FACULTY PROCESSES USED TO EVALUATE
SELF-REFLECTIVE
JOURNALS IN AN ONLINE RN-BSN PROGRAM
by
Kathleen E. Polley-Payne
DEBORAH S. ADELMAN, Ph.D., Faculty Mentor and Chair
DONNA TALIAFERRO, Ph.D., Committee Member
HOWARD JACOBS, Ph.D., Committee Member
Amy Smith, Ph.D., Dean, School of Education
A Dissertation Presented in Partial Fulfillment
Of the Requirements for the Degree
Doctor of Philosophy
Capella University
November 2017
© Kathleen E. Polley-Payne
Abstract
Evaluation of student learning activities is part of the fabric of higher education.
Expected by accrediting agencies within the health professions disciplines in curricula
aimed at the development of reflective practitioners. Student self-reflecting journaling is
a strategy frequently employed as a tool to develop reflective practitioners and promote
critical reflection. Despite the value of strategy, there is little agreement in the literature
regarding the methods and processes employed in the evaluation of student journals.
Self-reflection journals, employed intermittently in health professions education, usually
focuses on a clinical event. The purpose of this qualitative study was to explore what
processes faculty use in online programs that deploy self-reflective journals to evaluate
online registered nursing-bachelor of science nursing (RN-BSN) students’ self-reflection
journals. Eight online RN-BSN faculty who have extensive experience with the systemic
use of self-reflective journals in the curriculum participated in the study to provide their
insights and experiences with the evaluation of student self-reflective journals. The
results revealed a surprising consensus on the first steps along with general agreement on
the challenges with the evaluation of the self-reflective journals and the benefits of self reflection journals in the development of reflective practice. The constant comparison
data analysis revealed three broad themes regarding the processes employed for
evaluation: the steps in the process, the key behaviors faculty expected to find in the
journals, and the faculty’s beliefs regarding the value of self-reflective journals in moving
students to closer to reflective practice.
Dedication
I wish to express my eternal gratitude and love to my husband, John, who has supported
me throughout this process and has constantly encouraged me when the task seemed arduous and
insurmountable. To my daughter Bridget, who is the most beautiful chapter in the story of my
life. She has made me better, stronger, and been the source of more joy than I ever could have
imaged. To my oldest, closest, and true friends, Diane Olsen and Sally Calhoun, for their wise
counsel and the many days of listening as I made this journey.
My profound gratitude and thanks to Alex Vuckovic, MD; Arlene Licata-Miller, LICSW;
and Kenny Shindelman, LICSW, whose expertise, skill, compassion, and deep caring made this
dissertation and my ability to contribute to the profession possible. With great humility, I wish
to dedicate this body of work to the incredible practitioners that I have worked with at Lucille
Salter Packard Children’s Hospital: Vicki Link, RN, MBA; Michael Link, MD; Rick Moss, MD,
Dale Umetsu, MD; John Kerner, MD; and Louise Kerner, RN, BSN. They embody the spirit of
reflective practice and have served as role models and mentors. Through their daily practice,
they taught me to think out of the box, examine clinical issues from every perspective, while
always keeping in the forefront the impact of providers’ decisions on families and children with
life-threatening illnesses.
iii
Acknowledgments
The journey along the road to dissertation had many moments of joy, heartache, and
discovery. The process has allowed for personal and professional growth. I count myself very
fortunate to be surrounded by a pool of talented individuals that have played a significant role in
making this a reality for me. First, I would like to express my honest, heartfelt gratitude to my
mentor, Dr. Deborah S. Adelman: Without her humor, guidance, patience, persistence, and
knowledge, I may not have been successful in accomplishing this research. I would also like to
thank my other committee members, Dr. Donna Taliaferro and Dr. Howard Jacob, for their time,
knowledge, and support during this journey. Without the support and guidance of these
individuals, I could not have succeeded on this journey.
I would like to express my deepest gratitude to the faculty who participated in my study.
You not only provided insight into your experiences with the evaluation of student self-reflective
journals but you gave your most precious commodity—your time. I was very fortunate to enter
nursing at a time when the discipline of nursing became recognized as a distinct separate body of
knowledge. The influence of Dr. Jacqueline Fawcett and her contemporary nursing theorists
provided nursing with an increasing body of knowledge that spoke to the unique contributions of
nursing to the health of individuals, families, and communities. On a more personal level, I want
to thank Jackie Fawcett, Greer Glazer, Cynthia Aber, and Judy Beal, our paths intersected at
challenging times in my life. It was not always easy or convenient for them to work with me,
and yet they each gave so very generously of their time, knowledge, and expertise, leaving a
lasting impression on my personal and professional life.
iv
Table of Contents
Acknowledgment
iv
List of Tables
viii
List of Figures
ix
CHAPTER 1. INTRODUCTION
1
Introduction to the Problem
1
Background, Context, and Theoretical Framework
4
Statement of the Problem
13
Purpose of the Study
14
Research Question
15
Rationale, Relevance, and Significance
16
Nature of the Study
18
Definition of Terms
19
Assumptions, Limitations, and Delimitations
21
Organization of the Remainder of the Study
26
CHAPTER 2. LITERATURE REVIEW
27
Introduction to the Literature Review
27
Theoretical Framework
28
King’s Theory of Goal Attainment
29
Application of King’s Theory of Goal Attainment to This Study
32
Review of the Research Literature and Methodological Literature
35
Review of the Research Literature
36
Review of Methodological Issues
54
Synthesis of Research Findings
56
v
Critique of Previous Research
60
Chapter 2 Summary
60
CHAPTER 3. METHODOLOGY
62
Introduction to Chapter 3
62
Purpose of the Study
62
Research Question
63
Qualitative Research Design
64
Target Population, Sampling Method, and Related Procedures
64
Instrumentation
66
Data Collection
68
Data Analysis Procedures
69
Limitations of the Research Design
72
Credibility
73
Dependability and Transferability
73
Expected Findings
74
Ethical Issues
75
Chapter 3 Summary
75
CHAPTER 4. PRESENTATION OF THE DATA
77
Introduction: The Study and the Researcher
77
Description of the Sample
80
Research Methodology Applied to the Data Analysis
81
Presentation of Data and Results of the Analysis
83
Summary
100
vi
CHAPTER 5. CONCLUSIONS AND DISCUSSION
101
Introduction
101
Summary of the Results
102
Discussion of the Results
113
Limitations
127
Implication of the Results for Practice
129
Recommendations for Further Research
131
Conclusion
131
Reference
133
STATEMENT OF ORIGINAL WORK
149
CAPSTONE PUBLISHING AGREEMENT
150
vii
List of Tables
Table 1. Mezirow’s (1978) Ten Phases of Transformative Learning
45
Table 2. Demographic Characteristics of Study Participants
81
viii
List of Figures
Figure 1. Kings’ Process of Human Interaction with adaptive metaparadigm in parenthesis.
ix
34
CHAPTER 1. INTRODUCTION
Introduction to the Problem
Identified for decades in the general education and health professions literature, reflection
and the reflective process are integral to the development of expert practitioners and lifelong
learners (Dewey, 1938; Johns, 2013; Koole et al., 2011; Schön, 1987). Schön (1983) advanced
the belief that reflection and the reflective process are critical components in resolving the
dilemma of rigor versus relevance challenging practitioners and lies at the core of what
professionals do and how they become reflective practitioners. Licensing authorities, accrediting
bodies, and professional organizations expect that practitioners enter the professional practice
disciplines with the knowledge, skills, attitudes, and behaviors to be reflective practitioners
(American Association of Colleges of Nursing [AACN], 2016; Benner, Sutphen, Leonard, &
Day, 2010; Higher Learning Commission [HLC], 2016; McLeod, Barr, & Welch, 2015).
However, the time-honored professional educational approaches that lean towards the positivist
worldview and methods of inquiry fall short in promoting the professional skills that
acknowledge the “self” and others in solving increasingly complex clinical circumstances
(Benner et al., 2010; Caldwell & Grobbel, 2013; Schön, 1983, 1987).
As the hallmark of professional practice and grounded in educational theory and the
professional practice models, reflective practice aims at acknowledging the self and others in
solving complex clinical issues (Dunn & Musolino, 2011; Schön, 1987). Dewey (1933) posited
that the educational process has two dimensions: psychological and sociological. He espoused
that education must commence with insights into the psychological make-up of a student’s
1
capabilities, interests, and habits, which demand continual interpretation of what they mean
within the context of learning and the process of reshaping perceptions through the sociological
context to advance learning. According to Dewey (1933), the role of the educator was to select
certain influences on the student and assist the student in assimilating those influences within a
specific societal context, thus enabling the student to make responses to a situation that would
make him/her successful within society. Schön (1983, 1987), who was heavily influenced by
Dewey, described this interplay between the psychological and sociological influences as the
foundational cornerstones of his theory of reflective practice. The professional paradigm of the
student’s chosen profession provides the societal context in Schön’s model (Schön, 1983).
Although Schön (1987) described the concept of reflective practice, he did not articulate how
educators help students achieve the professional artistry described within his account of
reflective practice.
In reviewing the education and nursing literature, self-reflective journaling emerged as a
strategy to promote reflection that has the potential to increase one’s awareness of one's current
range of knowledge as well as an increased awareness of self (Bulman & Schutz, 2013; Johns,
2013; Silvia, Valerio & Lorenza, 2013). Tightly woven into the tapestry of clinical education is
reflective journaling, yet there is little evidence in the literature that examines the use of selfreflective journals in non-clinical courses (Bradshaw & Lowenstein, 2014; Tashiro, Shimpuku,
Naruse, Muftuah, & Matsutani, 2013). In addition to the lack of evidence in the literature of
studies that examined the use of self-reflection journals in non-clinical education, few studies
looked at the faculty role in the development of reflective practitioners (Brown, Holt-Macy,
Martin, Skau, & Vogt, 2015). While there is evidence of the increasing use of self-reflective
journals in nursing and health professions education literature (Chambers, Bronson, & Hassell,
2
2011; Dyment & O’Connell, 2011; Kennison, 2012), there remains a lack of reliable and widelyaccepted methods of evaluating self-reflective journals, especially within the realm of subjective
entries aimed at development of the self (Boussard, 2015; Richards, 2015).
In keeping with the Spellings Commission (2006), HLC (2016) and NLN (2016), which
are governing bodies in higher education, have placed a great value on linking teaching strategies
to learning outcome measures. Associated with the development of reflective practitioners,
journal writing as a teaching strategy holds particular promise especially in the online
environment (Booth, 2012; Ross, 2011). Employed in the face-to-face nursing learning
environment, journal writing is a deliberate, reflective teaching strategy utilized to facilitate the
integration of theory and practice, improve the development of insight, and stimulate cognitive
awareness and critical thinking (Barbour, 2013; Bulman & Schutz, 2013; Sherwood & HortonDeutsch, 2012). However, there were few studies found in the health profession literature that
address the application of self-reflective journals in the online environment where the
student/teacher relationship takes place in the computer-mediated environment (Booth, 2012;
Langley & Brown, 2010).
Enrollment in online registered nursing-bachelor of science nursing (RN-BSN) courses
rose by 12.4% from 2012-2013 and 10% from 2013-14 (AACN, 2015), and shows no signs of
slowing as the profession aims to reach a workforce that is 80% prepared at the baccalaureate
level by 2020 (Health and Medicine Division of the National Academies of Science Engineering
and Medicine [HMD], 2015). Thus, it is critical that nurse educators employ teaching strategies
grounded in adult learning theory, allowing post-licensure nurses to reframe their learning based
upon new information and adapt to the online environment (Asselin, 2011; Stirling, 2015). In an
early study by Andrusyszyn and Davie (1999), the researchers suggested that reflective levels
3
could increase through interactive journaling in the computer-mediated environment. There have
been some studies since then that have considered the facilitation of reflection in the computermediated environment (Ross, 2011). With the increasing popularity of online undergraduate
post-licensure nursing courses, the call to develop reflective practitioners, and the goal of
measuring educational effectiveness (AACN, 2014-2015), it is critical to understand the process
faculty employ to evaluate student learning outcomes associated with online self-reflection
journals.
The purpose of this study was to explore what processes nursing faculty employ to
evaluate online RN-BSN students’ self-reflective journals. It also addressed promoting a greater
understanding of how self-reflection journals can contribute to the development of reflective
practitioners. The next section of this chapter will address the context and theoretical framework
that will guide this study.
Background, Context, and Theoretical Framework
Within the general education and nursing education literature, there is an increasing
number of studies that examine reflection, reflective practice, and reflective journaling as key
concepts in the development of reflective practitioners (Dube & Ducharme, 2015; Mann et al.,
2009). However, there is a lack of clarity on the definitions of reflection and reflective practice,
the application of reflective journaling in the face-to-face, blended, and online environments, and
the processes used to evaluate student learning through reflective journals (Bulman & Schutz,
2013; Dube & Ducharme, 2015; Dyment & O’Connell, 2011). To enhance the understanding of
the background, context, and conceptual framework supporting this study, presented in the next
few paragraphs, the researcher discussed the lack of clarity with the terms reflection and
4
reflective practice. Offered is a discussion of the opportunities and challenges for online selfreflective journals to facilitate reflective practice while presenting the varying perspectives and
unique challenges of evaluation of self-reflective journals.
Reflective Practice
The call for reflective practice has proliferated over the past three decades throughout the
numerous fields of professional practice and practice disciplines (Chamber et al., 2011; McLeod
et al., 2015; Norrie, Hammond, D’Avray, Collington, & Fook, 2012). However, within different
disciplines and intellectual traditions, the meaning of reflective practice differs significantly
(Sherwood & Horton-Deutsch, 2012). Defined as a learning and growth process that
incorporates an introspection of one’s professional practice, inclusive of experiences, thoughts,
emotions, actions, and knowledge that enhance it, reflective practice remains a concept worthy of
exploration within the health professions literature (Dube & Ducharme, 2015; Sherwood &
Deutsch, 2012). In a review of the health professions literature, there is a consensus that
reflective practice practitioners acknowledge that an element of critical theory exists, suggesting
that the process of reflection will initiate a change in perspective or transformational thinking
that leads to action (Kinsella, 2009; Mezirow, 1998). In published manuscripts regarding
reflective practice, the following key characteristics emerged: (a) practice knowledge, (b)
autonomy, (c) critical thinking, and (d) open-mindedness (Sherwood & Deutsch, 2012).
In reviewing how the authors of published studies defined reflective practice, many based
their definitions upon the established theoretical writings of Boud, Keough, and Walker (1985),
Boyd and Fales (1983), Dewey (1933), Johns (2013), Mezirow (1998), and Schön (1983, 1987).
A significant number of studies in nursing and the health professions recognized Schön’s (1983)
writings on reflection-in-action, tacit knowledge, reflection during clinical practice experiences,
5
reflection-on-action, and reflection upon reviewing an experience after the fact as foundational to
an understanding of a reflective practitioner (Barbour, 2013; Bulman et al., 2012; Ng, Kinsella,
Friesen, & Hodges, 2015). While investigating the definition of reflective practice, two common
themes appeared within both the nursing and health professions literature: the recognition that
the experiences of the practitioner provide the basis for new learning, and the capacity for
reflection is essential to achieve professional competence inclusive of self-knowledge (Dube &
Ducharme, 2015; Mann et al., 2009).
Reflective practitioners engage in critical self-reflection, reflecting critically on the
influence of their assumptions, beliefs, feelings, and behaviors while being mindful of their
influence on the larger social/professional context (Dewey, 1938; Schön, 1987). While recent
authors ground reflective practice in inquiry (Bulman & Schutz, 2013; Sherwood & HortonDeutsch, 2012), Dewey (1933) focused on intentional and retrospective reflection and posited
that educators must guide students through the reflective process. Employed as a tool to
stimulate the reflective process, journal writing allows for deliberate analysis and thoughtful
feedback by faculty to help guide students through the reflective process (Dube & Ducharme,
2015). Self-reflective journals allow the practitioner to describe and analyze an experience from
practice highlighting learning while advancing his/her practice guided by a frame of reference or
guiding question structuring his or her reflection (Dube & Ducharme, 2015; Zeki, 2012).
Presented later in this section are merits and risks of journal writing in online programs.
However, for this study, reflection-on-action while embracing critical self-reflection provided the
cornerstone for the faculty to facilitate the transition from practicing nurse to reflective
practitioner through faculty’s evaluation of students’ online self-reflective journals.
6
Reflection
Reflection is a process that requires the individual to revisit a period related to prior
valued experiences in search of significant findings or understandings about oneself, and one’s
actions, values, or knowledge gained, which becomes integrated into the learner’s conceptual
framework (Boud et al., 1985; Bulman & Schutz, 2013; Sherwood & Deutsch, 2012). Reflection
does not focus on specific criteria for performance (Bulman et al., 2012); rather, it challenges
one to shed new light on an indeterminate situation by achieving clarity and deliberately
examining what happened in the past (Dewey, 1938). Dewey (1938) argued that reflection is an
active, dynamic, and deliberate process that deeply influences one’s experiences. This active
dynamic process lies at the heart of Schön’s (1983) work on the reflective practice. However,
learning to reflect deeply and critically is a learned skill (Dewey, 1938; Embo, Driessen, Valcke,
& Van Der Vleuten; 2014).
Dewey (1933) suggested that it is not possible to teach a student what he or she must
know; instead, teachers should coach a student by examining the subject through the student’s
lens, the relationship between means, methods employed, and results achieved. Dewey asserted
that the role of the faculty member was to structure the considered material in such a way as to
highlight the link between theory and experience for the student (Dewey, 1938). Reflection
encompasses both the constructed experience and the process used to deconstruct it as a means to
reconstruct the experience with new insights for action (Sherwood & Horton-Deutsch, 2012). It
is during this period of examination of the constructed experience and its deconstruction that the
value of interaction with a mentor or colleagues is realized (Bulman & Schutz, 2013; Dewey,
1938). This process of deconstruction and reconstruction lies at the heart of constructivist
education theory and explored for its contribution to reflective practice in Chapter 2.
7
In his writings, Dewey (1938) maintained that education was both interactive and social.
Johns (2013) went further, arguing that reflection is extremely difficult to achieve without expert
guidance. Schutz (2013) and Boud and Walker (1998) posited that the role of the reflective
learning facilitator or faculty member is critical and has a significant influence on the reflective
experience of the practitioner. Through the faculty’s structure of guided reflection, the faculty
guide student through a careful analysis of his or her lens that informs an action or a response to
a situation provided by the faculty member (de Swardt, du Toit, & Botha; 2012). Journal writing
relates to Schön’s (1983) articulated theory of reflection-on-action as it provides a means of
puzzling through a practice or life experience that has been disorienting or given a reason for
pause and serves to influence future action (Dewey, 1933; Schön, 1987). Within the literature,
there is considerable discussion devoted to the pros and cons of self-reflective journaling
discussed briefly next and more fully explored in Chapter 2.
Journal Writing
Journal writing, employed across a wide variety of disciplines in higher education, is an
important tool in the development of reflective practitioners (Boud, 2001; Chirema, 2007; Dymet
& O’Connell, 2011). However, for journal writing to be effective as a tool to enhance reflection
and increase self-awareness, there is a need for thoughtfully crafted guiding questions and
faculty feedback to be non-judgmental and accepting of differences (Sherwood & HortonDeutsch, 2012; Zeki, 2012). The instructor, more mentor than expert, must offer insightful
feedback to students (Johns, 2006; Sherwood & Horton-Deutsch, 2012). The knowledge that
one is writing for an external audience can profoundly shape what one writes and even what one
allows one’s self to question (Boud, 2001). There are challenges to students and faculty
concerning self-reflective journals, students by the very content of what they write, and faculty
8
with their role in reading student journals. Faculty members are often in the position of
facilitating as well as evaluating the student’s learning, and both faculty and students are mindful
of the consequences and benefits of the evaluation of students’ self-reflective journals (Bulman
& Schutz, 2013). The challenge of facilitating and evaluating student self-reflection journals can
be quite problematic (Boud, 2001; Bulman & Schutz, 2013). This dilemma is particularly true as
students’ self-reflective journals move from a focus on a critical incident to an examination of
current knowledge, thoughts, and beliefs as an exploration of self (Boud, 2001, Tashiro et al.,
2013)
Guiding questions, faculty behavior, and faculty feedback are essential components
contributing to the development of reflective practitioners (Canniford & Young, 2015). At
times, guiding questions used to bridge the theory-practice gap trigger emotional reactions
(Tashiro et al., 2013). Due to the very personal nature of the interaction in journal writing,
faculty needs to have some experience with reflection so that they can offer a balance between
support and challenge (Bulman & Schutz, 2013). Discussed briefly in the next section and more
fully explored in Chapter 2 are the unique challenges experienced by online faculty as facilitator
and evaluator of student self-reflection.
