Think back to the professional development objectives you set at the beginning of your practicum experience. Now that you are this far into your practicum experience, it

Teaching and Learning in Nursing 12 (2017) 39–42

Contents lists available at ScienceDirect

Teaching and Learning in Nursing

journal homepage: www.jtln.org

Review of Journaling as a Teaching and Learning Strategy

Laura B. Miller, MSN, BS, APRN-FNP-C⁎ College of Nursing and Allied Health Professions, University of Louisiana at Lafayette, Lafayette, LA

a b s t r a c ta r t i c l e i n f o

⁎ Corresponding author. Tel.: +1 405 412 0980. E-mail address: [email protected]

http://dx.doi.org/10.1016/j.teln.2016.10.004 1557-3087/© 2017 Organization for Associate DegreeNur

Keywords:

Journaling Reflection Reflective Nursing education

Journaling is an educational tool commonly used within nursing associate and bachelor degree programs. This article reviews journaling history, research, usage, and advantages and disadvantages within nursing education. New research trends reflect an interest in combining journaling with technology, pairing with simulation, and incorporating into graduate nursing programs to evolve with the changing needs of health care and technology.

© 2017 Organization for Associate DegreeNursing. Published by Elsevier Inc. All rights reserved.

Journaling within education, also called reflective learning journaling, is generally defined as writing about learning experiences (Hermansyah, 2016). This tool encourages reflection of self that leads to development and growth of judgment, personal values, and critical thinking skills. There may be guided questioning for the student to consider, or it may be a free-writing activity. Journaling is a widely and commonly used teaching strategy in a variety of school subjects such as psychology, teaching, mathematics, and sociology (Hashemi & Mirzaei, 2015). Within education, it is employed as a strategy to en- hance learning. Although journaling has been around for many cen- turies, it was specifically used as an educational tool in the latter half of the 20th century (Smith, 2013). It is commonly used within nursing education, mainly within undergraduate and prelicensure programs. Popularization of its use within nursing likely began when Donald Schon, in his 1987 book, detailed the importance of re- flective practice development in practitioners (Langley & Brown, 2010). Journaling was employed as a method to increase students' re- flection. Journaling within nursing commonly involves the activity of writing about experiences following clinical and simulation experi- ences. It may take place in class or postconference or be assigned as homework. The purpose specifically within nursing is to develop the future nurse to his or her full potential.

The American Nurses Association (2010) recognizes reflection as an essential educational skill in the nurse. The nurse is no longer ex- pected to only provide technical skills but also to provide value through critical thinking and judgment (Ruiz-López et al., 2015).

sing. Published by Elsevier Inc. All

Many educators like journaling because it helps the student to con- nect and apply information learned in the classroom to the clinical learning environment (Langley & Brown, 2010). Other educators like it because it helps students see their own strengths and weak- nesses in a learning area (Ruiz-López et al., 2015). One of the most helpful purposes of the journal is that the students can take a scenario and plan how to improve on it in the future. Therefore, it encourages refinement of action in different health care situations. One model of student self-reflection is the DEAL Model for Critical Reflection. “DEAL” is an acronym for Describe, Examine, and Articulate Learning. In this approach to deepen student learning, the student describes the learning experience, thinks about how specific goals were met, and decides how to improve in the future (Ash & Clayton, 2009). Most nurses in practice self-reflect by thinking about or engaging in conversations about events and experiences, but the nursing student is just learning this process, and the journal can provide guidance and direction for his or her thinking (Cladwell & Grobbel, 2013). In this ar- ticle, journaling research, usage, advantages and disadvantages, and issues and trends are discussed.

Research

A number of research studies focusing on the use of journaling in education, nursing, and other health care disciplines have been com- pleted over the past several decades. Most of the research available on this topic is qualitative because of the subjective nature of the ac- tivity and limited scoring methods (Epp, 2008). A literature search on journaling reveals that many of these studies focus on the benefits that journaling provides or the students' ability to be reflective of their practice following the activity. Research suggests that one ben- efit of journaling is to develop students' knowledge, skills, and judg- ment (Bussard, 2015; Epp, 2008; Estrada & Rahman, 2014; Langley

rights reserved.

Degree of reflection 0 no reflection, experiences are listed 1 some reflection is evident 2 deep reflection is evident

Application of theory 0 no theory components are correlated 1 some integration from readings/lectures to experience 2 strong integration from readings/lectures to experience

Analysis for future improvement 0 no thought towards improvement 1 some thought towards improvement, not well developed 2 well-thought plan for future improvement

Development of values 0 no value development indicated 1 some value development mentioned but not well-developed 2 full exploration of a change of one or more values

Degree of completion 0 not completed 1 not all questions answered, short response 2 full journal entry meeting length requirement

Total Points ___/10

Fig. 1. Example journaling rubric.

