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

Backgrounth 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 joumaling, 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.