Journal of Nursing Education

Educational Innovations 

From Metacognition to Practice Cognition: The DNP e-Portfolio to Promote Integrated Learning

Kelley M. Anderson, PhD, FNP, CHFN-K; Patricia DesLauriers, DNP, RN, FNP-C; Catherine H. Horvath, DNP, APRN, CRNA; Margaret Slota, DNP, RN, FAAN; Jean Nelson Farley, DNP, RN, PNP-BC, CRRN

Abstract

Background:

Educating Doctor of Nursing Practice (DNP) students for an increasingly complex health care environment requires novel applications of learning concepts and technology. A deliberate and thoughtful process is required to integrate concepts of the DNP program into practice paradigm changes to subsequently improve students' abilities to innovate solutions to complex practice problems.

Method:

The authors constructed or participated in electronic portfolio development inspired by theories of metacognition and integrated learning. The objective was to develop DNP student's reflection, integration of concepts, and technological capabilities to foster the deliberative competencies related to the DNP Essentials and the foundations of the DNP program.

Results:

The pedagogical process demonstrates how e-portfolios adapted into the doctoral-level curriculum for DNP students can address the Essentials and foster the development of metacognitive capabilities, which translates into practice changes.

Conclusion:

The authors suggest that this pedagogical approach has the potential to optimize reflective and deliberative competencies among DNP students. [J Nurs Educ. 2017;56(8):497–500.]

Abstract

Background:

Educating Doctor of Nursing Practice (DNP) students for an increasingly complex health care environment requires novel applications of learning concepts and technology. A deliberate and thoughtful process is required to integrate concepts of the DNP program into practice paradigm changes to subsequently improve students' abilities to innovate solutions to complex practice problems.

Method:

The authors constructed or participated in electronic portfolio development inspired by theories of metacognition and integrated learning. The objective was to develop DNP student's reflection, integration of concepts, and technological capabilities to foster the deliberative competencies related to the DNP Essentials and the foundations of the DNP program.

Results:

The pedagogical process demonstrates how e-portfolios adapted into the doctoral-level curriculum for DNP students can address the Essentials and foster the development of metacognitive capabilities, which translates into practice changes.

Conclusion:

The authors suggest that this pedagogical approach has the potential to optimize reflective and deliberative competencies among DNP students. [J Nurs Educ. 2017;56(8):497–500.]

Integrative learning is the process of establishing connections between concepts and experiences for application to novel and complex issues or challenges. An e-portfolio is an integrative learning approach to assist faculty and students to plan, track, and evaluate learning and performance through the organized and systematic presentation of educational, experiential outcomes. Use of the e-portfolio within a Doctor of Nursing Practice (DNP) program augments the student's ability to clearly understand and articulate how classroom and clinical experiences, such as executive sessions, clinical activities, and employment, have influenced learning and visibly showcase specifically what was learned.

Compilation of the portfolio promotes student engagement in the broader use of technological advances in teaching and learning, as it compels the integration of multiple technologies into documents to collect, organize, analyze, guide, design, and communicate experiences. In addition, the e-portfolio provides incremental opportunities to examine the content of the e-portfolios in the context of the DNP curriculum to validate course learning objectives and to document and plan to fill learning gaps. This article presents the theoretical foundation for the e-portfolio and its components with the integration of processes within a postmaster's DNP program.

Theoretical Linkages Between Metacognition and Practice Cognition

DNP students synthesize their previous nursing practice knowledge base and experiential learning with significantly complex and extensive curricular information, including systems-focused clinical, quality, and financial data. Recognizing the complexity of this process, e-portfolios are a process for students to link classroom learning, course assignments, and core curricular essentials to their professional growth and clinical practice. Creating such links provides a powerful opportunity for DNP students to reflect on their strengths, which informs successful strategies to rectify gaps in their critical thinking ability and expertise. Kuiper and Pesut (2004) noted that the development of effective reasoning promotes the acquisition of a variety of competencies needed by nurses if they are to practice competitively in the health care delivery system. Evidence exists that supports the idea that critical thinking and reflective practices are closely associated and are synergized with the use of self-regulated learning prompts (Kuiper & Pesut, 2004). It is particularly vital for the doctoral-prepared nurse to expand and refine expertise in decision making in response to the value placed on this skill by health system employers to fulfill their mandate to improve patient outcomes and “expect proficiency in the level of reflection needed to support clinical decision making and judgments” (Kuiper & Pesut, 2004, p. 382).

