14
This article was downloaded by: [Universite De Paris 1] On: 31 August 2013, At: 00:33 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Reflective Practice: International and Multidisciplinary Perspectives Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/crep20 Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection Mary Kate Garrity a a Trent University, Ontario, Canada Published online: 19 Oct 2012. To cite this article: Mary Kate Garrity (2013) Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection, Reflective Practice: International and Multidisciplinary Perspectives, 14:1, 118-130, DOI: 10.1080/14623943.2012.732940 To link to this article: http://dx.doi.org/10.1080/14623943.2012.732940 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms- and-conditions

Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

Embed Size (px)

Citation preview

Page 1: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

This article was downloaded by: [Universite De Paris 1]On: 31 August 2013, At: 00:33Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Reflective Practice: International andMultidisciplinary PerspectivesPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/crep20

Developing nursing leadership skillsthrough reflective journaling: a nursingprofessor’s personal reflectionMary Kate Garrity aa Trent University, Ontario, CanadaPublished online: 19 Oct 2012.

To cite this article: Mary Kate Garrity (2013) Developing nursing leadership skills through reflectivejournaling: a nursing professor’s personal reflection, Reflective Practice: International andMultidisciplinary Perspectives, 14:1, 118-130, DOI: 10.1080/14623943.2012.732940

To link to this article: http://dx.doi.org/10.1080/14623943.2012.732940

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever orhowsoever caused arising directly or indirectly in connection with, in relation to or arisingout of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Page 2: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

Developing nursing leadership skills through reflective journaling:a nursing professor’s personal reflection

Mary Kate Garrity*

Trent University, Ontario, Canada

(Received 4 January 2012; final version received 10 August 2012)

Reflective journaling can be an effective teaching strategy in undergraduatenursing education. In particular, reflective journaling has been shown to increasethe learner's critical thinking and future application of new knowledge. This per-sonal reflective paper describes and discusses the design, implementation, evalu-ation and effectiveness of a reflective journaling assignment in assistingundergraduate nursing students with developing nursing leadership skills. Theassignment was implemented across seven sections of a collaborative nursingdegree program and students were given the opportunity to provide their feed-back on the usefulness of reflective journaling in helping them develop strongerleadership skills. This paper concludes with a discussion of revisions and recom-mendations for a more successful implementation of this assignment.

Keywords: reflective journaling; leadership; community health nursing; teachingstrategy; critical thinking

Introduction

This paper is a reflective analysis of a Canadian nursing professor’s experience indesigning, implementing and evaluating a reflective journal assignment (RJA) in aBachelor of Science in Nursing (BScN) leadership course. This paper provides abackground of the course and offers a context explaining why this type of assign-ment was created and implemented, a description of the assignment, and a discus-sion of results from students’ evaluations of the assignment. It concludes bydiscussing ways in which to revise the RJA and future recommendations for a moresuccessful implementation.

The LEARN format was chosen to frame this reflection for two reasons. Thefirst reason is that this format is the same format used by students within the BScNprogram for reflective writing assignments. The second reason is my belief that forstudents to value their learning experiences then their teachers should lead by exam-ple, therefore, the LEARN format was used to guide the writing of this reflection.The acronym LEARN stands for Look Back (briefly outlining the situation),Elaborate (objective and subjective recall of the situation’s details), Analyze the sit-uation, Revision of situation (actions that would be preserved or changed), andNew perspective (future recommendations). There is a strong focus on the analysissection of this paper as it offers a detailed discussion of the RJA by applying

*Email: [email protected]

Reflective PracticeVol. 14, No. 1, February 2013, 118–130

ISSN 1462-3943 print/ISSN 1470-1103 online� 2013 Taylor & Francishttp://dx.doi.org/10.1080/14623943.2012.732940http://www.tandfonline.com

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 00:

33 3

1 A

ugus

t 201

3

Page 3: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

relevant research to various aspects of the assignment. The analysis acts as afoundation for the discussion about what worked well in the assignment and shouldtherefore be preserved and what aspects need revised. The analysis section alsoserves as the basis for recommendations to improve the assignment.

Look back and elaborate

In 2011, an RJA was implemented in a required leadership course as a way for thirdyear nursing students to develop leadership skills in a community health setting.Nursing leadership in this course is defined using the Canadian Nurses Association(2009) Position Statement on Nursing Leadership. The theme of the third year isprimary health care within a community health nursing context. However, the lead-ership course had a very strong association with hospital nursing, nursing manage-ment and the American health care system. Over the years, course team meetingsand anecdotal student feedback indicated that these factors created dissatisfactionamong nursing students as it was not congruent with the foci of the year. Therefore,to assist students with making a stronger connection between leadership and com-munity health nursing from a Canadian perspective, the team adopted a Canadianleadership textbook and implemented an RJA.

