Critique the Collection of Evidence in Your Portfolio

Critique the collection of evidence in your portfolio that support the achievement of two NMC proficiencies in the Care Delivery domain. In this essay, I will evaluate my own ability to generate reliable and valid evidence in my portfolio in support of two NMC proficiencies from the Care Delivery domain (NMC, 2004) at Bondy (1983) level 2. I will critique a cross section selection of my portfolio, identifying my strengths and limitations in demonstrating the achievement of the proficiencies in practice through supporting evidence and develop and action plan to develop my knowledge, skills and attitude around the chosen proficiencies.

The NMC (2004), under the Nursing and Midwifery Order (2001), are required to maintain a register of all qualified nurses and midwives, and establish standards of proficiencies that students on pre-registration courses must achieve in order to gain entry to their relevant part of the register. Each standard of proficiency requires supporting evidence to verify achievement; this is in the form of a portfolio.

A portfolio is a varied collection of evidence, with the aim to convey the qualities, competencies and abilities of the owner, whilst demonstrating both achieved and potential development, conventionally consisting of written reflective, critical accounts (Brown 1995). Portfolios are essential in nursing to integrate theory into practice, addressing the issue of the theory-practice divide and therefore upholding evidence based practice (Jasper, 1995).

For student nurses, portfolios are beneficial because this principle of applying theory to practice results in the reinforcement of learning through the process of re? ction (Lambeth et al. 1989). McMullan et al (2003) stated that this learning process had two sides that combine together and enhance each other; the professional, practical skills and experience student nurses learn and gain on practice placements and the academic side where the student acquires knowledge and skills through the research for their portfolio evidence, such as problem-solving and critical thinking.

I will be assessing a varied cross section of my portfolio evidence considering the categories of data from Webb et al’s (2003) study, as seen in Table 1 below, based on Guba and Lincoln’s (1985,1989) criteria for valuating qualitative research, in order to critique the validity and reliability of my portfolio evidence. Validity is the measurement of what is claimed to be measured and reliability is the constancy of this measurement (Carter, 1991). Table 1: The categories of data from Webb et al’s (2003) study, mapped against criteria for evaluating qualitative research. (Based on Guba and Lincoln, 1985,1989) The first standard of proficiency for which I will critique my portfolio of evidence is 2. 5. 1:

Ensure that current research findings and other evidence are incorporated in practice. NMC, 2004) As seen in the two Assessment Results pages of my OAR (Appendices 1 and 2), I achieved Bondy level 2 during my acute placement and Bondy level 3 during my health visitor placement. During the acute placement, I submitted # pieces of evidence to support this proficiency, and during the health visitor placement I submitted # pieces of supporting evidence (Appendices 3). For the cross-sectional appraisal of my evidence I have chosen to evaluate the following pieces: Health Visitor WB1; Health Visitor WP1 and; Acute RW1. The first portfolio evidence I will critique is WB1 (Appendix 5) from my Health Visitor placement.

As part of the child branch programme, I was given a workbook to help me to understand nursing care delivery in a community environment. This evidence piece is the first exercise in the workbook that encouraged me to think of the overall health in the local area of my practice placement, Lincoln. I looked at the statistics regarding the socioeconomic, cultural and environmental health of Lincoln, relating back to and comparing with the caseload at my practice placement. The NMC (2004) proficiency 2. 5. 1 has been achieved in WB1 as I incorporated a variety of current research and other evidence throughout.

For my evaluation of Lincoln’s overall health, I consulted and referenced sixteen different sources, counting each unique source only once, even if the same source had been consulted for a separate piece of research elsewhere in WB1. These sources were diverse in status and nature; I included figures from the 2001 Census, the Office for National Statistics and the local county council, related and compared them with the caseload I saw during that placement, and explained the comparison incorporating knowledge and theories from research articles, books and other literature, conveying clearly how I came to my conclusions.

