Guided Reflective Writing and Student Clinical Judgment Development: A Descriptive Study of Nursing Student and Faculty Perspectives

Abstract

Literature supports guided reflection and clinical judgment development as key components to enhancing students’ knowledge and preparation for complex nursing care. Faculty are challenged to prepare new nurses to enter the complex health care arena and often note problems in helping students transition classroom learning to clinical application. The National Council of State Boards of Nursing (NCSBN) recognizes and supports teaching clinical judgment in nursing curricula to better prepare nursing students for professional practice (2018). Guided reflective writing provides opportunities for nursing students to synthesize and evaluate evidence related to clinical experiences and may support clinical judgment development. The purpose of this qualitative descriptive study was to examine student and faculty perspectives of the benefits and challenges of guided reflective writing for clinical judgment development following clinical experiences. A convenience sample of Junior (n=28) and Senior (n=19) nursing students and faculty (n=4) were recruited from a baccalaureate degree nursing program at a small Midwestern university. These students used the Guided Reflective Writing Assignment organized by Tanner’s Clinical Judgment Model (2006). Student participants were asked to participate in an open-ended survey regarding their experience of the Guided Reflective Writing Assignment post-clinical. A focus group gained faculty perspectives of the assignment. Methods to assure trustworthiness included follow-up participant interviews and artifact analysis. Qualitative data was analyzed using content analysis to identify themes from the responses. An organizing frame relevant to reflective writing and clinical judgment for patient care emerged from the group descriptors. Since different student levels provided different perspectives of the assignment, a final theme for each student group was developed: 1) Organizes basic nursing care (Junior One students) and 2) Sense of wholeness (Senior Two students). Progression in clinical judgment from Junior One to Senior Two students was supported with participant comments. Faculty concurred with students’ perspectives with their final theme, Encourages deep thinking. Study findings reflect support and value of the Guided Reflective Writing Assignment for assisting students gain clinical judgment skills. The study helps advance the science of learning and leads to further research opportunities and implications for nursing students, faculty, graduates, and patient care.