyone in authority or power. For reflective writing to have any developmental learning value, it has to be absolutely honest. Writers must have total freedom of expression and feel that they can be critical if need be. When students know that their writing will be assessed, they become reluctant and guarded in expressing their thoughts and feelings, and are inclined to write what they think that assessors want to read. The reflective writing thus becomes assessment led, resulting in a reduction of its learning value (McMullan et al., 2003). Although literature has reported the conflict between summative assessment and the developmental value of the portfolio (Gallagher, 2001), this study showed that any assessment, whether formative or summative, will reduce the learning value of reflection and thereby the effectiveness of reflective writing in linking practice and theory. However, although the study indicates that any assessment reduces the learning value of reflective writing, and of the portfolio, students find the process of reflection important for their developmental learning. Yet, paradoxically, if the pressure of assessment is not present students might not reflect. A possible compromise might be to use peer assessment for reflective writing.
7. Conclusion Portfolios can be very effective as an assessment and learning tool, but it is essential that both students and mentors receive clear guidelines on and comprehensive
support with their use, thereby reducing the anxiety that preparing a portfolio gives students. Without these, students and mentors will become increasingly stressed and demoralised with the use of portfolios in practice. It is also important to place portfolio use into context. Ideally they should be designed in such as way that they are relevant, clear and user- friendly for both students and mentors, and so can be used effectively in an environment that is extremely busy and stressful.
References Cayne, J., 1995. Portfolios: a developmental influence? Journal of Advanced Nursing 21, 395–405. Crandall, S., 1998. Portfolios link education with practice. Radiologic Technology 69, 479–482. Dolan, G., Fairbairn, G., Harris, S., 2004. Is our student portfolio valued? Nurse Education Today 24 (1), 4–13. ENB, 1996. Regulations and Guidelines for the Approval of Institutions and Courses. English National Board for Nursing, Midwifery and Health Visiting, London. Endacott, R., Gray, M., Jasper, K., McMullan, M., Scholes, J., Webb, C., 2004. Using portfolios in the assessment of learning and competence: the impact of four models. Nurse Education in Practice 4 (4), 250–257. Gallagher, P., 2001. An evaluation of a standards based portfolio. Nurse Education Today 21, 409–416. Gannon, F.T., Draper, P.R., Watson, R., Proctor, S., Norman, I.J., 2001. Putting portfolios in their place. Nurse Education Today 21, 534–540. Gerrish, K., McManus, M., Ashworth, P., 1997. Levels of achievement: a review of the assessment of practice. English National Board for Nursing, Midwifery & Health Visiting, London. Girot, E.A., 2000. Assessment of graduates and diplomates in practice in the UK—are we measuring the same level of competence? Journal of Clinical Nursing 9, 330–337. Grant, A., Dornan, T.L., 2001. What is a learning portfolio? Diabetic Medicine 18, 1–4. Harris, S., Dolan, G., Fairbairn, G., 2001. Reflecting on the use of student portfolios. Nurse Education Today 21, 278–286. Karlowicz, K.A., 2000. The value of student portfolios to evaluate undergraduate nursing programs. Nurse Educator 25, 82–87. Lambeth, S., Volden, C., Deschle, L., 1989. Portfolios: they work for RNs. Journal of Nursing Education 28, 42–44. McMullan, M., Endacott, R., Gray, M., Miller, C., Scholes, J., Webb, C., 2003. Portfolios and assessment of competence— a review of the literature. Journal of Advanced Nursing 41 (3), 283–294. Mitchell, M., 1994. The views of students and teachers on the use of portfolios as a learning and assessment tool in midwifery education. Nurse Education Today 14, 38–43. Murrell, K., Harris, L., Tomsett, G., 1998. Using a portfolio to assess clinical practice. Professional Nurse 13, 220–223. Pallant, J., 2001. SPSS Survival Manual: A Step by Step Guide to Data Analysis using SPPS. Open University Press, Buckingham.
ARTICLE IN PRESS M. McMullan / International Journal of Nursing Studies 43 (2006) 333–343 Phillips, M., Bharj, K., 1996. ‘Developing a tool for the assessment of clinical learning’ BJM Supplement of Education. British Journal of Midwifery 4, 471–475. Pitkala, K.H., Mantyranta, T., 2004. Feelings related to first patient experiences in medical school: a qualitative study on students’ personal portfolios. Patient Education and Couseling 54 (2), 171–177. Priest, H., Roberts, P., 1998. Assessing students’ clinical performance. Nursing Standard 12, 37–41. Scholes, J., Endacott, R., Gray, M., Jasper, K., McMullan, M., Webb, C., 2004. Making portfolios work in practice. Journal of Advanced Nursing 46, 595–603. Snadden, D., Thomas, M.L., 1998. Portfolios learning in general practice vocational training—does it work? Medical Education 32, 401–406.