WP1 (Appendix 6) from my Health Visitor placement is a work product in which I examined the use of information technology in nursing and how it presented in my practice placement, through the software SystmOne. I briefly discussed legislation regarding confidentiality issues and best practice regarding record keeping according to the NMC (2008) Code of Conduct. I discussed how SystmOne is used in my placement area and example scenarios of each aspect of use that I mentioned.

The NMC (2004) proficiency 2. 5. has been achieved in WP1 as I incorporated current research and other evidence. I included only three unique sources for this piece, but as this piece was more a description of SystmOne’s use, this amount, though less, is adequate, especially as they were incredibly diverse in that I included legislation, the NMC’s (2008) Code of Conduct and a research article all reinforcing the same point, in other words, I used triangulation (Miles and Huberman, 1984). RW1 (Appendix 7) from my acute medical placement is a reflection of my learning to feed via nasogastric tube (NGT).

I explained why a nurse would need this skill, discussed different circumstances where NGT may be used and developed a fictitious care plan based on one of those stated circumstances. I then went on to explain the procedure of feeding via NGT, including how to check correct positioning, how to calculate feed amounts, and the actual process of feeding via NGT and correct record keeping. Throughout the piece, I incorporated current and relevant research and guidelines, with basic referencing, and discussed and explained that unpredictable circumstances could arise, and how to adapt practice to each individual situation.

The NMC (2004) proficiency 2. 5. 1 has been achieved in RW1 as I incorporated current research and other evidence. Again, I included a lesser amount of sources for this piece, and though I proved that I base my nursing practice on current research and other sources, I should have included more in my evidence, as I made many points in this reflective piece that went unsupported. In each of these pieces, I incorporated data and research to support evidence of my practice. This in itself is achieving NMC (2004) proficiency 2. 5. 1.

Including and identifying these sources to support my evidence shows the credibility of my work. However, there were no reference lists, in any of the evidence, to illustrate precisely which works, articles, data or other source the information came from. This detracts from my portfolio’s dependability (Webb et al, 2003), and not providing links to online sources devaluates the confirmability (Webb et al, 2003). Also, in two of the three pieces critiqued, I did not use triangulation; including multiple sources reinforcing one point to show that various independent sources agree (Miles and Huberman, 1984).

Using triangulation would have enhanced the validity of my work (Mathison, 1988), and I only used triangulation in WP1. I did, however, in each of these pieces, include a comprehensive audit trail showing how my conclusions were drawn. I showed reliability, as seen in my APR (Appendix 3), as I proved my achievement of the proficiency in several different pieces of evidence. Altogether, these three pieces are valid portfolio evidence, because I used several supporting sources, and had a clear audit trail. My portfolio also showed reliability as I proved repeatedly my achievement of this proficiency throughout my portfolio.

Nevertheless, I need to use triangulation in my evidence, and include comprehensive reference lists, with links to online sources. The second standard of proficiency for which I will critique my portfolio of evidence is 2. 8. 3: Recognise the need for adaptation and adapt nursing practice to meet varying and unpredictable circumstances. (NMC, 2004) As seen in the two Assessment Results pages of my OAR (See Appendices 1 and 2), I achieved Bondy level 2 during my acute placement and Bondy level 3 during my health visitor placement.

During the acute placement, I submitted # pieces of evidence to support this proficiency, and during the health visitor placement I submitted # pieces of supporting evidence (See Appendices 4). For the cross-sectional appraisal of my evidence I have chosen to evaluate the following pieces: Acute RW1; Health Visitor AP1 and; Health Visitor WP2. RW1 (Appendix 7), the reflection of my learning to feed via nasogastric tube, also proves my achievement of NMC (2004) proficiency 2. 8. 3, as throughout the piece I discussed and explained that unpredictable circumstances could arise, and how to adapt practice to each individual situation.

