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What is a journal, and why is it so important in
first-year Nursing? How do students incorporate clinical
theories and classroom information into their personal
writing? And how does the Nursing student incorporate
him/herself into the reflective writing required? These
are only a few of the many questions that we are struggling
to answer for students thinking about, or even registered
in, the Nursing program. Since it is a good idea to know
and understand what is expected before one enters such
a specific field, we hope that the below information will
better prepare students interested in the Nursing occupation.
For the following article, we have decided to use the
format (such as headers) and style (including that of
APA documentation) of a Nursing article, or scholarly
paper. Our sources range from interviews to educational
Nursing articles, as very few books dedicated even so
much as a chapter to personal writing, reflective writing,
or journalling.
Introduction
Upon conducting interviews
with Nursing instructors and students at the University
College of the Cariboo, we discovered that a large portion
of the curriculum involves detailed and reflective writing,
more specifically referred to as Journalling. The reasons
for requiring students to do reflective writing are many,
and the results are equally important. Journalling is
a crucial aspect of Nursing scholarship, culminating personal
experiences, clinical practices, and theoretical approaches;
it requires students to make links between thought and
action, concept and praxis. Students are encouraged to
incorporate themselves into their journals without inhibitions:
desires, opinions, emotions, or disapproval. "Writing
skills are thinking skills", and through journalling
students inform their instructors of information that
is not issued in other writing assignments: the student’s
attitude, ideological cognitive awareness, personality,
and ethics when dealing with human problems. (Heaslip,
1999)
Journals can be thought of as "public
discourse" because reading aloud, group discussions,
and feedback in class are encouraged by Nursing instructors.
This exercise "organizes thought and thereby facilitates
analysis and synthesis." (Heinrich, 1992) As a pedagogical
tool, journals and reflective writing create connections
for students, and allow them to create connections for
themselves on their own terms.
What is Journalling and
Why
"Journals are written dialogues between the
self and a chosen audience member", usually to
a classmate or instructor, which is "used as a
diagnostic tool to assess students’ reading abilities,
writing skills, problems with adjusting to the student
role, study habits, or reading and study problems not
apparent with testing"; its main objective is to
get students to "write themselves into understanding."
(Heinrich, 1992) Along with incorporating theories and
practices into their personal writing, students are
also asked to write about their personal experiences,
as student Nurses, to better help the instructor understand
their experiences and perspective. "Students are
required to write weekly journals about their reaction
to experiences in class, to readings, and to clinical
practices", which is a way for students to reflect
on their means of personal growth, understanding, and
development. (Magnussen & Trotter, 1997)
The Principles of Reflective Writing
- Reflective journal writing is an opening: a way
to explore what we can become without being judged.
Stories are a gift to ourselves and others, and
express the uniqueness of individuals and their
circumstance as well as the common ground they share.
- What we bring to an experience is essential to
our understanding of what occurs. This is influenced
by our past, our future, and out present world-views.
- A deeper understanding enables us to integrate
former learning with experiences, to form relationships
between parts of knowledge, and to search for meaning.
- We reflect because issues arise that need to consideration
both before and after we act. As nurses, we are
agents of history for ourselves and others.
- Critical reflection promotes an understanding
of diversity in beliefs, values, behavior, and social
structures. Any claims to a universal truth or total
certainty are questioned. The more we share our
thoughts and feelings, the more we challenge accepted
views of traditions and myths, which have kept alternate
interpretations from becoming possibilities.
- Reflection is not a political act.
- Because reflective writing is a personal journey,
students are to write only what they feel comfortable
sharing.
- Journal writings are not right or wrong, simply
places to discuss movement in thinking.
- Journal entries are reflections, which often evoke
more questions than answers. The purpose of forming
questions is to help focus on personal meaning and
interpretation in the reflective moment.
- Journals are confidential between the student
and the instructor.
- Change is the only constant, and writing reflectively
offers a way to examine the meaning of change.
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(Collaborative
Curriculum Guide, 1996)
Journal Guidelines and Evaluation
The purpose of the journal
is shaped by the guidelines that students follow when
writing journals. There is more emphasis on the "qualitative"
than the "quantitative" approach to journalling,
meaning that quality is more important than quantity.
"Journal entries should be about two-three hundred
words an entry and concise in frequency and length",
says Heinrich, and the time spent writing and re-reading
these journals, "for a three-credit course would
approximate six hours per week." (1992) This may
seem like a lot of time (or too much time, as some argue)
but the assignment is to help the student’s understanding
and developing as a Nurse, and is not for the instructor
to mark.