Analyze

Reflective journaling and nursing leadership education

Research discussing reflective journaling as a teaching strategy in leadership educa-tion highlights its effectiveness in promoting leadership competencies, such as criti-cal thinking, ethical reasoning and emotional competence. Research suggests thatjournaling assists nursing students’ with critical thinking about their practice(Kuiper, Murdock, & Grant, 2010; Marchigiano, Eduljee, & Harvey, 2011; Walsh &Seldomridge, 2006). This finding is significant since critical thinking about one’snursing actions can transform students’ ways of thinking and acting in practice (Ass-elin, 2011). Other research supporting the use of journaling in nursing education dis-cusses its helpfulness with developing students’ confidence in ethical reasoningskills (Callister, Luthy, Thompson, & Memmet, 2009) and emotional competence(Harrison & Fopma-Loy, 2010). Ethical reasoning skills and emotional competenceare identified as important leadership competencies throughout the course text Nurs-ing Leadership from a Canadian Perspective (Pangman & Pangman, 2010).

The central theme in Callister et al. (2009) research, ‘in the process of becom-ing’, captures a student nurse’s journey to becoming an ethical and professionalnurse and identifies several sub-themes that can be applied to leadership develop-ment. Callister et al. (2009) found that reflective journaling promotes students’ abil-ity to recognize an ethical dilemma and critically analyze their behaviours in thesituation. They stated that the reflective process involved in journaling contributesto a student’s knowledge of the ethical decision-making process, leading to furtherprofessional development. Similarly, Harrison and Fopma-Loy (2010) found thatreflective journaling enhances emotional competencies in nursing students. Theysupported journaling as a strategy that may be used in nursing leadership courses asa way to develop emotional competencies (Harrison & Fopma-Loy, 2010). I believethat their article is significant for the nursing profession as emotional competence is

Reflective Practice 119

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 00:

33 3

1 A

ugus

t 201

3

Page 4: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

often a competency overlooked by nursing educators. As students enter their thirdyear of the BScN program, they leave behind a ‘doing to’ perspective of providingcare and enter into a ‘doing with’ relationship with their clients. Therefore, emo-tional competence is an important leadership competency that students must developin order to build effective partnerships with clients. Reflective journaling has beenshown to accomplish this task.

Reflective journal design

Research supports the finding that a structured RJA with guiding questions, asopposed to free journaling, is most effective in stimulating a student’s critical reflec-tion, thinking and, personal and professional transformation in self and practice(Billings, 2006; Lasater & Nielsen, 2009; Nielsen, Stragnell, & Jester, 2007). Criti-cal reflection within the context of this assignment encourages students to explorethe basis of their assumptions and beliefs and to move from a ‘blame the victim’perspective, as is what is so often expressed by many novice nursing students whendiscussing issues such as homelessness, poverty and unemployment, towards a per-spective that includes political action and advocacy for communities at risk forhealth inequities. Becoming politically active and acting as advocates are nursingleadership competencies that students in the course are encouraged to develop.

Perry (2000) stated that learning to engage in meaningful, critical reflectionabout a situation is a skill that is acquired through a structured process involvingprobing questions and guidance either from faculty or through peer feedback(Horn & Freed, 2008) about specific aspects of clinical practice. Daroszewski, Kin-ser, and Lloyd (2004) conducted a pilot study exploring the use of online, directedjournaling in advanced practice community health clinical education to improveclinical learning among graduate nursing students. The themes arising from theiranalysis supports the use of directed journaling in promoting mentoring skills, dis-cussion skills, socialization and critical thinking in advanced practice nursing educa-tion. Lasater and Nielsen (2009) and Nielsen et al. (2007) used Tanner’s (2006)clinical judgement model and guide for reflection to structure the reflective journalwriting in their research. This guide facilitates students’ reflection on previousknowledge being brought to practice, what new learning needs to occur to adapt tothe experience, and identify ways to achieve that learning. Their research indicatesthat a structured model of critical reflection helps students explore the nature oftheir practice experiences in a more meaningful way. Similar to Daroszewki et al.(2004), Lasater and Nielsen (2009) and Nielsen et al. (2007) encouraged the use ofa model for reflection in community health nursing contexts. Nielsen et al. (2007)reported that the probing questions included with the guide stimulates critical think-ing, application of theory to practice (knowledge transfer), transformation in think-ing about practice and nursing knowledge, and in-depth exploration of emotionsthat students attach to the practice experience.

