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Nurse Education Today

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Contemporary Issues

Developing a work-based learning model for advanced reflection in project work

Keywords:Work-based learningAdvanced nursing practiceReflectionProject workContinuing professional development

Introduction

This paper aims to stimulate discussion around the theory andpractice of work-based learning in higher education institutions andadvanced practice programmes. It builds on academic discussionsalready taking place in the field of work-based learning (WBL) andexamines the theoretical underpinning of this educational methodol-ogy. Work-based learning has increased in popularity and recognitionover the last few years in the United Kingdom, Australia and Canadaparticularly, although this is an international phenomenon (Boudand Solomon, 2001; Schmidt and Gibbs, 2009). In this article it isthe continuing professional development of health and social careprofessionals that is being addressed. However, there is a widerscope, as foundation degrees and pre-registration courses move to-ward increasing this learning style within their modules (Jacksonand Thurgate, 2011) and leaders in the field move more towards for-mal research methodologies.

It is argued here that this kind of reflective learning is profession-ally expected, yet educationally theoretically under-developed. Thefocus of this paper is on the development of a conceptual tool,which should be placed in the context of a growing understandingof the epistemology of WBL. The project module described in thispaper is one that offers flexible learning as part of a diploma, degreeor postgraduate course. It can be taken as part of a specialist pathwayor as a ‘stand alone’ award of academic credit. The tool was developedto facilitate a broader understanding of the learning that can beachieved through this kind of project work and to discuss the signifi-cance of this tool for enhancing reflection. There has been some excel-lent analysis of work based learning as a concept (Manley et al, 2009).Yet there are differences in the way this learning is integrated intohigher education programmes and in the way achievement is under-stood and appreciated (Moore and Bridger, 2008). This paper willexamine some of these considerations and offers an approach thatprovides some consistency in the structuring, presentation and con-tent of practitioner portfolios.

Conflicting Pressures

The drive to produce a new model for work-based learning (WBL)emerged in debates that arose during the assessment of student portfo-lios. Continuing professional development students were experiencingconflicting pressures, as they were asked to produce high standards in

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Please cite this article as: Roberts, M., et al., Developing a work-based letion Today (2013), http://dx.doi.org/10.1016/j.nedt.2012.12.002

three very different areas ofwork. Theywere expected to critique the lit-erature on a subject, analyse workplace data and then apply high levelsof reflection in evaluating these findings. These are all commendableintellectual activities and pertinent to the nature of the task. However,the significance of each area for assessment appeared to be weighteddifferently by different markers. It appeared that these contrastingviews of what was important and credible could originate from differingviews of clinical evidence. Knowledge has been described as a ‘contestedconcept’ (Blackler, 1995) and in examining these conflicting expecta-tions it was realised that underpinning assumptions about ‘fact’ or ‘legit-imate learning’ in nursing and healthcare might be the source of theproblem. It appeared to stem from some of the difficulties of balancingthe art and science of nursing and the very different epistemologicalbackgrounds of different specialist/branch perspectives.

The Project Process

The students on these university programmes were using a WBLmethodology to identify areas for service improvement in healthand social care. With the help of both an academic and work-basedsupervisor, they set their own objectives and designed their own pro-jects. Through this process the students were able to suggest learningactivities that would help them to achieve their goals. This kind ofmodule is not unusual in universities in the United Kingdom (UK)today. As in many other institutions the students draw their work to-gether into a portfolio. There are a variety of accounts of developingpractice expertise through WBL (Moore and Bridger, 2008). In addi-tion useful portfolio guidance has been produced by Jasper andFulton (2005) for professional courses. These suggestions have con-tributed to the consideration of good practice and essential portfolioenclosures for different academic levels of achievement.

