This assignment will briefly consider the merit of portfolio evidence. It will define validity; reliability and triangulation to enable an appraisal to be made of the strengths and weaknesses of the content of six portfolio evidences (one from non-branch) generated during practice placement which will be included within appendices to underpin the achievement of Nursing and Midwifery Council (NMC) practice proficiencies ???2.1.1??™ (utilise a range of effective and appropriate communication and engagement skills) and ???2.3.1??™ (select valid and reliable assessment tools for the required purpose). It will discuss how the portfolio evidences were used to achieve Bondy (1983) practice level performance during placement practice. Finally, it will develop an action plan which will be included within appendices to improve the knowledge, skills and attitudes necessary for legal, safe and effective practice whilst unsupervised (NMC 2011).
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Portfolio is ???a collection of evidence, usually in written form, of both the products and processes of learning which verifies achievements of personal and professional development, by providing critical analysis of its contents??? (McCullan, Endacott, Gray, Jasper, Miller, Scholes and Webb (2003, p.289). Portfolio evidence is a valuable asset which can be beneficial to review and reflect upon professional development, formulate thoughts, identify limitations and decide what new learning need is required (Pearce 2003). Consequently, as a valuable learning asset, there is need for portfolio evidence to be valid and reliable.

Joppe (2000) maintains that validity is the extent to which a measure or method possess the quality of being truthful and believable. Reliability is defined as the extent to which results are consistent over time in the use of a particular instrument (Burns and Grove 2009). Creswell & Miller (2000 P.126) define triangulation as the ???formation in a study using a validity procedure for convergence among different sources of information???. It involves collection of data from multiple sources (Burns and Grove 2005).
In this regard, portfolio evidences Reflective writing (13), Learning Disability Practice Activity (3) Witness Statement (18) and Direct Observation (6) will be appraised to consider their strengths and weaknesses in the achievement of (NMC) practice proficiency [2.1.1] and Bondy (1983) practice level achievement.
Reflective Writing (13) included within appendix (3). This portfolio evidence is a reflection of practice experience. The strengths in this portfolio evidence consist of the followings; firstly, the use of the Gibbs (1988) reflective model as a framework to structure the discussion. Bulman (1994) suggest the use of framework to reflect on practice. Whilst, Gerrish and Lacey (2006) maintains that the use of framework aids to evaluate information objectively and methodically. Secondly, the use of credible sources such as; National Institute of Clinical Excellence (NICE) the (NMC) and current literature sources, which were directly cited within the content to enhance the objectivity of the skill, knowledge and attitude utilised to promote therapeutic relationship and to, demonstrate informed rationale for care. Thirdly, the use of anonymity in its description to ensure the confidentiality of written and verbal information acquired in practice (NMC 2010). The portfolio evidence is valid and reliable because, the account can be related to the event that took place in practice and the framework, policies and literature evidences used to structure and support the discussion, are from credible sources. However, the weaknesses in the portfolio evidence includes; variation in the account of the role performed during the practice experience, the failure to evidence how the skill, knowledge and attitude applied during the practice intervention was demonstrated to underpin Bondy (1983) practice level performance. Thorne and Darbyshire (2005) maintain that there is an obligation to show how result led to achieved outcome. It seems to suggest to potential readers that, it was informed on observed learning. In this respect, the validity is affected.

Learning Disability Practice Activity (3) included within appendix (4), is a reflection of non-branch experience from an insight visit. The strengths in this portfolio evidence were that, it was structured around the specific learning outcome; it used well validated and operational definitions and guidelines from sources such as the NMC, Department of Health, Mencap and Disability Rights Commission as well as, current academic literature sources, to promote professional practice, to support its discussion and to underpin the application of skill, knowledge and attitude, necessary to promote effective communication and engagement skills such as, active listening. Furthermore, the portfolio evidence provided a degree of prove, that the skill, knowledge and attitude, utilised to underpin the (NMC) standard of proficiency, were achieved with minimal supervision. This is in keeping with the ability to demonstrate professional behaviour with underpinning ethical framework from the (NMC) to underpin practice performance necessary to achieve Bondy (1983) practice level (4). The validity and reliability of this piece of evidence is enhanced by, the mention of the setting, the aim of the visit and the date of the visit. In addition, the portfolio evidence was signed and accepted in practice by the observer and mentor, to verify practice based achievement. However, the weakness in this portfolio evidence is the lack of direct annotation of achieved (NMC) standard of proficiencies within the text.

Direct Observation (6) included within appendix (5). The strength in this portfolio evidence includes; the use of credible sources such as, the NMC, NHS Choices, Department of Health, British National Formulary and current academic literature sources to underpin practice and to demonstrate knowledge of evidenced based practice, achieved with minimal supervision. The account of the skill observed was described with underpinning credible literature evidence to underpin what was learned in terms of knowledge, skills and attitude and how it would inform future practice in keeping with, the objective of a direct observation. Also, the portfolio evidence was clearly annotated to identify achieved (NMC) practice outcome. Lastly, an accurate list of all books, website and policies alluded to within the evidence, are included in the reference list to enhance the Validity and reliability of the portfolio evidence (Polit and Beck, 2006). However, the weakness in the portfolio evidence is that, it cannot be used to verify Bondy (1983) practice level performance. This is because; it seems to suggest to potential readers, that it is a statement of learning experience.

