The use of reflective journals in the promotion of reflection and learning in post registration nursing students

Reflective journal writing has frequently been used in nursing and other health care fields
as an educational strategy to promote reflection and learning. Although reflective journal
writing is recognised as a valuable tool to promote students' learning, very little research
has been undertaken to evaluate its use. The overall aim of this study is to examine the
use of reflective journals in the promotion of reflection and learning in post-registration
nursing students. In order to achieve that aim a qualitative descriptive case study design
was utilised to examine four objectives. The first was to analyse reflective journals
completed by students during a period of learning in order to determine the extent and
level of reflection achieved. The second, to examine the use of reflective journals as an
educational strategy for facilitating learning in the practice setting. Thirdly, there was the
intention to examine the nature and content of guidelines given to students with regard to
the use of a reflective journal, and fourthly, to examine the support given to students by
preceptors in relation to completing a reflective journal during their practice experience.

A purposive homogenous sample of eighty one part-time post-registration nursing
students undertaking one of four modules, either as part of the Diploma in Professional
Studies in Palliative Care Nursing or the Diploma in Breast Care Nursing during one
semester constituted the total sample. Forty- two students agreed to participate in the
research.

Data were collected from reflective journals completed during one module and by
interviews with fifteen students, two teachers and three preceptors.
Forty-two journals were analysed to determine the extent and level of reflection using a
model devised by Boud et al. [1985] and adapted by Wong et al. [1995]. A model devised
by Mezirow [1990] was used to identify the non-reflectors, reflectors, and critical reflectors.

The findings suggest that student writing can be used as evidence for the presence or
absence of reflective thinking. Allocating students to the three categories of non-reflector,
reflector and critical reflector was possible. However, identifying textual elements within
the journals and allocating them to the finer levels of reflection was more difficult and less
reliable. Evidence suggests overall that journals are a useful tool for promoting reflection
and learning. However, some students appear to benefit more from journals than others.
Approximately two thirds of the respondents were able to demonstrate varying levels of
reflection and were classified as either reflectors or critical reflectors. The remaining one
third of the respondents were unable to demonstrate any levels of reflection. Overall
respondents expressed positive views, regarding the use of reflective journals. However, a
small number found writing challenging and some questioned their use. Some
respondents preferred to talk about their reflections rather than write them in a journal.
The importance of receiving clear guidance on the purpose of journal writing from
teachers, and the need for non-judgemental feedback were highlighted as important
factors in promoting the effective use of journals. Some concern was expressed regarding
the disclosure of confidential information, and also who would have access to journals
when used for assessment purposes. The issue of the time required for reflection and
writing a journal was a major concern for some respondents. Students valued the role of
preceptors in supporting their journal writing during the practice experience. Preceptors
considered that the preparation they received for their role was adequate. However, they
did request debriefing sessions following their support of students who had experienced
difficult situations.

This study has presented further evidence that overall, reflective journals may be used as
a tool to promote reflection and learning in post-registration nursing students.