The literature is replete with efforts to facilitate acquisition of high-level reasoning skills (Coutinho, 2007; Meek, Riner, Pesut, Runsche, & Allam, 2013; Tanner, 2012). Kuiper and Pesut (2004) asserted that acquiring such skills in nursing practice requires development of both cognitive and metacognitive skills, which they described as the “intellectual work of the mind,” (p. 382) or “thinking about thinking” (p. 384). Origins of this learning technique may be traced from the Socratic method of questioning to the work of Dewey (1933), a philosopher who proposed that combining reflection on formal learning and real-world experiences contributes more to knowledge acquisition than participating solely in the experiences themselves.

More recently, Flavell (1979) defined metacognition as “knowledge or beliefs about what factors or variables act and interact in what ways to affect the course and outcome of cognitive processes” (p. 907). Further refinements in educational psychology have reinforced the importance of metacognition in developing self-awareness and self-monitoring of thinking and performance to achieve intentional learning, engagement in reasoned decision making, and determining appropriate course corrections as warranted (Coutinho, 2007; Schraw & Moshman, 1995; Tanner, 2012). Thus, engaging in effective reasoning requires introspective thinking that “carefully considers and examines issues of concern related to an experience” (Kuiper & Pesut, 2004, p. 384). Applying this framework to the DNP learning experience through initiation and maintenance of an electronic, professional portfolio during the DNP program of study offers a strategic method to transform learning from simply acquiring new knowledge to developing “awareness of themselves as learners and how they can best learn” (Meek et al., 2013, p. 83).

DNP Essentials Related to the e-Portfolio

Student outcomes in DNP programs are closely linked to the Essentials of Doctoral Education for Advanced Nursing Practice (American Association of Colleges of Nursing [AACN], 2006) and the Doctor of Nursing Practice: Current Issues and Clarifying Recommendations (AACN, 2015), which build on the generalist and specialized foundations of nursing education. The DNP position statement (AACN, 2004) identifies “development of needed advanced competencies for increasingly complex practice, faculty, and leadership roles” (p. 4) as an important component of DNP education. The Essentials (AACN, 2006) address a variety of advanced competencies, including clinical scholarship, organizational leadership and ethics, and principles of quality, patient safety, financial management, political advocacy, clinical prevention, population health, and systems thinking. The most significant planned outcomes for DNP graduates are the abilities to assess organizational readiness for change, manage planning and implementation of change projects, and evaluate the outcomes of programmatic and practice improvements. Key concepts from all of the Essentials (AACN, 2006) are integral in facilitating and evaluating practice changes at the systems level by the completion of the program. These competencies require significant synthesis of learning and reflection.

The e-portfolio provides a transparent view of the student's personal and professional achievement of completing the DNP eight curricular essentials, as detailed by the AACN (2006) Essentials. Green, Wyllie, and Jackson (2014) stated that the theoretical foundation supporting the e-portfolio originated from Knowles' androgogic adult learning theory. Self-reflection of past experiences, goal setting, and learning outcomes provides a rich learning framework as students evaluate their underlying understanding of the eight AACN (2006) Essentials, recognize deficiencies in their professional and educational experiences, and plan how they will mitigate or accomplish them during their educational journey.

e-Portfolio Components

The e-portfolio was divided into several Web-based components to provide a framework for the students and consistency for all cohorts enrolled in the DNP program. Eight primary components exist, including a home page and separate pages for the DNP Essentials (AACN, 2006), program of study, career development plan, clinical practicum, licensure and certifications, mission and values, and the reflection journal. To enhance clarity for the student and programmatic consistency, documents were developed outlining e-Portfolios concepts and components including a check sheet of the overall Web pages, a table for the DNP Essentials (AACN, 2006), and a Google™ Drive Excel®-type spreadsheet to allow up-to-date tracking and timing of clinical experiences.