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Tiwari, A., Tang, C., 2003. From process to outcome: the effect of portfolio assessment on student learning. Nurse Education Today 23, 2692–2777. UKCC, 1986. Project 2000: A New Preparation for Practice. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London. Webb, C., Endacott, R., Gray, M., McMullan, M., Miller, C., Scholes, J., 2002. Models of portfolios. Medical Education 36 (10), 897–898. Wenzel, L.S., Briggs, K.L., Puryear, B.L., 1998. Portfolio: authentic assessment in the age of the curriculum revolution. Journal of Nursing Education 37, 208–212. Woodward, H., 1998. Reflective Journals and Portfolios: learning through assessment. Assessment & Evaluation in Higher Education 23, 415–423.
International Journal of Nursing Studies 43 (2006) 333–343 www.elsevier.com/locate/ijnurstu
Students’ perceptions on the use of portfolios in pre-registration nursing education: A questionnaire survey Mirjam McMullan Faculty of Health and Social Work, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK Received 4 January 2005; received in revised form 11 May 2005; accepted 17 May 2005
Abstract Background: Portfolios encourage both personal and professional development through the process of reflective practice and critical analysis. In clinical placements portfolios are used both as a learning tool and as an assessment tool. Objectives: To determine nursing students’ perceptions on the use and effectiveness of portfolios in their education as well as their perceptions on the use of the portfolio as both an assessment and learning tool in clinical placement. Design: Postal questionnaire survey. Settings: Higher Education Institute in the UK. Participants: 90 first and 84 third year pre-registration diploma of nursing students. Methods: Postal questionnaires were sent to 131 first year and 122 third year students, with a reminder 3 weeks later. The total response rate was 69% (174/253), with a response rate of 69% (90/131) for first year students and a response rate of 69% (84/122) for third year students. Results: Students felt that portfolios were very time-consuming, causing them a great deal of anxiety, and were not very effective in developing and assessing their learning and competence. Using portfolios for both assessment and learning creates a conflict. Any assessment reduces the honesty and learning value of reflective writing and of the portfolio. Additionally, students become increasingly demoralised with portfolio use over time with experience. The study suggested three main linked reasons for this, namely the conflict between using portfolios for both assessment and learning, the design of the portfolio and the amount of support and guidance students feel they receive with their portfolio use. Conclusions: Portfolios can be very effective as an assessment and learning tool, but it is essential that both students and mentors receive clear guidelines on and comprehensive support with their use. They should be designed in such as way that they are relevant, clear and user-friendly for both students and mentors. r 2005 Elsevier Ltd. All rights reserved. Keywords: Portfolio; Assessment; Learning; Reflection
What is already known about the topic?
Corresponding author. Tel.: +44 1752 233831.
Portfolios
E-mail address: [email protected]. 0020-7489/$ - see front matter r 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijnurstu.2005.05.005
provide cumulative information about students’ achievement and progress.
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Portfolios encourage both personal and professional
development through the process of reflective practice and critical analysis. Portfolios are used both for learning and assessment.
What this paper adds
Students find portfolios very time-consuming, caus
ing them a great deal of anxiety, and not very effective in developing and assessing their learning and competence. Any assessment reduces the honesty and learning value of reflective writing and of the portfolio. Students become increasingly demoralised with portfolio use over time with experience.
1. Introduction In nursing education in the United Kingdom, portfolios began to be used to assess clinical competence and learning at the end of the 1980s and the beginning of the 1990s. In 1986 a radical change in nurse education occurred in the form of ‘Project 2000—a new preparation for practice’ (UKCC, 1986). Schools of nursing joined with the institutes of Higher Education resulting in the exploration of different methods of teaching and learning, such as experiential learning and studentcentred methodologies. This in turn led to different ways of assessment, portfolios being one of them. Eventually, in 1996, the English National Board for Nursing, Midwifery and Health Visiting made it compulsory for students to keep portfolios to provide cumulative information about their achievement and progress (ENB, 1996). However, research has shown that the purpose and design of portfolios can vary between different nursing programmes and different Higher Education Institutions (Webb et al., 2002; Endacott et al., 2004). Presently, not only in the UK, but in many countries, portfolios are used in nursing and medical education (Wenzel et al., 1998; Tiwari and Tang, 2003; Pitkala and Mantyranta, 2004). In the Higher Education Institute in this study, portfolios are not only used as a learning tool but also as an assessment tool in clinical placements. Portfolios, in addition to providing carefully selected examples of achievement of learning outcomes, encourage both personal and professional development through the process of reflective practice and critical analysis. Yet, although there has been a lot of theoretical discussion concerning portfolio use, there exists little empirical evidence in the literature regarding students’ perceptions on the use of portfolios (Gerrish et al., 1997). In particular, there is little evidence of whether
students themselves feel that the use of portfolios helps them to develop personally and professionally and whether they feel portfolios are effective in assessing their learning and competence. In addition, little is known whether students’ perceptions on the use of portfolios change over time with experience. This study would like to fill in this gap and concentrate on the students’ perceptions on the use of portfolios in preregistration nursing education.
