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Mapping the learning journey of community nursing students in a digitalised world

22 July 2021

Cathy Taylor looked at the perceptions of nurses when using e-portfolios to record their work. Here, she discusses the benefits and pitfalls of digital recording, and its potential for expansion.

Author:

Cathy Taylor is an associate professor at the department of nursing, Swansea University. 


Research summary

  • This evaluative study explores the perceptions and experiences of community nursing post-registration students while using an e-portfolio. 
  • Traditionally, students submitted portfolios as paper copies; however, a new electronic version was implemented using Pebble+ as a software platform.
  • A predominantly qualitative approach explored students’ views and experiences of using the e-portfolio in practice.
  • Findings demonstrate that students value the e-portfolio, and overall found it a positive experience. However, some barriers were evident, including the availability of wi-fi (especially in rural areas) and access to expert technical support.
  • Successful implementation of the e-portfolio has had a positive impact for students, practice partners and the teaching team.

Introduction

Community nursing programmes at Swansea University have used portfolios for a number of years, mainly as a learning tool to assess student learning and competence while students are in clinical practice placements (McMullan, 2006; Murray et al, 2006; Coffey, 2005). More recently, momentum in technology due to Covid-19 and an increase in use of digital media across the globe has presented new challenges for education. Previously, Wright and Tabony (2016) reported how an e-portfolio had been successfully implemented to assess specialist community public health nursing (SCPHN) students in practice, suggesting the e-portfolio had been useful in allowing students to link theory to practice in an ‘organised, systematic way’. This success seemed enviable and gave momentum to the development of a new e-portfolio at Swansea, implemented with a cohort of new post-registration community nursing students. This paper discusses a study that aimed to explore the perceptions and experiences of post-registration community students when using an e-portfolio for the first time.


Background

A portfolio has been described as ‘a collection of evidence that is gathered together over a period of time to show a student’s learning journey’ (Butler et al, 2006: 2); a dynamic record of the student’s learning, professional development and growth (Murray et al, 2006). It may contain different types of evidence, including achievement of learning outcomes, self-evaluations, short placement experiences, authentic learning tasks and reflective pieces; the ultimate goal is to showcase personal achievement and professional development through reflective thinking and critical analysis over a period of time (McMullan, 2006). A portfolio is a crucial assessment element in community nursing programmes, key to providing evidence of fitness to practise for registration through the achievement of competencies using a reflective pedagogy (Pincombe et al, 2010). The process of collecting evidence as well as deliberating about it enables students to become active participants in their learning (Smith and Tillema, 2006). This concept of active learning embraces Vygotsky’s constructivist learning theory where new knowledge and learning moves forward through planned interaction, a process of scaffolding (Coombs, 2018; Spouse 1998), ensuring support and challenge at the right time.  

Currently there is an increase in expectation and demand to use technological pedagogies to promote active leaning; the goal is to enhance the student experience through a digital culture. For this to be successful, it is essential that attention be given to both the capabilities of students as well as educators and practice partners. Currant et al (2008) suggest that not all students are ‘digitally ready’ when they arrive at university and that it is dangerous to make assumptions about what ‘Generation Y’ students want from and can do with technology. 

They acknowledge that students come to university with different experiences and skills and suggest educators need to consider the individual typologies of digital learners when planning new digital learning activities. The Joint Information Systems Committee (JISC, 2015) suggests that it is not only important to consider individual students’ digital capability when implementing new technologically enhanced learning approaches but also the level of confidence and experience that educators have in using technology. Andrews and Cole (2015) suggested that staff commitment or educator ‘buy-in’ can affect the acceptance of using a tool such as an e-portfolio, suggesting that previous success or failure when using technology can influence their enthusiasm to implement a new technological innovation such as an e-portfolio.

Within the nursing profession, while historically there has been agreement on the value of portfolios to demonstrate professional ability for registration purposes (McMullan, 2006; Murray et al, 2006; Coffey, 2005), nursing portfolios at Swansea have predominantly been submitted by students in paper format. The evolution to an electronic format is viewed as a challenge to implement, requiring enhanced technological skill and robust software packages to ensure protection of confidentiality and intellectual property rights (Challis, 2005). JISC (2008: 6) defines an e-portfolio as ‘the product, created by the learner, a collection of digital artefacts articulating experiences, achievements and learning’. An e-portfolio provides an interactive learning object or landscape (Mihram, 2004), a space where students can document new experiences, allowing scaffolding of new areas of meaning and learning. Many benefits of e-portfolios have been discussed in the literature (Ryan, 2018; Birks et al, 2016; Wuetherick and Dickinson, 2015; Joyce, 2005), suggesting an increase in student accountability and autonomy, enhanced learning, development of professional skills, and the ability to share work easily while being able to track, reflect and evaluate learning (Green et al, 2014). However, the reason for using e-portfolios should be carefully considered, with Robertson (2017) suggesting caution to ensure the right pedagogic model is used for portfolio development; the technology is only of value to create the right environment to support the approach. 

