Guided reflective journals depict a correlation to the

academic success of nursing students

Valerie Taylor-Haslip MS, FNP, RN

LaGuardia Community College, Health Sciences Department/Nursing, New York 11553

Abstract Reflective guided journal assignments can be correlated to the academic success of nursing
students in the clinical area through the evaluation of the student's level of reflective writing. The
student's journal recordings can be compared with their course grades and course completion rates.
Students are encouraged to better prepare themselves for the clinical area and to self-direct their learning
experiences, and the nursing instructor identifies students who require additional guidance in applying
theoretical concepts.
2010 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights
reserved.
KEYWORDS:
Reflection;
Guided;
Journal
Lecture and discussion has been the primary methodol-
ogy for teaching theoretical principles to nursing students,
with the standard measurement of student preparedness and
academic success being that of pen-and-paper testing.
However, it was observed that student academic success
as measured by this method does not reflect the actual level
of student performance in the clinical area. It is not certain if
students memorize factual material and find it difficult to
apply what they had learned in the clinical area, but for a
student to successfully pass the entire course, they must
achieve the same level of success in both the classroom and
the clinical area. In some cases, the students perform
successfully in the classroom but do not perform success-
fully in the clinical area. If students are encouraged to
reflect upon their clinical performance, they could gain
insight into the areas they need additional theoretical focus,
thus fostering them to internalize the concepts they have
learned in the classroom and improve their academic
success in both areas.
As a strategy to enable students to reflect upon their
performance, guided reflective journal assignments were
added to the clinical requirements of the parentchild course.
Students were given a guided journal reflective writing
assignment to compel them to self-reflect upon their practice
in the clinical setting and to encourage them to be better
prepared for their clinical experience. The assignment was
chosen because of the belief that, if students were given the
time necessary to reflect upon their actions, they would make
the required changes in study habits to be successful in the
clinical area. It was also thought that students would become
insightful as they recorded their thought processes and made
a connection between the rationales of their decision making
and their actions in the clinical setting. Rosenbaum, Lobas,
and Ferguson (2005) stated the following:
For learners who must provide practical application of
their didactic knowledge in a clinical setting it is
important that they become aware of their attitudes
toward learningreflection compels learners to examine
the larger context, meaning and implications of action in
their experiences to make them better (p. 1187).
It is much more important for students to become
engaged in the concepts rather than just memorize
* Corresponding author.
E-mail addresses: tayhas@aol.com, vtaylor@lagcc.cuny.edu
www.jtln.org
1557-3087/$ see front matter 2010 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
doi:10.1016/j.teln.2010.01.002
Teaching and Learning in Nursing (2010) 5, 6872
theoretical facts. The purpose of guided journals is for them
to be used as a method to engage students to understand
how to be better learners. A better learner translates into a
better student, who then becomes a competent registered
nurse graduate.
Guided reflective journals are a form of exploratory
writing whose purpose is to stimulate student thinking about
his or her theoretical and clinical concepts (Bean, 2001).
They provide student-centered written conversation between
the learner and instructor regarding significant experiences
that have occurred in the clinical area. In the journal, the
student can pose questions, seek clarification of specific
items, find meaning, and discuss matters of concern and
interest with the instructor (Paterson, 1995). Students are
given specific guidance in the areas to reflect upon and
maintain a personal record of educational experiences and
lessons learned during the experience.
Reflective writing in the form of a guided journal allows
the students to focus their attention on what they have been
able to accomplish in the clinical setting in direct correlation
to how much knowledge they have attained. In her research,
Deanna Dye (2005) stated the following:
An essential component of expert professional practice is
the practitioner's ability to critically reflect on his or her
performance. The process of reflection guides the student
to the areas of strength and weakness and directs them to
acquire additional knowledge to meet the standards of
performance criteria and to become a competent
practitioner as a registered nurse (p. 1).
Dye (2005) suggested that journaling (guided journal)
with a structured format, clear instructions and ongoing
feedback has been found to be most successful in
maintaining student engagement (p. 1). Increased student
engagement as an active participant in the learning process
directs students to increase their knowledge to provide them
with a better understanding of the course content, enhances
their knowledge development, and reinforces theoretical
information. This will strengthen the student's application
of the course theory to the laboratory- and clinical-
performance-based skills required to become competent
practitioners. These elements are significant for students
entering the profession because precision and accuracy are
of vital importance for the population to whom they
provide care. It is supposed that once students realize the
limitations of their knowledge base, they will be encour-
aged to increase the amount of study time, which will then
result in an increase in the percentage points on examina-
tions and other program coursework completed by the
student; thus, it translated into a more competent and
knowledgeable graduate registered nurse.
The students for whom this assignment was initiated were
on the motherbaby and pediatric clinical rotations of a
major municipal hospital, and the number of students
involved consisted of 30 (with 2 men and 28 women). The
students were divided into three evening clinical groups,
each group consisting of 10 students. The students ranged in
age from the mid-20s to the mid-50s, most of whom were
returning to school while working full-time.