Conceptualising Learning

Christensen (2009) reviewed these types of evidence in more detailas he attempted to highlight the greater depth of reflection needed foradvanced practice in critical care. He tried to conceptualise the differentareas of knowledge involved and created an integratedmodel. His workbuilt on the typology of knowledge described by Rolfe (1998): scientific,experiential and personal knowledge. However, Christenson's modeldid not appear sufficiently comprehensive or concrete to assist us inour university endeavours. The question arose: are scientific arguments,descriptions of practice and personal reflection enough? There was noclear acknowledgement of patient feedback, wider influences on careor anymore in depth analysis of psycho-social systems in theworkplace.In addition, how could students be guided to critique, compare andsynthesise these various elements in the final portfolio. This collage ofmaterial still appeared nebulous and difficult to judge. This paper out-lines how previous work was built upon and drawn together into a

arning model for advanced reflection in project work, Nurse Educa-

LAP

PRACTICE

LITERATURE

REFLECTION

Fig. 1. The Project Prism. This drawing provides an outline of the triangular prism openedup to highlight the base as the learning action plan and the three sides/elements ofevidence from the literature, work practice and reflection.

2 Contemporary Issues

new conceptual framework or model for WBL projects. It is hoped thatthis tool will help students to appreciate the separate aspects of thework and to visualise their learning journey as a whole.

Designing the Tool

The development of portfolio guidelines was the first step in try-ing to protect the students from inequitable criticism. The guidelinesallotted equal weighting to the three key elements of informationfrom the literature, information from practice and personal reflection.A triangle was visualised and this was presented in a poster at the16th International Reflective Practice Conference in June 2010 (Rob-erts and Von Fintel). Although allowing the three big areas of workto be distinguished as separate areas of activity, it did not go farenough in helping students to integrate the whole. Students wereable to distinguish these separate bodies of work and worked throughthem logically to produce very good pieces of work, but there was adanger of the work becoming formulaic and a more creative flowwas sought. Doctoral work around developing a typology of work-based learning has helped the development of the visual conceptthat supports these theoretical developments. A further image wastherefore created to symbolise the construction element of the syn-thesis and a three dimensional image seemedmore appropriate. A tri-angular pyramid was thus constructed to frame the whole.

This pyramid became a prism as insight was added to the consid-eration of the whole and the different areas of learning werehighlighted. The image created allows light to be filtered through dif-ferent perspectives to illuminate the problem chosen. Focusing on asingle issue the WBL students in a constructivist way are able tobreak down the problem into component parts examine it fromdifferent standpoints and then bring these ideas together again toproduce solutions. They would identify the most appropriate bench-marks set by policy and ‘best practice’ (often identified in the litera-ture), then evaluate current practice activity through audit or dataanalysis. Then search for solutions through consultation exercisesleading to the discussion of various options. Finally students reflecton how these different sources of knowledge shed light on theissue. The image of a prism has the advantage of capturing the differ-ent areas of learning in a solid pyramid construction, but in additionillustrates how one question can be split into a series of research ac-tivities that contribute to overall insight and understanding of thewhole.

The Prism

As outlined in Fig. 1 the project action plan forms the basis of thework and actually holds the sides together. The project plan forms thefoundation or the blueprint of the work and is formally agreed be-tween the three parties: the student, university and workplace. Eachelement/side of the prism then has equal weight and does not standalone. One side consists of the findings from a critical review of theliterature, another draws together a series of practice activities andthe third takes the form of the reflection on each stage of the process.This final construction emerged out of discussions between educatorsand students. The areas of reflection highlighted in Fig. 2, outliningthe learning journey show how insights can be split into different as-pects of learning. This learning can be separated into different areas ofgrowing understanding. Throughout the project the students arelearning about themselves and their capabilities (personal learning)and they are doing this in exploring their professional role. This usu-ally involves some development of new clinical skills at the same timeas increasing knowledge of their subject or field of practice (theoret-ical understanding). In order to gather information or implementchange in practice they have to learn about local political influences,organisational systems and this leads to an increased social aware-ness or strategic insight. Finally in reflecting back over this work

Please cite this article as: Roberts, M., et al., Developing a work-based letion Today (2013), http://dx.doi.org/10.1016/j.nedt.2012.12.002

they find that they have enhanced their communication skills. Aslight is split in a prism, the project itself triggers a range of differentchallenges that provide these different sources of enlightenment.

