Elsevier

Nurse Education Today

Volume 69, October 2018, Pages 159-164
Nurse Education Today

Facilitating student learning with critical reflective journaling in psychiatric mental health nursing clinical education: A qualitative study

https://doi.org/10.1016/j.nedt.2018.07.015Get rights and content

Abstract

Background

Critical reflective journaling has been used to facilitate student learning in various disciplines; however, there is only limited data available on its application in clinical education in the area of psychiatric mental health nursing.

Objectives

The aims of the study were to: 1) explore types of events or issues that senior nursing students chose to reflect upon in their critical reflective journals during their 5-week psychiatric mental health nursing clinical practicum; and 2) assess students' evaluations of critical reflective journaling.

Design & Methods

For this qualitative study, we collected data from senior nursing students who were enrolled in the mental health clinical practicum from March to June 2016 and agreed to participate in the study. During the 5-week psychiatric mental health nursing clinical practicum, students completed four weeks of clinical rotations in two units and submitted one journal entry each week reflecting upon an instance they selected and completed a survey to evaluate critical reflective journaling. De-identified data were analyzed using qualitative content analysis.

Results

We analyzed 236 journal entries and survey results completed by 59 students. Students chose to reflect upon the following issues: boundaries of therapeutic relationships, responses to patient symptoms, and own attitudes and biases toward mental illness. They reported that critical reflective journaling provided them opportunities for self-reflection and self-emancipation, which led to increased motivation for full engagement in the clinical practicum and increased understanding of patients' perspectives as well as mental health nursing competency. Overall, students were satisfied with critical reflective journaling but also identified areas for improvement in regard to its application in clinical education.

Conclusions

Through critical reflective journaling, nursing students are able to self-reflect on issues arisen during their clinical rotation, which leads to improvement of their competency in psychiatric mental health nursing and full engagement in the clinical practicum.

Introduction

Psychiatric mental health nursing is one of the core courses in undergraduate nursing programs, but many nursing students perceive its clinical practicum as difficult and stressful (Barry and Ward, 2017; Gunay and Kilinc, 2018). The stress and difficulties are often stemming from the ‘prejudice’ that psychiatric patients are violent and thus they may express aggression toward students (Koskinen et al., 2011). In addition, students' low confidence in communication skills and lack of ability to handle acute situations prior to the practicum can contribute to the high level of stress and anxiety during the clinical practicum (Fiedler et al., 2012).

To address these difficulties and challenges, as well as to cultivate critical thinking skills, nursing educators have developed and implemented various effective, evidence-based teaching strategies, such as simulation, role-playing, and reflective journaling (Hermanns and Haas, 2016; Miller, 2017; Mousa, 2015; Nelson, 2017). Particularly, critical reflective journaling, which started as a pedagogical method to develop critical thinking skills, has been adopted steadily and extensively in the nursing field. It helps students to achieve the development of critical thinking skills, synthesis of knowledge, and professional growth (Naber and Markley, 2017). Critical reflective journaling also facilitates students' self-awareness (Frankel, 2009; Ganzer and Zauderer, 2013), which is an essential component in psychiatric mental health nursing.

With the increased use of reflective journaling in the academic field in recent years, many have brought attention to issues and challenges concerning its use (Dyment and O'Connell, 2010). In particular, analyzing 75 studies focused on reflective journaling across diverse fields, O'Connell and Dyment (2011) identified several issues of reflective journaling, such as insufficient reflection, lack of training or structure for students, and legal and ethical issues related to students' privacy and evaluation of journal entries. Journaling may also invoke anxiety in some students and produce negative feelings, if proper feedback is not provided (Naber and Markley, 2017). In addition, there are gaps in the literature pertaining to the application of critical reflective journaling in nursing education. In a literature review published in 2008, only nine studies were identified as focusing on reflective journaling for undergraduate practice courses (Epp, 2008). In a recent review of studies that examined reflective practice in nursing education and practice, 24 studies were identified as focusing on the use of reflective practice in nursing education. But, the majority of the studies were targeting graduate level nursing education (Dubé and Ducharme, 2015).

Moreover, only a few studies examined the application of critical reflective journaling in practice environment, including psychiatric mental health nursing practice (Cooke and Matarasso, 2005; Curtin et al., 2015; Dubé and Ducharme, 2015; Hermanns and Haas, 2016; Kroning, 2016; Ruiz-Lopez et al., 2015). Consequently, issues that nursing students reflect upon during psychiatric mental health nursing clinical practicum and student-perceived benefits and limitations of using critical reflective journaling have not been fully understood. Understanding students' perspectives on effective teaching and learning would be an important first step toward improving the quality and effectiveness of clinical education in nursing.

The specific aims of the present study were to: 1) explore types of events or issues that senior nursing students chose to reflect upon in their critical reflective journals during their 5-week psychiatric mental health nursing clinical practicum; and 2) assess students' evaluations of critical reflective journaling. Ultimately, we aim to improve the quality of psychiatric and mental health nursing clinical practicum.

Section snippets

Design & Procedure

In this qualitative study, we collected data from senior nursing students who were enrolled in the mental health clinical practicum. During the 5-week psychiatric mental health nursing clinical practicum, students completed four weeks of clinical rotations in two units out of 7 diverse psychiatric hospital units (i.e., open psychiatric units for adults, closed psychiatric units for adults, a closed psychiatric unit for children and adolescents, and a day hospital) and one week of clinical

Results

The age of the 59 students who agreed to participate in the study ranged from 21 years to 27 years (mean 21.98, SD 1.39). Ninety-five percent of the students were female. All students were in their fourth year (final year) of a baccalaureate nursing program.

Discussion

In this descriptive qualitative study, we explored types of events or issues that senior nursing students chose to reflect upon in their critical reflective journals during their 5-week psychiatric mental health nursing clinical practicum and assessed students' evaluations of critical reflective journaling. The present study revealed that major areas or issues that students chose to reflect upon were boundaries in the therapeutic relationship, responses to patient symptoms, and their own

Conclusions

Critical reflective journaling provides nursing students opportunities to self-reflect on issues arisen during psychiatric mental health nursing practicum. By reflecting upon boundaries in the therapeutic relationship, their own responses to patient symptoms, and their own attitudes and biases toward mental illness, students are able to improve their competency in psychiatric mental health nursing and fully engage in the clinical practicum. Critical reflective journaling can be an effective

Funding Sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of Interest

None.

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