Thirty guided journals were collected and reviewed over
the entire semester. Each journal was evaluated for the
student's level of reflection recorded in the journal.
Students were asked to record their learning experiences
and reflect upon them in the journals. They were asked to
document the sources they used as scientific rationale for
the decisions and actions they carried out during the clinical
rotation day.
The assignment was clearly written and distributed to
the students on the first day of class, along with verbal
instructions of the guided journal process and the expecta-
tions of the assignment. Each of the students was given a
journal to record his or her reflections. The students were
instructed to set a personal clinical objective to be met each
clinical day and reflect upon the experience of achieving
that goal. Students were instructed to research areas where
they had a knowledge deficit and reflect upon their
readiness to perform in the clinical area. Students were
also instructed to reflect upon what they would do
differently to improve the circumstances to allow them to
achieve their goal.
The contents of the journals were kept confidential, and
the instructor met with each student each clinical week. In
instances where the student required additional referrals to
the nursing laboratory or other student services, the instructor
monitored the student's journal on a more frequent basis. The
journals were evaluated for the level of reflection using the
Hatton and Smith (1995) levels of reflection criteria.
Hatton and Smith (1995), in a study conducted at the
University of Sydney, operationally defined reflective
student writing and developed criteria against which
evidence of reflective writing could be evaluated. The four
criteria, (a) descriptive, (b) descriptive reflection, (c) dialogic
reflection, and (d) critical reflection, were adapted for use as
a method of maintaining consistency and fairness in
evaluating each student's journal. Examples of student
entries of each type with the exception of critical reflection
can be found in Table 1. Examples of critical reflection are
not provided because no student was able to demonstrate this
level of reflection.
1. Descriptive writing
Descriptive writing is described as not reflective at all,
but merely reports events. In this form of reflective
writing, the student does respond using critical thinking and
justifications for actions and provide reasons for the actions
taken (Hatton & Smith, 1995). These journal entries
provided detailed task-oriented description of the duties
carried out by the student, without describing why they
carried out the actions or how well they felt they were able
to accomplish the task. Students who are first introduced to
69 Guided reflective journals depict a correlation to the academic success of nursing students
the guided journals demonstrated this form of reflective
wring in their first two entries. After feedback from the
instructor, they were able to move on to the next level of
descriptive reflection.
2. Descriptive reflection writing
Descriptive reflective writing is defined as reflection
that does attempt to provide reasons based often upon the
student's personal judgment or what they have read in the
literature. This type of reflection is based generally on one
perspective or factor as the rationale (Hatton & Smith,
1995). Theses entries provided student self-assessment
and clarification of their intentions. Most students were
able to demonstrate this level of reflection on a consistent
basis throughout the course.
3. Dialogic reflection writing
Dialogic reflective writing is a form of conversation the
student has with themselves, where they explore a rationale for
their actions and reveal a level of understanding of concepts.
Students demonstrate less reporting of events but rather more
discussion of the experience, showing evidence that they are
using judgment, seeking possible alternatives, explaining their
actions in situations, and beginning to hypothesize about
future actions (Hatton & Smith, 1995). Very few students
demonstrated reflective writing at this level.
4. Critical reflective writing
Critical reflective writing involves clear rationale for
actions and decisions, taking into account the broader
Table 1 Student guided reflective journal entries based upon the Hatton and Smith (1995) criteria
Student journal entry Descriptive Descriptive reflection Dialogic reflection Critical reflection
Student 1 Week 2
Today I was assigned to 34
year old patient who had a
C-Section done. She also had
Sickle Cell Disease and was
concerned about her newborn
baby getting the disease. My
goal was to teach her about
the disease and also how to
care for her wound to prevent
infection. I was able to
inform her that for her
daughter to get the disease
the father would have to have
the disease and the newborn
chances would be 25%. I also
taught her about
handwashing technique to
prevent infection and also to
walk as much as she can to
prevent constipation.
Week 7
Today I was assigned to the
newborn nursery. Since I am
repeating this course, I
decided to explore all of the
areas of newborn assessment
so that I can get a better
understanding. I was more
comfortable in doing a
thorough assessment along
with my professor and I am
sure this will help me in my
exam.
None
Student 2 Week 1
Today I was assigned to my
first clinical task and duties
[and] I was a little nervous
when professor gave me the
assignment. Although I am a
nurse for 5 years I never
worked on a maternity unit. I
was glad to get this
experience so in the future I
can think of working the
maternity unit at times.
Week 7
my patient today was a 7
year old boy diagnosed with
status Asthmaticus. I have
learned that status
Asthmaticus can cause
severe respiratory distress
and without immediate care
the child may progress to
respiratory failure and die.
After receiving treatment
[with] solumedrol, which I
administered with my
professor, my patient was
able to walk around without
any respiratory distress. I
wrote a note, gave report to
the nurse and I was very
happy I got the opportunity to
help.