2. Literature review Portfolios are used both for professional and personal development. They are not only used to inform, but also to transform the student. For professional development, portfolios have been introduced as assessment strategies that will integrate theory and practice and thereby address the issue of the theory–practice divide (Gallagher, 2001). After all, on the one hand students acquire knowledge and skills, such as problem solving and critical thinking, from academics, but on the other hand they also acquire and develop the equally important practical skills and experiences from clinicians. However, for professional practice in the ‘real world’ it is important that the two are combined and are able to enhance each other. Theory needs to be applied to practice, resulting in the reinforcement of the learning (Lambeth et al., 1989); but also, through the process of reflection, practice needs to be applied back to theory. A portfolio, through its reflective component, could provide this link between the two and thereby help to reduce the ‘reality shock’ which is experienced by many students when they move into practice (Harris et al., 2001). A recent study by Gallagher (2001) showed that, although the portfolio as an alternative form of assessment was well received by students, the link made between theory and practice was not as strong as anticipated. According to Gallagher, this could be due to the fact that in his study the students had no autonomy in developing their portfolios and that the questions in the study were not sufficiently explicit. On the other hand, in a post-registration study by Murrell et al. (1998), portfolios not only brought theory and practice closer together, but also led to improvements in practice and allowed students to take control of their own learning needs. Murrell et al. (1998) did point out, however, that the size of their study was small and the result could have, therefore, occurred by chance. For personal development, rather than only being a medium providing the product of the student’s accomplishments, a portfolio can also be a catalyst for growth. It is claimed that portfolios will help to assess and promote critical thinking (Wenzel et al., 1998) and that the actual process of developing the portfolio itself can
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lead to an awareness of the student’s own skills, strengths and limitations, as well as giving an indication of his or her developmental needs (Priest and Roberts, 1998). Because of their continuous nature and structure of active involvement, portfolios encourage students to develop self-reflection and to take charge of their own, lifelong learning. They allow students to assume ownership and thereby promote a sense of responsibility. This increase in responsibility might create anxiety in some students, but will encourage them to accept accountability and thereby help prepare them for working practice. Over time, as information demonstrating personal growth is accumulated, portfolios will also help students to increase their feelings of self-esteem and confidence (Wenzel et al., 1998; Harris et al., 2001). However, some authors argue that although portfolios are supposed to stimulate the development of selfawareness, personal growth and independent learning, there is little evidence to support these assumptions (Mitchell, 1994; Cayne, 1995). Reflection is a major component of portfolios as it helps students to learn from experience and practice, thereby helping them to bridge the theory–practice gap (Gallagher, 2001). Through the reflective process students are able to identify gaps in knowledge and/or skills and competence (Grant and Dornan, 2001), but also to reconfirm and document strengths, skills and knowledge (Harris et al., 2001). However, there is a general reluctance by students to engage in self-reflection. The focus on fears and weaknesses as well as strengths may be seen as threatening. They may feel uncertain on how to reflect and not all tutors are necessarily good facilitators of self-reflection (Karlowicz, 2000). Also, as most reflection occurs through the written medium, some students’ writing skills will be better than others (Snadden and Thomas, 1998). Mitchell (1994) found a positive correlation between the writing skills of students and the positive feeling they had about portfolio assessment. In her study, in contrast to the literature, students found that keeping a portfolio contributed little to their self-awareness of strengths and weaknesses and, in some cases, that it even reinforced weaknesses without pointing the way to development. She concluded that this occurred because the portfolios in her study were being summatively assessed, while many discussed in the literature were not. As soon as students know that their writing will be assessed they become very reluctant to express their innermost thoughts and feelings. They see it as an ‘invasion of privacy’ and are inclined to write what they think the assessor wants to read (Woodward, 1998; Scholes et al., 2004). The portfolio becomes assessment-led, resulting in reduction in its learning value (McMullan et al., 2003). Clearly a conflict exists between the summative assessment and the learning, developmental value of the portfolio (Gallagher, 2001). Reflective learning is
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most effective when the contents are personal and ‘owned’ by the student. However, summative assessment tends to lead to alteration of the contents, as students become reluctant to include personal incidents, especially problem areas and difficulties. Yet, these are often the incidents that trigger real learning (Harris et al., 2001). Mitchell (1994) sums this up very well: Problems may arise when portfolios are used for both purposes of learning and assessment. Summative assessment included as a purpose of portfolio use may have a profound effect on the way students contribute to their use. It may also affect their experiences and perceptions of the benefits to themselves of portfolio use. Summative assessment could thus lead to reduced ‘ownership’ and developmental use of portfolios by students. Other problems concerning portfolios are related to their compilation and the ethical issues of privacy and confidentiality (Gannon et al., 2001; Dolan et al., 2004). If the students are not assured of the confidentiality of the portfolio’s content, it will become unreliable as an assessment tool as the entries will often be censored. The issue of honesty in portfolios is another important factor in their use. Gannon et al. (2001) suggest that there is a negative correlation between use of the portfolio as an assessment tool and the honesty of the entries, thereby reducing its validity and credibility. Portfolios have also been criticised both for the amount of time it takes to complete and to assess them (Harris et al., 2001). Students additionally express anxiety about the uncertainty of the nature and amount of evidence to provide in the portfolio (Phillips and Bharj, 1996). This anxiety, together with the time- consuming aspect of portfoliokeeping, will often have a negative effect on student motivation (Mitchell, 1994).
