Pilot testing of guidelines to support good practice in the development of professional portfolios.

AIMS: The aims of this study were to evaluate whether the introduction of new evidence based portfolio guidelines helped students and assessors to understand the expectations for completion of a clinical practice portfolio, and whether this understanding resulted in the submission of evidence consistent with the guidelines. METHODS: New evidence based portfolio guidelines were introduced to an undergraduate BSc (Hons) Radiography (Diagnostic) programme. A total of 134 students completed 12 item questionnaires relating to using the portfolio guidelines. Semi-structured interviews were undertaken with 12 students and 5 lecturer practitioners. Documentary analysis was undertaken on 26 portfolios. RESULTS: Survey data indicated that the new guidelines increased students' understanding of portfolio evidence requirements. Statistically significant increases in scores were evident for only two out of 12 questions; these related to understanding the need for critical reflection and which elements of the portfolio would be rewarded in assessment. Survey data also indicated some dissatisfaction with the role of lecturer practitioners and clinical assessors in relation to portfolio development. Interviews provided more mixed perceptions of the contribution of enhanced guidelines and identified some reasons for dissatisfaction with the lecturer practitioner and clinical assessor role. Documentary analysis indicated that whilst the guidelines improved students' and lecturers' understanding of evidence requirements, this did not translate into portfolio evidence which matched guideline expectations. Portfolio evidence was restricted to meeting the minimum profession specific task requirements and often indicated a mis-match between guideline expectations and assessor assessment judgements. CONCLUSIONS: New evidence based guidelines improved understanding of evidence and presentation requirements for clinical practice portfolios. Consistent interpretation of portfolio guidelines however requires structured preparation and ongoing support of students, assessors and lecturers if the pedagogic aims for clinical portfolio use are to become an integral part of providing evidence of meeting professional competence requirements.

The development of evidence based guidelines for clinical practice portfolios.

AIMS: Although the use of portfolios is widespread within healthcare education, agreement on their purpose, content, assessment and value is still debated. The objective of this study was to achieve consensus on quality criteria for clinical practice portfolios that would act as guidance for students and lecturers. METHODS: A Delphi survey was undertaken to seek consensus on the opinions of 23 'expert participants' through a series of rounds of structured questionnaires. The Delphi tool was produced as an on-line survey questionnaire and panel experts were invited to score statements using a discrete 7 point visual analogue scale. The statements were written as quality criteria relating to portfolio development which had been identified from the literature and by the research team. The survey employed three rounds of feedback and consensus was measured as 80% agreement for each quality criteria scoring 5 and above. RESULTS: Consensus was reached on 31 quality criteria which were categorised into 4 areas: structured collection of labelled evidence; nature of evidence; critical reflection; and assessment and judgement. Mean scores for the final wording of the quality criteria ranged from 5.3 to 6.8 with the standard deviation for all of the mean scores being below 1.5. There was consensus that these quality criteria were relevant to health and social care professionals involved in developing clinical practice portfolios. CONCLUSIONS: The Delphi process facilitated exchange of ideas amongst panel 'experts' about the content and evaluation of clinical practice portfolios, with most debate relating to judgement of competence and rewarding originality and creativity. These issues illustrate the tensions between educational values and professional constraints. The Delphi process proved to be an effective method for achieving consensus on quality criteria for clinical practice portfolios and enabled the development of validated guidelines.

Meeting the needs of minority ethnic patients.

BACKGROUND: Certain aspects of nursing care related to minority ethnic patients are being highlighted in the literature, but there is little exploration of nurses' experiences of caring for people from specific minority ethnic groups. AIM: This paper reports an investigation into the experiences of Registered Nurses caring for hospitalized Pakistani patients in the United Kingdom. METHOD: A qualitative study, with a sample of 30 Registered Nurses using semi-structured interviews. The sample was self-selecting from a large health care organization in the north of England, covering adult acute, critical and rehabilitation care settings. RESULTS: Interviewees had difficulty in explaining the meaning of culture and spirituality and their relationship to nursing practice. They also had limited understanding of the Pakistani community, and deficits were identified in meeting the challenges offered by this community. Inadequate implementation of 'holism', poor preparation to meet the needs of an ethnically diverse society and the presence of racism in practice settings emerged as explanations for the deficits participants identified between their expectations and the reality in care settings. CONCLUSION: Although 'holism' is a relevant concept for enhancing nursing practice, its meaning needs to be further debated in order to avoid a tokenistic approach to its implementation in the care of patients from minority ethnic communities.

Nursing ethics, caring and culture.

Recent years have witnessed the publication of numerous articles that draw a critical alignment between ethics and caring. In essence, this theme suggests that caring is a moral pursuit centred on the beneficent attention of one person shown to another. Yet, if such language is to have real poignancy, it must be geared towards an inclusive agenda that meets the needs of all within the community. Research evidence suggests that this is not always the case, especially in terms of the care offered to members of minority ethnic groups. This article will focus on the findings of a qualitative research study that explored the expectations and perceived experiences of nursing care among members of the Pakistani community in Bradford, West Yorkshire, UK. The findings suggest that nurses should develop a more informed narrative that readily reflects the needs of the Pakistani community.

Managing society's difference and diversity.

The need for nurses to be more culturally sensitive to deliver better health care to minority ethnic groups is the subject of this article. The author argues that there needs to be better understanding of equality, more value placed on diversity, better recognition of racism and active challenging of racism when and where it occurs in health care.