Cognition and Reflective Writing In Nursing Education

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Reflective Writing In Nursing Education

Cognition and Reflective Writing In Nursing Education

What Is Reflective Writing,Role of Faculty In Reflective Writing,Meaningfulness of  Reflective Writing In Nursing Education,Importance of Reflective Writing In Nursing Education.

What Is Reflective Writing

   Reflective writing is an assignment that involves the deliberate and recursive contemplation of thoughts, feelings, and interactions about significant clinical experiences that results in self awareness and improved practice (Asselin, Schwartz Barcott, & Osterman, 2013; Kennison & Misselwitz, 2002) . As such, reflective writing proffers a unique and complex mode of thinking

Role of Faculty In Reflective Writing

    Faculty can encourage students' critical thinking skills, as well as their meta cognition thinking about thinking-through the use of reflective writing as a pedagogical strategy. Although similarities exist among academic writing, narrative pedagogy, and writing programs (writing across the curriculum, writing in the disciplines, and writing to learn), there are distinct differences. For instance, narrative pedagogy entails openly sharing practice experiences, whereas reflective writing about practice experiences is intended to be a confidential dialogue among trusted teachers or mentors. 

    Students may be asked, but not required, to share their reflective writing. In initiating reflective writing as pedagogy, it is important for faculty to clarify the purpose of the assignment, describe the reflective process, and ensure confidentiality of submitted work.Most experts purport that the process of reflection, the starting point for reflective writing, incorporates three dynamic stages: awareness of unsettling or surprising thoughts and feelings critical analysis of the situation, and development of a new perspective (Freshwater, 2008; Regmi & Naidoo, 2013). 

    For instance, in the first stage, a medication error may prompt the student to worry about the patient's response and anxiety or guilt about making the mistake. Following along in stage two, the student analyzes the sequence of steps leading to the error and interactions during that time, trying to figure out how the error happened. In stage three. the student learns what practice change will prevent a recurrence of the mistake.

    There are several models of varying complexity that systematically guide students' reflection and reflective writing through steps, cycles, or cue questions. Baker's (1996) semi structured four step model works well with students who are new to the reflective writing process (Kennison, 2012). A more challenging model is Johns's (2004) Structured Reflective Cycle (SRC) that provides cue questions pertaining to Carper's (1978) four patterns of knowing: ethical, personal, aesthetic, and empirical. 

    A fifth pattern, reflectivity, has been added. A more recent model (Kim, LauzonClabo, Burbank, Leveillee, & Martins, 2010), Critical Reflective Inquiry (CRI), uses cue questions to guide students through three distinct interrelated phases, processes, and outcomes. In so doing, the CRI model shows three progressive depths of thinking: descriptive, reflective, and critical. While one model of reflection has not been found to be more effective than another, reflective models to guide faculty-developed cue questions may structure the writing and, therefore, facilitate learning

Meaningfulness of  Reflective Writing In Nursing Education

    Reflecting on, and writing about, meaningful practice experiences help students connect theory with practice (Langley & Brown, 2010), articulate everyday ethical behavior, and learn from successes and mistakes (Benner, Sutphen, Leonard, & Day, 2010) Students report that reflective writing makes them think, analyze, and improve their practice, offers a record of practice experiences and provides a platform for expression (Hong & Chew, 2008). 

    Reflecting on practice is fostered when students have one or two patient assignments as opposed to larger patient assignments (Benner et al, 2010). Over time and with practice, students achieve higher levels of reflection (Ip et al. 2012; Langley& Brown, 2010) with the goal of continually improving practice.While reflective writing is recognized as effective pedagogy, there is a dearth of research on learning outcomes on reflective writing A recent experimental study (Naber & Wyatt, 2014) used a pre-test post test design to compare the effects of a reflective writing intervention on the critical thinking skills and dispositions of baccalaureate nursing students. 

    After a 6-week reflective writing intervention, the experimental group's post test scores showed a significant increase in the truth seeking sub scale of critical thinking dispositions when compared to the control group. In an earlier descriptive study, Kennison (2006) found a positive correlation between teacher ratings of baccalaureate students' reflective writings and the students' critical thinking scores.Taylor Haslip (2010) found that students' levels of reflection evidenced in their writing correlated with clinical performance and examination scores. 

    In a related study, researchers used a 4-week reflective writing strategy to determine whether the level of reflection improved (Ip et al., 2012). Results indicated a significant difference in frequency and percentage of higher levels of reflection between baseline and posttests (Ip et al., 2012). In a 3-week continuing education program using reflective writing of clinical situations, participants demonstrated a significant increase in self reflection scores (Asselin & Fain, 2013).

    In a recent study, faculty and graduate students agreed that reflective journal writing in an online graduate course enabled self-awareness of attitudes, strengths/weaknesses, personal meaning, and understanding of problems from others' perspectives (Langley & Brown, 2010). . Survey results support previous findings that lack of time for students to reflect and for faculty to grade the reflection were common barriers. 

    Designating time for students to reflectively write during their scheduled clinical experience is recommended to lessen this concern (Hong & Chew, 2008) and facilitate direct teacher feedback for students' questions. Barriers to effective reflective writing have been noted in the literature. Students may write what they believe the teacher wants to hear, deliberately omitting errors and problematic behavior for fear of lower grades. However, students need a safe haven to reflect about their own and others' practice mistakes (Benner et al, 2010; Kennison, 2012) without fear of negative grading consequences. 

    Experts recommend that reflective writing not be used as a means of assessing students' clinical performance. Faculty identified grading reflective writing as problematic and a barrier to using the strategy (Langley & Brown, 2010). Rather than assigning a grade, the reflective writing may be evaluated for process and level of reflection (Kennison, 2012). Time constraints remain a common problem for students (lp et al., 2012; Kennison, 2012, Langley & Brown, 2010) who prefer shorter writing assignments. 

    Knowing that reflective writing about complex clinical experiences takes time and practice, the teacher may be at odds trying to satisfy students with short writing assignments insufficient for developing depth of thinking. However, shorter writing assignments at the onset of reflective writing across a nursing program may well be appropriate for students new to the writing process. Additionally, graduate students in an online course identified lack of trust in those reading their reflective writing as a detriment (Langley & Brown, 2010).

    Reflective writing may conjure anxiety and vulnerability as students open themselves to expressing their deepest feelings about emotionally laden practice experiences. The teacher or facilitator needs to openly sun port students in a nonjudgmental way. From 323/434 writing reflective as effective per or depends on faculty development on how to use the strategy, clearly outlined purpose and expectations, dialogic feedback focusing on process, and confidentiality in a trusting supportive environment (Kennison, 2012).

Importance of Reflective Writing In Nursing Education

    While there is widespread use of reflective writing and the literature supports its value as a pedagogical strategy, there is a paucity of research on resultant outcomes, specifically on practice changes. Additionally, there is lit the empirical evidence that any one model or method is most effective in facilitating reflective writing (Asselin & Fain, 2013). Finally, best practices in facilitating and evaluating reflective writing added to the nurse educator's repertoire of teaching skills.

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