Witness statement (18) included within appendix (6) describes the outcome of a nursing intervention. The strength of the evidence is gained in the use of current sources of literature evidence and the (NMC) to demonstrate evidence based practice and to elaborate on the application of theory and skill. Also, there is a critical appraisal of the evidence to identify practice limitation in support of Polit, Becks and Hungler (2001) i.e. ???not having access to maracis use???. There is also, a descriptive account of the skills, knowledge and attitude utilised during the care intervention i.e., (1:1 conversation, the use of active listening, offering of a cup of coffee) to promote effective communication and engagement skills with supporting credible literature evidence. In addition, the portfolio evidence was able to show that professional practice was achieved with minimal supervision in the ability to utilise evidence based rationale and the NMC guidelines, to underpin professional practice at a degree necessary to achieve Bondy (1983) practice level (4). Furthermore, the portfolio evidence contains proof of the signatures of both the observer and the mentor to verify practice based achievement. Megginson and Clutterbuck (2005) identify mentors as experts who can measure results. Considering all of the above mentioned, the reliability and validity of the portfolio evidence is enhanced to underpin the achievement of practice outcome [2.1.1] and the Bondy practice level attained. The weakness of the portfolio evidence is errors in spelling and punctuation signs within its content.

In summary, the portfolio evidences Reflective writing (13), Learning Disability Practice Activity (3), Witness Statement (18) and Direct Observation (6) shows that the NMC practice outcome [2.1.1] was achieved by triangulation. LoBiondo-Wood and Haber, (2006) maintains that this type of approach enhances the credibility of an evidence. Although, the validity and reliability of the generated evidences is affected as a result of the weaknesses identified within them, there is applicability of validity and reliability in the portfolio evidences because, they all provided a degree of their account with wide range of sources of evidence to support care delivery and to underpin the achievement of the standard of proficiency [2.1.1]. They showed consistencies in the use of direct citations of relevant evidence and annotations of (NMC) outcomes within their content to underpin practice. Lastly, they included an accurate list of all books, journals, and website cited within their content, in the reference lists as a source of further information. Polit and Beck, (2006) suggest that all sources alluded to within a topic, should be accurately referenced.

Reflective Discussion (RD14) and Reflection on Practice (16) will hereby, be appraised to consider their strengths and weaknesses in the achievement of (NMC) practice outcome (2.3.1) and Bondy (1983) practice level achievement.
Reflective Discussion (14) included within appendix (7) is a discussion based on a home visit to conduct an assessment. There is strength in the portfolio evidence because; it used various literature sources to access other viewpoints, to make appraisal and references and to underpin the application of knowledge, skills and attitude appropriate in care delivery. Also, it used well validated sources such as, the Department of Health and the Lincolnshire Partnership NHS Foundation Trust to foster discussion on the rationale for the selection of the assessment tools used during practice. Furthermore, the standards of proficiencies were clearly annotated within the content to underpin achieved outcome. The portfolio evidence is valid to verify the achievement of Bondy (1983) practice level (4) because; it provided an account of how practice was achieved with minimal supervision, in the ability to utilise evidence based rationale to underpin professional practice necessary to achieve this level. The weakness in the portfolio evidence is that it did not use a reflective model to structure the discussion to improve its objectivity.

Reflection on Practice (16) included within appendix (8) is a care management study. The strength of the portfolio evidence consist of; the use of knowledge from the NMC to underpin professional, legal and ethical principles, the use of dates to structure the account of various practice events to make it easy for potential readers to identify different occurrences that took place and discussions. Furthermore, it used a vast range of literature sources to make appraisal and informed judgement. In addition, there is evidence to suggest that practice was carried out with decreased supervision in the ability to demonstrate professional behaviour and in showing awareness of responsibilities to self and others at a degree necessary to achieve Bondy (1983) level (4) performance. The limitations in the evidence includes, the lack of evidence to underpin some nursing actions, the lack of direct annotation of some achieved (NMC) standard of proficiencies within the text. Also, the model of the assessment tool used was not evidenced to verify its validity. Denzin, (2001) maintains that all approaches used to support interpretation of results, should be clearly referenced. These factors appear to affect the validity and reliability of the portfolio evidence.

In summary, the portfolio evidences Reflective Discussion (14) and Case management study (2) all used a wide range of credible academic literature sources, Trust policies and National guidelines to foster discussion on the rationale for care, to demonstrate the transfer of skills, knowledge and attitude, to support the selection of assessment tool and to underpin the achievement of practice outcome, in support of Higgs & Jones (2000). The practice outcome [2.3.1] was achieved by triangulation method because, two portfolio evidences were used. Furthermore, the portfolio evidences were signed by the mentor in practice and accepted as evidence to verify practice based achievement and Bondy (1983) practice level performance. These factors indicate that there are appropriate and considerable degree of supporting evidences within both portfolio evidences to gain validity and reliability.

This assignment has used the definitions of validity, reliability and triangulation to enable an appraisal to be made of the strengths and weaknesses of the content of six portfolio evidences generated during placement practice, to underpin achievement of two NMC standards of proficiencies. It has identified learning needs, through gaps in knowledge and developed an action plan, to improve professional competence which includes the combination of skills, knowledge, attitudes and technical abilities that underpin safe and effective nursing practice. This conclusion is a summary of the areas covered in this assignment.

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