Writing clear objectives

My teaching philosophy supports the belief that a primary responsibility of a tea-cher is to promote student success in the learning environment. One example ofhow a teacher can promote students’ success is by designing well-developed learn-ing objectives (McDonald, 2007). Establishing clear objectives for assignments also

120 M.K. Garrity

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 00:

33 3

1 A

ugus

t 201

3

Page 5: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

assists with the development of evaluation tools that assess whether the assignmenteffectively addresses student learning outcomes. The learning objective for this RJAis: students will demonstrate their application of leadership theories and skills intheir community health nursing practice through weekly critical reflections. Thisobjective addresses many of the overall curriculum and course objectives, such as:to expand and integrate community health nursing course concepts and theories; tointegrate leadership theories and concepts into community health practice settings;and to reflect critically on personal development of leadership skills.

The clearer an objective is described the easier it is for students to understandthe significance of doing what is asked of them. I believe that when students areaware of the significance and the applicability of the assignment then this in turnleads to a student’s success in the assignment. When designing objectives for anyassignment, I follow the acronym SMART. The letter ‘S’ means specific. ‘S’usually focuses on what is to be accomplished by the learner; identifies the impor-tance of the task to the learner; where the learning is to take place; and, who isinvolved in the learning. McDonald (2007) stated that when students know what isexpected of them then they will aim for optimal performance. The letter ‘M’ repre-sents the extent to which a learning outcome can be measured. ‘M’ asks the ques-tion, How do we know if the objective has been accomplished? Well-writtenobjectives provide the blueprint for developing assessment methods that reliablyassess students’ success in meeting the course objectives (McDonald, 2007). Thethird letter ‘A’ stands for achievable. Can a third year nursing student developknowledge and skill in leadership as it applies to community health nursing in onesemester? This letter makes us ask, ‘Are we setting our students up for failure byasking them to meet an unattainable goal?’ The letter ‘R’ represents relevancy ofthe objective. If students do not find the learning objective meaningful to theirdevelopment as a nurse, then a possibility exists that students will not focus ondeveloping specific skills. Finally, ‘T’ represents time-specific. Well-written objec-tives specify the duration of time over which an objective is achieved. It also makesteachers think about whether the objective can be realistically achieved in aspecified time frame. Can students develop knowledge of leadership theories andconcepts and apply this knowledge in their practice in seven weeks? Havingtime-specific objectives also keeps students focused on completing the assignment.

Leadership development assignment: reflective journal

The RJA is a structured design. Between weeks two and eight of the semester stu-dents write weekly entries corresponding to weekly topics describing a significantleadership experience. These experiences arise from their community health place-ment. The journal entries are guided by questions designed to stimulate students’critical reflection of a practice experience. These questions were created by anothercourse instructor and myself and include the following:

(1) Describe what made you recognize the event as a learning experience? Forexample, did you stop to spend time thinking about it after it happened?Could you make sense of the experience? Did you experience any emotionalreactions? If so, what emotions did you feel at the time and why do youthink you felt this way?

Reflective Practice 121

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 00:

33 3

1 A

ugus

t 201

3

Page 6: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

(2) Discuss a theoretical framework that you can apply to the incident, experi-ence or observation.

(3) Describe what you learned from this learning experience.(4) Describe what you did as a result of this learning experience in your place-

ment or discuss the implications it may have on your present practice?(5) Describe how you would apply this learning experience in your future prac-

tice as a Registered Nurse?

These questions are similar to questions presented in much of the journaling litera-ture as questions that stimulate students’ critical thinking, reflection and new learn-ing (Horn & Freed, 2008; Kuiper et al., 2010; Nielsen et al., 2007).

This assignment used a traditional, written approach to reflective writing asopposed to using technology-based learning strategies. Although online teachingstrategies are becoming increasingly popular, the one reason that this assignmentdid not use this approach was faculty-based. Most of the instructors were unfamiliarwith using internet-based strategies as a tool for assessing students. Three instruc-tors voiced their unfamiliarity with how to use certain features of the university’slearning management system. This latter reason coupled with the fact that it was anew course assignment, which given my teaching experience, meant possibleunforeseen problems may have been overwhelming for faculty to tackle. Therefore,a traditional, written approach was used for this assignment.

Other requirements for the journal include: word length of journal entries witheach entry being between 200 and 250 words; submission of journal to teacher orteaching assistant at weeks five and eight for feedback; and, evidence of theoreticalreferences from peer-reviewed sources. The reason for a word limit was based onfaculty workload. Even though I believe that the quality of what is written is muchmore important than word length, this was a course with 50–75 students in each ofthe seven sections and not having a word limit imposed on assignments wouldmake faculty workload, including the provision of quality feedback, very challeng-ing. Sources vary as to the length of a reflective journal entry. Length of entries aredescribed either through the amount of time spent journaling, such as one minute(Asselin, 2011) to one hour (Darowszewki et al., 2004) or a fixed word/page count,including no assigned length (Kuiper et al., 2010). Much of the literature does notmention the length of students’ individual journal entries. This could suggest thatthe length of the journal entry is not an important requirement, but that a student’sdemonstration of engaging in the critical reflection process takes priority. Assessingwhether there is a relationship between length of journal entries and enhancedknowledge transfer, transformation and critical thinking is an area requiring furtherinvestigation.