40 L.B. Miller / Teaching and Learning in Nursing 12 (2017) 39–42

& Brown, 2010; Lasater & Nielsen, 2009; McCallum, 2013); it de- velops critical thinking skills (Estrada & Rahman, 2014; Lasater & Nielsen, 2009; Raterink, 2016; Watson, 2010), and it develops per- sonal values such as cultural sensitivity and caring (Kuo, Turton, Cheng, & Lee-Hsieh, 2011; Ross, Mahal, Chinnapen, Kolar, & Woodman, 2014; Schuessler, Wilder, & Byrd, 2012; Taliaferro & Diesel, 2016). Journaling encourages self-reflection (Epp, 2008; Hashemi & Mirzaei, 2015; Lew & Schmidt, 2011). Most undergradu- ate students have lower levels of reflection (Silvia, Valerio, & Lorenza, 2013). However, reflection through journaling was found to increase over time (Schuessler et al., 2012; Taylor-Haslip, 2009). Several re- search studies suggest that higher levels of reflection in students' journals are associated with higher scoring on examinations and overall grade or some improvement in academic performance (Lew & Schmidt, 2011; Moon, 2006; Taylor-Haslip, 2009). Therefore, journaling as a learning activity can benefit students in many ways.

In addition to the benefits of journaling, studies also explore stu- dent and educator perceptions about journaling. The students have been found to value journaling as a learning activity or appreciate the learning outcomes associated with it (Langley & Brown, 2010; Ruiz-López et al., 2015). The educators also find that journaling is a preferred activity for reaching learning outcomes (Langley & Brown, 2010; Ruiz-López et al., 2015). These perceptions are important be- cause it suggests that this learning strategy is appealing and per- ceived as helpful by both faculty and students. Research indicates that students express an increase in self-awareness regarding knowl- edge and emotions (Langley & Brown, 2010; Ruiz-López et al., 2015; Silvia et al., 2013). This perception is congruent with the fact that journaling is meant to provoke self-reflection. However, students prefer writing journals that take less time (Hendrix, O'Malley, Sullivan, & Carmon, 2012; Langley & Brown, 2010). Less- experienced students prefer semistructured journals and more- experienced students prefer free writing their journals (Hendrix et al., 2012). Students would prefer anonymity or report a distrust in sharing the journals (Hendrix et al., 2013; Langley & Brown, 2010; Ruiz-López et al., 2015; Silvia et al., 2013). Recognizing what students perceive to be barriers to this learning activity can lead to ar- ranging the activity to be more acceptable. For example, nursing fac- ulty should recognize the importance of students' trust in the reader and consider whether anonymous writing would still achieve the same learning outcomes.

At this time, there is little to no research knowledge about how journaling differs across clinical areas and what the most reliable evaluation strategies are for achieving objectivity and interrater reli- ability. Currently, many nursing educators are using a subjective pass-or-fail method of grading journals. A more objective method of evaluating is by using a structured rubric. One way to structure journaling rubrics may be to include the following domains: degree of reflection, application of theory, analysis for future improvement, development of values, and degree of completion (see Fig. 1). Anoth- er way to structure the rubric is by using the service–learning goals of the DEAL Model: personal growth, civic engagement, and academic enhancement (Ash & Clayton, 2009).

Usage

When the journaling strategy and expectations are well ex- plained, there are specific roles for the teacher and the learner. The teacher's role is to explain the purpose of journaling and his or her ex- pectations in regard to content, reflection, and length. Teachers are also responsible for providing guided questions, when applicable, that represent the outcome the educator would like to achieve in re- gard to student learning. The teacher also has the responsibility to re- view the leaner's completed journal, provide thought-provoking questions and comments, and help merge ideas that remained

unconnected (Ruiz-López et al., 2015). The teacher should use infor- mation about identified weaknesses to help shape learning for that student in the future (Watson, 2010). Finally, the teacher provides a grade when it is used as an assignment based on a points system or completion grade.

The learner is the writer of the journal. It is their responsibility to use guided questions or thoughts about their experiences to stimu- late thinking and explore meaning. The student should reflect on their own growth and follow teacher-outlined expectations related to content, depth, and length. The learner also has the responsibility to make sure the journal, if used as an assignment, is submitted on time and with substantive depth.