Internationally, in recent years, there has been a drive to move from paper to electronic versions especially in health-related professional programmes. Mason and Williams (2016) discussed the use and value of e-portfolios to assess undergraduate paramedic students in Australia, while Lopez et al (2011) reported on the development of an e-portfolio system in a school of pharmacy in Texas. Pincombe et al (2010), Andrews and Cole (2015) and Birks et al (2016) presented student experiences and perceptions of using e-portfolios in both nursing and midwifery in Australia, and Nielsen et al (2015) reported on the use of an e-portfolio on a 10-week nursing course in Denmark. The different studies highlighted strengths and challenges of its implementation and use. 


Study aim

In view of this, it was decided to develop an e-portfolio for students enrolled on post-registration community nursing programmes. Traditional paper-based clinical portfolios had been used for a number of years; these have been essential in providing key evidence as to whether students were fit for purpose to gain registration with the NMC as a community practitioner. Programmes require a 50% theory and 50% practice component; students must demonstrate the achievement of competencies through the completion of a clinical portfolio to pass the programme and successfully register with the NMC. As educators it was important to improve the availability and portability of the existing portfolio towards an electronic version. Concurrently, it was noted that colleagues within other universities had already successfully implemented an electronic portfolio for a similar purpose thereby increasing impetus for the development of the e-portfolio at local level.

Initially, the team piloted an electronic version of the All Wales Clinical Practice Portfolio assessment document that had originally been developed by all four universities in Wales. The e-portfolio in essence became an electronic version of the original paper portfolio but had the additional aim of creating an online environment where the student could record evidence of their learning in a new, more dynamic way. The e-portfolio enabled the student to record evidence of experience and competency and allowed personal academic mentors to give quick feedback, achieve swifter marking and verification of competency to take place. The pilot (albeit small) reported positive feedback from both the student and practice assessor, providing motivation to expand its implementation. Other students from the same cohort requested the e-portfolio, asking ‘Why can’t we have this as well?’, providing further incentive for its on-going development. With the assistance of a dedicated e-learning lecturer, the e-portfolio was later made available to all students on community programmes. This included health visiting, school nursing and district nursing students enrolled both on a full-time and part-time basis. 


Method

It was essential to report on the experiences of these students; the aim was to explore and review the perceptions and experiences of students when using the e-portfolio. The objectives were to identify the perceived value and role of the e-portfolio, alongside the benefits and barriers that may have influenced its use. Essentially, the study wanted to determine the e-portfolio’s usability and evaluate how beneficial it was for students studying on post-registration community programmes while on clinical placement.

A predominantly qualitative approach was used to explore students’ views and experiences of using the e-portfolio in clinical practice. To achieve data for the study, an exploratory questionnaire was used to address the research aim and objectives.  

Participants were purposively selected using the following inclusion criteria that all students were deemed to be a NMC registrant, aged 18 or over, be currently enrolled on a post-registration community nursing programme, and that all participants had a designated practice placement where they would be using the e-portfolio as a learning tool.

The University Ethics Committee granted permission for the study. All participants were provided with a written information sheet about the study. The information sheet explained the aim and rationale behind the study. All participants were assured that their views would be highly valued and that participation in the study was voluntary. All data gathered would be confidential to the researchers with anonymity retained by the researcher. Prior to being given the questionnaire, the researcher explained the rationale behind the selection of participants and clearly ensured the aim and objectives of the study were discussed to relieve any potential concerns. As is common practice, it was assumed that consent was given if the participant completed and returned the questionnaire. Standard processes to ensure validity and rigour in qualitative research were employed (Holloway and Wheeler, 2009). An ‘audit trail’ was maintained throughout the study.


Results 

Forty-five out of 50 students completed the questionnaire, giving a response rate of 90%. (Twenty-eight students were district nursing students, 14 health visitors and three were school nurses). Ninety-eight per cent of participants (n= 44) were female, with only one male respondent. Twenty-four per cent (n=11) were aged 20 to 30 years, 38% (n=17) aged 30 to 40 years, and 38% (n=17) aged 40 to 50 years. Sixty per cent (n=27) were enrolled on a BSc/graduate diploma community nursing programme, the remaining 40% (n=18) on a postgraduate diploma community nursing programme.

