Facilitating student learning with critical reflective journaling in psychiatric mental health nursing clinical education: A qualitative study
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.
References (35)
- et al.
Clinical education in psychiatric mental health nursing: overcoming current challenges
Nurse Educ. Today
(2016) The value of reflective journaling in undergraduate nursing education: a literature review
Int. J. Nurs. Stud.
(2008)- et al.
The transfer of theoretical knowledge to clinical practice by nursing students and the difficulties they experience: a qualitative study
Nurse Educ. Today
(2018) - et al.
The effects of scenario-based simulation course training on nurses' communication competence and self-efficacy: a randomized controlled trial
J. Prof. Nurs.
(2015) Review of journaling as a teaching and learning strategy
Teach. Learn. Nurs.
(2017)- et al.
A guide to nursing students' written reflections for students and educators
Nurse Educ. Pract.
(2017) Methods faculty use to facilitate nursing students' critical thinking
Teach. Learn. Nurs.
(2017)- et al.
The use of reflective journaling as a learning strategy during the clinical rotations of students from the faculty of health sciences: an action-research study
Nurse Educ. Today
(2015) - et al.
Undergraduate nursing students' understandings of mental health: a review of the literature
Issues Ment. Health Nurs.
(2017) Enhancing Learning Through Self-assessment
(2005)
Patients with mental illness: general nurses' attitudes and expectations
Nurs. Stand.
Promoting reflection in mental health nursing practice: a case illustration using problem-based learning
Int. J. Ment. Health Nurs.
Challenging the public stigma of mental illness: a meta-analysis of outcome studies
Psychiatr. Serv.
Teaching critical reflection skills for advanced mental health nursing practice: a deconstructive-reconstructive approach
J. Adv. Nurs.
Role modelling-making the most of a powerful teaching strategy
BMJ
Exploring the use of critical reflective inquiry with nursing students participating in an international service-learning experience
J. Nurs. Educ.
Empathy in the emotional interactions with patients. Is it positive for nurses too?
J. Nurs. Educ. Pract.
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