3. Aims and objectives When reviewing the literature some interesting issues become apparent, such as the conflict that exists between the use of portfolios as both an assessment tool and as a developmental learning tool. According to the literature, due to this dual use, assessment could have a detrimental effect on the developmental learning value of the portfolio, with the result that portfolio use might become assessment-led (McMullan et al., 2003). Another interesting issue is reflective writing, which is a major developmental component of portfolios. The honesty of reflective writing could be influenced by assessment and, in particular, by the fact whether the assessment is summative or formative (Gannon et al., 2001). Additionally the reflective writing ability of the
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students might influence the way students feel about the use and effectiveness of a portfolio as an assessment tool and as a developmental learning tool (Snadden and Thomas, 1998). Other issues concern the support and guidance given to the student regarding portfolio use, the time it takes to complete the portfolio and the anxiety that preparing a portfolio gives the students. All these issues have been raised in the literature, but so far there exists a paucity of empirical studies, particularly quantitative, which have researched these issues further from a student’s perspective. The aim of this study is therefore to obtain students’ perspectives on the process of using a portfolio in their education as well as their perceptions on the use of the portfolio as both an assessment and learning tool in clinical placement. The objectives are to determine whether students feel that the process of using a portfolio helps them in their personal and professional development, whether they feel portfolios are effective in helping them to learn from practice and how effective they feel portfolios are in assessing their learning and competence. In addition, to determine, from a student’s perspective, whether the use of the portfolio as both an assessment and learning tool reduces the learning value of the portfolio and whether students’ perceptions on the use of portfolios change over time with experience.
4. Methodology 4.1. Sample A total sample of 254 pre-registration diploma of nursing students at one UK university were contacted for the study, consisting of one group of first year (n ¼ 131) and one group of third year (n ¼ 122) students. Both groups used portfolios during their education.
quantitative studies to test statistically these research questions. 4.3. Research instrument The research instrument used for this survey was a postal questionnaire consisting of several sections. Section A provided demographic details such as age, gender and the student’s year of study. The following four sections covered respectively constructs of Personal Development (B), Professional Development (C), Effectiveness of the Portfolio (D) and Portfolio Support and Guidance Received (E). Each of these constructs was made up of 4–7 items that have been raised in the literature, with each item having a five-point Likert response scale, ranging from strongly disagree (1) to strongly agree (5). Likert scales were used in order to determine the strength of the different feelings and opinions held by the students about the use of portfolios. Section F consisted of 10 general statements reflecting research questions raised in the literature. Again, each of these statements had a five-point Likert response scale, ranging from strongly disagree (1) to strongly agree (5). In addition, section F had a question asking respondents if they thought that portfolios, on the whole, were a good thing or not and why. The final section (section G) consisted of an open-ended question offering the opportunity to make any additional comments about the use of portfolios. Face validity of the questionnaire was achieved by review of its format and content by university educators and also through initial pilot testing with second year nursing students (n ¼ 56) who were not included in the main study. Reliability analysis showed that all four constructs in the questionnaire had good internal consistency, with Cronbach’s Alpha Coefficients of, respectively, 0.9, 0.88, 0.86 and 0.89 (Pallant, 2001). 4.4. Research procedure
4.2. Research design The research design chosen for this study was mainly quantitative, with two additional open-ended questions. This approach was chosen partly because the large number of students meant that focus groups or interviews with a smaller sample of students would not have been representative enough of the whole group, but mainly because no previous large-scale correlational survey had been carried out to determine students’ perceptions on portfolio use. The quantitative surveys carried out so far had been of a small scale (n ¼ 30–40) and had been mainly descriptive (Gallagher, 2001). In addition, although the literature had raised some interesting research questions through some small scale quantitative and qualitative studies (Murrell et al., 1998; Gannon et al., 2001), there had been no large-scale
The questionnaires were sent by post to the first year (n ¼ 131) and third year (n ¼ 122) students, with a reminder 3 weeks later. After 8 weeks, at the point of analysis, the total response rate was 69% (174/253), with a response rate of 69% (90/131) for first year students and a response rate of 69% (84/122) for third year students. 4.5. Data analysis The questionnaires yielded both quantitative and qualitative data. For quantitative analysis the statistical package SPSS version 11.5.1 was used. The quantitative data type was either categorical, such as demographic details (section A), or interval (five-point Likert scales, ranging from strongly disagree (1) to strongly agree (5)).
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To form a total score for each construct (sections B to E) the scores of each item in a construct were added together. Both descriptive and bivariate analysis was carried out. Dependent on the purpose of the statistical test and the data type, the bivariate analysis consisted of an independent t-test, a paired sample t-test or a Pearson correlation. To determine the difference between the mean scores between first and third year students the independent t-test was used. The paired-sample t-test was used to measure the same person in terms of his or her response to two different questions rated on the same scale and, finally, to explore the relationship between two continuous variables the Pearson correlation test was used. The qualitative data emerging from the last question in section F and from section G were analysed for recurrent themes (thematic analysis).
Table 1 Participant demographics by year of study
4.6. Ethical issues
they helped them to develop independent learning (mean ¼ 3.39, SD ¼ 1.00, 52% agreed/strongly agreed). Even fewer students (42%) felt that portfolios helped to promote critical thinking (mean ¼ 3.17, SD ¼ 1.03) and only 31% felt that portfolios helped to improve their self-esteem (mean ¼ 2.94, SD ¼ 1.00).