Introduction of the e-portfolio

Participants were asked whether they had used IT on a regular basis prior to starting their programme. A majority of 80% (n=36) stated that they had used IT before for both leisure and work purposes, saying:

‘Within my clinical workstation/portal to access results’ (SCPHN 1).

‘Ward acuity data base’ (SCPHN 6).

and social activities such as:

‘Shopping, banking, travel and social media’ (DN 4, 9, 10, 17). 

However, when asked if they had used an e-portfolio before, only four respondents said that they had, with one respondent stating that they had used an e-portfolio when undertaking previous studies at another university. Participants were asked whether they felt they had received clear guidance on how to use the portfolio at the start of the programme, with 75% (n=30) stating that guidance was clear but a little overwhelming. Sixty-four per cent of respondents felt that the e-portfolio was useful as it helped to guide their learning while in practice:

‘Instant access to it and the ability to share with practice and tutors. It would be with you always so if you had an ad hoc hour you could spend time with it in practice’ (DN 8).

‘I feel the e-portfolio is useful to guide learning as it is an easy and efficient way of demonstrating the development of skills and knowledge in clinical practice’ (SCPHN 11).

‘Useful to keep track of reflections and professional development’ (SCPHN 5).


Usability and ease of use

In order to find out how students felt about the usability of the e-portfolio they were asked to respond to questions using a 1 to 5 point Likert scale (1 strongly disagree to 5 strongly agree). Sixty per cent of respondents either agreed or strongly agreed that the e-portfolio was easy to use, 58% (n=26) stated that navigating the e-portfolio was easy, and 75.5% (n=34) found accessing it easy with 58% (n=26) stating that it was generally easy to add and upload evidence:

‘I had difficulty at first downloading the assets but with practice it became much easier’ (SCPHN 10).

‘I found it good when taking a photo to add for evidence’ (DN 15).

However, some less positive issues were reported with regard to usability:

‘I could not upload things such as signatures from the app but this could have been my phone’ (SCPHN 6).

‘I work in a rural area (no wi-fi etc) so I couldn’t access it via the iPad unless at home- would have liked to download it for it to be accessible offline’ (DN 11).

In relation to accessing support if technical issues arose, 58% felt that this was sufficient but some did comment that there was sometimes a ‘time delay’ in gaining an answer or a response to their queries:

‘A direct contact to troubleshoot issues with rather than via the lecturers would have been useful (DN 5). 

‘A live chat may be useful as not easy to get hold of staff to help with issues’ (SCPHN 1).

Benefits and barriers

Participants were asked as to whether they preferred using an e-portfolio instead of a paper version. Sixty-nine per cent (n=31) agreed that it was better, stating the e-portfolio offered:

‘Easy access, tidier and easy-to-store information. And I can write more in some elements and you don’t have the risk of losing the paper version’ (SCPHN 3).

‘Once I had become familiar with it, it was easy to use, submitted automatically, didn’t have to travel in to submit’ (DN 7).  

However, 58% (n=26) of participants stated that they experienced some technical difficulties at some point with one respondent revealing:

‘Initially I lost some work and this has caused some anxiety’ (DN 20).

Despite this, 71% (n=32) of the cohort stated that they felt that the e-portfolio successfully showcased their learning over the course of the programme:

‘I could reflect in practice and update my portfolio in real time’ (DN 13).

When asked to rate their overall experience of using the portfolio, 91% (n=41) reported that their experience had been good or above: 

‘I would highly recommend the e-portfolio’ (DN 9). 

‘Easy to access and found having an e-portfolio better than a paper portfolio due to it being more organised’ (DN 13).

‘I believe that the e-portfolio is better than the paper version. However, it may prove difficult if students don’t have a great amount of IT experience. Therefore more guidance throughout the year would be beneficial’ (SCPHN 3).

Only 9% (n=4) suggested that their experience had been mixed:

‘Some aspects good and some poor, with some tweaking could be good, should continue’ (DN 11).


Discussion 

From the findings, it can be established that the overall student experience of using the e-portfolio was positive. This seemed to be irrespective of age or gender, with no significant difference in the responses to the questionnaires noted. Initially, at the start of the programme, despite the majority of students having a first degree, it was felt that not all students in the group were ‘digitally ready’ and seemed to have various skills of digital competence. 