Students submitted their journal to their teacher or teaching assistant for feed-back in weeks five and eight of the semester. Only the second half of the journalwas graded which gave students an opportunity to incorporate feedback from thefirst submission. Giving feedback to students is an opportunity for teachers to pro-vide students with encouragement. It also offers stimulating suggestions forimprovements in areas, such as: identifying the leadership skill in the practice expe-rience; describing the relationship between the theoretical concept or theory, theleadership skill, and the experience being described; identifying how a change inunderstanding occurred and how this change influenced practice; and describingemotions and behaviours of self and others involved in the experience.

122 M.K. Garrity

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 00:

33 3

1 A

ugus

t 201

3

Page 7: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

Faculty feedback is cited by many authors as an important component of reflec-tive journaling assignments. Lasater and Nielsen (2009) discussed how both hand-written and online faculty feedback in the form of guiding questions and generalcomments encourages students to think more deeply about their practice situation.Nielsen et al. (2007) highlighted many benefits of using a particular rubric to guidefaculty feedback. This rubric, the Lasater (2007) Clinical Judgement Rubric, out-lines criteria that reflects the evolution of a student’s critical thinking and judge-ment, assists with faculty evaluation of student’s performance, helps facultyconstruct questions that stimulate metacognition and critical thinking, and uses astandardized language to dialogue with students about their progress. This feedbackfacilitates students’ progress towards nursing competence (Nielsen et al., 2007).Billings (2006) stated that there needs to be different sources of feedback, includingpeers and instructors. She further indicated that feedback should consist of ‘teachingcomments’ (p. 105). Billings (2006), as well as Nielsen et al. (2007) discussed simi-lar elements of feedback such as: describing the relationship between the theoreticalconcept or theory, the leadership skill, and the experience being described; identify-ing how a change in understanding occurred and how this change influenced prac-tice; and describing emotions and behaviours of self and others involved in theexperience. These elements of feedback were part of the RJ assignment. Further-more, Billings (2006) made the important assertion that feedback must be based onthe content of the journal and not the personality of the writer. It is important forfaculty to remain conscious of this assertion to eliminate biases they may haveabout individual students.

A final point I would like to make about faculty feedback is faculty’s perceptionregarding the length of time it takes to provide students with feedback. It was apoint of debate at the year-end course planning meeting between members of theleadership course team that there is too marking with this assignment. The partici-pants in the study conducted by Harrison and Fopma-Loy (2010) supported thisfeeling. However, in the words of Lasater and Nielsen (2009), ‘… the requirementof structured reflective writing … has not markedly increased faculty workload, butthe added insight into student thinking and learning makes any increase a valuabletrade-off’ (p. 44). I concur with Lasater and Nielsen as I believe that it is ourresponsibility and duty as nurse educators to provide students with constructivefeedback that will enhance their confidence and nursing competency.

Assessment of students’ reflective journals

The RJA in the leadership course is a graded assignment. A student’s grade isdetermined using the school of nursing’s grading guidelines as well as specific crite-ria for the assignment. The template identifies the following aspects that need to beaddressed in a journal entry: practice experience is described using theory; behav-iours noted in experience are described in detail; general writing skills; journal entrydemonstrated understanding of leadership topic and related material; student demon-strated critical reflection through the critiquing of personal assumptions and values;evidence of how assumptions and values changed; literature is not regurgitated butintegrated into student’s experience; analysis of social relations is evident; journalentry is understandable and concise; and accurate use of APA format.

Faculty teaching the leadership course raised valid concerns relating to theassessment of reflective journals. One concern amongst faculty was how to fairly

Reflective Practice 123

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 00:

33 3

1 A

ugus

t 201

3

Page 8: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

assess writing that explores students’ values, beliefs and assumptions about theirpractice experiences. Bevis (1989) and Hargreaves (2004) strongly advocatedagainst grading reflective journals as they believed that when a grade is assigned toa student’s work it stunts a student’s creativity, genuineness and reflection. Factorscontributing to this stunting of creativity, honesty and reflection include the powerand authority of a teacher and students giving the teacher what s/he wants(Hargreaves, 2004; Holmes, 1997). This latter factor suggests that students write ina way that they think will please their teacher. Another concern amongst facultywas whether personal reflections should be graded. Given that the College ofNurses of Ontario, the profession’s provincial regulatory body, requires nurses toengage in reflective practice, the assessment of a student’s ability to reflect on anexperience and learn from that reflection is of paramount importance to the develop-ing competencies of nursing students. Therefore, I believe that it is important thatthe assessment of critical reflective journals continue. However, nursing instructorsmust use ways that allow for an ethical approach to grading.