University ethical clearance was obtained for the study. Enclosed with the postal questionnaire was a cover letter informing the students about the study and ensuring anonymity and confidentiality of both the students and their data. Contact details were given in the contact letter in case students required further information before deciding to participate or if they wanted to be kept informed of the results of the study. Students were free to return the questionnaire or not, and could withdraw their data from the study at any time without affecting their relationship with the University. Return of the questionnaire, however, implied consent to participate in the study.
5. Results 5.1. Participants’ characteristics Table 1 shows that most of the first year students (n ¼ 90) were 24 years or younger (39%) and were female (90%). Of the third year students (n ¼ 82), the majority (41%) were in the 35–44 years age group and 89% were female. 5.2. Personal and Professional Development Table 2 shows that, of the 173 students, 74% agreed or strongly agreed that portfolios helped them to take responsibility for their own professional development (mean ¼ 3.78, SD ¼ 0.9), and 60% agreed or strongly agreed that portfolios enhanced their reflective skills (mean ¼ 3.51, SD ¼ 1.05). However, only about half felt that portfolios helped them to become aware of their strengths (mean ¼ 3.25, SD ¼ 0.981, 52% agreed/ strongly agreed) and weaknesses (mean ¼ 3.24, SDF ¼ 0.979, 51% agree/strongly agreed), and that
Year of study First (n ¼ 90) (%)
Third (n ¼ 82) (%)
Age
24 years and under 25–34 years 35–44 years 45–54 years 55 years and over
39 30 23 7 1
16 26 41 15 2
Gender
Male Female
10 90
11 89
5.3. General statements In section F of the survey the students were asked 10 general statements which arose from the literature review. Table 3 shows that students felt that portfolios took a great deal of time to complete (mean ¼ 3.87, SD ¼ 0.893, 73% agreed/strongly agreed) and caused them much anxiety (mean ¼ 3.68, SD ¼ 1.095, 64% agreed/strongly agreed). Only 37% of the students felt they had good reflective writing skills (mean ¼ 3.25, SD ¼ 0.801). A statistically significant negative correlation was found between how good the students perceived their reflective writing skills to be and the anxiety that preparing the portfolio gave them (r ¼ 0.159, n ¼ 174, p ¼ 0.036), with higher levels of perceived reflective writing skills associated with lower levels of anxiety. In addition, as in Mitchell’s (1994) study, a statistically significant positive correlation was found between students’ perceived reflective writing skills and whether they liked the portfolio as an assessment tool (r ¼ 0.189, n ¼ 174, p ¼ 0.012). However, apart from a statistically significant positive correlation between students’ own perceived reflective writing skills and improved confidence (r ¼ 0.162, n ¼ 174, p ¼ 0.032), no statistically significant correlations were found between students’ own perceived reflective writing skills and any of the other personal and professional developmental characteristics, such as independent learning (r ¼ 0.057, n ¼ 173, p ¼ 0.453), awareness of strengths (r ¼ 0.089, n ¼ 174, p ¼ 0.241) and weaknesses (r ¼ 0.018, n ¼ 174, p ¼ 0.818), and
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Table 2 Personal and professional development (n ¼ 173)
Personal Development
Professional development
Strongly disagree/ disagree (%)
Neutral (%)
% Strongly agree/agree
Mean (SD)
Aware of strengths Aware of weaknesses Develop independent learning Value life-long learning Improve self-esteem Improve confidence Responsibility for own professional development
28 28 22
20 21 26
52 51 52
3.25 (.981) 3.24 (.979) 3.39 (1.00)
28 37 32 12
32 32 26 14
40 31 42 74
3.17 2.94 3.15 3.78
Link theory-practice Identify areas where knowledge is good Identify areas where skills are good Identify areas where knowledge is weak Identify areas where skills are weak Promote critical thinking Enhance reflective skills
23 25
26 27
51 48
3.32 (.956) 3.24 (.943)
21
28
51
3.32 (.931)
28
27
45
3.18 (.938)
25
25
50
3.28 (.952)
29 20
29 20
42 60
3.17 (1.03) 3.51 (1.05)
(.974) (1.00) (1.04) (.900)
Table 3 General statements regarding portfolio use (n ¼ 174)
Portfolio takes a lot of time to complete Portfolio causes a lot of anxiety Have good reflective writing skills Difficult reflective writing when summative assessed Difficult reflective writing when formative assessed Like portfolio as assessment tool Like portfolio as learning tool Portfolio both summative and formative assessed increases learning value Portfolio only summative assessed increases learning value Portfolio only formative assessed increases learning value
linking theory and practice (r ¼ 0.054, n ¼ 174, p ¼ 0.478). A possible reason for this is that, for reflective writing to have any developmental learning value, it has to be totally honest. The percentage of students who found it difficult to be critical and honest in their reflective writing was quite large, not only for summative assessment (49% agreed/ strongly agreed, mean ¼ 3.3, SD ¼ 1.01), but also for formative assessment (41% agreed/strongly agreed,
Strongly disagree/ disagree (%)
Neutral (%)
Strongly agree/agree (%)
Mean (SD)
8 20 17 24 26 45 38 42
20 16 46 27 33 31 31 34
73 64 37 49 41 24 31 24
3.87 3.68 3.25 3.30 3.21 2.72 2.86 2.69
35 42
44 46
21 12
2.82 (.858) 2.66 (.788)
(.893) (1.095) (.801) (1.01) (.965) (1.046) (1.024) (.971)
mean ¼ 3.21, SD ¼ 0.965). Analysis showed that on average students found it statistically significantly more difficult to be critical and honest in their reflective writing when this was summatively assessed than when it was formatively assessed (t ¼ 2.576, d.f. ¼ 173, p ¼ 0.011). The very fact that the writing was assessed (whether formatively or summatively) greatly reduced the reflection’s effectiveness, as it became very difficult for students to be critical and honest if their work was
