Reflective journaling of nursing students on weight bias

Background: Self-reflection, combined with clinical experience, has been shown to enhance clinical and didactic knowledge among undergraduate nursing students. Reflective journaling is a valuable educational tool that builds critical thinking skills and raises self-awareness through the purposeful inspection of beliefs and attitudes. However, there are little data available on reflective journaling during clinical education exploring weight bias as part of a weight sensitivity training program. Objectives: The study aimed to explore the use of reflective journals as a tool to raise self-awareness and self-reflection of weight bias as part of a weight sensitivity training program. Settings: The project was conducted at a four-year pre-licensure baccalaureate nursing program with third-year clinical students in a private Catholic university in southeastern Pennsylvania, USA. Participants: All third-year students enrolled in a medical-surgical clinical practicum were eligible to participate from August to December 2017. Design & methods: For this qualitative study, data were collected during the 15-week medical-surgical clinical practicum, in which students completed five journal entries. De-identified data were analyzed using thematic analysis. Results: A total of 98 students, 18 years of age and older consented, and 280 journal entries were analyzed. Four themes emerged from a majority of the journal entries: 1) increased self-awareness of personal weight bias; 2) acknowledgment of obesity as a chronic disease and not a choice; 3) insufficient resources or training may perpetuate weight bias; and 4) opportunity for weight sensitivity training to improve patient care. Conclusions: Through reflective journaling, nursing students were able to periodically self-reflect on their personal weight bias as it pertained to caring for patients with obesity. This introspective self-reflection as part of a weight sensitivity training may lead to not only improving clinical competencies in patient care but also in reducing weight bias in clinical practicum.