Literature discussing the ethical assessment of reflective journals supports the useof templates as a way of assisting students’ progress and success in their writing.Lasater and Nielsen (2009) recommended that an assessment template focusing ontheory and process as opposed to content in the entry helps guide a fair evaluationof a student’s critical reflection. Focusing on process as opposed to content can facil-itate a non-judgemental assessment of a student’s ability to reflect critically on thenature of the experience (Bournier, 2003). Plack, Driscoll, Blissett, McKenna, andPlack (2005) created an assessment tool evaluating the level of reflection that occursin students’ journals. They determined through inter-rater reliability scores that theirtool satisfactorily evaluated a student’s level of competence in the reflective processas well as providing a tool to establish a benchmark in a student’s progress in thereflection process. Monica and Misselwitz (2002) cited Hahneman, stating that stu-dents tend to devalue assignments that are not graded and therefore do not put forthas much effort in preparing for these assignments. While I do not completely agreewith Hahnemann’s assumption, based on my 10 years of teaching nursing students, asmall number of students are driven only by grades. A personal example from myteaching practice that illustrates this belief is my use of one-minute, ungraded papers.At the end of a class, I sometimes ask students to write down the most meaningfulthing that they learned and how it can be applied to their practice. The responses Ireceive from the majority of students are thoughtful and reflective.

Informal student evaluation of the reflective journal assignment

Evaluation of this RJA assessed whether the assignment met its objectives. Theevaluation was not designed at the same time as the assignment’s objectives andtherefore did not align with best practices of program evaluation. However, the pur-pose for evaluating the assignment was to obtain a snapshot of students’ perceptionsof how it enhanced critical thinking about leadership and how they applied leader-ship theory to their practice. Five-point Likert-type scales collected ordinal data onstudents’ level of agreement relating to several aspects of the reflective journalingassignment. In this evaluation, a score of 1 indicated strongly disagreeing with astatement while a score of 5 indicted strongly agreeing with a statement. A score of3 indicated feeling neutral about the statement. Items 1 to 3 focused on studentlearning outcomes. The items students responded to asked for their level of

124 M.K. Garrity

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 00:

33 3

1 A

ugus

t 201

3

Page 9: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

agreement about the effectiveness of the assignment in developing their knowledgeof leadership, critical thinking skills, and awareness of thoughts and perceptionsrelated to nursing leadership. Item 1 asked students to rank their agreement with thestatement, ‘Reflective journaling helped develop my knowledge and understandingof nursing leadership’. Item 2 asked students to rate their level of agreement withthe statement, ‘Reflective journaling highlighted thoughts and perceptions related tonursing leadership’. Item 3 asked students whether reflective journaling helped fur-ther develop their critical thinking skills. Items 4 and 5 focused on the clarity of theassignment description (Item 4) and the usefulness of the journaling template inhelping students organize their journal (Item 5).

Eighty evaluations were returned from a possible 476 students. Several reasonsexplain the low response rate. Two instructors did not distribute the evaluation to theirclass. The timing of evaluations was two weeks before the end of the semester andattendance is low across all courses and years at this time. One group of evaluationswas not received in time to be included in results. Two students did not respond toItem 4 in the evaluation. Since the evaluations are an anonymous process, there wasno way of determining students’ rationale for not responding to these questions.

The mode score relating to students’ level of agreement was determined foritems 1–5 by totalling student responses for each item and ranking of agreement.The mean score and standard deviation, although commonly reported withLikert-type scales, were not calculated because of the ordinal nature of the data,meaning there is no possible measurement between, for example, the labels ofstrongly disagrees and disagrees. Table 1 presents a summary of student responses.

Table 1 indicates that approximately 41% of third year nursing studentsparticipating in the evaluation agreed that reflective journaling helped develop theirknowledge and understanding of nursing leadership. Almost half of respondentsagreed that reflective journaling highlights thoughts and perceptions relating to nurs-ing leadership and approximately on-third of students strongly agreed that reflectivejournaling helped further develop their critical thinking skills. Thirty-two out of 78students felt neutral about the clarity of the assignment description. Twenty-four outof 80 students agreed that the template was helpful in organizing their journalentries, while only 15% strongly agreed with the template’s helpfulness.

Table 1. Summary of student responses (n = 80).

1 (strongly disagree) 2 (disagree) 3 (neutral) 4 (agree) 5 (strongly agree)

ItemI1 6 7 15 33 (41.25%) 19I2 3 6 11 39 (48.75%) 21I3 2 6 17 26 29 (36.25%)I4 8 11 32 (41.25%) 16 11I5 12 15 14 24 (30%) 15

Notes: I1-I3, I5: n = 80; I4: n = 78.I1: Reflective journaling helped develop my knowledge and understanding of nursing leadership.I2: Reflective journaling highlighted thoughts and perceptions related to nursing leadership.I3: Reflective journaling helped further develop my critical thinking skills.I4: Assignment description was clear.I5: Journaling template helped me organize my journal.