None
70 V. Taylor-Haslip
theoretical, historical, social, and political context of their
experience. The student demonstrates awareness that their
actions are influenced by and have an effect upon multiple
contexts; the discussion is from more than one personal
perspective (Hatton & Smith, 1995). There were no students
who were able to demonstrate this level of reflection.
A baseline evaluation of the guided journals was
conducted the first week of the assignment. Students were
given both verbal and written feedback of how to improve
their reflection in the journals. The instructor responded in
writing to student recordings directly in the journal to
encourage the student to increase their level of reflection for
the next week. This showed a gradual increase in the level of
reflection of some of the students, whereas other students did
not improve in the level of reflection at all. Most students
demonstrated a higher level of reflection in their journals as
the clinical rotation weeks progressed. Students became
more focused upon the results and the effect of their actions,
as opposed to just reporting the tasks they accomplished.
Students also made reference to how much they were
learning and how the experience was affecting their
academic success.
A comparison between the student's application of theory
to the clinical assignment and quality of the reflective writing
was closely observed. All improvements in the clinical
performance were reflected in the student's clinical experi-
ence evaluation conducted at midsemester and on the final
clinical evaluation. A comparison was made with the
student's new knowledge applied in the clinical area and
an increase in the student's grades.
Student's grades were monitored for trends depicting an
increase in academic performance over the semester. The
guided journals of the students who showed a trend in
increasing grades were reevaluated for a trend in increasing
reflective writing levels. A comparison was made at the end
of the semester to determine if the students who
demonstrated a higher level of reflection and knowledge
application in the clinical setting also demonstrated a trend
of increased grades.
At the completion of the semester, the ability of the
students to reflectively record their experiences improved
from where they began. After applying the Hatton and Smith
(1995) criteria for evaluation, the findings showed that 3 of
the students demonstrated descriptive writing, 14 students
demonstrated descriptive reflective writing, and 13 students
demonstrated dialogic reflective writing.
There was a correlation between the student's level of
reflection and the student's performance in the clinical
setting and the performance on the written exams. At Week
1, 100% of students made entries into the journals. However,
only 27% of the students recorded at the descriptive
reflection level. The average student grade on the first
examination was 75%, and clinical performance was at the
beginning stages of evaluation. By the fourth week, 17% of
students were writing at the descriptive reflective level, the
average student examination grade was 82%, and 90% were
performing satisfactorily in the clinical area. At the eighth
week, 90% of the students were reflectively recording in
their journals, 51% of the students were writing at the
descriptive reflection level, and 48% were writing at the
dialogic reflective level. The average student examination
grade was 77%, and 96% had satisfactory clinical perfor-
mance. The final evaluation at the end of the semester at
Week 12 showed no changes in the number of entries the
students had made and no changes in the level of reflective
writing from the second week. The average examination
grade was 85% on the final examination, and student
satisfactory performance in the clinical area was at 96%
(see Fig. 1).
Those students who reflected more often tended to seek
clarification with the instructor more frequently in both the
classroom and clinical settings. Students demonstrated an
increase in new knowledge applied in the clinical setting. An
increase in the student's knowledge was evaluated by the
responses to verbal questions and the sources cited in other
written clinical assignments.
5. Conclusion and discussion
A comparison can be made between the use of guided
reflective journals and student academic success when
evaluating student progress overall on both examinations
and clinical performance over the course of the semester.
There is a clear correlation between the increase of clinical
performance and the students' ability to move to the next
level of reflective writing; as the students improve in the
level of reflective writing, so does their clinical performance.
There is also a strong correlation between the rise in the
examination grades and the level of reflective writing,
although there was a decline in the average examination
grade at Week 8. Further investigation is necessary to
determine what variable impacted this result.
It is clear that a moderate to high level of refection in a
student is necessary for growth in both academic success in
the classroom and clinical practice. Students must become in
tuned to themselves and have an appreciation for the
limitations of their knowledge base. Beginning students
Fig. 1 Comparison of student academic performance in correla-
tion to the level of reflective writing.
71 Guided reflective journals depict a correlation to the academic success of nursing students
reflect at a lower level, which may primarily consist of an
awareness of a specific perception, meaning, or behavior
(Jensen & Joy, 2005), which usually consists of telling
specific events in the journal. They do not know what it is
they have not learned until they attempt to make decisions
and reflect upon their actions. It is not until they achieve
additional knowledge do the students understand the
limitations of their practice. When asked, What prevented
you from achieving your goal today and what could I have
done better? The instructor must ask, Does the student
begin to think? The thinking leads to a search for the
answer, which leads to an increase in study. The guided
journal reflection moves the student through this process to
higher levels of reflection. Reflection in the clinical setting
forces students to acknowledge the strengths and limitations
in their ability to make decisions concerning patient care.
When students are provided reflective questions and specific
educational goals, they begin to utilize a different level of
thought process. When guided journal questions require the
student to become more self-reflective and are complex, the
student is motivated to develop progressively into higher
levels of critical thinking and decision making.
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Hatton, N., & Smith, D. (1995). Reflection in teacher education: Towards
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72 V. Taylor-Haslip