This paper is intended to be the first of a series of three articles,which examine this educational process more fully. The intention isto highlight the strength of this holistic approach from three differentperspectives: firstly education, then clinical specialism from a clinicallead and finally from the position of advancing practice, a student/practitioner perspective.

Educational Concerns

Academic lecturers wrestle with how to assess and evaluate thelearning gained in the workplace. Practice, as an activity, has only re-cently (NMC, Course Validations, 2012) begun to be accredited in UKuniversities. In pre-registration reflection has been used alongsideobserved learning records and care planning documents as evidenceof achievement. In post-registration nursing, students are encouragedto investigate practice and to use critical thinking and report likeapproaches to examine the results for WBL projects. They critiqueservices, as they would in texts. Knowledge is gained throughquestioning and data analysis and resembles research in its investiga-tive approach, yet being situated and specific to a local workplacecannot be generalised. Professional/ethical concerns and politicalconsiderations still have to be taken into account and students, as em-ployees need to walk a difficult and diplomatic path in completingthese investigations.

In terms of knowledge there is a debate as to whether this processis one of ‘knowing that’ or ‘knowing how’ and this weighting mayvary depending on the project, the student may be acquiring knowl-edge about a service or be developing their own skills through obser-vation and communication. If a student has chosen to focus on a set ofadvanced skills required to assess a patient, for example in abdominalexamination, their objectivesmay be: to establishwhat is best practicefrom the literature, then to examine how this is implemented throughobserving experienced practitioners in the field, before learningand practising the skills themselves. In order to assess this project amarker would be ascertaining whether the literature was adequatelyinvestigated and critiqued, the observations adequate in terms ofthe organisation of visits and questioning of those seen. The assessorwould also want to know how theory was compared to practice.Underpinning knowledge would have to be demonstrated, profes-sional approaches identified and this would include an awareness ofthe consumer perspective. The rigour is often in the questions askedby the student to show that both breadth and depth of understandinghave been achieved.

arning model for advanced reflection in project work, Nurse Educa-

LEARNING JOURNEY PROJECT

PERSONAL LEARNING

SOCIAL AWARENESS

PROFESSIONAL ROLES

CLINICAL SKILLS

ORGANISATIONAL SYSTEMS

THEORETICAL UNDERSTANDING

ENHANCED COMMUNICATION

Fig. 2. Areas of Learning. Highlights the way that the learning journey as a whole consists of different areas of learning: personal learning; professional role; clinical skills; theoreticalunderstanding; social awareness; and communication skills.

3Contemporary Issues

Assessing Knowledge from the Workplace

Boud and Solomon (2001)warned universities that they needed toadapt to and become more flexible in their approach to learning or acrisis would follow. Universities have adopted WBL, but in making ittheir own have tried to contain it within an academic writing frame-work. They have not necessarily accepted the nature of that knowl-edge. The portfolio for nursing is still vulnerable to being judgedas an academic essay based on scientific proof, rather than a moreeclectic document recording diverse achievement. Therefore ournormal portfolio assessment criteria can appear inadequate in theface of this more complex task. Thematerial contained in the portfoliomay document the subtleties around political adaptation, the blendingof qualitative and quantitative data and the transformatory elementsof learning that are not acknowledged in traditional marking regimes.The projects themselves are transforming practice in that theyoften involve change management projects. We would not judge astudent's injection technique by simply expecting them to write anessay about the procedure, so why do we expect more complex WBLprojects impacting on practice to be judged by academic evidencealone?

Products and Processes

The conceptual model proposed here simply identifies differentareas of learning that can materialise in these projects and helps usto visualise the areas that may need to be assessed. However wedo not claim that every student will learn all of these things. Thereare certain common elements in terms of accuracy of data, relevanceof material collected and general credibility and authenticity, butthere is still a lot more work to do to create assessment tools thatwill help us compare and rate these varied types of learning work.The question for supervisors and markers is has the student doneenough and to a high enough standard to be considered rigorous inapproach.

