Abstract
Reflection and critical reflection are essential to understanding the meaning behind one’s actions, contributing to deeper learning. Thinking is an essential aspect of health care and central to the professional development of nurses. Guidance is fundamental to assisting nursing students in understanding thoughtful self-reflection related to practice. Written narratives, often in the form of journaling, are a unique approach that has the potential to facilitate learning through critical reflective thinking. Reflective activities play an influential role in guiding the student during actual or potential situations related to their practice, thereby supporting knowledge, skills, and reflective thinking, and are effective and feasible in improving critical reflection. However, little evidence exists about the most effective reflective content and processes. The purpose of this study was to evaluate the effect of using guided reflective journaling, informed by the Critical Reflective Inquiry Model (CRI) and Analytical Model of Nursing Practice, to improve reflection and critical reflection in prelicensure nursing students post simulation-based education (SBE). A quasi-experimental pretest-posttest longitudinal design of a 3-week reflective journaling activity in 55 prelicensure nursing students (n = 26 intervention and 29 control) post simulation was recruited from two institutions. After confirming eligibility and obtaining baseline data, the Reflective Thinking Inventory (RTI, 3 item subscale) and Critical Reflective Thinking Inventory (CRIAT, 45 items) measured reflection and critical reflection, respectively. In addition to the reflective surveys that were completed by both groups, the intervention group completed a guided reflective journaling activity. At the completion of week three, both groups were again emailed a Qualtrics link to complete the CRI Assessment Tool and RTI tool. Study data were analyzed using chi-square, a two-way multivariate analysis of covariance and Pillai’s Trace as appropriate. Although the main findings of this study demonstrated no statistically significant difference in reflective scores between those that engaged in a reflective activity post SBE across a three-week intervention period, results of this study trended in the predicted direction with each measure, as there was a mean increase from baseline for reflection (control group) and critical reflection (intervention group) measures at posttest. Findings suggest guided reflective journaling post simulation-based education may enhance critical reflection with a greater dose. This study is the first known study to apply a theoretical model to guide reflection post SBE. Results confirmed that utilizing a reflective model to guide reflective journaling was a beneficial framework to promote reflection in this population. This argument is plausible for this study since the intervention group improved in critical reflection over time.