Reflective Practice 125

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 00:

33 3

1 A

ugus

t 201

3

Page 10: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

Three further categories of data were created: agree, disagree and neutral. Thedata are presented in Table 2. They show that the majority of students completingthe evaluation agreed with the statement assessed in Item 1. A total of 65% ofresponses indicated that students agreed that reflective journaling increased theirknowledge of nursing leadership while 16.25% students disagreed with this item.The percentage of students rating this item neutral was 18.75%. Item 2 asked stu-dents to rate their level of agreement with the statement, ‘Journaling highlightsthoughts and perceptions relating to nursing leadership’. A total of 75% of studentsagreed with this item while 11.25% disagreed. The remaining 13.75% of studentsindicated a neutral response. Item 3 asked students to rate their level of agreementwith the statement, ‘Reflective journaling helped further develop my criticalthinking skills’. The majority of students agreed that journaling developed theircritical thinking skills.

Items 4 and 5 asked for students’ level of agreement with the clarity of assign-ment description and the usefulness of a journaling template in helping them orga-nize their entries. Analysis indicates that the frequency of student responses washighest in the neutral category at 41.025%. Two evaluation forms had missingresponses for this item and the percentage is calculated using 78 as opposed to 80students. However, approximately 35% of students agreed that the assignmentdescription was clear and easy to follow, while approximately 24% of students dis-agreed with this item. Almost half the number of students completing the evaluation(48.75%) agreed that the journaling template provided structure to their reflectivejournal while 33.75% disagreed and 17.50% were neutral with respect to thetemplate providing structure.

Reflecting on the results of the evaluation, it is noted that the majority of stu-dents (69.58%) completing the evaluation agreed that the learning outcomes of theassignment described in Items 1–3 were achieved. The reflective journal appears tohave the greatest influence on highlighting students’ thoughts and perceptions relat-ing to nursing leadership, followed by students’ further development of criticalthinking skills and then knowledge development of nursing leadership. It is disap-pointing that the journal assignment did not achieve a higher percentage of studentsagreeing with Item 1 as this was a priority learning outcome.

Items 4 and 5 rate the clarity of the assignment description and the usefulnessof the journaling template that was provided to students to help them organize theirjournal entries. The percentage of students who disagreed with Item 4 was higherthan desired. This high percentage suggests that the assignment description shouldbe revised. Almost half the respondents (41%) felt neutral about the clarity of theassignment’s description, which also suggests that the description of the reflectivejournaling assignment should be revised and made clearer to students.

Table 2. Agree/ disagree/neutral responses.

Item Agree Disagree Neutral

I1. 52 (65.00%) 13 (16.25%) 15 (18.75%)I2. 60 (75.00%) 9 (11.25%) 11 (13.75%)I3. 55 (68.75%) 8 (10.00%) 17 (21.25%)I4. 27 (34.615%) 19 (24.358%) 32 (41.025%)I5 39 (48.75%) 27 (33.75%) 14 (17.50%)

126 M.K. Garrity

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 00:

33 3

1 A

ugus

t 201

3

Page 11: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

Revisions

Based on the informal evaluation results and my reflective analysis of the RJA, thefollowing areas of the RJ assignment need to be revised: journal entry word length;clarity of assignment description; assignment template, delivery of student feedback;and planning and timing of assignment evaluation. Anecdotal evidence from stu-dents indicates that it is difficult to critically reflect on their experiences between200 and 250 words in a way that allows them to explore fully their emotions,thoughts and reactions. I recommend that word length of the journal be increased to500 words. Although the literature exploring optimal word length is scarce I believethat students are voicing a valuable concern about their inability to write a qualitycritical reflection. As I stated previously, examining word length of RJ assignmentsand the process of reflection is an area for further investigation.

The assignment description is another area of the RJ assignment that needsrevising. Many students feel that the description is unclear. Therefore, the teachingteam should consider rewriting the description using more concrete language andinclude several examples of journal entries. I believe that the use of concrete lan-guage and the provision of examples will provide students with clearer expectationsof the assignment requirements.

The third area of the assignment that needs revising is the use of a weekly tem-plate. The current template assigns weekly topics that students are required to reflectupon in their practice. Students questioned what they should do if the weekly topicwas not significant to their practice that week and were feeling stressed at not beingable to ‘match’ the weekly topic with their weekly practice experiences. Someinstructors advised their students not to focus on the weekly topics but insteadchoose a meaningful experience each week and apply leadership theory and con-cepts to their reflection. Upon reflection, this template should be revised and stu-dents should be encouraged to first focus on describing their experience and thenfind applicable theoretical references.