Evaluation of Online Self-reflective Journals
While reflective practice lies at the heart of professional development and lifelong
learning, assessment and evaluation of learning lie at the heart of educational institutions (HLC,
2016; Spellings Commission, 2006). Directed towards the measurement of student learning,
evaluation aims at providing evidence of what students know and can do while paying special
attention to aims, values, perceptions, needs, and resources (Canniford & Young, 2015, Lesie,
2013, McLeod et al., 2015). Evaluation of student learning activities typically involves an
9
assessment of a planned learning activity with clear outcomes and measurements of those
outcomes prescribed (Bourner, 2003). Although using self-reflective journals within a
curriculum is a planned activity, the aims, values, and perceptions of the assignment have wide
variation from both the student’s and the faculty’s perspective, making facilitation and
evaluation challenging (McLeod et al., 2015; Wear, Zarconi, Garden, & Jones, 2012; Yannuzzi,
2009). The challenge presented with evaluation of reflective learning and, more specifically,
reflective journals, entailed significant and variable events presented from student’s practice
environment that are unplanned, and put forth subjective rather than objective knowledge, which
can be challenging to evaluate (Bourner, 2003; Bulman & Schultz, 2013; Sherwood & HortonDeutsch 2012). When considering the evaluation of the subjective learning found in reflection
journals, one must be cognizant of the larger contextual factors: (a) social, (b) cultural, (c)
political, (d) institutional, and (e) discipline-specific assumptions that influence faculty (Boud &
Walker, 1998; Bulman & Schutz, 2013).
Evaluation of student learning activities is part of the fabric of higher education;
accrediting bodies look for the achievement of student learning outcomes as a measure of
institutional and programmatic effectiveness (NLN, 2016; HLC, 2016). Despite the increasing
emphasis placed on evaluation of student learning outcomes and the increasing use of selfreflection journals in higher education, there is little agreement in the literature regarding the
methods and processes employed in the evaluation of student journals (Bradshaw & Lowenstein,
2014; Sherwood & Horton-Deutsch, 2012). While some authors, such as Hargreaves (2004) and
Dymet and O’Connell (2011), espoused that students’ journal writing should be private to avoid
inhibiting critical thought and reflection, others contended that it is critical to assess reflective
learning to provide feedback to students and certify that students have developed the capacity to
10
learn through reflection (Lew & Schmidt, 2011). So how does faculty manage the balance
between facilitator or learning and evaluator of learning?
As noted in the discussion on journal writing, the faculty has a dual role of being the
facilitator of the reflective process while also being the evaluator of student learning concerning
the reflective process. Bulman and Schutz (2013) discussed the key role faculty has in
encouraging open and honest reflection in their students, and that can only happen if there is a
positive relationship between the student and the faculty member where trust and communication
exist. An early qualitative study by Andrusyszyn and Davie (1999) explored facilitating
reflection through online journals; the authors found that trust influenced the degree to which
students were prepared to reveal their innermost thoughts and personal selves (Booth, 2012).
Strategies for building trust in online communities are available in the literature (Booth, 2012;
Piorkowski, 2014). It was beyond the scope of this study to address trust and its importance in
the online environment; however, it is important to note that there are unique challenges to
facilitating and evaluating reflection in the online environment. Some of these challenges relate
to building a trusting relationship between students and faculty (Booth, 2012). Trust between the
faculty member and student is a key ingredient to developing students capable of reflection and
becoming reflective practitioners (Booth, 2012; Bulman & Schultz, 2013; Dewey, 1938) while
giving faculty the ability to assess students’ reflective capacity (Boud et al., 1985; Canniford &
Young, 2015; Ng et al., 2015). Given the increasing emphasis on the importance of assessment
and evaluation in higher education (HLC, 2016) and the uncertainty surrounding how to evaluate
reflection journals, this study provided general education and health profession faculties with
insights from an online RN-BSN faculty on the processes they employ to evaluate the learning
outcomes associated with self-reflection journals of online RN-BSN students.
11
The reflection of self and the relationship between the faculty member and student, along
with unique challenges of the online environment, aligns well with the dynamic and interrelated
systems expressed in King’s theory of goal attainment. For this reason, her theory, supported by
the works of Dewey (1933, 1938), Mezirow (1997), and Schön (1983, 1987), was used as the
conceptual framework upon which to frame the study. Although King’s conceptual system and
theory of goal attainment provided the framework to guide the study, the constructivist paradigm
provided greater grounding within the educational context and aligns well with the personal,
interpersonal, and social systems described by King.
King (1990) asserted that her conceptual system is an offshoot of systems thinking.
King’s conceptual system reflects a reciprocal worldview, consisting of three interacting and
dynamic systems: (a) the personal system, (b) the interpersonal system, and (c) the social system.
When viewed together, the three systems provide a holistic worldview as well as a holistic way
to view the problem addressed in this study. King’s conceptual system emphasizes change,
which she saw as constant, innate, and advantageous (Fawcett & DeSanto-Madeya, 2013). King
(1997) regarded the three interacting systems as connected through communication targeted
towards goal directed behavior. In considering the application of King’s conceptual system and
theory of goal attainment to this study, there is an increased focus on specific dimensions of each
system articulated by King (1997, 1981). Within the personal system, there are two dimensions
of focus (i.e., perception, defined as each person’s awareness of what is real in his or her life and
environment, and self, a unified complex person who perceives, thinks, imagines, decides,
identifies goals, and selects a means to achieve them). Within the interpersonal system the
dimensions of transaction, defined as observable goal-directed interaction, and role, which
includes expected behaviors that associated with a person’s position in a social system, apply to
12
this study. King’s social system, attends to the influence of authority, power, control, and the
influence of the organizations influencing the environment where the transaction takes place.
In this study, the issue under investigation is the process faculty employ to evaluate the
student-learning outcomes associated with online self-reflection journals. Factors influencing
faculty members are (a) their system, their values, beliefs, and experiences that shape their
reality; (b) the interpersonal system, in terms of their communication with students which is
transactional and goal-directed; and (c) the social system, the discipline, and institutional specific
norms, which influences how faculty perceive their role, authority, duties, and responsibilities.
In education, the constructivist worldview attends to individuals’ assumptions and perceptions
and seeks a change or transformation in thinking guided by faculty. Thus, the writings of Dewey
(1933, 1938), Mezirow (1997), and Schön (1983, 1987) serve to inform the educational context
and interaction between the three reciprocal and interactive systems posited by King (1981,
1997). King’s theory of goal attainment and the interaction-transaction process represent a
vehicle for interaction and transactions that lead to goal attainment (Fawcett & DeSanto-Madeya,
2013). If the student and faculty member have a relationship where the goal is to develop a
reflective practice with self-reflective journaling employed as a tool to develop reflective
practitioners, then it is critical to understand the process faculty uses to evaluate student learning
through student self-reflective journals. This conundrum highlights the problem researched in
this study and discussed in the next section.
Statement of the Problem
Nursing education is at a significant moment in time. Innovations in science and
technology, consumer activism, fiscal changes in the healthcare landscape, changing student and
13
client demographics, and diverse practice settings have resulted in dramatic changes in practice
and demand for changes in the education of practitioners (Benner et al., 2010; Sherwood &
Horton-Deutsch, 2012). Nursing students, especially post-licensure baccalaureate students, who
have practice experience, must engage in high-level critical thinking, and draw upon theory and
practice to solve immediate practice issues that may be unfamiliar to them or may challenge their
previously held beliefs (Asselin, 2011; Bulman, Lathlean, & Gobbi, 2012). Reflective practice
as articulated by Schön (1987) refers to an individual’s awareness of his or her knowledge and
skills in combination with current situations to create new learning and solve ill-defined practice
issues. A review of the nursing and health professions educational curricula literature regarding
found significant evidence suggestive of self-reflective journaling as a strategy that promotes
self-reflective practice (McLeod et al., 2015; Schön, 1987; Wear et al., 2012). However, there is
a lack of evidence in the literature that addresses how faculty evaluates the student-learning
outcomes associated with online self-reflection journals (Asselin, 2011; Mann et al., 2009;
McLeod et al., 2015). The growing use of reflective journals in online nursing and health
profession programs provided the impetus for this study.
Purpose of the Study
The purpose of this study was to explore the processes employed by nursing faculty to
evaluate online RN-BSN students’ self-reflective journals with the hope to garner a greater
understanding of how self-reflection journals can contribute to the development of reflective
practitioners. Self-reflective journaling as a pedagogical strategy to assist learners in achieving
the goal of reflective practice is the strategy most frequently reported in the literature (Barbour,
2013; McLeod et al., 2015; Parrish & Cookes, 2014). There has been a sizeable number of
14
empirical studies that established the acceptance of self-reflection as a useful teaching and
learning strategy in both the traditional and online learning environments (Bradshaw &
Lowenstein, 2014; Bulman et al., 2012; Caldwell & Gobbell, 2013; McLeod et al., 2015).
Nonetheless, a review of the nursing and education literature also revealed that there is a lack of
consensus on the format, focus, and tone of the feedback, as well as the value, criteria, and
processes used for evaluation (Bradshaw & Lowenstein, 2014; Dekker, Schornrock-Adema,
Snoek, van der Molen, & Cohen-Schotanus, 2013). With the conflicting viewpoints about and
lack of clarity of the definitions of reflection and reflective practice, adding to the lack of
consensus on the evaluation of self-reflection journals, a qualitative research design provided the
greatest insight into understanding the processes faculty use to evaluate online student selfreflective journals.
Research Question
This study sought to understand how online RN-BSN faculty construct and interpret the
processes used to evaluate online self-reflection journals of online undergraduate post-licensure
students. The basic qualitative research design allowed for interviews with a purposeful sample
of faculty to capture direct quotes from the participants about their experiences, opinions,
feelings, and knowledge regarding the process used to evaluate self-reflection journals through
detailed descriptions of their activities, behaviors, and actions (Patton, 2002). The following was
the research question that guided this study: What process does faculty use to evaluate the
learning outcomes associated with self-reflection journals written by online RN-BSN students?
Within the nursing and health professions, literature many studies cited the use of selfreflection journals in the practice arena, yet few studies considered the value of self-reflective in
15
online non-clinical courses (Beveridge, Fruchter, Sanmartin, & deLottinville, 2014). Per AACN
(2014-2015), there is an increasing number of online RN-BSN programs populating the nursing
education landscape. The increasing number of online programs, the call for the development of
reflective practitioners (Bulman & Schutz, 2013), and the demand for teaching strategies that
embrace adult experiential learning (Klein-Collins, 2011; McLeod et al., 2015) provide an
optimal context for the use of self-reflective journaling in online post-licensure programs.
However, the lack of consensus on the value, criteria, and processes used to evaluate selfreflective journals could prove to be a barrier to the adoption of online self-reflective journaling
in RN-BSN programs (Parrish & Cookes, 2014). The next section of this dissertation discusses
the rational for the study, its relevance to nursing and health professions education literature and
its significance at this point.
Rationale, Relevance, and Significance
Reflection and reflective practice are evident in the general education literature and
increasingly in the health profession literature (McLeod et al., 2015; Ng et al., 2015; Tashiro, et
al., 2013). As stated by McLeod et al. (2015), faculty across the health professions have been
incorporating reflective teaching strategies into their curricula. However, evidence to support
and inform the inclusion of these teaching strategies remains theoretical (Mann et al., 2009;
McLeod et al., 2015). In a review of the literature conducted by Mann et al. (2009), most studies
regarding faculty evaluation of students’ reflection considered the issue within the context of the
traditional classroom environment with a focus on critical incidents. The studies revealed that
the relationship between student and teacher was central to facilitating the reflective process.
However, there is little evidence found in the literature that considers the application of self16
reflective journals in the online environment where the student-teacher relationship takes place
as well as wide variation in evaluation approaches (Asselin, 2011; Dyment & O’Connell, 2011;
McLeod et al., 2015). With the growing number of online courses and programs coupled with
the wide variation in evaluation methods used for self-reflective journals, there was a strong
rationale to conduct this study.
Not only was there a strong rationale to conduct this study, but the call for increasing
teaching strategies that promote the development of reflective practitioners had never been
stronger and contributed to the rationale for this study. In 2009, Benner, who directed the
Carnegie Foundation for the Advancement of Teaching, released the results of the first national
nursing education study in 30 years. Educating Nurses: A Call for Radical Transformation
explored the strengths and weaknesses in nursing education while providing recommendations
on nursing curricula redesign. Benner et al. (2010) posited that to be safe and effective
practitioners’ nurses need to leave nursing programs with a disposition towards lifelong-learning
and the skills to be reflective practitioners. Throughout the health and social caring professions,
reflective practitioners are a focus of attention (Dekker et al., 2013; McLeod et al., 2015).
As of March 2015, the latest data available at the time of this study, AACN reported that
there were 679 RN-BSN programs in the United States with more than 400 of those programs
offering some portion of their program online. The significant and increasing number of online
programs (AACN, 2014-2015; Allen & Seaman, 2016), the pressure to demonstrate student
learning outcomes expected by accreditors (CCNE 2013; HLC, 2016), the call for the
development of reflective practitioners (Benner et al., 2010; Bulman & Schutz, 2013; McLeod et
al., 2015; Tannebaum, Hall, & Deaton, 2013), and the demand for teaching strategies that
embrace adult experiential learning (McLeod et al., 2015) provide an optimal context for the use
17
of self-reflective journaling as a strategy to develop reflective practitioners in online postlicensure programs. However, the lack of consensus on the value, criteria, and processes used to
evaluate self-reflective journals could prove to be a barrier to the adoption of online selfreflective journaling in RN-BSN programs (Parrish & Cookes, 2014). As discussed in the next
section, the lack of consensus on the value, criteria, and processes used to evaluate self-reflection
journals played an integral role in the nature of the study and the methodology employed.
Nature of the Study
In looking at the wide variation in definitions of terms and the application of selfreflection in the online environment, it is clear that the knower and the known are interdependent
and the values of the knower mediate and shape that which we know (Maykut & Morehouse,
1994). Thus, a basic qualitative research approach provides the most comprehensive approach to
understand the process used by faculty to assess self-reflection journals in the online
environment. Ultimately, the purpose of qualitative educational research is to improve
educational practice (Creswell, 2013) and the basic qualitative research design is particularly
well suited to obtain an in-depth understanding of effective educational processes and in this
case, the process used to evaluate students’ online self-reflective journals with an aim towards
developing reflective practitioners. A basic qualitative research study’s focus is on meaning and
understanding of a process of a particular issue or phenomenon (Merriam & Tisdell, 2015).
With the focus on a particular issue of investigation, it is important that the participants have
knowledge and experience with the issue under investigation (Creswell, 2013; Merriam &
Tisdell, 2015; Munhall, 2012). In this particular study, the issue under investigation was the
process used by faculty to evaluate self-reflection journals in an online post-licensure program;
18
the researcher and the participants in the study have extensive experience evaluating online
student self-reflective journals. Chapter 3 will more comprehensively examine and discuss the
qualitative research design, sample, population, data, and data analysis, employed in this study.
The next section of this chapter will explicitly define the key terms employed throughout the rest
of the dissertation.
Definition of Terms
To understand the background and context of this study, the background section of
Chapter 1 discussed the challenges of and lack of clarity with many of the terms used in
published studies on reflection and reflective practice. With the variation in definitions of terms
seen in the literature, it is imperative that the operational definitions of the terms in this study are
clear. The following definitions clarify these terms for use in this study.
Critical Thinking
Critical thinking is the intellectually disciplined process of actively and skillfully
conceptualizing, applying, analyzing, synthesizing, and evaluating information gathered from or
generated by observation, experience, reflection, reasoning, or communication, as a guide to
belief and action. The National Council for Excellence in Critical Thinking (1987-2015) builds
upon Scriven & Paul (1987) definition of critical thinking in its exemplary form as; based on
universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision,
consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness.
Evaluation
Evaluation is the systematic exploration and judgement of working processes,
experiences, and outcomes. It pays special attention to aims, values, perceptions, needs, and
19
resources. This study focuses on student learning and providing evidence of what students have
learned or how they have changed as a result of a planned learning activity (Ashford-Rowe,
Herrington, & Brown, 2014). It is inclusive of a value statement, a verbal statement of a state of
affairs considered valuable or important, and the actual measure selected to represent that
outcome (Astin & Antonio, 2012).
Reflection
Reflection is a process that requires the individual to revisit a period related to prior
valued experiences in search of significant findings or understandings about oneself, one’s
actions, values, or knowledge gained, which becomes integrated into the learner’s conceptual
framework (Boud, 1998; Dewey, 1938; Johns, 2013). Reflection is a metacognitive process that
is observable and measurable and is socially constructed and situated (Garrison & Akyol, 2015).
Reflection allows one to explore their own beliefs and perceptions while providing a vehicle to
explore other’s actions, values, and knowledge within their context to allow for shared problemsolving (Ker, 2015).
Reflective Practice
Reflective practice is a learning and growth process that incorporates introspection of
one’s professional practice, inclusive of experiences, thoughts, emotions, actions, and knowledge
that enhance it with an eye towards action and incorporates an element of artistry that transcends
technical rationality (Dewey, 1938; Schön, 1987). To acquire reflective practice, a student must
possess the skills of self-awareness, description, critical analysis, synthesis, and evaluation.
Grounded in clinical experiences reflective practice integrates into practical learning into one’s
repertoire with the help of a mentor (Bulman & Schutz, 2013).
20
Self
Self refers to the individual as separate from the external environment, comprising all
aspects of personal existence and the internal environment (King, 1981). From one’s tangible
sensory experiences and perceptions, an individual begins to name persons, experiences, and
things in the environment for later recall. This process of categorizing and labeling personal
experiences provides the basis for forming a general approach or understanding about people or
things (King, 1992).
Self-reflection
Self-reflection is the process through which individuals assess the validity of the
assumptions that underlie their knowledge, reasoning, social structures, and ideologies
(Brookfield, 1986). Self-reflection requires one to see one’s self as part of the problem
experienced (Yannuzzi, 2009). There is recognition that one’s view of the situation helps define
and shape the understanding of a situation or experience and may be unique to the individual
(Maykut & Morehouse, 1994).
This section covered the operational definitions in this study the next section covers the
assumptions, limitations, and delimitations associated with this study. In conducting research,
there are certain things that are out of the control of the researcher and things that are under the
control of the researcher. The next section will explore both those things out of the control of the
researcher and within the control of the researcher.
Assumptions, Limitations, and Delimitations
This section will identify the assumptions, limitations, and delimitations that guided and
played a role in this study. All research begins with assumptions the researcher makes.
21
Assumptions are inclusive of things that are out of the control of the researcher, but without
acknowledgement, the study could not progress. For example, the researcher assumes that study
participants’ responses are a true reflection of their beliefs. The researcher provides a rationale
for each assumption and illuminates how it contributes to the outcomes of the study (Simon,
2011). In contrast, the limitations of a study include to the factors that limit the outcomes.
The limitations of a study speak to those characteristics of design or methodology that
impact the findings of the study (Creswell, 2013). An example of a limitation is time. A study
conducted over a certain period, is representative of the conditions and understandings of that
time in history but may not be representative of current conditions and understandings. It is
critical that an explanation of how the researcher will adjust for the limitations of the study to
address how it might affect the outcomes of the study. Limitations of a study are outside of the
researcher's control, whereas delimitations are factors that the researcher can control (Simon,
2011).
Delimitations are the characteristics that limit the scope of a study while defining the
boundaries and context of the study (Simon, 2011). Delimitations are within the control of the
researcher and are inclusive of such characteristics as (a) choice of objectives, (b) research
questions, (c) population chosen, and (d) theoretical perspectives adopted (Simon, 2011). The
purpose statement of the students explains the intent of the study and the intended
accomplishments of the study (Simon, 2011). In general, the delimitations section of a study
includes the implicit and explicit understandings under the control of the researcher that bind the
parameters of the study. The following paragraphs will discuss the assumptions, limitations, and
delimitations of the study.
22
Assumptions
The following assumptions influenced this study. First, multiple constructed realities
exist (Guba & Lincoln, 1994). These constructed realities are socio-psychological constructs
forming an interconnected whole, and can only be understood as such (Maykut & Morehouse,
1994). Using a qualitative approach, especially in this study where so many of the key terms
lack clarity, allows a multifaceted view of the processes employed by faculty to facilitate and
evaluate the self-reflective journals of online RN-BSN students, which increases the potential for
more fully understanding the processes employed by faculty. Second, the knower and the known
shape each other (Maykut & Morehouse, 1994), and the intimate relationship with the subject
matter and the participants in the study held by the researcher is an example of how the knower
and known shaped this research. In any qualitative research study, it is imperative that
researchers bracket biases that might influence the study. Chapter 3 provides details on the
bracketing of biases specific to this study.
Third, although self-reflection journals require critical self-reflection, which is an internal
process, other assumptions included that reflection and the reflective process are also metacognitive processes and, as such, behaviors that constitute evidence of the reflective process are
observable and measurable. Another assumption was that programs assess and evaluate what
they value, and therefore the process used by faculty to evaluate student self-reflection journals
reveal the faculty’s values and beliefs of the students’ achievement of course and program
learning outcomes.
Also, this study assumed that reflection applied to the personal, intra-personal, and
interpersonal aspects of nursing education in both the clinical and scientific domains contributes
to the development of becoming a reflective practitioner, which contributes to improved patient
23
outcomes. Incorporated into this study is the belief that the introspection of self and the
communication between the faculty member and student most profoundly affects the students’
ability to transform from practicing professional to the reflective practitioner. There is a basic
assumption that the goal of the students and faculty is to use self-reflective journaling as a tool to
develop reflective practitioners. Along with basic assumptions, there are limitations pertinent to
this study that was out of the control of the researcher.