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seen by anyone with any authority or power. Students feared that anything they wrote might be used against them: Reflection is meant to be a personal experience. Can a student really and truly reflect on one’s mentor, personal tutor and lecturer’s attitude, especially if they are unhelpful? The student will be crucified on the wards and in University. I have seen it happen and help from anyone is rare! My reflections are personal. Why should it be judged formatively and summatively? (Third Year Student) Only 24% of respondents agreed or strongly agreed that they liked the portfolio as an assessment tool (mean ¼ 2.72, SD ¼ 1.046) and 31% agreed or strongly agreed that they liked the portfolio as a developmental learning tool (mean ¼ 2.86, SD ¼ 1.024). The difference between the two was found to be statistically significant (t ¼ 2.459, d.f. ¼ 173, p ¼ 0.015), with on average students liking the portfolio more as a developmental learning tool than as an assessment tool. Because of the dual nature of this portfolio, we were interested in determining whether assessment interfered with the learning value of the portfolio and whether this depended on the type of assessment. We, therefore, asked students whether having the content of their portfolios only summatively, only formatively or both summatively and formatively assessed increased its learning value. The percentage who actually felt that assessment increased the learning value was very low (21% agreed or strongly agreed that the learning value of the portfolio increased if the assessment was only summative; mean ¼ 2.82, SD ¼ 0.858), while 24% agreed with this if the assessment was both summative and formative (mean ¼ 2.69, SD ¼ 0.971) and 12% agreed or strongly agreed if the assessment was only formative (mean ¼ 2.66, SD ¼ 0.788). No matter which combination of assessments was used, very few students felt that assessment increased the learning value of the portfolio. There was a statistically significant difference in the increase in learning value that students felt they would
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get whether the content of their portfolio was only summatively or only formatively assessed (t ¼ 2.204, d.f. ¼ 173, p ¼ 0.029). Students felt that if there had to be an assessment of their portfolio content they would prefer only summative assessment (mean ¼ 2.82, SD ¼ 0.858) to only formative assessment (mean ¼ 2.66, SD ¼ 0.788), especially for their clinical skills: It [portfolio] would have more meaning for me if goals were clearly defined with feedback from mentors and tutors plus grades that would encourage learning and motivate me to get the most out of my practiceySummatively assessed—gives you an idea on how you are doing and gives a sense of achievement. (Third Year Student) It is interesting that students on average would also prefer only summative (mean ¼ 2.82, SD ¼ 0.858) to having both summative and formative assessment (mean ¼ 2.69, SD ¼ 0.971), although the difference was not statistically significant (t ¼ 1.462, d.f. ¼ 173, p ¼ 0.145). 5.4. Support and Guidance Table 4 shows that only 32% of the students (n ¼ 174) felt they received clear guidelines on the purpose of the portfolio (mean ¼ 2.75, SD ¼ 1.124), 33% were clear on which evidence they needed to include in their portfolios (mean ¼ 2.72, SD ¼ 1.141) and 21% were clear on how much evidence they needed to include in their portfolios (mean ¼ 2.46, SD ¼ 1.046). When it came to receiving support and guidance on how to use the portfolio only 13% felt they received this (mean ¼ 2.19, SD ¼ 0.933) and only 6% reported having regular feedback sessions (mean ¼ 2.01, SD ¼ 0.829). The amount of support and guidance students received greatly influenced the amount of anxiety students felt about the preparation of their portfolios (see Table 3). We found that a large percentage of students (73%) felt that portfolios took a great deal of time to complete (mean ¼ 3.87, SD ¼ 0.893) and that preparing them was very stressful and caused them
Table 4 Support and Guidance Received (n ¼ 174)
On purpose of portfolio Which evidence to include How much evidence to include How to use the portfolio Regular feedback sessions
Strongly disagree/ disagree (%)
Neutral (%)
Strongly agree/agree (%)
Mean (SD)
47 50 61 71 77
21 17 18 16 17
32 33 21 13 6
2.75 2.72 2.46 2.19 2.01
(1.124) (1.141) (1.046) (.933) (.829)
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much anxiety (64% agreed/strongly agreed, mean ¼ 3.68, SD ¼ 1.095): They [portfolios] take a lot of time and cause a lot of anxiety wondering whether we are putting the right or enough content into them. (First Year Student) It was, therefore, not surprising to find a statistically significant positive relationship between the time it took students to prepare portfolios and the amount of anxiety that preparing a portfolio gave them (r ¼ 0.577, n ¼ 174, po0.0005), with higher levels of time associated with higher levels of anxiety. Additionally, the more anxious the students became, the less they liked the portfolio as an assessment tool (r ¼ 0.179, n ¼ 174, p ¼ 0.036). However, support and guidance received on how to use the portfolio statistically significantly reduced the anxiety that preparing a portfolio gave students (r ¼ 0.19, n ¼ 174, p ¼ 0.012) and statistically significantly improved the way they felt about the portfolio as an assessment tool (r ¼ 0.404, n ¼ 174, po0.0005) and as a learning tool (r ¼ 0.367, n ¼ 174, po0.0005). This was also clearly reflected in the statistically significant positive correlation found between the support and guidance construct on the one hand and the personal development (r ¼ 0.406, n ¼ 173, po0.0005) and professional development constructs (r ¼ 0.4, n ¼ 174, po0.0005) on the other. The more support and guidance students felt they received with their portfolios, the more they felt that the process helped them with their personal and professional development.