Journals are initially commented on by
the instructor, who gives a few suggestions for the next
journal entry, but are used later for the student’s reflective
purposes. The instructor gives positive constructive criticism
on journals, and they are not recorded for marks. Students
must evaluate themselves by what they say in their dialogue
journals and how they deal with specific situations. The
journal becomes like a diary to themselves, or as Andrews
explains: "my journal… became an avenue to another
dimension of myself… writing my journal became a reflective,
valued space for me each week." (1998) Journals function
not only as conversational dialogue between student and
instructor, but within the student for reflective purposes.
Critical Analysis
Not only are students asked to
write themselves into their work, they are also required
to write others into their work, most notably literary
critics. As Andrews illustrates in her opening paragraph
about the effect of journal writing, she states that,
"the connective links between theories presented
in the classroom and clinical practices are revealed…
encouraging students’ critical thinking." (1998)
Critical reflection applies to students who use it as
a dialogue between their instructors. As explained in
a Curriculum Guide, "it involves raising questions,
explicating new thinking, and transforming understandings
about practice." (1996) Critical reflection involves
the study of the inter-disciplinary aspects on Nursing:
psychological, historical, socio-cultural, economical,
biological, etc. (Heaslip, 1999) Integrating critical
thinking and analysis into journals, pertaining it to
experiences and situations, helps students evaluate their
world-view and develop a clear understanding of themselves.
Students have to make connections between how they act
and how they tell others to act: reflection links their
theories and practice, helping students prepare for clinical
situations.(Guide,1996)
It is critical that students are
able to deal with concept in practical situations, because
of the work involved in Nursing. "You’re constantly
applying theories to practice", as Jessica Chardon
explains, "In class we learn about dealing with loss
and grieving, sexuality, caring, and health promotion
(there’s more), and then we have to apply what we’ve learned
in clinical situations. It’s not like business, when you
don’t apply what you’ve learned until you graduate and
are in the work force. We apply what we are taught weekly."
(1999) In hospital and clinical situations, it is important
that Nursing students are able to implement concepts and
link experiences in their journals.
Kathleen Heinrich discusses a method
of incorporating all aspects of learning. It is called
the "Triangulation Approach", which is a model
of journalling that "helps students link personal
and professional experiences in light of the theory emerging
from readings and class discussions."(1992) It could
be visualized as such:
Interview with a Nursing Instructor
Along with knowledge gained
from articles and student’s journals, we also researched
writing in first year nursing by interviewing Penny Heaslip,
who teaches Nursing communication at UCC. Penny was a
strong supporter of reflective writing in first year nursing.
"Our purpose," she explains, "is to try
to understand the experience a person had and what meaning
they’re making of it."(1999)
First-year Nursing, more than many
other disciplines, is about molding the ways students
think and how they perceive the world. A nurse in training
must learn to think as efficiently as s/he must learn
to write. S/he must learn to have an open mind, to not
be judgmental, and to deal with people from all areas
of life. And much of the reflective writing done in first
year nursing attempts to make those changes. Penny explains
"in school, of course, teachers need to have some
way of finding out what the thoughts [of students] are.
So, that’s where reflective writing comes in."(1999)
Hence the Nursing journal. This ongoing
documentation, written after every Nursing class, is among
the most personal writing a first-year student will do.
More than a simple account of the work of the day, a Nursing
journal is full of anecdotes which are explored and analyzed
by the student. Theories that were taught that day are
questioned; insights that students gained are recorded.
Penny explains journals thusly: "what it really is
an integration between classroom and clinical practice."(1999)
It makes sense that the writing of
a discipline that involves a large amount of human interaction
would take a very personal tone. "If you think of
the work of a nurse," explains Penny, "you’re
working with people….We want to know what kind of meaning
our students are making of those experiences."(1999)
Ideally, students writing and reading back in their journals
will see their own growth as individuals and Nurses. The
writing also can have a cathartic effect, as Nursing students
in later years might write about a patients death or her
own personal frustration in their clinical experience.
As explored earlier in the Heinrich article,
journalling can also be a dialogue between instructors
and students in Nursing. Since journals are read, but
not evaluated, they can be thought of as a building of
a trust relationship between a student and his instructor.