Limitations
Identified are four main limitations within this study. The first includes the knowledge
and skills as a qualitative researcher with particular attention to the impact of novice skills as an
interviewer and analyst of qualitative data. In qualitative research, the researcher is the primary
instrument for data collection and data analysis, and, with that in mind, the researcher’s
knowledge, past experiences, skills, and potential biases influence the study (Merriam & Tisdell,
2015). The second limitation identified lies with the relationship between the primary research
instrument and the participants in this study. While a prior employment and professional
relationship with the participants facilitated access to the participants and data, there was a risk
of overlapping relationships causing anxiety to the participants. Although it did not appear to be
the case, participants might have been hesitant to share any negative thoughts about online
reflective journaling due to the researcher’s role in the development of online reflective journals
systemic use throughout several RN-BSN curricula.
Thirdly, qualitative research can be infinite in scope; however, budgetary and time
constraints that help to inform subjective decisions on how to parameterize their studies (Safman
& Sobel, 2004). Decisions researchers make are reflective of the concerns mentioned above
influence the quality and usefulness of the resulting findings. In this study, interviews of nine
24
participants achieved thematic saturation. Lastly, this sample represented the changing paradigm
in nursing education that looks at using self-reflection journals as a key component of becoming
a reflective practitioner and its application in the online environment. The participants in this
study have experience with self-reflective journals as a teaching strategy and have some shared
definitions of the key concepts under investigation. That may decrease the transferability of this
study to other populations. A discussion of the delimitations of the study will further enhance
the ability to transfer this study to other populations.
Delimitations
Delimitations of a study help set the boundaries and context of the study and reveal the
intent and purpose of the study. The first delineation is in choosing the problem under
investigation, which is the process faculty use to evaluate online student self-reflective journals
in an online RN-BSN program. The second delimitation is the inclusion criteria for sample
participants, which included (a) teaching three or more terms in an online program, preferably
RN-BSN, (b) teaching minimum of half-time or .5 FTE, and (c) had experience evaluating online
self-reflective in at least one online course that used online self-reflection journals systemically
through the curriculum. Although there were a variety of ages, all the participants had a
minimum of a master’s degree in nursing with four participants reaching the doctoral level and
only one of those holding a doctorate in education. A larger sample with less exclusive criteria
may have added additional understanding of faculty’s processes to evaluate online student selfreflective journals. The next section will provide insight into the organization of the remainder
of the study.
25
Organization of the Remainder of the Study
Chapter 2 reviews the literature informing this study and a thorough and comprehensive
discussion of King’s theory of goal attainment and supporting foundational literature from the
constructivist paradigm. Chapter 3 will provide an in-depth discussion on the qualitative research
design along with the rationale and justification for the chosen methodology. Chapter 3 will also
describe the data collection and analysis processes. Chapter 4 will begin with a description of
the sample and a summary of the results followed by samples of detailed analysis that constitute
evidence for the summary of the results and will lead to Chapter 5. Chapter 5 describes how the
outcomes of the study contribute to the current literature on the processes faculty employ to
evaluate student online self-reflection journals. It contains a discussion of the results that may
help other researchers and educators, with suggestions and recommendations for future study.
26
CHAPTER 2. LITERATURE REVIEW
Introduction to the Literature Review
As described in Chapter 1, within the professional practice disciplines and throughout the
educational literature, there is a lack of clarity with the definitions of reflection and reflective
practice, the application of reflective journaling in the online environment, and the processes
used to evaluate student reflective journals. Despite the lack of clarity of the terms above, the
professional practice disciplines continue to promote the development of reflective practitioners
as key to meeting the complex healthcare issues facing providers (Chambers et al., 2011;
McLeod et al., 2015; Norrie et al., 2012). The purpose of Chapter 2 is to provide a more
comprehensive analysis of reflection as a key ingredient to the development of reflective
practitioners. Also, the goal of Chapter 2 is to analyze the literature regarding self-reflective
journals as a tool to develop reflective practice and review the current literature regarding the
process/processes used to evaluate student learning associated with reflective journaling in the
general health profession and nursing education literature.
Chapter 2 goes on to discuss how the general understanding of the concept of reflection
within the general and health professions education, and how studies within the general and
health professions education literature described the key components necessary to achieve
reflective practice and the behaviors that demonstrate learning outcomes associated with
reflective practice. The information reviewed established a foundation for the development of
this research study by identifying both the available knowledge and areas for further research in
the literature. Additionally, this chapter includes recommendations of taxonomy in the literature
27
review and an introduction to the accepted research methods used to validate the existing
methodology. This section of the dissertation provides validation of the applied methodology
and the theoretical framework that guided this study as a result of a review of the nursing and
health professions education literature.
The literature review includes education literature from various sources inclusive of
journals and books within the disciplines of education, allied health, public health, medicine, and
nursing, and the Internet. Journal articles collected from multiple electronic databases,
Academic Search Premier (EBSCOHost), CINAHL Complete, Education Research Complete,
ProQuest, and Science Direct using the following key words: reflection, reflective practice, and
reflective journaling, which represent the backbone of the sources presented in the review.
These articles and publications documenting previous research studies were valuable as a means
to illuminate the current knowledge on the evaluation of learning outcomes associated with
student self-reflection journals and served as the foundation for analysis of gaps in 32 research
studies conducted internationally, with 26 of those studies using the qualitative research design.
Books and articles from the Internet were background materials that, when combined with the
journal articles, revealed the relevancy of reflection and reflective practice for today’s health
profession education and the challenges experienced in the evaluation of learning outcomes
associated with reflective journals as a tool to develop a reflective practice within professional
practice education.
Theoretical Framework
The theoretical framework that guided this study was King’s conceptual system and
theory of goal attainment. King’s work focused on the continuing ability of individuals to meet
28
their basic needs so that they might function in their socially defined roles, as well as, on
individuals interacting with three open, dynamic, and interactive systems. King (1997)
considered a system as a set of parts—the personal, interpersonal, and social systems—linked
through communication aimed towards goal-directed behavior. Heavily influenced by von
Bertalanffy’s (1968) general systems theory and Dewey’s (1938) transactional constructivism,
King developed her theory for the discipline of nursing. With King’s philosophical core based
upon general systems theory and the nursing metaparadigm, adaption of her conceptual model
and theory of goal attainment to the discipline of education was an easy adaption. In the adapted
educational model, the student and the faculty member engage in targeted communication aimed
at the achievement of learning outcomes. Presented next is a discussion of the linkage and
adaption of King’s conceptual system and theory of goal attainment to the teaching learning
process.
King’s Theory of Goal Attainment
King was a nursing theorist who began to develop her conceptual system at a time when
defining nursing as a unique science and discipline was paramount within the profession. King
(1981, 1989, 1990, 1992, 1997, 2007) described the philosophical foundations of her conceptual
system and theory of goal attainment as developing from a general systems theory. Because
King’s scholarly work purposely provided a theoretical framework aimed at advancing the
discipline of nursing, it is important to understand the metaparadigm of nursing and its ability to
be adapted to meet the educational process and individual learning outcomes.
The term metaparadigm is a set of concepts and propositions that describe the essence of
a particular discipline (Fawcett, 2005). A metaparadigm is a general worldview of a discipline
29
that serves as the broad boundaries of the discipline and lends itself as a framework in which
allows for the development of more specific theories and conceptual models (Fawcett &
DeSanto-Madeya, 2013). Within the current version of the nursing metaparadigm, there are four
central concepts. The first includes human beings, or individuals, recognized as a culture,
community, or other groups of aggregates who are participants in nursing. The second concept
is that of the environment, which applies to human-beings and their significant others, as well as
the setting in which nursing occurs, inclusive of the broader landscape of local, regional,
national, and world-wide cultural, social, economic, and political conditions. The third critical
concept is health, which refers to human processes of living and dying. The fourth concept is
nursing, which refers to the actions taken by nurses on behalf of or in collaboration with human
beings and the goals or outcomes of nursing actions (Fawcett & DeSanto-Madeya, 2013).
For this study, an adaptation of the nursing paradigm provided a framework to reflect a
paradigm of teaching and learning. Neuman and Fawcett (2011) similarly adapted the nursing
metaparadigm as they explained the application of the Neuman systems model to nursing
education. Applying King’s theory of goal attainment to the previously mentioned adapted
metaparadigm the concept of human beings represents students or aggregates of students,
faculty, or aggregates of faculty who engage in formal education programs and share all of the
dimensions of human nature described by King (1981). The concept of the environment includes
students and faculty and the setting in which the educational process takes place. The concept of
environment is inclusive of the broader educational landscape of local, regional, national, and
worldwide cultural, social, economic, and political conditions that affect education and the
delivery of education. The concept of health includes learning outcomes, inclusive of the
processes and activities included in teaching/learning activities incorporating evaluation of
30
learning. The concept of education replaces nursing, which refers to educational theory and the
teaching learning strategies and activities taken by faculty to achieve student-learning outcomes.
Thus, the adapted concepts are human beings (i.e., student or faculty member), environment,
learning outcomes, and education (i.e., the discipline).
King (1981, 1990, 2007) offered several assumptions that are basic to her conceptual
framework and written with the adapted metaparadigm concepts in parentheses. The first of
these assumptions refers to human beings (students), who are open systems that are in constant
interaction with their environment. The next set of assumptions concern health (knowledge),
which is the focus of human beings interacting with the environment, and that the goal of nursing
(the educational process and faculty’s) is to help individuals (students) and groups (groups of
students) achieve health (learning) so that they may fulfill their socially defined roles. King
emphasized that both the nurse (faculty member) and the client (student) bring important
knowledge and information to the relationship and that they work together to achieve goals
(learning). Within both King’s conceptual system and the adapted metaparadigm, specific
assumptions about human beings include that they are social, spiritual, sentient, rational,
reacting, perceiving, controlling, purposeful, action oriented, and time oriented. Of these, King
(1992) felt that perception was the most important because it influences behavior and that human
beings’ perceptions come from the context of their life to determine what is real in his or her life
and his/her environment.
The conceptual framework of the interpersonal system had the greatest influence on the
development of her theory (Fawcett & DeSanto-Madeya, 2013). She stated that personal systems
and social systems influence the quality of care (quality of learning). However, found in the
explanation of the interpersonal system are the essential components of the theory of goal
31
attainment. A description of the interpersonal system revealed a system of “two people (students
and faculty member), who are usually strangers, come together in a health care organization (an
educational setting) to help and to be helped to improve health (teaching and learning) that
permits functioning in their societal roles” (King, 1981, p. 142). Although the interpersonal
system had the greatest influence on her theory of goal attainment, key concepts included
perception, communication, interaction, transaction, self, role, growth, and development, and
coping with stress, time, and personal space.
Transaction is an essential concept presented in King’s theory of goal attainment. King
made it clear that she borrowed the term from Dewey to identify an observed experience in the
nurse-client interaction (King, 1992). She explained that when two persons come together in the
roles of nurse (faculty member) and client (student), often in a healthcare setting (an educational
program), each person perceives the other as making mental judgements and engaging in some
sort of mental action. Although one cannot directly observe these behaviors, nurses (faculty) and
clients (students) do make suppositions about one another. She asserted that one could directly
observe dyadic interactions and record the observations in a systematic and with an analysis of
the observed interactions, thus identifying transaction. Presented in Figure 1 on the following
pages is King’s graphic presentation of the process of transaction.
Application of King’s Theory of Goal Attainment to This Study
Found in general, adult, and experiential learning, theories are the underlying principles
for the use of self-reflective journals (Dewey, 1933, Mezirow, 1997). In 1933, Dewey published
shared his definition of reflection as a process of deliberate examination of any belief or form of
knowledge, illuminating the supporting foundations and its application to future situations. In
32
his writings, Dewey argued that education was both interactive and social (Dewey, 1933).
Dewey (1933) suggested that it is not possible to teach a student what he must know but that
faculty member can act as a coach and by examining the relationship between means and
methods employed and results achieved through a student’s lens. Dewey (1938) asserted that the
role of the faculty member was to structure educational material in such a way, as to facilitate the
link between theory and experience for the student. The link between experience and education
espoused by Dewey provided a foundation to begin the work of Schön (1983).
Schön’s (1983) scholarly work on reflection-in and -on-action supports the case for
practice-based theory. In 1987, Schön argued that inherent in the practice of professionals there
is a recognized deep-seated core of artistry. Schön (1987) described artistry as an intelligence, a
manner of knowing, that draws upon professional practice, applied science, and research-based
wisdom expressed through the individual practitioner’s skill. Argyis and Schön (1974) espoused
that professionals have mental maps that guide their actions in certain situations. Moreover, they
asserted that these mental maps guide individuals’ actions more so than their espoused theories.
Aimed at the deliberate and conscious examination of the actions taken by professionals, selfreflection allows practitioners to respond to problematic situations and engages them in problem
reframing, problem resolving and prioritizing of practical knowledge over abstract knowledge
(Shapiro, 2011).
33
Perception
Nurse
(Faculty)
Feedback
Judgement
Action
Reaction
Interaction
Transaction
Action
Patient
(Student)
Judgement
Perception
Feedback
Figure 1. Kings’ Process of Human Interaction with adaptive metaparadigm in parenthesis.
From Toward a theory for nursing: General concepts of human behavior, by I. King, 1971, New
York, NY: Wiley. Reprinted with permission.
In reviewing King’s theory of goal attainment both the client (student) and the nurse
(faculty member) come to the healthcare (learning) environment with a set of assumptions and
beliefs that form perceptions, which influence behavior (the personal system). The student and
faculty member through interaction create transactions that allow them to achieve health
(learning outcomes) and are part of the interpersonal system and a significant element of the
theory of goal attainment. Dewey believed that all learning comes from experience and that the
concepts of continuity and interaction are fundamental to learning. Dewey (1933) described
continuity as the process learners need to connect what they have learned from the past and see
the possibility for future implications. Dewey described interactivity, stating that an experience
is what it is due to a transaction taking place between the individual and what at the time
constitutes the environment (Merriam & Bierema, 2014). He went on to say that construction of
34
meaning from experience is both individually and socially constructed; the instructor’s role is to
facilitate meaning making from the experience for future application. The transaction between
client (student) and nurse (faculty member) lies at the heart of King’s theory of goal attainment.
For this study, it was critical to understanding how his or her system influences the actions of the
faculty member. An understanding of the student’s system and the expectations of the faculty
role from the broader social system (education and nursing), along with the influence of the
transaction between student and faculty member as they reach to achieve the learning outcomes
of the program contributed to the understanding of the study.
Review of the Research Literature and Methodological Literature
This section presents the current research literature and the literature on the
methodological literature. As noted in Chapter 1, there is a lack of clarity and consensus with
reflection, reflective practitioner, and reflective journaling. With this in mind, it was not
surprising to find that most of the nursing education and health profession education studies
reviewed in the literature followed a qualitative methodology. In a review of the research
literature on reflective practice, it was interesting to note that of, the 37 research studies found,
only seven studies conducted within the United States with the majority of studies hailing from
the United Kingdom and Australia. Healthcare accrediting agencies in the United States
continue to cite reflection and reflective practice as critical components of professional education
within the healthcare professions including medicine and nursing (McLeod et al., 2015; Ng et al.,
2015).
35
Review of the Research Literature
As previously stated, there remains conflicting opinions within the professional education
literature regarding the value, validity, and reliability of the evaluation of student reflective
activities (Asselin, 2011; Dorn, 2014; Dyment & O’Connell, 2011) while acknowledging that
reflection on experience is an increasingly critical component of professional development and
lifelong learning (Boud & Walker, 1985; Schön, 1983; Stirling, 2015). As will be presented in
the following sections, self-reflection is a highly personal and subjective process, which lies at
the heart of the challenges with the evaluation of reflection (Bulman & Schutz, 2013; Schutz,
2012).
Throughout the general education and health professions literature, authors described the
evaluation of reflection in both summative and formative ways while indicating that tension
exists both about the evaluation of reflection and the tools used as a guide for faculty to evaluate
reflection (Dyment & O’Connell, 2011; Koole et al., 2011; Schutz, 2013). This section will
begin with a review of the current professional education literature on reflection while
acknowledging the challenges with incorporating reflection into professional practice education.
It will continue with educators’ perception of reflection’s role in the development of reflective
practitioners, and move on to the body of evidence on the assessment and evaluation of reflection
with special attention to the evaluation of online self-reflective journals as a tool to develop
reflective practitioners.
Reflection
Educators in the health, teaching, legal, social sciences, and business professions have
long acknowledged that theoretical knowledge acquisition falls short in providing students with
the ability to think and act professionally (Bulman et al., 2012; Chambers et al., 2011; Jayatilleke
36
& Mackie, 2012; Koole et al., 2012). Widely recognized as an essential characteristic linking
theory to practice is and the road to professional practice competency is reflection (Bulman et al.,
2012; Norrie et al., 2012; Schön, 1983, 1987). On the one hand, educators view reflection as a
powerful and valuable educational process that allows individuals to reduce or eliminate the
theory-practice gap by increasing critical thinking (Bulman et al., 2012; Dorn, 2014). It also
allows practitioners to evaluate their practice (Erlandson, 2014) and to promote learner selfawareness by bringing into the conscious tacit knowledge (Benner, 2009; Jayatilleke & Mackie,
2012). On the other hand, an increasing number of research studies reveal both internal and
external barriers with the incorporation of reflection into the professional practice disciplines.
Barriers to the incorporation of reflection into the professional practice disciplines
include faculty’s misinterpretation of the literature and lack of understanding of the concept of
reflection. Although reflection is a metacognitive process, frequently faculty encounter deeply
emotional reflective journals that they feel ill prepared to address. In a study by Duffy (2009),
the researcher discovered that preceptors perceived a lack of experience and knowledge in
assisting students with reflective practice had a negative impact on the students. A study
conducted by Caldwell and Grobbel (2013) highlighting the need for mentor support and
emotional impact training for reflective practice mentors expanded the assertions offered by
Duffy’s 2009 study. Faculty challenges with the lack of understanding of the concept of
reflection give rise to other associated barriers with the integration of reflection into the
professional practice disciplines.
Faculties face new challenges with providing students with the knowledge, skills,
attitudes, and behaviors to deliver high quality healthcare across an increasingly complex
healthcare landscape (Benner et al., 2010). In looking at the barriers that contribute to the
37
infusion of effective reflective teaching strategies into the health professions curriculum, other
barriers include a lack of time for students to reflect and faculty to facilitate and assess students’
level of reflection. Assessing students’ level of reflection is even more complicated when
studies reveal that lack of insight on the part of the student or faculty member is an impediment
to becoming a reflective practitioner (Boud & Walker, 1998; Stirling, 2015). Create a trusting
and safe environment for students in the computer-mediated environment requires an increase in
experience in the creating of online communities of inquiry which many faculties do not have
(Piorkowski, 2014). With reflection increasingly integrated into professional practice curricula,
there is increasing pressure to validate its benefits for professional practice disciplines and health
care delivery (Asselin, 2011; Caldwell & Grobbel, 2013). It is only through systematic
evaluation that the effect of reflection on professional practice education can be measured
(Dyment & O’Connell, 2011). To appreciate the challenges and barriers to effective evaluation
of reflection fully, it is critical that one has a clear understanding of the term reflection and how
the concept functions in professional practice curricula.
Processes of Reflection
In reviewing the general education and health professions literature on reflection, most
authors discussed stages or levels of reflection as they attempted to define and research reflection
and evidence of reflective practice (Boud et al., 1985; Boyd & Fales, 1983; Bradbury-Jones, et
al., 2009; Johns, 2013; Mezirow, 1997). At times, it can be confusing to differentiate between
the different types of reflection, guided by the purpose of the reflection, and the levels of
reflection in the literature when reading published studies. For example, consider Argyis and
Schön’s (1974) theories of single-loop and double-loop learning. The authors posited that people
have mental maps that unconsciously guide how they will respond to situations. These mental
38
maps created through the context of one’s life and are inclusive of their values, attitudes, beliefs,
and operating framework, the authors refer to these as governing variables. These governing
variables come into play with each new situation.
When individuals encounter a situation and take action, one of two things can happen:
achievement of the perceived and outcome there was no achievement of the expected outcomes.
Argyis and Schön (1974) referred to these two different processes as single-loop learning, which
involves connecting an action with an outcome, and double-loop learning, which involves an
individual’s need to reexamine and reevaluate their assumptions and actions to achieve the
desired outcome. When considering the example mentioned above, a question develops whether
the aforementioned is an example of reflection or conversely is it an example of different levels
of reflection, with single-loop learning as being non-reflective, or intuitive and double-loop
learning as deliberate reflection aimed at testing assumptions. This is a perfect example where a
situation can fit the definition of reflection or demonstrate the different levels of reflection.
The example presented above is but one example that contributes to the challenges and
barriers surrounding the lack of clarity around the concept of reflection and the evaluation of
reflective activity. With reflection and reflective practice considered critical components of
professional healthcare education, there is increasing scholarly dialogue aimed at finding a
consensus definition of reflection and reflective practice (Nguyen et al., 2014). Caldwell and
Grobbel (2013) concluded that reflection has the potential to improve clinical reasoning while
having a positive influence on patient care; however, the authors suggest that additional studies
to educate preceptors with reflective practice would increase the research evidence.