SD ¼ 1.064). When it came to the effectiveness of portfolios in assessing learning and competence, only 26% felt that portfolios were very effective in assessing learning (mean ¼ 2.79, SD ¼ 0.966) and 24% in assessing competence (mean ¼ 2.78, SD ¼ 0.939). However, the results did show that increased support and guidance statistically significantly improved students’ feelings about the effectiveness of the portfolio (r ¼ 0.483, n ¼ 173, po0.0005), with higher levels of overall support and guidance associated with higher levels of overall portfolio effectiveness. When third year students results were compared with those of first year students, the former were much less positive about the use of portfolios in their nursing education. Compared with first year students, they felt that the portfolio helped them statistically significantly less with their professional development (t ¼ 2.103, d.f. ¼ 172, p ¼ 0.037) and was overall statistically significantly less effective in helping them to prepare for and to learn from practice and in assessing their competence and learning (t ¼ 2.472, d.f. ¼ 171, p ¼ 0.014). Additionally, compared with first year students, third year students felt they received statistically significantly less support and guidance with portfolio use (t ¼ 2.150, d.f. ¼ 172, p ¼ 0.033). Regarding portfolio design, students complained that they were too big and bulky and that the language used was very repetitive and confusing to both students and mentors. In addition, some learning outcomes were not appropriate to particular practice placements, and students felt that they ended up concentrating more on getting everything ‘signed off’ rather than learning more about their placement areas and clinical skills:
5.5. Portfolio Effectiveness The level of support and guidance given to students with their portfolios also influenced their feelings about its effectiveness. Table 5 shows that when respondents (n ¼ 173) were asked how effective they felt portfolios were, the majority did not seem to think they were very effective. Although 42% felt that portfolios were very effective in helping them to learn from practice (mean ¼ 3.10, SD ¼ 1.079), only 29% felt that they helped them to be prepared for practice (mean ¼ 2.76,
Most assessors don’t understand what is needed. It took me a while myself to know how much and which evidence is neededyThe way things are worded is confusing, surely they could be better worded so it doesn’t take half an hour to know what they mean. They repeat quite a bit alsoyTo fulfil the criteria for completing a portfolio, students waste valuable time finding sometimes irrelevant information to include as evidenceyIn my experience they cause unnecessary worry and added pressure. (Third Year Student)
Table 5 Effectiveness of the portfolio (n ¼ 173)
To prepare for practice To learn from practice Assessing learning Assessing competence
Strongly disagree/ disagree (%)
Neutral (%)
Strongly agree/agree (%)
Mean (SD)
48 30 42 43
23 28 32 33
29 42 26 24
2.76 3.10 2.79 2.78
(1.064) (1.079) (.966) (.939)
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6. Discussion Portfolios are used both for personal and professional development at both pre- and post-registration levels in nursing education in the UK. According to the literature, they encourage students to enhance their reflective skills (Grant and Dornan, 2001) and help them to become aware of their strengths and weaknesses (Priest and Roberts, 1998). They help students to take responsibility for their own professional development and promote critical thinking (Wenzel et al., 1998). In addition, they help students to develop independent learning and increase their feelings of self-esteem and confidence (Harris et al., 2001). Although in our study they did help students to enhance their reflective skills and to develop a sense of responsibility for their own professional development, when it came to stimulating the development of self-awareness, independent learning, critical thinking and self-esteem, support for these assumptions from a student perspective was not as strong as anticipated, confirming Mitchell (1994) and Cayne (1995) results. A possible reason why students in our study reported that portfolios helped them to enhance their reflective skills but not their critical thinking skills, even though critical thinking is an important component of reflection, could be due to the amount of support and guidance students feel they receive with their portfolio use. If students, as the students in this study reported, do not receive ongoing support and guidance and regular feedback sessions on how to use the portfolio and on how to reflect, their reflective skills will remain shallow and the deeper critical thinking skills will not develop sufficiently. Additionally, our study found that third year students were more disillusioned with the use of portfolios than first year students. The findings suggested three main linked reasons for this, namely the amount of support and guidance students feel they receive with their portfolio use, the design of the portfolio and the conflict between using portfolios for both assessment and learning. Regarding support and guidance, for the use of portfolios to be successful the literature argues that it is essential that students receive clear guidelines on their purpose, content and structure (Gannon et al., 2001). Additionally, students will require ongoing support and guidance on how to use portfolios, with regular feedback sessions to know that they are on the right track (Grant and Dornan, 2001). In our study, the students overall did not seem to feel they received enough support and guidance with their portfolio use. This greatly influenced how they felt about the portfolio as an assessment and learning tool. They felt that portfolios were very time-consuming, causing them a great deal of anxiety, and were not very effective in assessing their learning and competence. However, our