I recommend keeping opportunities for feedback. However, instead of journalsubmissions being weeks 5 and 8, I would suggest that students submit entriesweekly with teachers providing immediate feedback and guidance. The literaturecited previously illustrates the importance of teacher feedback in the developmentof students’ reflective process and also nursing competence. I believe that weeklysubmissions of entries as opposed to twice in the semester may limit the temptationfor students to craft imaginary experiences at the last minute. If students submitentries on a weekly basis then this continuously encourages them to reflect on theirpractice and development of leadership skills in the community.

Ethical assessment of students’ ability to critically reflect on their practice isimportant to students’ development of nursing competencies. Assessing students’ability to critically reflect using tools such as the ones created by Plack, Driscoll,Blissett, McKenna, & Plack (2005) or Tanner’s (2006) Clinical Judgement Modelwould promote consistency and objectivity among and between teachers.

Planning for the evaluation of this assignment should begin at the assignmentrevision stage and not tacked onto the end of the course. This would help ensurethat evaluation questions align with the assignment’s objectives and that bothprocess and outcome measures are built into the evaluation. I also suggest that bothin-class and online evaluation strategies are incorporated so as to capture a largernumber of students’ responses.

Reflective Practice 127

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 00:

33 3

1 A

ugus

t 201

3

Page 12: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

If this assignment is implemented again then I would not change the struc-tured nature of the reflective questions. Given that previously noted researchsupports the usefulness of structured questions in stimulating critical thinkingand applying concepts to practice, these questions should remain as part of theassignment’s requirements. In addition, upon reading students’ journals it is evi-dent that these questions guided their reflection in a way that targeted leader-ship development and community health nursing practice. Therefore, Irecommend not changing the nature of these questions but further assist stu-dents with understanding what each question is asking of them by providingseveral examples of journal entries and by providing clarification as the needarises.

New perspective

Given the evolving nature of technology in the learning environment as well asthe evolving nature of today’s generation of students, I believe that a shift toinnovative online journaling strategies, such as blogging or using social net-works such as Facebook or Twitter, needs to take place. I believe in order tobest situate today’s nursing student for not only leadership positions but also topractice competently, then instructors need to be strongly encouraged and sup-ported by their peers and institution in their application of technology in theclassroom.

Daroszewski et al. (2004) explored the use of online journaling in an advancedpractice community health nursing practice course. They used their institution’slearning management system to set up a website for their students to engage inweekly, online discussions. Students were required to journal for 60 minutes andpeers were invited to comment on entries. Findings from this pilot study indicatedthat students perceive online journaling to be effective in promoting discussion, crit-ical thinking, mentoring and socialization. Students particularly liked how theycould read and comment on their peers’ experiences in practice. The authors con-cluded that online teaching strategies should become the norm in graduate nursingeducation. I concur with these authors and recommend that further research explor-ing the effectiveness of online journaling strategies in promoting nursing leadershipskills within a community health nursing context.

Although this personal reflection did not present much original material, it diddiscuss the application of reflective writing to the development of nursing leader-ship skills within the context of community health nursing. This is an area thatneeds further exploration and I hope that this paper stimulates further research andinterest into reflective writing, the development of leadership skills, and communityhealth nursing.

In conclusion, reflective journaling for the purposes of developing leadershipskills, bridging the connection between leadership theories and community healthnursing practice, is an effective tool in collaborative nursing programs. Clear assign-ment objectives and requirements, and teacher feedback are important componentsin enhancing students’ learning of not only the critical reflective process but alsonursing competence. Moving towards innovative online journaling strategies willonly propel nursing education into the future and prepare students for the evolvingnature of learning and practice.

128 M.K. Garrity

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 00:

33 3

1 A

ugus

t 201

3

Page 13: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

Note on contributor

Mary Kate Garrity is the RPN to BScN Program coordinator with the Trent/FlemingSchool of Nursing in Ontario, Canada. She has been teaching community healthnursing and nursing leadership to students for over a decade and is currently explor-ing the use of blogging as a teaching strategy in nursing education.

ReferencesAsselin, M.E. (2011). Using reflection strategies to link course knowledge to clinical prac-

tice. The RN-to-BSN student experience. Journal of Nursing Education, 50(3), 125–133.Bevis. E. (1989). Accessing learning: Determining worth or developing Excellence. From a

behaviourist toward an interpretive-criticism model. In Bevis, E.O. & Watson, J. (Eds.),Toward a caring curriculum: A new pedagogy for nursing (pp. 261–303). New York:National League for Nursing.

Billings, D. (2006). Journaling: A strategy for developing reflective practitioners. The Jour-nal of Continuing Education in Nursing, 37(3), 104–105. Retrieved from http://ezproxy.lib.ryerson.ca/login?url=http://search.proquest.com/docview/223313035?accountid=13631.