I proved my achievement of NMC (2004) proficiency 2. 8. 3, as I recognised when I might need to adapt my nursing practice in the context of feeding via NGT. For example, when explaining that positioning of the NGT can be confirmed by checking the pH of the aspirates is within normal range, I showed recognition that some cases may deviate from the norm, gave the example of medication side effects, and then stated an alternative method for that situation, supporting this point with referenced current research. AP1 (Appendix 8) from my Health Visitor placement is an action plan I formulated using Doran’s (1981) SMART principles.

I identified my four main aims for the placement in my first week and used the SMART principles to guide my planning of how to achieve these aims, resulting in twelve different goals to achieve in order to facilitate the meeting of my four original aims. I added a last column with tick boxes and my mentor’s signature at the bottom shows that she agreed that I achieved all the aims on my action plan through the SMART goals, by the final interview deadline I had set myself. I proved my achievement of NMC (2004) proficiency 2. 8. in the most basic method through this action plan, as I stated as one of my goals that I would take part in interventions when a child is not presenting as normal.

This goal was ticked and signed, proving that I had achieved this, through verification by my assessor (Webb et al, 2003), in this case my mentor. WP2 (Appendix 9) from my Health Visitor placement is a work product where I examined my involvement in the Health Visiting Service, relating this to the four main categories of nursing care delivery in the community: Health Surveillance; Health Protection; Health Promotion and; Health Actions.

I produced a table to show what the Health Visiting Service offers as part of their universal core programme and gave examples of individual needs of service users outside of this programme. I then went on to discuss my involvement in these activities, identifying which category the activity belonged to, after defining the categories. I proved my achievement of NMC (2004) proficiency 2. 8. 3 in the “Health Actions” part of WP2, as I spoke about the interventions I took part in outside of the universal core programme, in this context; individual needs.

This whole section is about children who are not presenting as “normal” and the extra support they would need from the health visiting service. I identified many different scenarios and discussed how nursing care would be adapted to those situations. However, I did not use any supporting evidence to prove my achievement of this NMC (2004) proficiency. On the other hand, my achievement is confirmed again through my mentor’s signature, as verification by my assessor (Webb et al, 2003). For both AP1 and WP2, my main method of demonstrating my achievement of the NMC (2004) proficiency is through verification.

Webb et al (2003) explained using verification in this manner within a portfolio as demonstrating the evidence is sufficiently thorough to demonstrate student competence. Nevertheless, I still incorporated data and research in these portfolio pieces, though simply not in support of the proficiency 2. 8. 3. I did, however, support the achievement of this proficiency in RW1, as I referenced current research directly relating to my recognising the need for and adapting nursing practice. For each of these pieces, I did not use triangulation to enhance the validility of my work, and still I have not included an all-inclusive reference list.

Again, though, I have shown reliability in achieving this outcome as seen in my APR (Appendix 4), as I proved my achievement of the proficiency in several different pieces of portfolio evidence. Altogether, these three pieces are valid portfolio evidence, through verification for two and supporting evidence for the other, and all had a clear audit trail. Nevertheless, triangulation in my evidence and the inclusion of reference lists is proving to be a recurring weakness throughout my portfolio.

During this evaluation, I have identified the strengths and limitations of my capacity to generate reliable and valid evidence in a cross section portfolio to support achievement of the NMC (2004) proficiencies at Bondy (1983) level 2. These strengths included credibility, as I included current research and other sources in my evidence, and clear audit trails, conveying precisely how I drew my conclusions in each piece. Another strong point is verification, as all my pieces were signed by my practice mentors, and reliability as I repeatedly proved my achievement of the proficiencies through numerous pieces of portfolio evidence.

However, my weaknesses showed I need to use triangulation to reinforce the validity of my work, and to increase my works dependability and confirmabilty by including comprehensive reference lists. These weaknesses have helped me to establish my aims, for which I developed an action plan using Doran’s (1981) SMART principles to develop my knowledge and skills in order to ensure I provide reliable and valid evidence in my portfolio to support my achievement of Bondy.