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study did show that for portfolio use to be successful clearly ongoing support and guidance is essential, as this will reduce the anxiety that preparing a portfolio give students, and improve the way they feel about the effectiveness of the portfolio as an assessment and learning tool and the use of portfolios for their personal and professional development. However, for portfolios to be successful, it is important that both students and mentors in practice receive support and guidance with their use. Mentors are often very busy and may not have enough time to devote to students. Additionally, like students, mentors find portfolios very time-consuming and stressful, mainly due to the large amount of paperwork, which in many cases is repetitive, unclear and not always appropriate to that particular practice placement. If mentors do not understand how to use portfolios and cannot themselves provide support, guidance and feedback to students, the latter will become demoralised and the value of portfolios will be diminished. Concerning portfolio design, our results indicate that at present they are designed in a way that actually reduces their overall learning value and that of the placement. Students feel that they end up concentrating more on getting signatures than on learning about their placement areas and clinical skills. Yet, to be able to know that they are competent to practise, they do want to continue to obtain placement feedback and assessment, especially of their clinical skills. However, the mode of assessment should be clear to both students and mentors, relevant to practice and not too numerous. A suggestion was made by some students that the portfolio should contain a summative assessed clinical skills list to motivate them and promote safer practice. In addition, instead of chasing up signatures for learning outcomes that were not always achievable, students would prefer mentors to write a formative report at the end, and perhaps in the middle, of the placement, which would include their strengths, weaknesses and any skills achieved. This would give them more thorough feedback and would improve their sense of achievement. Having mentors writing only one or two sets of progress reports would also reduce the time-consuming nature of portfolios for them, thereby giving them more time to spend with students. According to the literature, a key feature of the portfolio is that it contains evidence of achievement of learning outcomes (Crandall, 1998). To demonstrate learning for the owner, it is essential that the portfolio does not just contain a collection of evidence, but also shows how the student reflects on these items. Developmental learning is achieved through reflection and by applying practice back to theory so that the gap between the two is reduced (Girot, 2000). In our study, only 51% of students felt that the use of portfolios helped them to
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link theory and practice, 42% that the process of using portfolios helped them to learn from practice and only 31% liked the portfolio overall as a learning tool, thereby confirming Gallagher’s (2001) finding that portfolio use does not strengthen the link between theory and practice as much as anticipated. A probable reason for this arose through our qualitative analysis. Students felt that the portfolio appeared to focus more on theory and academic skills of writing than on practical clinical skills, thereby actually increasing the gap between practice and theory. Although reflection does help to link practice to theory, it does this through academic writing. What students really are nervous about in placement, and require feedback on, is practical clinical skills and their application of theory to practice. However, they feel that the emphasis of the portfolio is too much on theory and academic reflective writing, and this does not acknowledge enough the importance of clinical skills. Without this students may qualify as nurses but still not be sure that they have the necessary clinical skills. Additionally, although students like the process of reflection to help them link practice and theory, the study showed that they feel that they cannot be totally honest and critical in their writing if this is seen by anyone in authority or power. For reflective writing to have any developmental learning value, it has to be absolutely honest. Writers must have total freedom of expression and feel that they can be critical if need be. When students know that their writing will be assessed, they become reluctant and guarded in expressing their thoughts and feelings, and are inclined to write what they think that assessors want to read. The reflective writing thus becomes assessment led, resulting in a reduction of its learning value (McMullan et al., 2003). Although literature has reported the conflict between summative assessment and the developmental value of the portfolio (Gallagher, 2001), this study showed that any assessment, whether formative or summative, will reduce the learning value of reflection and thereby the effectiveness of reflective writing in linking practice and theory. However, although the study indicates that any assessment reduces the learning value of reflective writing, and of the portfolio, students find the process of reflection important for their developmental learning. Yet, paradoxically, if the pressure of assessment is not present students might not reflect. A possible compromise might be to use peer assessment for reflective writing.
7. Conclusion Portfolios can be very effective as an assessment and learning tool, but it is essential that both students and mentors receive clear guidelines on and comprehensive
support with their use, thereby reducing the anxiety that preparing a portfolio gives students. Without these, students and mentors will become increasingly stressed and demoralised with the use of portfolios in practice. It is also important to place portfolio use into context. Ideally they should be designed in such as way that they are relevant, clear and user- friendly for both students and mentors, and so can be used effectively in an environment that is extremely busy and stressful.
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