As previously noted, Dewey (1933) defined reflective thought as “active, persistent, and
careful consideration of any belief or supposed form of knowledge in the light of the grounds
39
that support it and the further conclusions to which it tends” (p. 118). In addition, Dewey (1933)
asserted that individuals progress through five different stages of thinking and reflection on a
situation: (a) propositions, in which the mind jumps ahead to a possible solution, (b) an
intellectualization of a problem that has been experienced a problem to be solved, (c) trial and
error of one idea after another as a hypothesis, to initiate and guide in the collection of factual
material that might solve the problem and or dilemma, (d) the mental analysis of the idea or
supposition; using reasoning is a part of the solution but not the whole solution, and (e) testing
the hypothesis by explicit, or artistic action. In examining the states of thinking, the reader
develops a sense of a process of thinking, yet absent from these states of thinking are the notions
of a triggering event and the interactive and social component of reflection that Dewey discussed
in his 1933 book, How We Think.
Despite the inference that Dewey posited stages of thinking, there is no sense of
hierarchical movement or conditions for movement from one stage to another. Another concern
with Dewey’s (1938) stages of thinking is that he only alluded to the contributions of emotions
and attitudes when he noted that the mental analysis of an idea or supposition using reasoning is
a part of the solution but not the whole solution. Previously, Dewey (1938) articulated the need
for an individual to consider the experience within the context of his or her life and discussed the
value of social interaction as a means to contextualize the new experience. These inconsistencies
and lack of full exploration of the stages of thinking and reflection contribute to the lack of
clarity around the definition of reflection. However, since Dewey’s seminal work on reflection,
there has been increasing scholarly dialogue and studies aimed at providing greater clarity of the
concept of reflection and the stages of the reflective process (Boud et al., 1985; Boyd & Fales,
1983; Bradbury et al., 2010; Johns, 2013; Mezirow, 2000).
40
Boyd and Fales (1983) described the reflective process as a series of steps beginning with
the individual experiencing a sense of inner discomfort leading to an identification or
clarification of the issue of concern that caused the inner discomfort. The next step in the
process requires an openness to new information from internal and external sources and finding a
resolution, expressed as an integration or creative synthesis of a new reality, establishing a
continuity of self with the past, present, and future, and finally deciding whether to act based on
the new reality. Boyd and Fales' (1983) research was concerned with describing the process of
reflective learning; however, they were quick to acknowledge that each goes through the process
differently, uses different strategies, and has different experiences that are salient triggers that
initiate the process of reflection. Boyd and Fales (1983) acknowledged that feelings could be the
trigger that initiates the reflective learning process.
Boud et al., (1985) expanded upon the writings of Boyd and Fales (1983) regarding the
important role played by feelings and beliefs in the reflective process. To increase the clarity
surrounding Dewey’s philosophy of reflection, Boud et al. (1985) reworked Dewey’s stages from
five to three, placing a greater emphasis on the role of emotions in reflective thinking. The first
of the three stages suggested by the authors includes returning to experience, meaning to recall
an experience, and select the salient details of the experience. The next step includes attending
to and connecting with feelings, requiring two different actions (i.e., paying attention to helpful
feelings and removing or limiting problematic ones). The third and final step involves
evaluating the experience, involving re-examining the experience considering one’s life context
and existing knowledge. This step also involves assimilating this new knowledge into one’s
conceptual framework. Bradbury, Coleman, Davies, Ellison, and Leigh (2010) expanded on the
work of Boud et al.’s (1985) attention to emotions.
41
Bradbury et al. (2010) appraised a new approach to reflection in nursing that examined
thoughts and feelings as the focus of the reflective process referred to as the Peshkin Approach.
The authors of the study Raised Emotions: A Critique of the Peshkin Approach to Reflection
challenged the notion posited by Schön (1987) that reflection should focus on action and posited
that thoughts and feelings should be the focus of reflection. They developed their approach to
reflection based upon the work of American anthropologist Peshkin (1988). Peshkin imagined
that subjectivity is an invariable component of one’s stages of inquiry and considered how one’s
subjectivity shapes their lines of inquiry and eventual outcomes. Building upon the work of
Peshkin and Bradbury et al., they identified four key stages that employ journal writing and
analysis of journal writings as the tool that best reflects an analysis of thoughts and feelings. The
stages of the Peshkin approach, as developed by Bradbury et al., involve preparation, journal
writing, journal analysis, and application to practice. Bradbury et al. argued while performing
the duties associated with the nursing role, individual’s emotions area at risk for being repressed
and that bringing those emotions to the forefront increases the individual’s self-awareness and
allows the individual to solve problems more effectively. Although Bradbury and associates
focused on the analysis of emotions, other prominent researchers incorporated feelings and other
ways of knowing as critical to the reflective process.
Johns (1995) endorsed Carper’s fundamental ways of knowing in nursing as a framework
to assist the practitioner’s learning from reflection on experience. Johns’ scholarly work focuses
on helping the practitioner access the “depth and breadth of reflection on an experience” (p. 226)
by exploring Carper’s ways of knowing in nursing. Carper (1978) theorized that knowing
through experience framed within a set of discrete yet interdependent ways of knowing:
empirical, ethical, personal, and aesthetic provides a holistic view of the discipline of nursing.
42
According to Carper (1978), empirical knowing relates to the body of empirical
knowledge specific to the discipline of nursing but can easily adapt to any specific discipline.
Carper (1978) asserted that interpretation within the context of the specific clinical situation
under investigation provides the foundation for empirical knowledge. The aesthetic way of
knowing is concerned with the practitioner’s response to a specific clinical situation. Embedded
in the view of aesthetic knowledge Carper’s (1978) belief that aesthetic knowing involves a
process of perceiving and understanding the nature of a clinical situation and interpreting all of
the information while envisioning a desired outcome.
Within Carper’s framework, personal knowledge is distinct from a personal way of
knowing (Johns, 1995). Personal ways of knowing focuses on the knowing of one’s self and
involves three inter-related factors: the perception of one’s feelings and prejudices about a
situation, the ability to manage one’s perceptions and feelings, and the ability to sustain one’s
self and managing anxiety. Lastly, Carper (1978) included ethical ways of knowing which is
inclusive of knowing what is right and wrong and being committed to taking action based upon
those beliefs. Johns’ expanded on Carper’s work. In Johns’ examination of Carper’s
fundamental ways of knowing, the author acknowledged Carper’s idea of discrete yet interrelated ways of knowing. Johns determined that the aesthetic way of knowing lies at the core of
professional practice and is informed by the empirical, personal, and ethical ways of knowing.
Like many of the other researchers’ examination of the reflective process, Johns sought to
understand how reflection leads to improved clinical performance as a reflective practitioner and
leads to transformative learning.
Within the general and health professions literature, many different researchers examined
various aspects of reflection, the reflective process, and the development of reflective
43
practitioner, framing their study around Mezirow (1990) and his treaties on critical reflection and
its role in transformational learning. Mezirow (2000) evolved his theory to create a
comprehensive portrayal of how learners interpret, validate, and reconstruct the meaning of their
experiences. Mezirow (1978) envisioned 10 stages of the transformative learning process (Table
1).
Although Mezirow (2000) identified 10 phases of transformative learning, he recognized
that learners may not proceed through the phases in exact sequence and that learners can
experience more than one phase at a time. In reviewing the literature, no precise definition of
reflection emerged, nor consensus upon the process of reflection. Each researcher or educational
theorist spoke to reflection as an active process that requires the application of and skill by the
learner personally benefitting from the process of reflecting on a particular experience or clinical
event (Bulman et al., 2012; Chambers et al., 2011). Reflection and the reflective process are key
ingredients to the development of reflective practitioners, and it does not seem possible to
overstate the degree to which accrediting and regulatory bodies have embraced Schön’s thoughts
on the value of reflective practitioners and of reflective practice (McLeod et al., 2015).
Reflective Practice
Although reflective practice is not the subject of this study, the development of reflective
practitioners is the driving force behind developing a complete understanding of reflection, how
to assess reflection, and the role of reflection in the development of reflective practitioners.
Reflection as both a concept and a teaching strategy frequently appears in studies conducted over
the past 20 yeasts in the nursing and the health professions literature (Chambers et al., 2011;
McLeod et al., 2015; Ng et al., 2015). Schön coined the term reflective practice when he
published The Reflective Practitioner (1983). Despite the panacea in the educational community
44
regarding reflective practice, major concerns in health professions education literature exist. The
lack of clarity surrounding the concept of reflective practice; the rational, logical articulation of
epistemological assumptions (Kinsella, 2009); and criteria for assessing and facilitating
reflective practice all remain in question (McLeod et al., 2015).
Table 1
Mezirow’s (1978) Ten Phases of Transformative Learning
Phase
Definition
Phase 1
A disorienting dilemma
Phase 2
A self-examination with feelings of guilt or shame
Phase 3
A critical assessment of epistemic, sociocultural, or psychic assumptions
Phase 4
Recognition that one’s discontent and the process of transformation are shared and
that others have negotiated a similar change
Phase 5
Exploration of options for new roles, relationships, and actions
Phase 6
Planning of a course of action
Phase 7
Acquisition of knowledge and skills for implementing one’s plans
Phase 8
Provisional trying of new roles
Phase 9
Building of competence and self-confidence in new roles and relationships
Phase 10
Reintegration into one’s life by conditions dictated by one’s perspective
Kinsella (2009) sought to extract central themes from the philosophical underpinnings of
reflective practice. Drawing on the work of Schön and writings by Dewey, Nelson Goodman,
Polanyi, and Ryle, she identified five central themes supported elsewhere in the general
education and nursing literature. The five themes identified by Kinsella were “(a) a broad
critique of technical rationality, (b) professional practice knowledge as artistry, (c) constructivist
45
assumptions in the theory, (d) the significance of tacit knowledge for professional practice
knowledge, and (e) overcoming mind body dualism to recognize the knowledge revealed in
intelligent actions” (p. 6). Supported in a review of the literature published by Norrie et al.
(2012) and Mann et al. (2009) as well as numerous studies within the health professions
literature are the five themes identified by Kinsella (Chambers et al., 2011; deSwardt, du Toit, &
Botha, 2012; Ng et al., 2015). Explored in the next section are the themes mentioned above,
examined with the intent of gaining a greater understanding of the role of reflection and the
reflective process in developing reflective practitioners.
Schön’s (1987) technical rationality embraced the notion that practical competence
transitions to professional competence when its instrumental problem-solving grounds in
scientific knowledge. He went on to say that a curriculum based on technical rationality begins
with relevant basic science and applied sciences followed by a learning practicum that allows
students to apply research-based knowledge to everyday problems. Schön argued that a
curriculum-based upon technical rationality falls short on helping prepare practitioners for the illdefined problems encountered in practice. He further espoused that an examination of the
relationship between competence and practical knowledge would be most beneficial viewed
through a lens focused on a greater understanding of the competence with which practitioners
solve everyday problems, which may be related to technical rationality but incorporates an
element of artistry.
Schön (1987) described artistry as “an exercise of intelligence, a knowing though
different in critical respects from our standard model of professional knowledge” (p. 13). In
writing his doctoral dissertation on reflective practice, Schön recognized that he was reworking
Dewey’s (1933) views on reflective thought. Both philosophers examined the link between
46
intentional reflection and action, and the idea that there is a component of artistry and aesthetics
to practice (Kinsella, 2009). Schön articulated that the aesthetics to practice developed through
thoughtful and deliberate examination of prior experiences reconsidered and redesigned through
the application of basic and applied sciences. As the practitioner reframes his or her learning,
there is a clear element of constructionist educational theory at play, and as they integrate that
new learning into practice, they develop a sense of ease and artistry to how they adapt to various
unfamiliar situations (Schön, 1987). It is this very understanding that educators look to facilitate,
assess, and evaluate. The acquiring of the necessary skills, processes, and behaviors that are
indicative of a reflective practitioner is the aim of health professions faculties (Barbour, 2013;
Chambers et al., 2011; Tsingos, Bosnic-Anticevich, & Smith, 2014). The most elusive
component of reflective practice is the significant role tacit knowledge plays in becoming a
competent, reflective practitioner.
Tacit knowledge described as the ability of a skilled practitioner to innovate and adapt to
never before experienced situations based on the “feel” of a situation (Bulman & Schutz, 2013).
Tacit knowledge is personal, and unlike explicit knowledge, it develops through logical
deduction rather being contextual, and it acquired through experience (Polanyi, 1966). Polanyi
(1966) suggested that reflective learning occurs on a subconscious level. To support his theory,
he presented the example of facial recognition, pointing out that individuals can recognize a
familiar face among hundreds of different faces, yet they do not know how they gained that
knowledge. Extracting knowledge from previous experiences whether subconsciously or
consciously can contribute to the development of reflective practice (Tsingos et al., 2014).
Journal writing has been one of the more popular approaches employed throughout the health
47
professions in the quest to develop reflective practitioners brings into the conscious mind
opportunities for new (McLeod et al., 2015).
Journal Writing as a Strategy to Develop Reflective Practice
Per Mezirow (2000), individuals create meaning through a process of interpretation of an
experience, inclusive of the context of one’s life and previous experiences. Journals provide an
opportunity to examine an experience while examining the contribution of one’s assumptions
and the contributions of self, and one’s relationship with others (Silvia, Valero, & Lorenza,
2013). Journal writing captures events on sheets of paper or in a notebook, or computer either
during or shortly after an experience. In many instances, critical events during a clinical
experience provide the starting point to guide students through a reflective process, considering
what happened, why it happened and how it might have been different (Chambers et al., 2011;
McLeod et al., 2015; Silvia et al., 2013). Silvia et al. posited that when a student reflects on an
experience, the process becomes reflecting on an experience and through journal writing
provides a vehicle that guides the student through all of the feelings and emotions about the
experience and the relationships with others involved in the experience. Compared to the
intimate ones discussed earlier by Bradbury-Jones et al. (2009) using the Peshkin Approach,
many of the journals in the literature begin with a critical experience and return to the experience
to bridge the theory-practice gap (Silvia et al., 2013).
Considering reflection as a critical skill in the development of a reflective practitioner,
the journal becomes a learning tool that uses the subject, the experience, and the relationship
with others to construct new knowledge that will help the student solve future clinical problems
(McLeod et al., 2015; Schön, 1987; Silvia et al., 2013). There is evidence to suggest that
writing, such as in a journal, promotes greater reflection as it provides for a separation of the
48
reflected experience and the student’s interpretation of the experience at the moment (Chambers
et al., 2011). Beginning the reflective process from a critical clinical incident provides a specific
context, and the role of educator becomes crucial in guiding students reflecting upon the
experience. Using a critical event for journal entries is an example of Schön’s (1983) reflectionon-action. Boud (2001) recommended reflective writing as a successful process of learning from
genuinely complex and muddled experiences. Boud's scholarly work parallels Mezirow’s
transformative learning theory, which maintains examining experiences being critically reflective
of one’s assumptions and to revise and reframe learning to inform future action.
In reviewing the literature regarding the evaluation of reflective writing, there existed
tension between those who believed that evaluation of reflective journals is critical to facilitate
students’ development towards reflective practice (Caldwell & Grobbel, 2013; Canniford &
Young, 2015) and those who believed that the simple idea of evaluating the process deeply
influenced the reflective process (Ashford-Rowe, Herrington, & Brown, 2014; Dyment &
O’Connell, 2011; Koole et al., 2011; Kennison, 2012). Besides the lack of clarity on the
definition of reflection, the various processes used to describe the reflective process, and the
varying definition of reflective practice throughout the health professions disciplines, within the
literature the terms assessment and evaluation seem to lack clarity. For many educators, the term
assessment is synonymous with evaluation, but for this study, evaluation means the ability to
measure to student learning outcomes (Ashford-Rowe et al., 2014).
As an essential piece of the educational process, evaluation of student learning provides
students with the opportunity to demonstrate acquired skills and knowledge while producing
evidence of their professional and academic achievements (Ashford-Rowe et al., 2014). To
achieve these goals evaluation strategies should allow the student to demonstrate the extent to
49
which a student has shown growth with their knowledge, skills, attitudes, and behaviors in their
respective disciplines (Ashford-Rowe et al., 2014; Bourner, 2003; Koole et al., 2011). Also,
there should be an evaluation of the metacognition as it establishes the value and importance of
critical reflection and critical self-reflection for personal and professional growth (Kaplan,
Silver, LaVaque-Manty, & Meizlish, 2013). Perhaps one of the most important elements
affecting evaluation of student learning is the ability to ensure accuracy in performance. This
critical element of evaluation speaks to the extent the student has engaged in the intellectual
input required to create or develop a product (Ashford-Rowe et al., 2014). Another critical
element of the evaluation process is the formal designing of an opportunity to provide feedback
to the student (Koole et al., 2011; McCarthy, Cassidy, & Tuohy, 2013; Stupans, March, &
Owens, 2013).
The use of reflective journal has the potential to meet the elements of an authentic
evaluation of student learning; however, there are challenges with the evaluation of student selfreflective journals (Herrington, Parker, & Boase-Jelinek, 2014). In fact, in a review of the
literature conducted by Dyment and O’Connell (2011), the authors reported wide variation in the
quality of reflection evidenced between studies, as well as little evidence of the achievement of
high levels of reflective thinking. In their review of the literature, Dyment and O’Connell listed
factors that limited the ability for students to achieve high levels of reflective thinking: lack of
clarity around expectations (Wear et al., 2012), providing students with structure and guidelines
(Beveridge et al., 2014; Zeki, 2012), and inconsistent use of reflective activities throughout the
curriculum, which did not allow students to develop the habit of reflective thinking (Koole et al.,
2011). Not only is there an issue with the achievement of high-levels of reflective thinking there
are other factors that inhibit reflection at any level (Dyment & O’Connell, 2011).
50
Sometimes there are circumstances present that prove to be barriers or even block the
ability for students to engage in reflection (Boud, 2001; Stirling, 2015). Reflection of the self
requires a secluded environment free from the scrutiny of others. The more journal writing
incorporates one’s doubts, uncertainties, trepidations (Dewey, 1933) inner discomforts
(Brookfield, 1986) or disorienting dilemmas (Mezirow, 2000) the more the writer needs to
consider the scrutiny of others. The influence of an external audience reading the journal can
have a profound effect on the level of reflection achieved. For example, revealing feelings about
a negative teaching experience in the classroom or clinical experience may lead to a failing grade
(Boud, 2001; Chambers et al., 2011). Simply knowing that there will be an evaluation of a
reflective journal, which will have a bearing on their grade, may influence the contents of the
reflection (Dyment & O’Connell, 2011). In the evaluation process, students expect to
demonstrate what they know whereas, the goal of reflection focuses on the process of
deconstructing what is not clear, perplexing, or not understood and asks the students to recognize
and accept ambiguities (Wear et al., 2012). These factors can inhibit the student achieving
higher levels of reflection.
Boud and Walker (1998) raised concerns over faculty misinterpretation of reflection and
the reflective process that lead to activities that are inconsistent with the nature of learning and
reflection. One such example is the practice of designing activities that take students through a
series of steps of reflection and require them to “reflect on demand” (p. 193). Frequently
components of reflection appear as a checklist almost like a recipe that students must follow,
which can lead the student to formulaic responses (Chambers et al., 2011). Chambers et al. and
Wear et al. (2012) went on to say that simply planning a time for reflection is inadequate;
deliberately planned activities for reflection must be presented within a context and students
51
provided with prompts. One of the most challenging barriers to effective evaluation of learning
is when faculty has a lack of experience with the reflective process for themselves as well as
facilitating reflection with students. In many studies, students highlighted an event from practice
that made them feel unprepared or uneasy as a starting point for their reflection (Dekker-Groener
et al., 2011; Hyler, 2015). However, triggering events can cause emotional angst and faculty
may be unprepared to manage those issues (Dyment & O’Connell, 2011; Wear et al., 2012).
Faculty may be unprepared for ethical issues and statements disclosed by students as reflective
assignments are challenging to keep contained (Hargreaves, 2003). Then there is the issue of the
power differential between student and teacher (Boud & Walker, 1998).
Researchers suggested that effective reflection requires that learners understand the value
of the reflective exercise and while providing guidance on the expectations of the reflective
activity (Beveridge et al., 2014). For reflective activities to facilitate the achievement of learning
outcomes, faculty must focus on the context (Dekker et al., 2011). By focusing on the context of
the reflection, the faculty member must be aware of the cultural, institutional, and disciplinary
context that influences the student and themselves (Boud & Walker, 1998). Faculty must focus
on the learner and put into perspective his or her assumptions about a learning event. Also, they
should focus on the process the student employed. However, the most critical ingredient to a
successful reflection activity is the building of a trusting relationship between the faculty
member and the student (Booth, 2012; Boud & Walker, 1998; Piorkowski, 2014). The issue of
trust between student and faculty member is also crucial when considering the use of reflective
journal writing (Booth, 2012; Boud 2001; Piorkowski, 2014). Although journals provide an
opportunity to examine the self in a relatively protected environment, when considering
evaluation, the student is aware of external scrutiny of what they write and the perception of the
52
faculty member, while examining the contribution of one’s assumptions and the contributions of
self, and one’s relationship with others (Dyment & O’Connell, 2010).
