A holistic approach to competence seems to be compatible with the use of portfolios to assess competence in nursing students, but the concept and its implementation is still evolving. A variety of assessment methods are needed for assessment and portfolios appear to have the potential to integrate these. Reflection is an essential component of a portfolio, as are the student-teacher relationship and explicit guidelines for constructing the portfolio. Issues of rigour in assessment of portfolios need to be addressed, but the assessor's professional judgement will inevitably enter into this assessment.

This study suggests that student nurses, at the point of qualification, may be inadequately prepared to identify and manage deteriorating patients in the clinical setting.