A student may be reviewing a service with a view to change andlearning about their organisation, but in so doing will be clarifyingtheir own professional role and personal situation within that frame-work of activity. Often student want to ‘upskill’ by taking on whathave been seen as doctor's roles in the past, yet have not necessarilyconsidered the impact on other practitioners around them. Personal,professional and a wider organisational leaning may therefore go

Please cite this article as: Roberts, M., et al., Developing a work-based letion Today (2013), http://dx.doi.org/10.1016/j.nedt.2012.12.002

together. This may lead them to think about how authors have con-sidered these effects in theoretical writings or researched this kindof skill mix. Creative solutions are then debated with colleagues en-suring communicative learning. This final application of the knowl-edge gained integrates the learning in an applied way. The nextchallenge lies in developing standardised criteria for judging theseinterlocking activities, but we believe that there needs to be an un-derstanding of the nature of this learning before it can be measured.If we can explain the value of the learning we can perhaps promoteit as a viable alternative to the increasingly popular e-learning for-mats. As education becomes a more open and competitive marketthere is a danger of universities losing business to more enterprisinge-learning providers, as managers find it difficult to release staff forstudy. WBL offers a more service-friendly alternative in terms ofbeing both accessible and professionally credible.

Conclusion

This prism could offer a balanced view of WBL. The emphasis in thisfirst article is on theory, the secondwill examine application to advancingclinical practice and the thirdwill consider impact of theWBL project as awhole froma student perspective.Wehope that this visualisation triggersfurther discussion of the nature of WBL and raises the profile of this kindof learning from a theoretical perspective.

References

Blackler, F., 1995. Knowledge, knowledge work and organizations: an overview andinterpretation. Organization Studies 16 (6), 1021–1046.

Boud, D., Solomon, N., 2001. Work-based Learning: A NewHigher Education. The Society forResearch into Higher Education & Open University Press, Buckingham.

Christensen, M., 2009. Advancing practice in critical care: a model of knowledge inte-gration. Practice Development 14 (2), 86–94.

Jackson, C., Thurgate, C., 2011. Workplace Learning in Health and Social Care, AStudent's Guide. Mc Graw Hill: Open University Press, Maidenhead.

Jasper, M.A., Fulton, J., 2005. Marking criteria for assessing practice-based portfolios atmaster's level. Nurse Education Today 25, 377–389.

Manley, K., Titchen, A., Harding, S., 2009. Work-based learning a concept analysis. Prac-tice Development in Health Care 8 (2), 87–127.

Moore, L., Bridger, J., 2008. Report: A Realistic Longitudinal Evaluation of the Work-based Learning of Qualified Nurses. University of West of England, Bristol.

Rolfe, G., 1998. Expanding Nursing Knowledge: understanding and researching yourown practice. Butterworth & Heinemann, Oxford.

Schmidt, R., Gibbs, P., 2009. The challenges of work-based learning in the changingcontext of the European higher education area. European Journal of Education 44(3) (Part 1).

arning model for advanced reflection in project work, Nurse Educa-

4 Contemporary Issues

Maggie RobertsUniversity of Nottingham, School of Nursing, Midwifery and

Physiotherapy, Faculty of Medicine and Health Sciences,B Floor (South Block Link), Queens Medical Centre,

Nottingham, NG7 2HA, United KingdomCorresponding author. Tel.: +44 115 8230943; fax: +44 115 8231211.

E-mail address: maggie.roberts@nottingham.ac.uk.

Nichola Vin Fintel1

Pathway Leader for Critical and Acute Care, University of Nottingham,School of Nursing, Midwifery and Physiotherapy,

Faculty of Medicine and Health Sciences, Royal Derby Hospital,Uttoxeter Road, Derby, DE22 3DT, United Kingdom

E-mail address: njvfintel@hotmail.com.1Tel.: +44 7961878480.

Please cite this article as: Roberts, M., et al., Developing a work-based letion Today (2013), http://dx.doi.org/10.1016/j.nedt.2012.12.002

Jayne BrownDerby Royal Hospital, Uttoxeter Road, Derby, DE22 3DT, United Kingdom

E-mail address: jayne.brown@nhs.net.

Available online xxxx

arning model for advanced reflection in project work, Nurse Educa-