Despite the challenges associated with the evaluation of reflective practice, with the
growing number of pre-and post-licensure programs incorporating reflection into the
curriculums, it is critical to understand the processes and approach to the evaluation of reflection
(Bulman & Schutz, 2013). Boud et al. (1985) proposed that the outcomes associated with
reflection are both cognitive and affective. The authors presented four key behaviors that are
potential outcomes that show evidence of reflection such as considering a prior experience with a
new perspective or showing a readiness to apply new learning to making a change in behavior
while vowing to act. Using these guides, measurement of reflective learning reflects the extent,
to which a student has made a change in perspective or behavior (Bulman & Schutz, 2013).
Many studies throughout the nursing and health professions literature cite the extent of a
change in behavior or perspective resulting from reflection as evidence of transformative
learning (McLeod et al., 2015). The next section of Chapter 2 reviewed the various
methodological approaches that researchers employed to study reflection and reflective practice.
The methodological approaches employed by researchers exist on a continuum. In considering
research methodologies as a continuum, situated on the left is quantitative research, where the
researcher subscribes to the belief that there is an objective reality revealed through thoughtfully
controlled research expressed through quantitative analysis. Situated to the far right of the
continuum is qualitative research, where the researcher subscribes to the creation of multiple
realities that coexist within the context of individual’s lives and experience of the world
(Munhall, 2013).
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Review of Methodological Issues
As presented in Chapter 1 and the review of the research literature above, the lack of
clarity on the definitions and understanding of reflection and reflective practice along with the
enabling and limiting factors associated with the evaluation of reflection, in particular, reflective
journals, is troublesome. In looking at the studies conducted to date regarding reflection,
reflective practice, strategies to promote reflection, and evaluation of reflection, it is not
surprising to find a large number of qualitative studies that seek to clarify the concepts, describe
the processes associated with reflection, and attempt to address best practices in the evaluation of
reflective writing. However, there is a desire within the health professions education literature to
come to a consensus on what are the key elements of reflective practice to demonstrate a
relationship between the development of reflective practitioners and positive patient outcomes
(Chambers et al., 2011; McLeod et al., 2015).
Between the years of 1995-2015, 40 nursing studies considered the concept of reflective
practice. Most of the nursing studies were qualitative and conducted in an academic context.
Most of the qualitative studies collected data through one-on-one interviews, focus groups, and
review of reflective journals (Dube & Ducharme, 2015). In reviewing the studies, few
researchers provided a clear definition of reflective practice or the frames of reference within
their studies. Based on the results of the qualitative studies reviewed, the evidence suggested
that most nurses valued reflective practice using both verbal and written strategies. Still,
qualitative research is time consuming and requires regular interaction with the concept of
reflection, thoughtful feedback, openness to learning, and existing critical thinking skills.
However, no extant studies reviewed linked reflective practice with positive patient outcomes
(Dube & Ducharme, 2015; McLeod et al., 2015). Also, few quantitative studies aimed at
54
students’ measurement of the reflective process and changes in point of view pre- and postreflective teaching and learning strategy existed. Again, there were no extant studies that looked
at the relationship between reflective process and positive patient outcomes thus the value of
reflective practice remains anecdotal (Dube & Ducharme, 2015).
Within the health professions education, there are few empirical studies, but there are
increasingly more publications presenting reflection and reflective practice (Dekkar et al., 2013;
McLeod et al., 2015; Norrie et al., 2012; Saperstein, Lilje, & Seibert, 2015). Research studies
within medicine, pharmacy, physical therapy, and occupational therapy are beginning to emerge
in the current health professions education literature inclusive of the role of reflection in interprofessional simulation experiences (McLeod et al., 2015). Emerging out of the health
professions literature is the inclusion of verbal reflection and mentoring coupled with written
portfolios (Chambers et al., 2011). In 2015, Hyler published a study that explored the nursing
students’ work experience using reflective journals. The study by Hyler (2015), along with a
new review of the literature by McLeod et al. (2015), illuminated best practices for teaching and
evaluation of reflective learning strategies used in pre-registration health professions education
as a means to develop reflective practitioners. Although McLeod and colleagues presented best
practices for reflective learning strategies, the use of reflective journaling, especially with prelicensure students, can present unsettling results. A qualitative descriptive study conducted by
Ramos et al. (2015) in Brazil investigated nursing student’s perception of ethical dilemmas faced
in the clinical setting revealed the faculty’s lack of preparedness to deal with the issues presented
by the students.
As reflective practice continues to emerge as a desired professional practice skill, there is
a need to understand the concept more clearly, identify the key characteristics associated with
55
reflective practitioners, and the teaching learning strategies associated with the development of
reflective practitioners. With the lack of clarity surrounding reflective practice and the call for
health profession educators to provide learning strategies to develop reflective practitioners, a
qualitative study provided the best methodology to explore the methods and processes faculty
employ in evaluating online reflection journals. In reviewing the available studies, the lack of
consensus on the terms and key criteria for evaluation of reflection and reflective practice lead to
the deployment of a qualitative research methodology over the quantitative approach. The next
section presents a synthesis of the research findings.
Synthesis of Research Findings
Educators in the health professions disciplines strive to provide students with the
knowledge, skills, attitudes, and behaviors that will allow them to provide high quality, costeffective care across increasingly diverse and complex healthcare systems. Licensing authorities
and professional practice disciplines have embraced Schön’s (1987) description of a reflective
practitioner as critical to the success of the professional practice disciplines. At the same time,
the HLC (2016) recommended that institutions of higher education demonstrate that students
have achieved the intended learning outcomes for their program of study. The goal of the
professional practice disciplines has been to produce students with the ability to be reflective
practitioners and lifelong learning (AACN, 2016; Chaffey, deLeeuw, & Finnegan, 2012).
Employed as a pedagogical strategy to assist learners in achieving the goal of reflective
practice, self-reflective journals are parts of the fiber of clinical education (Barbour, 2013;
McLeod et al., 2015; Parrish & Cookes, 2014). Yet the nursing and health profession education
literature offer little insight into uniformity in defining reflection, identifying the key
56
characteristics of reflective practitioners, or the methods and processes used to evaluate student
reflective learning, specifically self-reflective journals (Dyment & O’Connell, 2011; Koole, et al,
2011; McLeod et al., 2015). Despite the wide variations in the definition of reflection, reflective
process, and reflective practice, there is agreement on certain elements of each of the concepts
mentioned above.
Although reflection can have different meanings depending on the context and the
professional discipline, most disciplines regard it as a cyclical process that allows one to reflect
upon and analyze one’s own thinking and behavior with an aim towards transformation and/or
action (Bulman et al., 2012; Dewey, 1933; McLeod et al., 2015). Many educational theorists
have stated that the process of reflection usually begins with a circumstance or experience that
causes an uncomfortable feeling, a sense of uneasiness, which in turn leads to an
acknowledgement that one’s current knowledge is insufficient to address a current situation and
problem (Canniford & Young, 2015). This sense of uneasiness provides the motivation to begin
a critical examination of one’s feelings, knowledge, and assumptions while seeking to integrate
new theories and knowledge to address a current situation that may be unfamiliar (Mezirow,
2000)
Within the different professional practice disciplines, the terminology and details
regarding reflective processes are just as varied as the disciplines seeking to develop reflective
practitioners (McLeod et al., 2015; Ng et al., 2015). In explaining reflective processes, different
theorist suggested different terms that carried slight but distinct differences. Schön (1983) used
the terms reflection-in-action and reflection-on-action, Fogarty (1994) suggested a metacognitive
process. Boyd and Fales (1983) adopted the term reflective learning, while Mezirow et al. (1990)
utilized critical reflection, and Dewey (1933) employed reflective thinking. While different
57
theorists may disagree on the terms that describe reflection, there is recognition from the various
practice disciplines that various stages or levels of reflection that are both able to be measured as
a means to evaluate the reflective process and to help define reflection exist (Mann et.al, 2009;
Nguyen, Fernandez, Karsenti, & Charlin, 2014; Norrie et al., 2012).
Reflective practice requires one to possess the ability to reflect and be aware of what is
happening in practice. Then to deliberately and thoughtfully consider the influence of personal,
cultural, societal, and discipline specific knowledge on experiences in practice with an aim
towards improving future practice (Canniford & Young, 2015; Chambers et al., 2011; Schön,
1987). Although there is consensus on the ability of reflective practitioners to test their
assumptions and create new learning, most authors also mention an element of artistry and tacit
knowledge development that few have even attempted to explain (Bulman & Schutz, 2013;
Kinsella, 2009). It is this inability to explain this notion of professional artistry that contributes
to the challenges and barriers to develop and measure students’ progress towards reflective
practice.
There have been many papers and studies over the past 20 years that have focused on
reflection and reflective practice in both nursing and the health profession education literature.
However, studies in which the authors urge faculty to consider how to promote and evaluate the
effectiveness of reflective practice teaching strategies is relatively new. In 2015, McLeod et al.,
published a paper aimed at presenting an overview of the best practices for reflective learning
strategies employed in undergraduate health professions curricula. Reflective journaling
emerged as the strategy employed most often across the health profession disciplines. The stated
goal of reflective journaling was to capture and foster transformative learning as a step towards
reflective practice (McLeod et al., 2015). Students identified areas of practice surrounding
58
decision-making, ethical concerns, awareness of patient concerns and preferences, and sociopolitical decision-making as areas of practice where they experienced a change in perspective
because of the teaching strategy.
However, there were challenges presented throughout the studies as well. There were
discussions in all studies of the limiting factors that affect journaling writing such as a
disproportionate distribution of power, the building, and establishment of trust between the
faculty member and student, and permitting the students to make meaning within the context of
their own experiences. Other limiting factors were framing and coaching by discipline, focusing
on the learner, clarity of expectations for assignment, providing structure, not formulation, and
quality of faculty feedback (Dyment & O’Connell, 2011; McLeod et al., 2015; Silvia et al.,
2013). In several of the published studies, researchers found that faculty focused on students
writing levels and grammatical errors rather than on the process of reflection and level of
transformation (Canniford & Young, 2015). The study by Canniford and Young was the first of
its kind that researched leaning and assessment of competence in reflective practice. The
researchers wrote in their discussion that, due to the small sample size of their study at one
university with no information on faculty perceptions, there is a need for more research.
McLeod et al. (2015) and Richards (2015) echoed the sentiments of Canniford and Young.
While there is some consensus found in the literature on the definitions and value of reflection,
reflective practice, and the measurement of transformative learning there exists concerns with the
previous research. The next section will comment on the previous research on reflection and
reflective practice.
59
Critique of Previous Research
When one reads the literature regarding reflection and reflective practice, the terms
would seem understood; however, upon greater scrutiny, it is clear that even the most trusted
experts in the field have a lack of clarity with the terms (Boud, 2000; Bulman & Schutz, 2013).
There is increasing evidence in the literature that the terms reflection and reflective practitioner
have become too familiar and require more thoughtfulness and precision so as not to diminish
the contributions of reflection, the reflective process, and reflective practice to the professional
practice disciplines (Wear et al., 2012). Because reflection has taken on a variety of meanings
and seems to be understood differently by different authors, it remains difficult to operationalize
the concept and evaluate its contribution to the development of reflective practitioners (Bulman
et al., 2012; Ng et al., 2015; Nguyen, et al., 2014; Wear et al., 2012). Without the systematic use
of a curricular framework, which integrates reflection throughout the curriculum it is unlikely
that the health profession disciplines will be able to measure whether reflective practice
improves patient outcomes.
Chapter 2 Summary
Chapter 2 provided insights into the development of reflection as a key instructional
strategy. Reflection is not a new concept. Within the adult education literature, there is
considerable attention paid to the notion of linking theoretical knowledge with personal
knowledge, inclusive of feelings and perceptions, to gain insights into solving unfamiliar
problems (Bulman & Schutz, 2013; Dewey, 1938; Schön, 1987). There is compelling evidence
in the literature to support the inclusion of journal writing as a strategy to promote and facilitate
reflection and the reflective process.
60
Throughout the nursing and health professions literature, there is significant information
regarding reflection, reflective processes, and reflective practice, yet is a lack of clarity on the
definitions and key characteristics of the afore mentioned concepts. With the lack of clarity on
the concepts, it is very difficult to understand what processes faculty use to evaluate student selfreflective journals. A qualitative study offered the best hope to provide insights on the faculty’s
processes for evaluating self-reflective journals. Chapter 3 will explore the methodology used in
this study.
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CHAPTER 3. METHODOLOGY
Introduction to Chapter 3
Chapter 3 provides an overview of the methodology employed in the research conducted
to understand the processes faculty use to evaluate online student self-reflective journals. The
objective of the conducted research was to extend the body of knowledge of both the general
education and health professions education literature regarding the value, criteria, and processes
used by faculty to evaluate student learning outcomes associated with self-reflective journals.
The chapter presents in detail the basic qualitative research design and methods employed in this
study, starting with the purpose of the study in the next section.
Purpose of the Study
The purpose of this study was to obtain a rich description of the processes that faculty
members use to evaluate online RN-BSN student learning associated with self-reflection journals
with the hope of finding areas of consensus on the value, criteria, and processes employed by
faculty to evaluate student self-reflection journals. Explored with faculty were the issues
associated with evaluations of journal entries focused on critical events rather subjective entries
aimed at personal growth. Faculty shared perceptions of what they thought the evaluation
process would be versus the reality of the process. The purpose of this basic qualitative study
was to illuminate the processes and methods used to by faculty to evaluate online RN-BSN
students’ self-reflective journals. To achieve this goal, the researcher developed a set of
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questions into an interview protocol for collection of data. The next section describes the
research questions used in the study.
Research Question
The research question that drove this study was consistent with a basic qualitative design
that focuses on the meaning and processes of an issue of interest. The following research
question guided this study: What process does online faculty use to evaluate the student learning
outcome associated with self-reflection journals written by online RN-BSN students? The
research instrument aimed at eliciting information without making the faculty feel judged posed
the following interview questions:

Imagine that you have been asked to mentor a new faculty member: how would you
describe to the new faculty member the process you use to evaluate student self-reflection
journals?

Some feel that a self-reflection journal can't be evaluated because it is a subject statement
about the writer's feelings. How would you respond to this?

How would you describe the differences between evaluating reflection journals where a
critical incident is the foci of reflection, versus evaluating a reflection journal aimed at
professional development the foci surround testing assumptions through examining
thoughts and feelings in reflective journals?

How would you describe the ideal self-reflection journal?

How did your perception of evaluating self-reflective journals compare with the reality of
evaluating self-reflection journals?
The interview questions described above are open-ended and allow the participants to expand
upon their thoughts, feelings, and experiences.
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Qualitative Research Design
A basic qualitative design guided this study. A qualitative design is adaptable and
evolving, responsive to changes in the conditions of the study with the researcher serving as the
primary instrument allowing for maximum responsiveness and flexibility in the collection of data
(Merriam & Tisdell, 2015). With the collection of data consisting of thick, rich descriptions, the
researcher as the instrument was able to clarify and summarize the data with the participants
immediately. In this study, the use of a semi-structured interview allowed for some flexibility of
wording and sequencing of a predesigned set of questions allowing for differences in the
background of the participants (Merriam & Tisdell, 2015). This flexibility allowed the
researcher to have a more natural and free flowing exchange with the participants (Munhall,
2012). Interviews between the researcher and nursing faculty with experience teaching online
post-registration baccalaureate students served as the key data collection strategy. The hope of
the study’s author was that faculty would disclose their experiences with, the criteria used and
the processes employed to evaluate online self-reflection journals. The interview protocol was
the tool used to analyze, interpret, and report the data (Creswell, 2013). Interviews continued
until saturation of emerging themes became evident. Member checking, an independent data
analyst, and the use of an expert in qualitative research design reviewed the interview questions
enhanced credibility and trustworthiness of the study. The next section discusses the target
population sampling methods, sample size, setting of the study, and recruitment strategies.
Target Population, Sampling Method, and Related Procedures
There are approximately 48,666 full-time nursing faculties in the United States and 664
nursing programs that have an online component with the fastest growing number of online
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nursing programs addressing the RN-BSN population (L. Yan, personal communication, July 22,
2015). With the call for the development of reflective practitioners throughout the health
professions, all faculty teaching within the health professions belong to the target population, but
this study may be of special interest to faculty who teach in online programs. The researcher’s
LinkedIn network provided access to the target population and sample. This network consisted
of 60 full- and part-time faculty members who had taught in both the online and on-ground
teaching environments in pre-and post-licensure nursing and health professions programs in a
variety of institutions of higher learning in both the public and private non-profit sector,
geographically dispersed throughout the United States.
Sampling Method and Size
In this basic qualitative study, the sample consisted of a non-probability purposeful
sample where data collection consisted of semi-structured interviews with the researcher and the
participants as the key informants. From the LinkedIn site, 20 participants met the inclusion
criteria:





Taught greater than or equal to a .5 full-time equivalent for at least 2 years in an
institution of higher education in either pre-or post-licensure nursing or health profession
programs;
Taught a minimum of three academic terms online;
Had experienced evaluating self-reflective journals for three or more academic terms;
Had experience using Adobe Connect, and
Had access to a computer with a headset and microphone in a quiet distraction free
environment.
A total of 20 nursing faculty responded to a LinkedIn email invitation, voluntarily
agreeing to participate in the study and share their experiences with the evaluation of online RNBSN students’ self-reflective journals. Conduction of the interviews continued until the
achievement of content saturation with no new information revealed after interviewing 10
65
nursing faculty (Creswell, 2013; Munhall, 2012). The next session presents the setting of the
study.
Setting
Due to the geographic distribution of the participants, Adobe Connect, which is a multichannel meeting space (Salmons, 2014) (meaning the program has the ability for video and
synchronous conversation with the ability to archive the conversation) provided the means to
conduct interviews. With the agreement on a time for the interview, each participant received a
link to attend a private interview session using the Adobe Connect. Each participant had a
unique meeting URL so that the content was easily identifiable to the data analysts and
accessible only by the analysts. At the agreed upon interview time, each participant reported that
they were in a private location, without distractions or interruptions.
Recruitment
Recruited through a personal LinkedIn network, potential participants received an email
explaining the aim of the study. Included in the email were the purpose of the study, the
assurance of confidentiality with the use of pseudonyms to protect anonymity, the inclusion
criteria of participants, and the processes in place to ensure the security of the data. Participants
in the study received neither incentives nor compensation for study participation. The next
section discusses the research protocol used to collect data.
Instrumentation
A semi-structured interview process allowed for the novice qualitative researcher to
probe with some consistency yet flexibility through the interview process. An interview protocol
served as the tool to collect, analyzes, interpret, and report the data. Reviewed by a qualitative
66
research design expert a set of interview questions originally published by Merriam and Tisdell
(2016) guided the interview questions development. The interview questions were as follows:

Imagine that you have been asked to mentor a new faculty member, how would you
describe for the new faculty member the process you use to evaluate student selfreflection journals?

Some feel that a self-reflection journal can't be evaluated because it is a subject statement
about the writer's feelings. How would you respond to this?

How would you describe the differences between evaluating reflection journals where a
critical incident is the foci of reflection, versus evaluating a reflection journal aimed at
professional development the foci surround testing assumptions through examining
thoughts and feelings in reflective journals?

How would you describe the ideal self-reflection journal question?

How did your perception of evaluating self-reflective journals compare with the reality of
evaluating self-reflection journals?
The first question was hypothetical. According to Merriam and Tisdell (2015),
hypothetical questions ask the respondents to imagine; in this type of situation, the respondent
usually relays his or her actual experiences with the situation presented. The second question
posed as a devil’s advocate type question is valuable when a subject is controversial, and the
researcher wants to elicit the participant’s opinion. Posing the question this way tends to
depersonalize the issue, yet the participant’s response is very personal (Merriam & Tisdell,
2015). The third question explored the participant’s expectations versus reality when evaluating
journals entries focused on a critical incident versus more subjective professional or personal
development entries focused on assumptions, thoughts, and feelings. As stated by Merriam and
Tisdell, this question allows for garnering both opinion and information. It also allows the
respondent to share what he and or she might like to see changed. The fourth question
augmented this line of inquiry. The fifth question allowed the participants to validate prior data
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and to provide insight into the differences between expectations and reality. The interview
questions provided the tool for data collection, and the next section discusses the collection of
data.
Data Collection
A multi-channel meeting space, Adobe Connect, provided privacy for participant
interviews. Using an interview script, interviews began by explaining the purpose of the study,
collecting demographic information, and presenting data collection strategies. Following the
dissemination of the information, the participants who verbally consented during the taped
interview, to be part of the study, signed a consent form, and upload the consent form into the
Adobe Connect Meeting Room. With the receipt of the consent form into the Adobe Connect
meeting space, interviews began with the collection of demographic data. As the interview
progressed Participants expanded on their experiences, perceptions, assumptions, and
understanding of the phenomenon under investigation (Merriam & Tisdell, 2015).
