Clinical journaling allows students to reflect and retain their experiences and be active participants in the learning, while also reinforcing theoretical content. The student has the freedom to express thoughts, feelings, questions, and beliefs they may have not been able or willing to express during the clinical day. By utilizing purposeful instruction, the journal presents opportunities for both evaluation and critical reflection of clinical performance and previously held assumptions related to mental health. Journaling is a mechanism for self-awareness and awareness of the feelings of others. The student can demonstrate empathetic understanding and humility, providing for a deeper meaning of their experiences. Journaling helps students reflect on complicated social issues including cultural and societal issues about mental health, social justice, and patient rights. It is also a tool by which clinical educators can integrate and reinforce critical concepts and engage with students’ learning experiences.
In most of the recent literature, journaling has the greatest chance of success with robust orientation, clear expectations, and measureable goals for the student. This includes a rubric for guidance and feedback from the instructor. Reflective journaling has become a more commonplace pedagogy used in nursing education. Examples include the use of reflective journaling with progressive high fidelity simulation scenarios in a diploma medical-surgical course that identified eight positive themes including confidence, improved clinical judgement, and transfer of knowledge to the clinical setting (Bussard, 2015). Additionally, Ross et al. (2014) recognized clinical experience alone in the field of mental health does not accomplish all desirable learning objectives and critical self-reflection necessary for growth in practice. Students in a mental health course using reflective journaling augmented knowledge, personal attitude exploration, and skills development. The strategy of incorporation of reflective journaling provides an individualized tool for the instructor to evaluate experience, logical thought processes, and a focused needs analysis for the student in a mental health setting. Ross et al. (2014) concluded that within a welcoming atmosphere in a community mental health course students reflected more compassion and understanding toward the mental health community; it also transformed negative feelings of the students. Raterink (2016) examined the use of reflective journaling in a nurse practitioner program to guide the students to identify certain critical thinking habits of the mind for a deeper understanding of how students think and feel during a clinical scenario. The results from this qualitative study were favorable as students expressed an enhancement of their clinical decision skills by honing their critical thinking processes over time.
Journaling utilized early in the learning process allows for faculty to have the opportunity to evaluate the student’s critical thinking processes and nursing judgement. Clinical experiences, no matter the course or level of the student, is often a source of stress or anxiety for students. Students may experience high levels of stress during their clinical experience that it may interfere with learning and potentially impact their mental health. Students who are identified as having difficulties can be supported by faculty before a potential problem occurs. Similarly, students who are misunderstanding information can be corrected early through intervention from faculty. Journaling allows for a safe space for expression, enhancing the feeling of “caring for ourselves” when uncomfortable experiences occur. The student may be able to alleviate their stress through writing and understanding their experience. Additionally, journaling allows for transformation of previously held thoughts or beliefs through expression of feelings in a safe space.
The format of a journal can encompass a wide variety of possibilities depending on the learning objectives related to the course or clinical site. In this example presentation, the journal includes a pre-clinical reflection, nursing assessments, clinical day entries, and a post-clinical/course reflection. The journal format presented is guided and directly reflective of the mental health clinical assessment and clinical experiences of the undergraduate student.