Use of reflective writing rubric for assessment and grading in diabetes education and training 

Background
Learning is an essential part for professional development and using reflective writing rubric for assessment and grading learners for diabetes education promotes learners to reflect through assessment information to yield meaningful insights about learning and help connect learners to the overall program goals. 

Nurse educators from St. Luke’s Hospital (SLH) explored using reflective writing rubric  concurrently with the post program evaluation of a diabetes comprehensive training for inpatient nurses over 4 months. The course consists of 10 didactic lectures, case studies and hands-on sessions on glucose testing and injection technique provided by a multi-disciplinary team of healthcare professionals comprising endocrinologist, diabetes educator, dietician, pharmacist, quality and safety director and sport medicine physician.  

Aim
This study aims to describe the outcome of using reflective writing rubric for assessment and grading of diabetes education and training of nurses.   
 
Method
A reflective learning evaluation criteria using rubric (RLER) was developed to be used concurrent with the pre and post training evaluations.  The rubric was developed using three domains which comprises the content quality, the critical thinking and the structure. Scoring was performed using the rubric. Only nursing staff who attended at least 4 education sessions were invited to participate in the RLER.  Three questions on “what did you learn from the diabetes course training”; “why does it matter to you” and “what might/should be done better in our care setting” were posted in the RLER.  The reflective writing rubric scoring was set at a maximum score of 30 marks. 

Results
A total of 167 nurses attended the sessions, of which 46% (76) nurses (Registered Nurses (RN): 51, Enrolled Nurses (EN): 25) responded to RLER. For those nurses who responded to RLER, 12% of nurses (RN: 7 EN: 2) reported (self-rated) they were good/excellent on diabetes care and management knowledge in the pre-course training.  91% (RN: 47 EN: 22) reported they had achieved good/excellent on diabetes care and management knowledge in the post course training. Based on the reflective scoring guided by the rubric, the means scores of RN and EN were 19.5  (range: 15-23/30 marks) and 18.7 (range 15-23/30) respectively.  Majority of nurses reflected they had acquired new learning knowledge such as quality control measures in glucose monitoring and storage; use of shorter needle size matters to prevent hypoglycemia and effects of medications. There were more than 50 ideas generated to improve the care setting for the question on “what might/should be done better in our care setting”. Examples of these ideas include getting  junior nursing staff to find out from RNs of whether any pre-meal diabetes medication was administered  before  patients consume  home-cooked foods to prevent surge of blood glucose; establishing diabetes  treatment goals for inpatients;  gathering patients with diabetes from different wards to conduct self-care management education and  provide education on effective nurse-doctor communication to discuss about patients presented with persistent trends of hyperglycemia or hypoglycaemia;  providing inpatient diabetic foot screening service and many others.  

Discussion
Reflective evaluation writing rubric could be used as a useful tool to create awareness of learners’ to reflect on daily care practice.  The evaluation of reflective writing allows educators to solicit valuable feedback that can potentially be used for process and clinical care improvement at the bedside.  However, many nurses are still not comfortable to pen down their reflections in writing, and more creative efforts are required to motivate nurses to participate in RELR activities.  

Conclusion
Reflective writing rubric on post diabetes education programme promotes self-reflection and an enriched learning experience for both nurses and educators. The solicited feedback yield valuable ideas that are beneficial for quality improvement and future professional development for the organisation.

Use of reflective writing rubric for assessment and grading in diabetes education and training in community hospital