The interview process began with open-ended exploratory questions. The semistructured interview process allowed flexibility in the process, allowing an increased
responsiveness to the situation at hand and the emerging worldview of the participants and their
ideas on the issue under investigation (Merriam & Tisdell, 2015). Active listening skills and
participants’ body language observed through the video component of the multi-channel meeting
space served as a measure of non-verbal communication to guide which responses from the
participants warranted further probing. All participants had periods of thoughtful deliberation
after hearing the questions and before providing their experiences and thoughts. As the
participants shared their responses, the researcher invited the participant to “tell me more about
68
that” or “can you expand upon your thoughts about that” to elicit a more in-depth understanding
of their experiences (Salmons, 2014). Adobe Connect allowed for the recording and archiving of
the exact words of the participants. Noted during the interview process and recorded within the
notes section of the multi-channel meeting space, were observations regarding the participants’
non-verbal communication. Considered in concert with the field notes were the verbatim
responses of the participants captured through the recording and archiving of the interviews
(Munhall, 2012). The next section describes the procedure used for data analysis.
Data Analysis Procedures
Before the transcription process, the assignment of pseudonyms along with the removal
of all identifying information from the transcript provided a means to safeguard the privacy of
the participants, which was saved as a computer file for coding and analysis. Archived digitally
recorded interviews transcribed verbatim into a double-spaced word document using line
numbering and wide margins allowed the researcher to employ color coding of key words and
phrase and easy identification of codes (Merriam & Tisdell, 2015). Reviewing each transcription
multiple times allowed the researcher to engage with the data to consider context and customs of
the participants to get a feel for the data (Creswell, 2013). The process began with letting the
purpose of the study provide the framework and lens to begin to analyze the data (Merriam &
Tisdell, 2015). The general method of data analysis began with labeling sections in the data set
that signaled responsiveness to the research question. Using a constant comparative method, as
described by Maykut and Morehouse (1994), data (words) were broken down into discreet units,
permitted the reorganization of data into categories. Identification of categories materialized in
two different ways, either by the participants’ customs and language or by patterns of words
69
identified as significant to the line of inquiry in this study (Maykut & Morehouse, 1994). After
identification of codes and themes in each interview, a comparison of each participant’s
transcript with the transcripts of the other participants allowed the researcher to compare codes
and categories to identify themes. In this process, analysis of the data continued while
simultaneously collecting data. Interviews continued until achievement of thematic saturation
occurred and produced no new information proving to be parsimonious and illuminating to the
research question (Merriam & Tisdell, 2015).
Coding Data
Once transcribed, a review of the transcripts looked for repetition of certain words or key
phrases. Words and phrases, which suggested steps the faculty followed when they began to
read the self-reflection journals or key words suggestive of the criteria they were looking for,
expectations, context, and perspective of the participants’ feelings, and thoughts were all
assigned codes. Next was the process of analytical coding, which is coding that comes from
reflection on meaning (Richards, 2015). The coding processes continued until it seemed that
there were no new codes identified, and the only data left uncoded was insignificant. This
process allowed for the deconstruction of the interviews into pieces of data and then
reconstructed in a new way that is responsive to the purpose of the study (Merriam & Tisdell,
2015). While analyzing the data and assigning codes, the application of inductive analysis led to
more questions and insights into the questions that arose and recorded in the margins on the
right-hand side of the paper for later analysis and further examination.
Overarching Themes
The development of themes comes from moving back and forth between tangible
crumbs of data and abstract concepts, between inductive and deductive analysis, and between
70
description and interpretation (Creswell, 2013; Merriam & Tisdell, 2015). The meanings and
understandings gained from this process constitute the findings of the study. Findings can be in
the form of descriptive accounts that cut across the data or provide insight into models or
theories that might explain the data. The goal was to find relationships, connections, similarities,
and differences between the themes. In keeping with a qualitative research design, themes
identified were such that an outsider would be able to understand within the context of the study
(Merriam & Tisdell, 2015).
Field Notes
Documented in the margins of the transcription were the observations of the non-verbal
communication of participants. Physical descriptions of the participants’ behaviors provided
visual reflections and perceptions of the participants’ thoughts and feelings as they responded to
the interview questions. The participants listened, explained, and shared, with an eye towards
gaining a greater understanding of the feelings of the participants through a review of the written
notes and observations added to the review of their contributions (Munhall, 2012).
Analysis and Evaluation
The data analysis was initially inductive and comparative (Merriam & Tisdell, 2015).
Throughout the processes described above, the goal of the analysis was to consolidate, reduce,
and interpret the findings of the study with the aspiration of creating a new understanding of the
issue under consideration. Thematic analysis of the themes and codes constructed from the data
examined the responsiveness to the purpose of the research. A review of the data ensured that
the themes identified were exhaustive and that placed within a single theme was all meaningful
data. A detailed examination of the data ensured mutual exclusivity while safeguarding that
there were no new concepts to discover. The labeling of each theme was reflective of the data
71
within the theme. Lastly, all themes were conceptually congruent, meaning that the level of
abstraction was the same within each theme. Reexamination of the data occurred multiple times,
which led to a deeper understanding of the data and identification of themes. This, in turn, led to
speculative explanations of the issue under investigation.
Interpretation of Data
The last step of the data collection process was the reporting of the findings from the data
inclusive of the interpretation of what the data meant and how it answered the research question.
Direct quotes from the participants served as evidence to support that the findings and
interpretation of the data through member checking accurately portrayed the faculty’s processes,
value, and criteria used to evaluate student self-reflective journals. The interpretation of the
findings built upon previously published studies and added to the body of knowledge of King’s
theory of goal attainment.
Limitations of the Research Design
In this qualitative research study, the researcher served as the primary instrument for data
collection and analysis (Merriam & Tisdell, 2015). Having extensive experience in online
nursing and health profession programs that systemically employed self-reflective journals
allowed the researcher to have a deep understanding of the issue under investigation but also
increased the risk of study bias. Researcher transparency during the study helped reduce the
impact of bias. Bracketing of personal beliefs while acknowledging and monitoring assumptions
related to the value, criteria, and processes associated with student self-reflective journals helped
to reduce the risks. Issues of sampling and recruitment bias could become challenging but were
72
thoughtfully addressed ensuring research extensiveness of the sample size before starting the
research study.
Credibility
Crosschecking and constant comparison of transcripts of interviews provided the initial
steps to consider credibility. In addition, field notes taken during participant interviews noted
facial expressions and body language that added information to the verbal responses of
participants to interview questions and provided insights into participants’ thoughts and feelings.
A second analyst independently analyzed the data. A comparison of the second analyst’s coding
and theme identification to the original data results to identified similarities and differences
between the two analyst findings from the data.
A third strategy to establish credibility was member checking. Within 2 weeks of the
initial interview, the participants reviewed transcripts of the interviews. They verified the
transcripts for accuracy and then also reviewed the initial themes identified through the data
analysis. The final step queried participants regarding the veracity of the researcher’s
preliminary findings (Merriam & Tisdell, 2015).
Dependability and Transferability
Associated with dependability in qualitative research is the notion that another researcher
who is not familiar with the study understands the decision tree and logic used by the researcher
(Thomas & Magilvy, 2011). In this study, the purpose of the study was described, along with a
discussion of the extensiveness of the sample, the data collection and analysis methods, and
finally a discussion on the findings of the study. To enhance the dependability and credibility of
73
the study, another colleague participated in the analysis of the study. With the detailed
description of the interview process and the process of data coding, another researcher should be
able to use the process to conduct a similar study. Conducting an independent analysis of the
data to identify similarity in the findings enhanced the dependability of the study (Merriam &
Tisdell, 2015; Salmons, 2014).
Unlike dependability, transferability refers to the extent to which the findings of a study
may apply to other situations, environments, and people. In this study, the participants had a 27year range in age and a variation in educational levels from MSN to DNP, Ed.D., J.D., and Ph.D.
in the disciplines of nursing, education, and law. The participants varied from full- to part-time
nursing faculty with part-time faculty holding jobs in various healthcare environments. Several
of the participants had used self-reflection journals in their educational programs, and all the
participants had a minimum of teaching 3 years in an online program that used self-reflection
journals as an assignment. Next is a discussion of the expected findings.
Expected Findings
There was an expectation that participants would honestly reveal their perceptions,
experiences, and thoughts regarding the processes they use to evaluate online RN-BSN students’
self-reflective journals. The hope was that data revealed similarities in the criteria and process
used by the faculty when evaluating the self-reflective journals that would serve to add to the
body of knowledge regarding how faculty evaluates student self-reflective journals. A final
expectation was that faculty would share their thoughts regarding self-reflective journals focused
on a critical event versus self-reflective journals and journals focused on subjective subjects such
74
as students’ thoughts and feelings. Because the participants would be sharing their thoughts and
feelings, the study required submission to the university's Institutional Review Board (IRB).
Ethical Issues
Submission of the study to the Capella University IRB ensured the protection of the
participants' human rights. The study underwent an expedited review, as this study looked at
educational processes and the researcher and participants did not share the same employer.
Thus, there were minimal risks for the participants of this study. Such a risk might be that
because the participants and researcher shared the same professional network of colleagues,
participants might fear that non-participation would reflect poorly on them professionally.
However, LinkedIn is a voluntary public site, where individuals self-select what information they
wish to share, it was unlikely that non-participation would result in any negative repercussion for
the participants. Participants signed an informed consent including an agreement for using a
multi-channel meeting space with the plan to record and archive the conversation. The consent
also guaranteed the secure storage of transcripts and the destruction of the transcripts 5 years
after the conclusion of the study. Also, the IRB and informed consent process guarantee the
right of participants to withdraw from the study at any time without repercussions.
Chapter 3 Summary
Chapter 3 provided an overview of the methodology employed in the research conducted
to understand the processes faculty use to evaluate online student self-reflective journals. The
objective of the conducted research was to extend the body of knowledge of both the general
education and health professions education literature regarding the value, criteria, and processes
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used by faculty to evaluate student-learning outcomes associated with self-reflective journals. In
considering the research question, a basic qualitative research design sketched the methodology
most likely to provide a greater understanding of the issue under investigation. The chapter
presented the research methodology, target population, sampling methods, and participant
recruitment strategies in detail. Also, Chapter 3 also presented a description of the
instrumentation, interview protocol, data collection strategies, and data analysis strategies
employed to demonstrate credibility and trustworthiness of the study. The chapter concluded
with a discussion of the credibility, transferability, dependability of the study, expected findings,
and the ethical issues. Chapter 4 will share the data and findings of the study.
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CHAPTER 4. PRESENTATION OF THE DATA
Introduction: The Study and the Researcher
The purpose of Chapter 4 is to describe the sample and sampling procedures employed in
this study along with a discussion of the data analysis and a summary of findings. Chapter 4
begins with a description of the study’s sample and continues to the research methodology,
followed by the presentation of data and results of the data analysis. The chapter concludes with
a summary of the findings of the study.
In reviewing the methodological literature on qualitative studies, Sandelowski (2011)
posited that data is foundational to interpretation (i.e., interpretation is data-based) and
understanding in qualitative studies, there is also emerging discussions that interpretation is
foundational to data (i.e., data as interpretation-based). A qualitative design is adaptable and
evolving, responsive to changes in the conditions of the study with the researcher serving as the
primary instrument allowing for maximum responsiveness and flexibility in the collection of data
and data becomes data by virtue of the researchers’ decision on what words fit the phenomenon
of interest (Merriam & Tisdell, 2015; Sandelowski, 2011). Thus, it is important to understand
the motives, background, and context that the researcher brings to the study and how it
influences the research question, data analysis, and ultimately the study findings (Sandelowski,
2011). It is equally important the researcher take some time to identify and bracket biases
(Merriam & Tisdell, 2015).
Serving as a direct care provider, nurse manager, nurse educator, and academic nurse
leader in nursing over the past 37 years allowed the researcher familiarity and increased
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understanding of both the practice and academic cultures of nursing. With the ever-changing
landscape in nursing, where innovation and scientific knowledge continue to be dynamic
processes across multiple nursing delivery environments, the demand for reflective practitioners
who can solve complex problems that they may not have faced before has never been greater
(Johns, 2013). Experienced nurses returning to school to complete a baccalaureate education are
a unique set of learners who come to the learning environment with a rich reservoir of
experiences that provides a platform for creating new ways of solving patient care problems as
they incorporate new knowledge into their clinical practice (Asselin, 2011, Asselin, SchwartzBarcott, & Osterman, 2013).
Developing an online RN-BSN program in 2004 and continuing with development of
new RN-BSN programs as late as 2014, the researcher has intimate knowledge of the
opportunities, challenges, and barriers to the development of associate degree and diploma
nurses into baccalaureate prepared nurses capable of becoming reflective practitioners. One of
the more common reflective teaching strategies mentioned in the nursing and education literature
is the use of self-reflection journals. In the programs developed by the researcher, the threading
of self-reflective journals held center-stage as a teaching strategy deliberately throughout the
curriculum. However, minutes from faculty meetings revealed divergent understandings of the
process and value of evaluating student self-reflection journals. With the lack of clarity on the
concept of reflection and varying opinions regarding reflective journaling’s value in facilitating
reflection found within the literature, an opportunity presented itself to conduct a study to find
what processes faculty employ to evaluate self-reflective journals. It is this question that
provided the impetus for this study and guided the development of the inclusion criteria for the
sample.
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In many qualitative studies, as in this study, the researcher serves as the primary research
instrument and, congruent with the four major topologies of questions introduced by Strauss,
Schatzman, Bucher, and Sabshin (1981), developed four open-ended questions: (a) a
hypothetical question aimed at what if; (b) a Devil’s advocate question, which seeks to
understand controversial issues, such as whether to evaluate self-reflection journals; (c) an ideal
position question, such as what would the ideal self-reflection question be, and, lastly; (d) an
interpretive question, aimed at restating a position presented by the participant and asking for a
reaction to obtain data to answer the research question. Using a constant comparative method,
analyzed data illuminated emerging themes. Comparison of codes applied to emerging themes
and categories continued throughout the analysis of data. Themes and categories identified from
the data served to organize and analyze data, driving the focus of the study.
With the collection and analysis of data, themes and categories emerged, which
facilitated the easy retrieval of data leading to inductive reasoning to answer the research
question (Merriam & Tisdell, 2015). The rich understanding of the data and emerging themes
provided insights into the value, criteria, and processes used by faculty to evaluate student
learning outcomes associated with self-reflective journals. A narrative format organized by the
themes identified through the data analysis provided the framework for the presentation of data.
The next section presents recruitment and selection of participants along with an in-depth
description of the sample. Subsequent sections of Chapter 4 consider the research methodology
and an interpretation of the findings of the study.
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Description of the Sample
Participants in this study included nursing faculty who had experience teaching in both
the on the ground and online learning environments that employ self-reflective journals as a
teaching strategy with an aim towards the development of reflective practitioners. Recruitment
of participants occurred through the researcher’s professional network on LinkedIn via email.
Study participants answered inclusion criteria questions before setting up interviews. There were
20 faculty members identified as meeting the inclusion criteria and eight initially contacted to set
up interviews, with the expectation that the sample would include 10-15 participants to achieve
thematic saturation. However, using a constant comparative analysis, achievement of thematic
saturation occurred after eight interviews with a ninth interview conducted to ensure there was
no new information. Interviews varied in length between 20-60 minutes and generated 116
pages of double-spaced transcripts. After the achievement of thematic saturation, the study was
complete, and the researcher contacted other potential participants and thanked them for their
willingness to participate in the study.
Demographic data of the study participants included four participants between the ages of
41-50, two between 61-70 years of age, and one faculty each identified as between the ages of
20-30, and 51-60 years of age. This revealed a range in years of teaching experience in higher
education between 2-37 years. Each of the participants had taught four or more terms in online
programs that employed self-reflective journals in one or more nursing education programs.
Table 2 provides a summary of the demographic composition of the sample. The arrangement of
interviews using a multi-channel meeting space, Adobe Connect, at a mutually agreed upon time
between the researcher and individual participants occurred during summer of 2015.
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Table 2
Demographic Characteristics of Study Participants
Participant Gender
Age Range
Ethnicity
Yrs. Teaching
Terms Online
Highest Degree
A
F
41-50
White
15
4
MSN
B
F
41-50
White
5
20
APRN-DNP
C
F
21-30
White
2
8
MSN
D
F
51-60
White
14
4
MSN
E
F
61-70
White
37
11
EdD
F
F
61-70
White
10
8
PhD
G
F
41-50
White
9
20
H
F
41-50
White
3
4
JD/DNP
MSN
Research Methodology Applied to the Data Analysis
This study used a basic qualitative research design to uncover the participants’
experiences with the evaluation of student self-reflective journals and the processes they
employed in the evaluation of the student self-reflective journals (Worthington, 2013). In-depth
interviews served as the data collection strategy to address the research question of this basic
qualitative study, it allowed for a fine distinction of understanding of the thinking and motivation
that drives behavior and attitude formation of the faculty members involved in the study (Roller
& Lavrakas, 2015). Qualitative data analysis is both inductive and comparative (Merriam &
Tisdell, 2015). A written interview protocol guided the in-depth interviews using a multichannel meeting space familiar to both the interviewer and interviewee. The semi-structured
interview process encouraged a back and forth dialogue and enabled increased flexibility in the
interview process by changing the wording of questions, changing the order of questions, and
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injecting probing questions for clarification and increased understanding in response to the
participants’ comments (Rubin & Rubin, 2012). A review of the current literature on selfreflection and self-reflective journals as a teaching strategy to develop reflective practitioner
enhanced the interviewer’s understanding of factors influencing faculty members’ evaluation of
student learning facilitated probing questions. The interviewer-interviewee relationship is the
cornerstone of the research utilizing in-depth interviews and the sharing of the background and
the context of the phenomenon of interest facilitated the free flow of information (Merriam &
Tisdell, 2015). The in-depth interview approach allowed the exploration of sensitive issues free
from the encumbrances of social pressure (Roller & Lavrakas, 2015).
The creation of a Word document that included a numbered line double-spaced document
with wide margins for easy review occurred after each review of the audio link of the interview.
Once transcribed and the preliminary analysis completed, a review of the transcript by the
participants, allowed attestation to the accuracy of the transcription and provided an opportunity
for the participants to weigh in on the researcher’s preliminary findings (Merriam & Tisdell,
2015). After transcription of the interview, an initial review of the script allowed for a
preliminary examination of the data, facilitating insights into the content while identifying
commonalities, themes, and categories. Analysis of the transcripts provided data placed in the
appropriate sections that contained similar words and information before the assignment of any
meaning. By coding repetitive words or words with like meaning were coded and themes
emerged that were then categorized. After the initial review of the transcripts a second
examination of the data permitted grouping those comments or codes that fit together and were
responsive to the research question. A repetition of this process continued with each interview
and with the completion of the second pass of analysis; examination of the newly analyzed script
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sought congruency with the script from the previous interview. A comparison with each new
data set looked to find commonalities between the interviews, which added to previously
identified themes and identify newly emerging themes that address the research question. This
process of inductive reasoning and comparison continued until no new themes emerged.
Presentation of Data and Results of the Analysis
This section will illuminate the identified themes from the data that support the purpose
of the study and answers the research question. Based on the research question, what process
does faculty employ to evaluate student self-reflective journals, the analysis and categorization
of data fell under three broad themes. In addition to the three broad themes, the data analysis
found sub-themes that contributed to a greater understanding of the broad categories identified.
The first of the three broad categories and sub-themes associated with it was the initial approach
taken as the faculty member aimed to evaluate the individual students’ journals. While the data
analysis revealed consensus on the initial approach to the evaluation process, sub-themes
emerged related to the rationale supporting the initial approach. Specifically, sub-themes
regarding the challenges associated with both faculty’s and student’s understanding of reflection
emerged. The second identified theme and the second step in the process regarded faculty
experiences with rubrics and guiding questions and their role in evaluating student’s journals.
The third broad theme and final step in the process involved the perceptions of faculty’s value of
self-reflection journals and how that influenced the grading of student self-reflective journals,
which are subjective in nature. Surprisingly, the data revealed a common first step in the
approach to evaluating journals. Thus, themes are presented as steps in the process faculty
employ when evaluating students’ self-reflective journals.
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Step One: Initial Approach
The participants described how they first approach evaluating journals in a more
consistent way than anticipated, stating that they take a quick read of the entire class’s
submission before settling down to evaluate a particular students journal in order to gain a sense
of where the students are in their thought process and to prepare themselves to provide quality
feedback to the students. Participant F stated, “Actually I tend to read the entire classes’ journals
as a quick first pass to get a sense of where the students are in their thought process.” Those
sentiments were echoed by Participant B, who stated, “as you read individual journals you then
consider the whole class to have a sense of where the students are and getting a sense of whether
or not the students are touching key points of the guiding question authentically or is it too
shallow with regard to the key points. Participant G added, “actually, I tend to read the entire
classes as a quick first glance to see if the students really understand reflection and where they
are at with the process.” Participant D shared that “I take a quick read first of the class to help
me get a sense of what they know about the content, where are they in their own processes of
learning and self-awareness.” During the interviews with participants as they discussed the steps
they take in developing a process used to evaluate student self-reflective journals, they took time
to explain that, while doing the initial pass through the classes self-reflective journals, they were
mindful of a few challenges both with students’ reflection journals and with their limitations with
reflection journals. Included in the next two sections are two sub-themes identified during the
analysis that contributed to the rationale offered for the initial approach to reading the entire
class’ journal entries.