The cognitive, affective, and psychomotor domains can all be used with this learning technique. The cognitive domain represents the student's ability to recall, think, and understand a concept and is bet- ter known as the “knowledge” domain (University of Connecticut, 2016). The students can use journaling to connect information learned in lecture to patients in the clinical setting with the same medical requirements. They can express their knowledge and rein- force learned information by writing about it. The affective domain represents the student's ability to express values or attitudes (University of Connecticut, 2016). The affective domain is the domain most commonly associated with this learning strategy. The students use journaling to explore meaning and emotions related to the health care setting and population groups. They learn about leadership, so- cial responsibility, culturally competent care, patient advocacy and autonomy, ethical considerations, and personal values. The psycho- motor domain represents the student's ability to demonstrate skills (University of Connecticut, 2016). This is the domain least commonly associated with journaling because the students do not actually per- form nursing skills when writing. However, some sources classify practicing critical reflection as a nursing skill (Ross et al., 2014). Journaling in this domain can be also used to write about skills that were performed and how they can be improved upon in the future.

Learning strategies are more helpful and likely to lead to learning outcomes when they are used with tool-appropriate subject matter. One of the most common appropriate uses of this learning strategy is related to clinical experiences. Educators ask the learner to describe a scenario, reflect on it, connect ideas, and improve upon it if it was experienced again or ask how they have changed because of it. It is

41L.B. Miller / Teaching and Learning in Nursing 12 (2017) 39–42

also commonly used to discuss cultural values, ethical considerations, therapeutic communication, and interprofessional collaboration and dialog. It is also appropriately used as a supplemental debriefing method following clinical simulation. The students are able to reflect on their skills, communication, and scenario of a simulation.

Advantages and Disadvantages

Journaling as an educational strategy has several advantages and disadvantages. Journaling provides an emotional outlet where students can explore emotions related to emergency situ- ations, new experiences and situations, and emerging values and social responsibilities (Ruiz-López et al., 2015). Nursing pro- grams can also be very stressful, and journaling helps the stu- dents to cope with these feelings (Ruiz-López et al., 2015). At the same time, this sharing of personal feelings is very personal to the writer. The writer may feel vulnerable or embarrassed and may not write truthfully if they do not trust the reader (Chan, 2009). Some students may view the assignment as busy work and not put much effort into the assignment. Some stu- dents believe that it is an invasion of privacy or is worried about their private thoughts being shared (Ruiz-López et al., 2015). Some students may feel that it creates a more intimate bond with the nurse educator that helps to increase learning (Ruiz-López et al., 2015). The students are able to reflect back on their experiences in order to improve them, and the instruc- tor can gauge the students' learning, judgment, and critical thinking skills (Chan, 2009). Journaling can also help to develop a student's writing skills as they learn to transfer thoughts to written information (Chan, 2009).

There are several disadvantages related to journaling. Grading journals is complicated because students may feel that it should be worth points because of the time the student invested, but it is diffi- cult to objectively grade subjective experiences (Chan, 2009). It can also be time consuming and labor intensive for the educator to read and provide thoughtful feedback (Chan, 2009; Langley & Brown, 2010). Clear expectations need to be set because the students need to understand what is expected of them (Chan, 2009). It is meant to be reflective of health care experiences involving the student and their patients and not for providing thoughts without filters or a com- pliant forum outside of these experiences. If the same questions are used from week to week or if the activity is overly structured, the stu- dent may not be as reflective in their responses. This could defeat the purpose of the thought-provoking activity by not allowing the depth of exploration and self-learning needed for a student or nurse to re- flect and grow from their experiences.

Issues and Trends

A literature search from PubMed and The Cumulative Index to Nursing and Allied Health Literature reveals that journaling research in nursing was popular from about the 1990s until about the early 2000s. During this period, nursing professionals concentrated on the need for reflective nurses. More recent journaling trends focus on journaling with the combination of technology. For example, Bussard (2015) and Reed (2015) focused on journaling following high-fidelity simulation. Others, such as Langley and Brown (2010), focused on journaling from within learning management systems, on-line discussion groups, and blogs. Another new focus is journaling within advanced practice nursing programs (Langley & Brown, 2010; Raterink, 2016; Williams, Gerardi, Gill, Soucy, & Taliaferro, 2009). These trends are developing through the increased need for nurse practitioners and higher education caused by increased complexity of medical care and a growing number of people who require health care services.

Conclusion

Journaling is an effective learning and teaching strategy within education and nursing to meet student learning outcomes. Research suggests that it encourages critical thinking, value development, and expression of feelings and deepens learning experiences. It is most effective when used appropriately and the advantages, such as emotional exploration, coping, increased learning, and improved writing, and disadvantages, such as difficulty grading, increased time required to grade and provide feedback, and continual efforts that need to be made toward making sure students meet expecta- tions, are considered. New journaling trends are changing and reflect an expansion of health care needs and technology growth. Further re- search is needed regarding comparison of evaluation methods and journaling between clinical areas.

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