As Penny puts it "I don’t know how a student could…write
what they write without having a certain level of trust."(1999)
The trust between instructor and student, created by the
journal writing, is the first step toward the trust a
Nurse will have to develop with her patients when s/he
is practicing in the field.
The interview with Penny Heaslip brought
to our attention the expectations of a Nursing instructor.
Once those were realized, it was time to interview some
first-year students.
Student Interviews
We chose three first-year nursing
students as subjects for our interviews, all of whom have
different backgrounds. Rhonda Madsen is a Nursing student
who entered the program immediately after high school.
Jess Chardon joined the program after spending two years
in Business studies. And Riley Smith, who has experience
as a Licensed Practicing Nurse, is returning to learn
how to write as a Nurse.
Question: Why do Nurses
do journals?
"To make sure we understand
what we’re doing in class."(Chardon, 1999) This seemed
to be the general consensus among the nursing students
we interviewed. Rhonda’s understanding is that journals
are used for reflection, in order for Nursing students
to learn from themselves.(1999) Riley’s opinion was similar;
she found that journals were to make sure students understood
what they were learning.(1999)
The students also responded to the personal
investment of the journals and the positive reinforcement
they received from them. Riley in particular explained
that, because journals were unmarked but were commented
on, they could be a source of encouragement to her and
other students.(1999)
Do you feel that personal writing is important
in Nursing? If so, why?
The student interviewees all agreed that personal
writing was very important in first year Nursing. Rhonda
explained that, through exploring their own opinions
through personal writing, those opinions were opened
up.(1999) This leads to a more open-minded student,
who still values his own opinions, but understands how
people can think differently.
Another reason for personal writing being important
to Nursing students, according to the three students we
interviewed, is that it leads to critical thinking. "They
want to see how we can interpret…," explains Jess(1999).
The journal exploration of the theories they’re taught
in class is a way of teaching Nursing students to question
and explore everything.
How do you integrate yourself into your
journals?
The example we heard most
from students in response to this question was the use
of the ‘I’ pronoun. Even though the journals deal in part
with theories and objective experience, they are unabashedly
written in the first person. This allows students to put
their own personal thoughts and feelings into the journal
much easier than if they were limited to third person.
In relation to using ‘I’, journals
use personal experience and anecdotes to reveal the feelings
of the student writing it. (Riley, 1999) According to
Rhonda, instructors "love when you use personal experience
to relate to the concepts."(1999) Nursing journals
are about integrating the personal with the clinical,
and so personal experience melds with students’ observations
on their experiences.
How are the personal journals
used after they are completed?
At the end of the semester in
Nursing Communication, students take their journals and
write a paper on personal growth.(Riley, 1999) This paper
is intended to be a final reflection on the student’s
first year in Nursing. Looking through the past year of
their own writing and choosing the insights they think
matter the most is a way of running a Nursing student
back over what they’ve learned. This extra exploration
can draw out insight and show the student that the journals
shouldn’t just be written and then never looked at again.
How can students coming
into first-year
Nursing better prepare
themselves for the personal writing expected?
Rhonda’s suggestion for first-year students
was to take a Nursing course in the summer, in order to
prepare for what the program will ask in the way of personal
writing. Riley suggested taking Nursing 117, a communications
course, in order for students to explore their own self-concept.(1999)
The ideas that Nursing puts forward aren’t always easy
to grasp at first, so extra preparation can be a big help.
Jess’ advice was to be open-minded and to remember that
"you gotta know how to write."(1999) Not many
students are aware how much writing a first-year student
is required to do, both clinical and personal.
Discussion on Reflective
Writing
There is some debate within the field
of Nursing on whether or not reflective writing (specifically
journals) is effective as a learning aid, or if it is
an all-consuming waste of time. Schon is a leading expert
of the theory of the reflective writing; he defines reflection
as "learning from events and incidents experienced
during a course or practical professional programme."(Durgahee
1998) Carolyn Mackintosh opposes the validity of reflective
writing: "there is little evidence that an objective
review of reflective practice and its implications for
nursing and nurse education has ever occurred." (1998)
An objective review is needed with all new theories before
they are put into practice. Reflective writing or "facilitating
reflection" as Taleb Durgahee calls it, needs a review.
And so he conducts a study that does objectively review
the aims and objectives of facilitated reflection.