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Students’ understanding of reflection. A times faculty shared that in their initial
review of the journals, students did not seem to have an understanding of the expectation or how
to write a reflective journal. The participants expressed distress when they realized that some of
the students were way off the mark when they went through the first pass read. Some stated that
there was a difference between newly graduated associate degree nurses and more experienced
nurses.
In considering the differences between newly graduated and licensed registered nurses
Participant D offered,
This term I have four students who just graduated in May. They have been a nurse for
what, 8 weeks? They are still scared at the responsibility they have and feel insecure
about it. I teach in an associate degree program, and we focus on knowing and a
prescribed set of actions, so I do not think they understand self-reflection and testing
assumptions. I am not sure they have the ability to have any insight.
Several of the participants noted that many of the experienced nurses do not see themselves as
experts. Participant G stated that,
Students need to understand that they are experts; they have more knowledge than the
average individual. They need to draw on their experiences and take what they have
learned in class and apply it to situations in new clinical experiences.
Participant E shared that “that students are actually looking at the content and looking at their
practice and making connections using critical thinking, you are looking for the process more
than the content.
Participant D wrote, “Students don’t necessarily understand the rubric or reflective
journals or how to use them, or what is expected from them. Participant E shared, “Initially
students don’t get it, and it’s hard to process that as a new faculty.” Participant E added,
That in the initial reading of the students’ journals I can get a sense of how the student
thinks and how good or not good they are able to reflect; may be this is something they
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have never done before and they really are not use to it.
Faculty spoke passionately about the challenges experienced with helping students who do not
seem to understand reflection and how to help those students. Participant G stated, “I struggle
with how to provide a student who doesn’t understand what to include in self-reflection and not
to include. It is sort of like some students get it and some students don’t.” Participant B stated,
I think the students are a little intimidated by it at first, because I don’t think they know
exactly what the faculty member is looking for and they do not know the faculty member
in the course. I’m not sure everybody even understands what self-reflection mean. They
do not really know how to reflect on some of their actions and assumptions or why they
hold the values they do.
In speaking with participants, not only did they experience challenges with students
understanding reflection and the role of reflective journals but they themselves struggled with
understanding of reflection and reflective journals.
Faculty’s understanding of reflection. Interestingly, analyzed data revealed a
recurrent premises of faculty’s limitations with understanding reflection and reflective journaling
and how it influenced the evaluation process of student’s self-reflective journals. One of the
participants who is very familiar with the development of online faculty regarding the use of
self-reflective journals as a teaching strategy, Participant A, added, “It is, important to
understand what the faculty member themselves understand and know about reflecting.” She
continued, “I would want to know what they understand about the process and then try to fill in
any gaps.” Another participant, Participant E, stated,
I mean the first time, when I didn’t understand what a reflective journal was and didn’t
really understand the purpose, it was very difficult and after you’ve done it a couple of
terms you feel like you’re doing a better job, as the program progressed and I had more
experience with journals I could see the impact on the students.
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After identifying the initial approach faculty employed as they evaluated student selfreflective journals a second “step” in the process emerged. Revealed through the data, the
second step in the process uncovered two different approaches to the evaluation process.
Participants either compared journal entries to the rubric aligned with the assignment or looked
to the guiding question to influence their evaluation of the students’ journal entries. The next
section describes the data collected concerning the contribution of rubrics and guiding questions
in the process of evaluation.
Step Two: Rubrics and Guiding Questions
After gaining an initial feel for where the students are in their thinking and a brief sense
of the level of their reflection, participants discussed their experiences with the criteria for
grading. The participants varied in whether they looked at the rubric or the guiding question to
inform the evaluation criteria they sought in the evaluation of student’s reflective journals. Each
approach involved considering the criteria for how they would evaluate the reflective journals.
Data reflected participants’ experiences with the guiding question framing the context for the
self-reflective journal assignment which was accompanied by a grading rubric. Participants felt
that the aim of the rubric was to create objective measures upon which the students should be
evaluated removing faculty subjectivity out of the equation.
Rubrics. Normally created in a simple, explicit, and easily understood fashion, rubrics
help students connect learning (what is taught) to assessment (methods of evaluation) (Abbott,
2014). Participants revealed that they use the grading rubric so guide them as they read the
journals to ensure that students are hitting the key points expected in the assignment. Participant
C stated, “So, you know that you are more grading it based on them touching on all the key
points you want then to focus on rather than the content on that specific entry.” Participant G
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added, “(that) after reading I would still go back and look at the grading rubric, materials that
they have that guides them with the assignment.” Participant A shared, ‘
Faculty ideas about student reflection journal entries usually come when the faculty
member has had a chance to look at the grading rubric for the assignment which feeds
into their assumptions about how the reflection journal should flow. Faculty can be very
concrete in applying the rubric to self-reflection journals, and their interpretation of what
the student is saying is guided by the rubric.
Other participants look to the guiding question as the next step in the process.
Guiding questions. Guiding questions for reflection journals provide a framework upon
which students can begin reflection that moves them to habits of thinking consistent with
becoming reflective practitioners (Moussa-Inaty, 2015). Participants in the study discussed that
reflection is a process and there are different levels of reflecting. Participant A asserted,
some students may be more-may have a deeper reflection with more insight and others
may not be quite so used to reflecting upon their performance so they do not have as
much insight. It is not the content feedback from the course that we are looking for,
we’re looking for that level of reflecting—how can they look back, this is what I knew,
this is what I have learned, this is where I am going with it.
Participant G noted, “If it’s a prompt or if there is a question included, then addressing the
prompt is an expectation of the journal. What from your knowledge base have you drawn upon
to address the question asked for in the reflection?” Participant C noted that “clarifying
questions help move the student to a new level of understanding.”
In reading the guiding question, evidence from the data suggested that participants began
to create their own set of expectations regarding the content of the students’ self-reflective
journals. As the faculty moves to a greater examination of the students’ reflective journal they
begin the process of evaluating the students’ reflective journals. In this study, participants’
feelings with regard to self-reflective journals being a graded activity illuminated their thoughts
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regarding key criteria they were looking for when they evaluate students’ journals. The next step
in the process is how faculty evaluates student self-reflective journals in the online environment.
Step Three: Assigning the Grade
Although evaluation ( the actual assignment of a grade) may seem to be the last step in
the processes, faculty’s perceptions and value in the teaching strategy had an impact on the
actual assignment of a grade and are noteworthy. As words were identified and interviews
deconstructed and then reconstructed faculty’s beliefs regarding the ability to assign a grade to
the subjective feelings shared in student journals revealed conflicting views. Under this broad
category, six sub-themes emerged: (a) the influence of participant’s perceptions and value of the
assignment, (b) they key words and criteria sought, (c) the value faculty place on the assignment,
(d) influence of the guiding question, (e) feedback to students, and (f) faculty development with
reflection and reflection journals.
Participants' perceptions and value of reflection journals. In reviewing the data, a
predominant theme emerged from the interviews regarding faculty’s belief that students need to
share the emotions they experience while reflecting upon the issue under review and greatly
influenced the assignment of a grade. Participant A stated,
You cannot have a reflection without having subjective feelings. So, the question
becomes how do you grade or evaluate this? The subjective feelings have to come out
because it’s part of that analytical piece to critical thinking: how is this, the knowledge
that I have, this is my understanding, that when new information comes into play there’s
an emotional reaction or there’s a reaction in the emotional self, a disruption in thinking
and fueled by this emotion, the person needs to decide if they are going to take in the new
information or discard it. This is part of the transformation of thinking and the learning
so when we are evaluating we have to not look at what the content is, but how the student
manages what they thought they knew, how they integrated the new knowledge, and now
what is it they understand.
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Participant C offered some of the same insights, “I don’t think you’re evaluating the
content in what they say, it’s whether they have done the critical thinking and looking at their
practice and making connections and that what you are evaluating the process more than the
content.” All the participants shared the common belief that they want students to share their
personal experiences with the skill or theory that was presented in the content being examined
and how did they feel about it, “I want to see evidence of critical thinking and emotional
awareness of learning and how it impacted their practice,” as stated clearly by Participant B. The
participants all echoed that the subjective feelings of the student were an integral part of the
process of self-reflection and were critical to the evaluation process. Rather than focus on the
actual content of what the student said, the participants looked for an analysis of the self from the
student, sharing what they already knew, and the accompanying assumptions, and then a sense of
changing their initial beliefs with application of new knowledge to new and different clinical
situations. Participants sought authentic and personal examples. As students revealed their
stories, faculty were quick to point out the key attributes they look for when evaluating selfreflection journals, that lead them to believe a sense of transformation has occurred.
Key characteristics. In evaluating self-reflection journals, the participants were
consistent with the characteristics they expect to see in self-reflective journals: (a) metacognitive process, (b) self-awareness, (c) openness to learn, (d) a capacity for reflection, viewed
as insight, (e) clinical experiences upon which to draw, and (f) the inclusion of feelings and
emotions in the process of learning. The participants found these to be critical and there was
little mention of whether the grading rubric contained these elements, the participants looked for
this regardless of the inclusion of the criteria in the grading rubric. Presented below are the
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participants’ words that illuminated the key characteristics participants look for when evaluating
self-reflection journals.
Each of the participants in the study spoke of critical analysis, critical thinking, and a
need for students to think more deeply about their experiences in the face of the presentation of
new content that should change behaviors and actions. According to Participant A, “there needs
to be an element of critical thinking I guess because it’s an analysis, it’s looking at how the
consideration of new knowledge would apply in their situation, whether it be clinical or personal
with their understanding.” Participant E expanded by stating:
When students share their analysis of how a concept is applied in practice, they use
critical thinking connecting the content to the actions, and at the same time, they share
their feelings about how it felt: good if successful, bad if not. They are applying what
they are learning versus just trying to memorize facts to be able to answer test questions?
Participants articulated that they looked for levels of reflection rather than rote memorization.
Participant G augmented the conversation of the need to see levels of reflection by discussing the
need to have deeper thinking about the experience, saying:
We do want to see your sort of critical thinking about an important aspect. We want to
hear you saying something that brings in your expertise, something more than the man on
the street would know a deeper thinking about the issue.
While sharing their thoughts about the role of critical thinking, the participants continued with
the ability of the student to demonstrate some level of self-awareness. Participant A elaborated,
“there [are] different levels of reflecting. Some students may be more—have a deeper reflection
with more insight, others may not be quite so used to reflecting on their performance, so they do
not have as much insight.”
Insight into ones’ values, assumptions, biases, and actions remained a recurrent theme
throughout the participant interviews. The data revealed the concerns participants experienced
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with student’s lack of understanding of reflection and the goal of reflective journals as a teaching
strategy inclusive of feelings. Participant B explained,
I am not sure everyone understands what self-reflection means, and even if you have in
the class kind of curious people, they really don’t know how to self-reflect on some of the
actions and assumptions or why they hold the values they have. They don’t have a lot of
insight into their own behaviors and progress.
Participant E espoused,
It is an important piece of self-reflection looking at assumptions about the situation and
how the learning changed your assumptions. Students may share their analysis of how a
concept is applied in practice, but at the same time, they should share their feelings about
it.
Participant A shared,
You cannot have a reflection without having subjective feelings; subjective feelings are
part of the analysis process. But how the student manages what they thought they knew,
what came up as new knowledge, and now what is it that they understand. . . I would
acknowledge that they’ve been able to identify what they have as far as assumptions . . .
students that are more apt to enter into a dialogue with the reflection are able to gain
more insight and understanding and their reflection is deeper.
All of the participants strongly felt that it is critical for students to examine their feelings and
assumptions to help them think internally about the way we think about patients and healthcare.
Participant G stated, “Self-awareness and the ability to examine one’s assumptions and biases
contribute greatly to the students’ self-reflection and the criteria that the faculty look for when
evaluating self-reflection journals.” The data revealed that openness to learning is critical to
self-reflection.
Touched on by several of the participants was the notion that students who were
successful with reflection need to open to learning and participants look for evidence of that
openness in the self-reflection journals. Participant C stated, “Faculty can evaluate the student’s
willingness to be open to learning and evaluate the students’ level of reflection, and that is
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important, as the students’ learn to become more proficient with the skills of self-reflection.”
Participant D discussed the difference between those that are open to learning and those who are
not,
Some students will tell you that I got this great opportunity to try out what we learned in
class, yet others say nothing. There is no feedback from some students and those students
there does not seem to be any insight.
When students do not have any insight, participants felt that those students were incapable of
writing good self-reflective journals and that there was no evidence of transformational learning,
which they see as a critical ingredient of self-reflection.
On the subject of insight, Participant D shared,
I have found that many of the nurses who have many years of experience and are now
nurse managers do not understand the role of self-reflection, how to complete selfreflection journals, and at times it is challenging to know how to give the best feedback to
students to move them forward with self-reflection. They have very little insight into
themselves as learners. They are just people taking a class.
Participant A shared that not only students struggle with insight but faculty new to evaluating
reflection journals also struggle, and shared this observation in her mentoring of faculty,
Looking at reflection is a process, it’s not mechanical, and there are different levels of
reflecting. Some students may be more, may have a deeper reflection with more insight
where others are not so use to reflecting and they do not have as much insight.” Some of
the newer faculty look at the rubric for the reflection and they themselves are very
concrete, the want the students to say here are my assumptions, they have to state their
biases, and then what they learned-they’re (faculty) are very concrete on how they
interpret what that-what the terms in the Rubric mean. It takes time and I try to tell the
faculty that it’s not the content feedback that we are looking for, we’re looking for the
level of reflecting.
Both faculty and students have clinical experiences upon which to draw and begin to make
connections with the process of reflection and why experiences and the inclusion of feelings and
emotions are critical to the process of reflection and should be part of the evaluation process.
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The interplay between experiences and emotion are eloquently relayed by Participant G,
Because as you in know in healthcare, nursing is such an intimate profession where you
are dealing with vulnerable people and you have real ethical responsibilities and I think
that if we do not take time to self-reflect and think about, what it is, the Affordable Care
Act or, a patient dying with AIDS or things like that, any basic nursing program always
brings in sort of, like, ethical issues where we go through the stages of development, we
have to think about the way we think of things, and reflect and take time and if the
exercise is on something very specific, like the Affordable Care Act that affects us
personally and professionally, we need to reflect upon it, so that we can continue to
provide care and work through our own feelings and ethical issues. When I first started, I
thought the reflection journals would provide opportunities to kind of vent and complain
and be pretty personal, and the truth is, students are pretty meaningful in what they write,
and they write about important things and they brought in real-life experiences from their
work and clinical time.
Participant B reiterated that she looks for experiences as the foundation for reflection. Data
analyzed revealed participants’ beliefs regarding the need for clinical experience as a key
ingredient to self-reflection.
The requirement of clinical experiences for good self-reflection continued to be a
recurrent theme. Participant B shared that in the evaluation process,
I want to read in their journals their personal experience with using the skills or theory
that was presented to them and how did they feel about using the skills. . . . emotional
awareness of the learning and how did it impact their practice.
The importance of articulating how the faculty evaluating self-reflection journals receive
reflection and emotional awareness by is best summed up by Participant E,
it was just so outstanding; it was just absolutely incredible to me, that someone could
articulate changes in practice and how they made that journey to transform practice in
just one term. As they found their new knowledge, they just grabbed everybody in the
community and were able to apply what they had learned. I want to work with this
person.
As noted from the above quotations and summary of the evidence of key characteristics that
faculty seek when evaluating self-reflection journals, it is not as simple as developing a rubric
where faculty follow a set of expectations. Rather, they have specific thoughts and ideas
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regarding the criteria they seek in self-reflection journals, and although not well understood, the
key elements of self-reflection found more consensus than diversity in the expectations
articulated by the participants.
Analysis of the data from interviews affirmed the need and the criteria available to
evaluate student self-reflective journals. As noted by Participant D, “if it’s worth a lot of pointsthey’ll [the students] pay attention to it, if it’s worth one point they are not going to pay any
attention.” Thus, the weight given to the self-reflection journal serves as an impetus for students
to place more effort into the assignment. Analysis of the data from the interviews illuminated
the criteria faculty sought to evaluate the self-reflective journals; however, the value within the
syllabus given to the assignment also plays a role in the effort expended by the student in
completing the assignment. The value assigned to the self-reflective journal assignment may be
reflective of the value assigned to the assignment by the faculty.
Value of students’ self-reflective journals. Promoted as a key ingredient to the
development of reflective practitioners, the ability to self-reflect and the infusion of selfreflective journals as an evaluation tool to measure students’ ability to self-reflect continues to
increase in popularity among nursing and health professions curricula (Sutphens, March, &
Owens, 2013). When considering how faculty evaluate student self-reflection journals, data
suggested that the value faculty place on the assignment influences their evaluation of the
students’ journals. Participants’ views regarding the value of self-reflection journals illuminated
their feelings and experiences regarding: (a) the framing of the assignment, (b) the role of faculty
feedback to increasing levels of reflection, (c) the merit of faculty development with regard to
self-reflection journals, and (d) challenges and benefits of self-reflection journals in the online
environment, specifically the difference between using a clinical incident as the focus of
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reflective journaling versus a focus on the presentation. Below are the participants’ responses
and the findings from the data.
Speaking to the value participants find in using self-reflective journals as a teaching
strategy, specifically in the post-licensure RN-BSN population, Participant C stated,
These students in particular come to the course with very definite ideas about nursing and
about their role. The value of self-reflective journaling is having then go back and
revisits their assumptions and then see if the content and application of the content has
changed their views. It is then they achieved new learning to have it incorporated (selfreflective journals) into the content throughout the term at different levels is beneficial to
the students. Especially the initial reflection before they even begin to consider the
content of the course versus that final reflection at the end of the course, when they can
look back on everything that they have learned, . . . they mention how they have learned
so much more than they thought of they’ve enjoyed the course more than they ever
thought they would and how much more applicable to practice than they ever thought it
would be.
Participant B not only discussed the value of self-reflection in the classroom setting but with the
nurses she manages in the practice area as nursing prepares the workforce for the 80%
baccalaureate prepared workforce by 2020.
I really do find this valuable not just in the students but people that I manage who are
nurses that I encourage to go back to school. I think that at first, they feel it’s not
anything they need to do to get their bachelors, do some of them do, some of them want
to, but I would say a lot of them are forced into doing it due to the requirements of their
job. I think it is important that they stop and think about what having a baccalaureate
degree adds to their practice. I think this happens during the self-reflective journals.
Each of the participants felt that the value of using self-reflection journals as a teaching strategy
to help nurses change practice and become reflective practitioners was important. However,
there was a considerable discussion to the framing of the reflective question as critical to
providing the students with a direction for their reflection. The next section will share the
findings about the framing of the guiding question.
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Guiding questions. Data revealed the importance the participants gave to the role of
guiding questions with reflection journals. Participant C stated, “I think the most important thing
in creating the question is to get them (the students) to think about whatever was discussed
during that module and what may have changed in the learning process.” Participant E expanded
on the thoughts regarding the construction of guiding questions by offering,
I think it has to be one that really does direct them that does ask a question that is
specific, putting it up front how does what you learned this week apply in practice. When
students share analysis of how a concept is applied, they are using the critical thinking
connecting the content to the actions, and at the same time, they share their feelings of
how it felt.
Participant C was very specific about the construction of guiding questions with the RN-BSN
population,
I think especially because they are RN’s already, I think I would frame it somewhere
along the lines of what did you learn and how would this content be helpful to you in
practice, I would make it as personal and relevant as possible.
All of the participants shared their recollection of reflections and statements by students that
made a significant impression on them. In response to the ideal self-reflection question
Participant shared her thoughts this way,
I don’t think there’s an ideal question because I think that nurses have to be reflective in
many areas and the question has to be specific towards that. So, may be the formulation
of the question would be topic of what they need to consider and as them (the students) to
look at what they thought it would be, and ow they might be able to apply that in future,
what would be the barriers?
Participant A shared a question posed in the Capstone Course she taught, “What might you take
away from this course and apply to your practice?” In the analysis of the data brought to light
the notion that the creating of guiding questions needs to allow for a connection to the content, it
must guide the students to consider what they have learned, how they would apply it, and how it
will change their practice. Analysis of the data from the question regarding the design of the
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ideal guiding question, the recurring theme was an open-ended question that allowed for the
connection between personal clinical experiences and the connection to new content with an aim
towards the student’s recounting of a change in approach or behavior. In identifying recurring
themes, participants also shared their thoughts and experiences on the role of feedback and its
contribution to the value of self-reflection journals.
Role of faculty feedback. Uncovered through the interviews was the repeated theme of
faculty feedback to students. Feedback to the students can help facilitate deeper reflection or can
stop the student from deeply thinking. Because this study analyzed data from an online program,
the concept of developing trust between the participants and students reoccurred in several
interviews. Participant B posited,
[I] want to begin the relationship with the student, . . . what are their goals for the course,
it’s not always what the class is about, but I don’t want to think about that, . . . it gives me
an idea of how the student thinks.