Bournier, T. (2003). Assessing reflective learning. Education & Training, 45(5), 267–272.Callister, L., Luthy, K., Thompson, P., & Memmott, R. (2009). Ethical reasoning in Bacca-

laureate nursing students. Nursing Ethics, 16(4), 499–510.Canadian Nurses Association, (2009). Canadian nurses association position statement on

nursing leadership. Retrieved from http://www2.cna-aiic.ca/CNA/documents/pdf/publica-tions/PS110_Leadership_2009_e.pdf.

Daroszewski, E., Kinser, A., & Lloyd, S. (2004). Online, directed journaling in communityhealth advanced practice nursing clinical education. Journal of Nursing Education, 43(4), 175–180. Retrieved from http://ezproxy.lib.ryerson.ca/login?url=http://search.pro-quest.com/docview/203943988?accountid=13631.

Hargreaves, J. (2004). So how do you feel about that? Assessing reflective practice. NurseEducation Today, 24(3), 196–201.

Harrison, P.A., & Fopma-Loy, J. (2010). Reflective journal prompts: A vehicle for stimulat-ing emotional competence in nursing. Journal of Nursing Education, 49(11), 644–652.

Holmes, V. (1997). Grading journals in critical practice: A delicate issue. Journal of NursingEducation, 36(10), 489–492. Retrieved from http://ezproxy.lib.ryerson.ca/login?url=http://search.proquest.com/docview/203960502?accountid=13631.

Horn, R., & Freed, S. (2008). Journaling and dialogue pairs to promote reflection in clinicalnursing education. Nursing Education Perspectives, 29(4), 220–225. Retrieved fromhttp://ezproxy.lib.ryerson.ca/login?url=http://search.proquest.com/docview/236646704?accountid=13631.

Kuiper, R.A., Murdock, N., & Grant, N. (2010). Thinking strategies of Baccalaureate nurs-ing students prompted by self-regulated learning strategies. Journal of Nursing Educa-tion, 8(49), 429–436.

Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessmentrubric. Journal of Nursing Education, 46(11), 496–503. Retrieved from http://ezproxy.lib.ryerson.ca/login?url=http://search.proquest.com/docview/203910278?accountid=13631.

Lasater, K., & Nielsen, A. (2009). Reflective journaling for clinical judgment developmentand evaluation. Journal of Nursing Education, 48(1), 40–44. Retrieved from http://ezpr-oxy.lib.ryerson.ca/login?url=http://search.proquest.com/docview/203951143?accountid=13631.

Marchigiano, G., Eduljee, N., & Harvey, K. (2011). Developing critical thinking skills fromclinical assignments: a pilot study on nursing students’ self-reported perceptions. Journalof, Nursing Management, 19, 143–152.

McDonald, M. (2007). The nurse educator’s guide to assessing learning outcomes. Mississa-uga, ON, Canada: Jones and Bartlett Publishers.

Monica, M.K., & Misselwitz, S. (2002). Evaluating reflective writing for appropriateness,fairness, and consistency. Nursing Education Perspectives, 23(5), 238–242.Retrieved from http://ezproxy.lib.ryerson.ca/login?url=http://search.proquest.com/docview/22013 8807?accountid=13631.

Reflective Practice 129

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 00:

33 3

1 A

ugus

t 201

3

Page 14: Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection

Nielsen, A., Stragnell, S., & Jester, P. (2007). Guide for reflection using the clinical judg-ment model. Journal of Nursing Education, 46(11), 513–516. Retrieved from http://ezpr-oxy.lib.ryerson.ca/login?url=http://search.proquest.com/docview/203963529?accountid=13631.

Pangman, V.C., & Pangman, C. (2010). Nursing leadership from a Canadian perspective.Philadelphia: Lippincott Williams & Wilkins.

Perry, M.A. (2000). Reflections on intuition and expertise. Journal of Clinical Nursing, 9(1),137–145.

Plack, M., Driscoll, M., Blissett, S., McKenna, R., & Plack, T. (2005). A method for assess-ing reflective journal writing. Journal of Allied Health, 34(4), 199–208. Retrieved fromhttp://ezproxy.lib.ryerson.ca/login?url=http://search.proquest.com/docview/211059040?accountid=13631.

Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgment innursing. Journal of Nursing Education, 45(6), 204–211. Retrieved from http://ezproxy.lib.ryerson.ca/login?url=http://search.proquest.com/docview/203965102?accountid=13631.

Walsh, C., & Seldomridge, L. (2006). Critical thinking: Back to square two. Journal ofNursing Education, 45(6), 212–219. Retrieved from http://ezproxy.lib.ryerson.ca/login?url=http://search.proquest.com/docview/203946852?accountid=13631.

130 M.K. Garrity

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 00:

33 3

1 A

ugus

t 201

3