e-Portfolio Implementation

The DNP program is an executive format, whereby students are on campus for an extended weekend for 3 to 4 days once or twice each semester, in addition to asynchronous and synchronous content. Implementation of the e-portfolio is conducted during the first campus executive session, at the initiation of the program with didactic content and hands-on workshops with experts in the WordPress platform to provide group and individual instruction. WordPress is an open-source content management system and the largest self-hosted blogging tool in the world, the Web pages produced are attractive and executive appearing. By using this platform, students have the opportunity to develop their own pages while gaining technological experiences and knowledge regarding open-source platforms. As the e-portfolios are developed, exemplars can be shared within cohorts of students and with the following cohorts of students.

Strategies to Promote Success of the DNP e-Portfolio

Success of the ePortfolio depends on support from the DNP program director and experts in design and technology, who provide students with consistent training regarding the platform, meaningful outcomes, clear expectations and guidelines, and integration into the DNP coursework. In addition, faculty training and workload implications are important to facilitate the development that is required to understand the mechanism and capabilities of the electronic platform and the design of relevant assignments. Completed portfolio posts are evaluated by faculty, and an opportunity to share individual portfolio submissions with peers is offered at the final executive session of each semester. Faculty access to the e-portfolio is available remotely from any location and allows timely pedagogical feedback. Faculty can simultaneously collaborate with students on their individual e-portfolio providing comments directly on the e-portfolio or by telephone while both participants are able to access the e-portfolio, which facilitates understanding through an expedited learning process.

Transferability

Ideally, information gathered in an e-portfolio should be transferable in customizable ways to a variety of platforms for multiple purposes over an extended period of time, with portability and accessibility from any location. Multiple types of input, including text documents, photographs, spreadsheets, presentations, and audio and video files increase the usability, communication, and collaboration requirements for a variety of purposes both in and out of the classroom. In the WordPress platform, students are able to select specific components of the portfolio to share and can securely limit accessibility of that information to specific end users. The system must support the student's ownership and confidentiality of their personal learning information (Reese & Levy, 2009). The e-portfolio can be easily formatted and tailored to the specific needs and requirements of employment applications or credentialing agencies. For example, the American Nurses Credentialing Center (2016) allows certification by a portfolio in specialty practices that do not have an examination available, including the areas of advanced forensic nursing, advanced genetic nursing, advanced public health nursing, emergency nurse practitioner, and faith community nursing (Smith & McDonald, 2013). In the future, connections to the platform would require seamless integration with other technology systems between the student and various stakeholders, such as other students, faculty, academic institutions, governing boards, the community, professional associations, accrediting boards, and licensing agencies, to allow a streamlined and time-saving transfer to occur (Chatham-Carpenter, Seawel, & Raschig, 2010; Reese & Levy, 2009).

Student Perspective

Millennial students have a preference for “real-world” projects (Ciocco & Holtzman, 2008, p. 69). The e-portfolio provides these students with a means to record evidence of skills, achievements, experience, professional development and ongoing learning (Green et al., 2014). Through the use of the e-portfolio, students “develop the skills of narrative to identify their strengths, enhance their professional development, and formulate a professional identity” (Graves & Epstein, 2011, p. 346). From the student perspective, e-portfolios are extremely time consuming and require great effort to initially produce, although revisions can often be conducted more quickly once developed (Ciocco & Holtzman, 2008).

