Does a reflective journal with educator feedback enhance clinical learning for nursing students?

By LAU Lai Yee, Claudia, RN, BNurs(Hons), MSc(WHS), Nurse Educator I


The purposes of this study were to assess and improve students' knowledge and attitude in the reflection journal practice and evaluate students' satisfaction towards the reflective practice with educator feedback.


The use of reflective journal has been identified as an effective tool to improve clinical competency of nurses. In reflection, nurses think consciously through their own experience and have self-discovery of own thought and action. Nurses can identify strategies for handling issues or avoiding problems in similar clinical circumstances. Their critical thinking and coping abilities are improved which in turn promote the quality of patient care. Moreover, some studies supported that nursing students with reflective practice think more positively and have less stress in clinical practice. In our school, the Enrolled Nursing students had reflective journal practice during clinical practicum but some of them found it difficult to write the journal and had limited gain from this practice. Guided practice by experienced educator can facilitate student to think deeply and positively which enhance learner’s learning. 


A total of ninety Second Year Enrolled Nursing students in a Higher Diploma in Nursing programme were invited to have bi-weekly reflective journal practice during their clinical practicum from May, 2017 to August, 2017. Pre-survey and post-survey were used to assess student’s knowledge, attitude and experience regarding the practice of reflective journal. An education seminar about reflective journal was provided to all students after the pre-survey. After student submitted their reflective journal(s) to educator, a face-to-face feedback session was provided during June-August, 2018.


The findings shown that there was an 31% decrease in the wrong concept and 28% increase in the self-rated knowledge about reflective journal practice. More than half students (51%-72%) agreed about the effectiveness of reflective journal like identifying own strength and weakness, strengthening critical thinking and analytical ability, improving own weakness and clinical competency. About 70% students satisfied with the educator’s feedback. However, 31% students expressed stressful to discuss their own experiences and 79% preferred to have more time for the journal writing.


Reflective journal is a useful tool to enhance clinical learning for nursing students. Knowledge and motivation in the reflective practice are cornerstone for its success.  

The findings justified the positive outcome of reflective journal practice with educator’s feedback which should be implemented to all nursing students in our school. Although guided reflective practice has positive impact on student learning, it requires qualified facilitator and manpower. In this study, one senior educator was responsible for the feedback session which could ensure the consistency of feedback. Training of mentoring and reflective practice is prime for all educators in view of increased number of students. More longitudinal studies are suggested to explore the effectiveness of written feedback.