For example, nearly all students displayed confidence in performing basic IT tasks such as browsing the internet or responding to an email, but many during the initial induction session displayed anxiety when asked to use the e-portfolio, concerned that they might ‘lose their work’ or that some sections would ‘not be saved correctly’. 

Despite the e-portfolio having a structured design with clear guidance and standardised templates, some students displayed anxiety in relation to what evidence to include, stating they felt confused. Martin and Grudzieki (2006) identified using a three-stage approach to training where students could develop their digital literacy. This includes digital competence to enhance skills, digital usage to improve application and digital transformation ensuring that digital usage is developed over a period of time. In relation to our SCPHN programme, the restricted timeframe of one year made this staged approach difficult to organise, which may explain why some students felt overwhelmed during the early stages of using the e-portfolio. 

Many students felt that the e-portfolio was useful in that it enabled them to showcase their learning, demonstrating achievement of competencies and skills. Throughout the duration of the programme, it could be seen that some students developed increased confidence in using the e-portfolio with some adding different creative assets and banners personalising their e-portfolio demonstrating individual ownership of personal learning spaces.

Students commented that the e-portfolio was user-friendly but did suggest that some areas were occasionally repetitive; this is a design fault of the workbook rather than the e-portfolio. Students liked the e-portfolio’s portability and the ability to share their workbooks with their practice assessors. Academic mentors were also able to tap in and track their student’s progress over time, enabling instantaneous feedback and support to occur, strengthening the links between academia and clinical practice. This gave ‘added value’ to the e-portfolio as areas for improvement could be discussed in tutorial time and with the practice assessor as required.

Some students did not always find using the e-portfolio easy and occasionally needed technical support to help them resolve a problem. It was important when planning the implementation of the e-portfolio that the team secured the support of an e-learning lecturer who had knowledge of the software platform so that support could be offered to students as required. This was important as some students reported dissatisfaction when technical issues arose. Some expected an instantaneous response and wanted to discuss issues face to face. When this occurred, it was usually with a member of the lecturing team, who often did not have the expertise to answer and resolve complex technical difficulties and had to refer on to achieve resolution, which meant a time delay for the student.

Other barriers included the availability of wi-fi and computer access, especially when students were based in placements in rural areas of Wales where internet connection was not always sufficient. Some students did not always have their own personal IT devices, but all students did have access to a mobile phone while on placement which allowed them to use the software application; this is a barrier of the environment rather than of the technology itself. On a positive note, students were able to auto-submit their portfolios electronically without travelling in – essential during Covid-19 lockdown – which unsurprisingly increased their overall satisfaction.

At the outset of the programmes, students were informed that the development and implementation of the e-portfolio was in its infancy. Both students and practice assessors had previously been involved in the co-construction of the paper version of the All Wales Clinical Portfolio and were enthused and motivated to take its development on to a new stage. Despite being familiar with the contents of the paper portfolio, all practice partners were offered training on the software platform at the outset of the programme, and practice assessor involvement was crucial to ensure smooth implementation enhancing the chances of success.


Implications and recommendations

Further suggestions identify that more training and support would be beneficial. A staged approach to developing students’ digital literacy needs further consideration. The aim is to give bite-size information to help minimise student feelings of being overwhelmed at the start of their programme. This invitation could be further extended to practice partners in order to reinforce new knowledge and skills.

One student suggested that to improve technical support, virtual drop-in sessions could be offered by technical experts. One respondent suggested a dedicated ‘live chat’ system and pre-recorded videos which would be beneficial offering further guidance and simple dos and don’ts.

A limitation of this study was that the sample size was relatively small, performed with just one cohort of students. However, a high response from the cohort provided a comprehensive reflection of their experiences using the e-portfolio. As only one software platform was used, it is recognised that extensive research using a range of e-portfolio software platforms and a larger sample would provide a more rounded picture.


Conclusion

This study has explored and evaluated the use of an e-portfolio with community nursing students. It has demonstrated that students have reported a positive experience of its use despite experiencing some challenges. Importantly, students found that it enabled them to effectively showcase their learning and provide evidence of competency, enabling professional registration with the NMC. 

The overall impact of the e-portfolio as a new digital innovation has been successful. It is worthy of consideration for all professional practitioners to use as a future tool to record evidence for professional revalidation and continuing professional development activities. The introduction of the e-portfolio represents an innovative change in the approach to the recording and presentation of evidence for professional registration. Development will continue to evolve, with further implementation scheduled for community programmes in the next academic year. This innovation has the potential to expand to other professional programmes that require a tool for students to demonstrate clinical competence, reinforcing the links between academia and clinical practice.

Image credit | iStock


References

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