Programmatic Outcomes and Accreditation

The Commission on Collegiate Nursing Education (CCNE) aims to ensure quality and integrity in nursing education by thoroughly assessing and supporting nursing programs to determine the effectiveness in practices that meet the identified standards for accreditation. A key component in this process of program evaluation is contained in Standard IV—Program Effectiveness: Assessment and Achievement of Program Outcomes (CCNE, 2013). Expected DNP program outcomes are identified and include variables such as program completion rates, employment, certification, and appropriate and relevant student learning outcomes, defined by the CCNE (2016) as “statements, including those focused on learning, explicitly describing the characteristics or attributes attained by students as a result of program activities” (p. 45). To meet accreditation standards, programs must identify “which quantitative and/or qualitative data are collected to assess achievement of the program outcomes” (CCNE, 2013, p. 19). The use of the e-portfolio provides a methodology for deriving qualitative and quantitative student-driven data that reflect how the DNP Essentials (AACN, 2006) have been used to meet desired student outcomes required by accreditation standards. In the AACN's (2015) white paper discussing the current issues and clarifying recommendations for DNP education, the task force suggests “Using an electronic student portfolio is one effective tool for tracking student progress and can serve as an excellent mechanism for documenting program outcomes for accreditation reporting” (p. 5). Portfolio documentation can also be used to generate students' formative and summative outcomes in programmatic evaluation and revision. Select student work can demonstrate attainment of competency in an array of analytical, theoretical, and evaluative processes. Development of a professional e-portfolio is also an indicator of technology competency and may be advantageous for those seeking careers in organizations with a cultural climate of progressive technological change (Dion & Smolenski, 2008).

The e-portfolio is individualized so that students entering DNP programs at various levels from diverse backgrounds and with varying abilities can highlight individual accomplishments and provide a cross-sectional showcase of the student's administrative capabilities for a higher level of clinical scholarship and practice. Most programs are developed to help students to progressively build on previous learning through scaffolding of knowledge, enabling students to gradually learn and achieve independence in complex domains (Hmelo-Silver, Duncan, & Chinn, 2007). Hmelo-Silver et al. (2007) determined that active learning processes support content mastery, epistemic practices, collaboration, and self-directed learning. As a learning process, instructional scaffolding encourages students to build on previous knowledge acquisition and achieve learning outcomes.

Discussion

DNP students are scholar practitioners. For the scholar practitioner, metacognition is an essential meaning-making activity involving reflection-in-action and reflection-on-action (Schön, 1983), related to the complex interactions of the key knowledge in the DNP Essentials (AACN, 2006). At the metacognitive level, the scholar-practitioners' analysis of their practice and their learning, specifically as they consider what decisions they made and what caused them to make those decisions, enables students to access knowledge that is often subliminal and operating at an intuitive level. As DNP students review the details of assign ments and experiences with particular significance to them, they assign meaning to that learning and acknowledge how the experience informed their expanding practice. Without documentation of these essential learning moments in the e-portfolio, the experiences are segmented, are solitary, and may be less likely to recall.

Finally, use of an e-portfolio can be likened to the student's own appreciative inquiry into his or her lived DNP educational experience. Appreciative inquiry (AI) is about searching for the best in people, organizations, and the relevant world around them (Cooperrider, Whitney, & Stavros, 2008), a “group process that inquires into, identifies, and further develops the best of ‘what is’ in organizations in order to create a better future” (Preskill & Catsambas, 2006, p. 1). Generally, AI involves a process of systematic discovery about an issue or system and uses techniques that encourage participants to assess and evaluate positive potential through the processes of discover/inquire, dream/imagine, and innovation/design; therefore, building a bridge between past successes and future visions and values. Just as AI recognizes the best in people and organizations, the e-portfolio allows the student to appreciate their DNP education and, through reflection and inquiry, ask questions of themselves—what worked well in their learning process, what best demonstrates the outcomes of their learning, what were the major milestones along the way, and what was the most outstanding achievement? The students' self-directed and self-reflective inquiry into their educational journey and scholarly achievements allows them to design and develop a comprehensive illustrated educational and career exemplar. The students' portfolios tell the story of their DNP education.

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Authors

Dr. Anderson is Associate Professor, Department of Professional Nursing Practice, Dr. Horvath is Instructor, Nurse Anesthesia Program, Dr. Slota is Associate Professor and Director, DNP Program, and Dr. Farley is Assistant Professor, Georgetown University, Washington, DC; and Dr. DesLauriers is Oncology Nurse Practitioner, City of Hope, Duarte, California.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Kelley M. Anderson, PhD, FNP, CHFN-K, Associate Professor, Department of Professional Nursing Practice, Georgetown University, 3800 Reservoir Road, St. Mary's Hall, Washington, DC 20057; e-mail: kma25@georgetown.edu.

Received: February 09, 2017
Accepted: March 02, 2017

10.3928/01484834-20170712-09

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