Summary of Negative View-Point
The exact definition of reflective writing is what seems
to be Durgahee’s concern in the article. Other scholars
in this field such as Dewey, Mezirow, and Schon seem to
have contradictory explanations of the reflective writing
process. Dewey divides reflective writing into five stages:
"suggestions for a solution; clarification of the
essence of the problem; the use of hypothesis; reasoning
about the results of using one of the hypothesis; and
testing the selected hypothesis by imaginative or event
action."(Durgahee1998) Mezirow ‘s concept is different
in that reflectivity is itself divided and does not take
place at a uniform level. Schon claims that reflection
is important to Nursing as a technical practice, which
is utilized and then analyzed in reflection.
Mackintosh points out these ambiguities and discusses
reflective writing in the classroom. She points out that
Cavanagh et al., in a study of 192 Nursing students, found
that only 46.3% were classed as reflective thinkers. Subsequently,
writing in journals is "time consuming, repetitive,
. . . superficial descriptive content, leading to boredom
for those using them." (1998)
Summary of Affirmative View-Point
Duragahee conducts a study
to "identify and explain the concepts used while
facilitating reflection and identify the skills required
by the teacher to make reflection a learning experience."
(1998) Reflective writing is "used to develop the
critical thinking of the students through writing (diary
keeping) . . . to become more aware (Durgahee 1992, 1996)
of their patients’ needs, the impact of context on the
quality of care given, and appreciate and develop their
own nursing philosophies."(1998) Concrete findings
show reflective writing in action: "some [students]
became unsure of why their past and present experiences
and their diaries were at the center of the timetable
and were the focus of learning." (Durgahee 1998)
Resistance from students was encountered because of the
uncertainty but, "students feel encouraged and reassured
when reflection is explained and demonstrated as a purposeful
exercise with clear direction." (Durgahee 1998) These
anxieties are calmed by showing established research on
the reflective process, and explaining the curriculum
of nursing to the students. Reflective writing is an active
process that "enables the students to think about
their practice, experience, skills, knowledge and attitudes.
It requires them to be actively involved in the process
and to develop independence of thought." (Durgahee
1998) The act of reflection actually teaches the student
to think reflectively; "facilitation is providing
a framework for thinking, feeling and developing insight."
(Durgahee 1998) Interpretation of experiences is crucial
because it forces the student to rethink their actions
in the next clinical situation.
Summary of Our View-Point
We agree with the affirmative point of view. After
a student Nurse has experienced discussion of a theory
in class or an emergency situation in practicum, reflection
is essential for psychological reasons. Even if students
do not at first "think reflectively" the nursing
profession obviously requires this skill and therefore
will be taught to in nursing courses such as Nursing
117/127. Reflective writing helps the students gain
insight into the profession and the clinical practices.
From our student interviews we can see that reflective
journal writing is useful and a valid learning strategy.
Analyses of Sample Student
Journals
These
journal entries, taken from two students in first
year Nursing, are good examples of a typical journal
entry. Journals reflecting clinical practice could not
be used because of confidentiality reasons. For the
communications course (Nursing 117) students are encouraged
to reflectively write after every class and the journals
are handed in at the end of the semester. Theories discussed
in class such as "Touch" are reflected upon
and integrated into the student’s own personal experiences.
Testing concepts by using them everyday is also encouraged
as a student reports in her entry. Many Nursing theories
involve communicating effectively in all forms (writing,
body language, and verbal) and therefore can be practiced
constantly.
Teacher comments are also included exemplifying
the opportunity for dialogue between the Nurse educator
and the students. The journals are not evaluated in terms
of punctuation, grammar, sentence structure, and spelling.
The writing is not formal, but simply a reflection of
the class and the students personal thoughts always using
the first person pronoun "I". Students are asked
to correct or re-write their journals if the teacher feels
they did not fully understand the theories discussed in
class.
Conclusion
Reflective writing is an important,
if not crucial, aspect to first-year Nursing. It is a
powerful technique that incorporates the personal experiences
and the knowledge gained through readings, classroom discussions,
and clinical practices. Students find journalling especially
helpful because it gives them an opportunity to have an
intimate dialogue with their instructors. Through writing
weekly entries and reflections, students learn how to
organize their thoughts and actions according to their
own world-view. It is a practice that searches for new
mediums of discourse for Nurses, and attempts to integrate
past and present experiences to determine future Nursing
actions. Journals are personal, as well as the Nursing
program, but as Riley Smith stated, "it is only as
personal as you want it to be."
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