Developing a trusting relationship allows the faculty member to increase the student’s ability to
be open to learning as Participant A shared,
I had a student who was very negative, she stated. “I am not learning anything, this is a
piece of—I’m wasting my time going through this, blah, blah, blah . . . and all these
negative things about the course and her experience and what she was doing. And my
tendency was wanting to bash her down and give her a poor grade, but these were her
feelings and this was real to her. This is where being online was an advantage, as I could
step back and not have my own reaction. . . and what happened is because I was being
respectful of the student’s feelings when she had an issue she contacted me and work it
out and we have a very different exchange than we had previously. She wrote on the
discussion board in a very public way a thank you for [my] professionalism in working
with a very difficult student. And that tells me she learned and has had some
transformation but does not yet recognize it. If I had not taken a moment and stepped
back and not react from my person, she might have missed this learning opportunity.
However, faculty need mentoring in how to deliver appropriate feedback in a way that increases
the development of a trusting relationship between the student and the faculty member. The next
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section will discuss the role of faculty development in the evaluation process of student selfreflection journals.
Faculty development. As noted in Chapter 2, there was a lack of clarity with the
concepts surrounding reflection, self-reflection, and the necessary characteristics an individual
must possess to carry out self-reflection (Asselin, 2011; Dorn, 2014; Dyment & O’Connell,
2011). In this study, Participants shared their experiences and feelings regarding the need for
development and mentoring to facilitate the evaluation of self-reflective journals and increase
students’ levels of self-reflection. Highlighted in response to a question of whether there is value
in the faculty members teaching the same course to meet and discuss their experiences in
evaluation self-reflection journals, was the affirmation that faculty needed to be increased
experience and development with the evaluation of student self-reflection journals and that
faculty meeting aimed at discussing guiding questions, and evaluation criteria was helpful.
Participant D stated,
I totally agree with that, and part of it is I feel like I’m reading the rubrics and looking at
the questions and still I am not able to understand where the student is coming from. At
times, what the students’ write has little to do with the self-reflection question asked. I
am at a loss of what to do, we use to have monthly meetings and we’d meet at the course
and discuss the issues we would find, what were we seeing, what have you done with the
feedback you have given students. I found this extremely helpful as a new online faculty
member.
Participant E augmented the data:
[As a faculty member] at first it feels like you’re out in limbo and you don’t know what
you’re doing. So, it becomes uncomfortable when you don’t understand – I mean the
first time I didn’t understand what a reflective journal was and I didn’t really understand
the purpose it was very difficult. As the program progressed I became more experienced
and I could see the impact on the students. That was powerful for me.
Other faculty members had had experience with self-reflection journals in their nursing
programs, as Participant B shared, “I think especially when I was in my doctoral program a lot of
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self-reflective practice was used and since it was an online program I felt very comfortable
leading others.” What faculty shared both from their developmental perspective as well as the
students’ development, the systemic use of self-reflection journals throughout a curriculum is
very beneficial. While the opportunity for a faculty to come together and discuss the initial
perceptions of the faculty when they have read the first pass, is very helpful to the faculty in their
evaluation of students’ self-reflective journals.
Summary
Chapter 4 presented a description of the study sample and sampling procedures along
with role and relationship of the researcher to the study and study findings. Participants in this
study included nursing faculty who had experience teaching in both the on the ground and online
learning environments that employ self-reflective journals as a teaching strategy with an aim
towards the development of reflective practitioners. In the presentation of data and the analysis
of data three broad categories of findings were identified: the process, or steps, the faculty
members take when evaluating online RN-BSN student self-reflective journals, the key
ingredients and criteria they seek to evaluate the student’s self-reflection journals, and finally the
value they assign to self-reflection journals as an assessment assignment to evaluate students’
self-reflective ability. Chapter 5 will present the conclusions and a discussion of the study’s
findings.
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CHAPTER 5. CONCLUSIONS AND DISCUSSION
Introduction
The purpose of this basic qualitative study was to gain a comprehensive understanding of
the processes faculty employed to evaluate the student-learning outcomes associated with online
RN-BSN students' self-reflection journals. Revealed in this study were the perceptions, insights,
observations, and methods of eight nursing faculty who routinely engage in the evaluation of
online RN-BSN students’ self-reflective journals. A basic qualitative study provided the
methodology to collect data aimed at reaching a holistic and deep understanding of the processes
and methods employed by faculty to evaluate online RN-BSN students’ self-reflection journals.
Chapter 5 serves to summarize the findings, discuss the results, and offer conclusions
based on the findings of the dissertation. The chapter begins with a summary and discussion of
the conclusions of the study. Subsequent sections provide a discussion of the results of the study
within the context of the current state of the literature and its alignment with the theoretical
model that guided it. The chapter then proceeds to present the limitations of the study, followed
by a discussion of the implications of the study findings to the both the general health profession
and nursing education literature, along with recommendations for further research. In
concluding the chapter, the presentation of a concise summary of the dissertation moves to some
overall conclusions on the process faculty employ in evaluation students’ self-reflective journals
and brings closure to the dissertation. The next section will outline a summary of the results of
the study.
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Summary of the Results
The results of this study identified commonalities and challenges experienced by faculty
as they sought to evaluate student self-reflective journals. Uncovered through the data analysis
were not only the actual steps taken in the evaluation process and key criteria to measure student
learning outcomes, but the value faculty found in the teaching strategy. Of significance and
quite surprising was the common first steps faculty employed as they approached the evaluation
process. The insights and experiences shared in this study provide educators within the health
professions an opportunity to increase their clarity on the processes and key criteria identified to
signal the transition to from practicing nurse to reflective practitioner while validating selfreflective journals as a successful teaching strategy. The research question that guided this study
was the following: What do faculty employ to evaluate self-reflective journals in an online RNBSN program?
Presented in the next section are the summarized results broken down into three broad
groups bound by the contextual understanding of reflection by the participants. The first
overarching theme identified was the process, or actual steps, the faculty member undertook as
they began the evaluation process, inclusive of the challenges with both student and faculty
understanding of the reflection, guiding questions, and rubrics. The second theme identified
included faculty perceptions of criteria demonstrated by the students needing inclusion in the
evaluation process. The final theme identified revealed the faculty’s perception of the role of the
guiding question and faculty development as a means to facilitate the transformation of learning
which represented the value found in self-reflection journals as a teaching strategy. Consistent
with the theoretical framework that guided the study, the influence of the faculty’s perceptions
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and assumptions regarding students’ self-reflection journals and the ability to establish a trusting
relationship between student and faculty member were foundational to the transaction facilitating
transformational learning.
Personal Perceptions
Participants shared their perceptions regarding their assumptions and understanding of
reflection and how to use self-reflection journals as a strategy to develop reflective practitioners.
Common to most of the participants was an expectation that students examine prior clinical
experiences, apply newly acquired knowledge, and to create new learning, sharing an awareness
of the assumptions and biases that influence the prior clinical experience. In some part of the
interview, each participant shared the belief that the students needed to have some self-awareness
coupled with critical thinking to apply newly gained knowledge to present clinical situations.
Most of the participants included the need for the student to share their thoughts and feelings
regarding the application of new knowledge as evidence of transformational learning.
Participant G provided a response that most represented the sentiments of the group:
Helping students understand what we are aiming for with the assignment is whether or
not the new theories of knowledge have merit for the students, how did they feel about it,
do they understand the concept, what was the impact of trying to apply it, or what is the
fear of trying to apply something new. That helps the faculty member know the students
understand the new concepts and begins the student on the path to self-evaluation of their
own knowledge.
Several of the participants expressed concern over some students’ lack of understanding,
skills, and motivation to complete self-reflective journals. Participant D explained,
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I have found many of the nurses who have many years of experience and are now nurse
mangers do not understand the role of self-reflection, or how to complete self-reflective
journals. Sometimes students will write, I do not know anything about this topic, period.
There was no awareness on the part of the student that, no matter what situation we
encounter, we usually have some expectations of what it is or what will happen based
upon your own experiences, assumptions, and biases.
The participants had varying perspectives on how to address the challenges associated with
student’s lack of insight and motivation but what was most interesting is that for some of the
participants the challenges experienced when grading student journals brought to the forefront
their lack of understanding of reflective journaling and challenged their skill at guiding students
to become reflective practitioners. Participant E explained, “It is very challenging when it’s not
something as a faculty member you have every done yourself.” She went on to say, “I didn’t
understand the purpose; it was very difficult.” However, this participant, as well as the other
participants, shared that she found the strategy worthwhile when as Participant E stated, “As the
program progressed and I had more experience, I could see the positive impact on the students.”
Emerging from analysis of the data was faculty member’s perception that self-reflection
journaling is a skill and improves with practice. Several of the participants took into
consideration where in the program of study the specific course they taught fell in the
curriculum, believing that a student's skill with reflection increased over time. As explained by
Participant C, “By the fourth course, students seem to be comfortable with using the journal and
expressing their feelings.” What became evident was the belief that the systemic use of
reflective journals throughout a curriculum allows students to improve skills with the process,
and the faculty finessed their ability to evaluate the journals with more expertise. As explained
by Participant E, “Now, after multiple journals the feedback is much better than the feedback I
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gave in the first few terms.” Discussed in the next paragraph are some unique benefits to the
evaluation of student self-reflection journals in the online environment.
Peppered throughout the data analysis was the shared experiences of the participants on the
benefits of using self-reflective journals in the online environment where the development of
developing a trusting relationship flourished between the students and the faculty member. The
majority of the participants discussed the need to develop a trusting environment for students to
share their innermost thoughts and feeling. As disclosed by Participant B, “I think at first the
students are a little intimidated, because they do not know what the faculty member is looking
for and they do not know the faculty member.” But as she went on to describe, “that relationship
builds, and I think they feel much more comfortable with my giving more personal feedback
because there is a trusting relationship.”
There was consensus that the written nature of the assignment provided students with
increased time to consider the guiding question, and the distance between the faculty member
and student allowed a certain sense of anonymity and freedom from judgement. As espoused by
Participant G, “The online environment has some challenges, but for some students, it provides a
benefit.” She went on to say, “In the traditional classroom there are some that are not likely to
speak up in from of others, the shyer students have an opportunity to come forward and discuss
their feelings in the online environment.” Most of the participants did not see the online
environment as a negative factor in the development of the trusting relationship needed to coach
the student towards transformational learning. However, one participant, participant D, found
the computer-mediated environment limited her ability to fully appreciate the students’ capacity
for reflection and see evidence of reflective practice as she stated, it is much more challenging in
the virtual environment.”
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All of the participants discussed the quality of the guiding question as being critical to the
success of the reflective journal. Summed up best by Participant D, “The framing of the question
is really crucial in my mind; students don’t necessarily understand the rubric or the language of
self-reflection or self-awareness, yet, if the question is good, the floodgates will open.”
Participants looked to the guiding question to trigger a memory of an experience, present a
variation on the situation which has the potential to integrate newly presented content, and then
ask the student for a new resolution, inclusive of the thought process and feelings utilized to
solve the issue. All of the participants agreed that the framing of the guiding question had a
direct impact on the quality of the student’s reflection journal.
The perceptions of the participants provide a context to increase the understanding of the
information garnered from the study. Presented above are the faculty assumptions and beliefs as
they engage in the evaluation of student self-reflective journals. In looking at the relationship
between the student and the faculty member, the interaction between the faculty member and the
student is central to the development of reflective practitioners (Dewey, 1933; Schon, 1987).
Understanding the assumptions and biases of the participants is crucial to understanding the
foundational factors in the relationship between the student and faculty member. The
overarching themes uncovered through the data analysis constitute the next section.
Steps in the Process
A novel finding of this study was the discovery that faculty started the evaluation process
by taking a quick first pass reading all of the students’ self-reflection journals within a given
class before reading the guiding question for the reflection topic or the rubric. Analyzed data
revealed that the faculty began the process by trying to get a sense of where the students were in
their thinking as a class, asking themselves about the student's level of thinking and then looking
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to see if they the students had the capacity for the needed insight. Once faculty had an
understanding of the where the class as a whole sat with the reflection, a review of the guiding
question and grading rubric set the stage for the evaluation of individual students’ self-reflection
journals. Participant G noted, “After reading all of the journals I develop an initial feeling about
their thought process, then I go back and look at the grading rubric to make a decision on how
the individual student addresses the issue.”
Several of the participants followed the steps of Participant G and examined the grading
rubric as a next step. While reviewing the grading rubric, faculty considered whether or not the
student demonstrated a sense of how to self-reflect, and if they have any insight into their
behaviors or did the student’s thinking only show a surface level of depth. As explained by
Participant C, “were their reflections too shallow and simply meeting the criteria in the rubric,
such as stating their assumptions but not sharing any insight into those assumptions.” Designed
as simple, explicit, and easily understood, a grading rubric should help students connect learning
to evaluation (Abbott, 2014). However, creating a rubric that captures the process of reflection
was lacking, “focusing on the rubric we have right now, I want to know what the student knew
about this topic before the module content, and what changed in their actions as a result of the
new content,” according to Participant C. However, several of the participants felt that the rubric
fell short of outlining what the faculty member was really seeking in the self-reflection journal.
Captured in this quote by Participant E, “I don’t know how to really put in a rubric what you are
looking for, it’s kind of like the student has it or they don’t. It is hard to put in concrete terms.”
For the participants who shared Participant E’s view on the grading rubric, they looked to
the guiding question as the next step in the evaluation process. Participant D summed up these
participants’ thoughts stating, “The framing of the question is critical because students don’t
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necessarily understand the rubric or the language of self-reflection.” Using the guiding question
as a loose framework, participants looked for students to reflect on previous ideas and what
might have changed. As stated by Participant E, “When students share their analysis of how a
concept is applied in practice, they use critical thinking connecting the content to the actions,
while describing how they felt about it.” The majority of the participants looked for students to
look at applying new content in the clinical area and compare their current actions with previous
actions, explaining why they made a change, and how they think the change will impact them
going forward. Whether the second step in the process is looking to the rubric or the guiding
question to direct the evaluation process, faculty sought the inclusion of some key actions that
demonstrated transformational learning. However, the participants did share some challenges
with the process of evaluation.
The data revealed wide variation in both the students’ understanding of the expectations
associated with self-reflective journaling along with faculty concerns regarding their assumptions
and perceptions of how the assignment should look. Several of the participants discussed the
differing levels of students’ ability to have meaningful reflections, and they found themselves
needing to provide the students with prompts to guide them in their reflection. Participant C
noted, “In their first nursing course, students had no experience with self-reflection journals and
they were not sure what was expected.” In working with students new to reflection, the
participants offered strategies to help the students be successful with the assignment. As
Participant D explained, “Well, at times I would have to go back and remind the students to read
the rubric grading criteria, as to why they are doing this reflection, what was the intent?”
Participant B summed up the general sense presented by the participants regarding
helping students with reflection, “the more we can discuss the reason for self-reflection journals,
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the more successful they can be.” However, there was a sense that some students lack the insight
to carry out reflective activities. Not only is the lack of insight a challenge but participants cited
a lack of clinical experience as another challenge for new graduates of associate degree
programs. As noted by Participant D, “They are still scared at the new responsibility they have
and feel insecure about it.” Supported by the assertion of other participants she went on to say,
“In the associate degree program, we focus on knowing and a prescribed set of actions. Content
is presented in a very prescribed way.” She was the sole participant who expressed that in the
clinical setting she can see emotions or reactions to help her understand the students’ thoughts,
whereas, in the virtual environment she felt at a loss to fully appreciate the students’ insights or
capacity for reflection. Participant D was the only participant who expressed, “I am not sure that
critical thinking is something you can really evaluate in a journal.” Other participants shared
their beliefs that self-reflective journals absolutely could be evaluated and offered what actions
and behaviors they sought when evaluating self-reflective journals. The next section presents the
findings from the data on the key criteria faculty seek when evaluating student self-reflective
journals.
Key Criteria
In helping students understand the aim of the assignment, there was a sense that there are
key criteria that must be evident to measure transformational learning. Some of the key terms
and concepts emerged from the data analysis: a discussion of prior experiences, an analysis of
assumptions made, critical thinking, a connection made between prior experiences and new
content, a description of a change in behavior, and a sharing of thoughts and feelings about a
change in practice as a result of the process. Implicit in the conversation with participants and
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expressed directly by several was the belief that the student had to have an openness to learning
and change.
Participant C’s description captured succinctly most of the participants’ thoughts
regarding evidence of self-reflection and transformational learning, “The value in self-reflection
is having them go back and revisit their assumptions, and then see if with the application of the
new content, assess if their views changed.” She then elaborated, “We didn’t need to elaborate
on what the book was saying - this was more from a personal and emotional point of view, what
had changed and what had they learned.” Analysis of the data clearly advanced the notion, that
in order to be able to reflect one had to be open to learning, be able to examine one’s
assumptions and biases that contribute to problem solving, possess the ability to critically
analyze a situation and apply new knowledge. In addition there should be an element of an
emotional reaction to the success or failure of the new action, which serves as the motivate to
make the change permanent and create new learning.
Participant E elaborated on the meaning of critical thinking, and openness to learning,
“Looking at things from a different perspective, to understand that there are multiple ways of
doing things or thinking about things and understanding that you can switch depending on the
situation or the action you are going to take.” She added that when considering critical thinking
within the realm of self-reflection, “Taking what they have learned, thinking about it, and being
able to make conclusions or draw some assumptions for their practice and then being able to
apply them.” Participant A added this caveat to the critical thinking piece, “Well the process of
deciding what works and what doesn’t is really an evaluation, and there’s a step that happens
where the learning gets transferred into or constructed into new knowledge, that is then
translated into practice.” As the participants revealed the behaviors that signal successful self110
reflection, they disclosed their thoughts regarding the value of the self-reflective journals as a
teaching strategy in the development of reflective practitioners. The next section will present the
findings of the study regarding self-reflection journaling as a key strategy in the development of
reflective practitioners.
Value of Self-Reflective Journaling
All of the participants in the study felt that self-reflection and self-reflection journaling is
a valuable teaching strategy to help with the development of reflective practitioners. Participant
G talked about how impressed she was with the students’ reflective journals as they progressed
through the program: “I remember being fascinated reading them and really being drawn in and I
could sense their wanting to share their experiences with me.” Other participants discussed the
joy they felt with reading the students stories of how the new content changed their practice.
This is highlighted by Participant D as she recalled her feelings as she read journals where
students discussed what kind of manager they wanted to be, “It was like the floodgates opened
and it was so exciting. One would say I am transformational no maybe I am transactional and as
they went through the analysis process you could just feel the wheels turning in their heads. I
was so excited.” Although the participants believed in self-reflective journals as a teaching
strategy, they were very clear about their role in providing feedback and coaching the students to
become reflective practitioners.
The participants revealed that they also needed some development in how to evaluate
self-reflective journals, as well as, how to provide feedback in a way that facilitated increased
levels of reflection for the students. Participant A described the following situation with regards
to the faculty role as a coach:
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I had a student that was very negative this term. She stated she is not learning anything.
This is a piece of crap course and I am wasting my time, blah, blah, blah . . . My initial
tendency was to bash her down, give her a poor grade and then defend why. On the other
had she was being reflective. Her feelings were real, and she was stating what she was
really going through. This is where the online environment works in your favor, I could
step back and not have my own reaction to what she was writing. And through
addressing I get that you feel this way, I understand which does not mean I agree. And
what happened is because I was respectful, and made an appointment to discuss the issue
further with the student. She wrote a very public thank you to me on the discussion
board, regarding my professionalism in handling a very difficult student. This made me
see that she has learned, she has been transformed she just has not recognized it yet.
Faculty have to be able to deal with all types of responses from students. They are not all
positive. All of the participants discussed the value in coming together as a faculty and having
faculty members who teach in the same course, and even across the curriculum discuss their
experiences with the evaluation of student self-reflection journals. Participant D shared, “We
would meet once a month and discuss what you have found, what you are seeing, how did you
frame the feedback to the student, which I found very helpful as a new faculty member.” She
resumed her comments stating, “Then they stopped. It made me feel like I was out on my own
and not sure I was in sync with the rest of the faculty.” The data on faculty development was
compelling.
The data analysis revealed that the participants agree that reflective journaling takes
practice, is a skill that needs to be developed, and that faculty need development on facilitating
the process from reflection to reflective practice. The participants share the belief that reflection
is subjective faculty need development on how to evaluate and facilitate reflective practice.
Participant A, “You can’t have reflection without subjective feelings, and so the question
becomes how do you evaluate that?” She continued, “The subjective feelings are part of the
analytical piece of critical thinking. When confronted with new knowledge, there is a disruption
that causes an emotional reaction, because you have to either discard your former beliefs or
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discard the new knowledge.” Many of the participants noted that what they are evaluating is the
process of reflection, not the actual content, but how the student manages what they thought they
knew when confronted with new knowledge.
Many of the participants felt that this was a good strategy for all educational levels and
levels of practitioners. Also, there was strong evidence to suggest that reflective thinking takes
practice and skill along with the facilitation of deeper levels of reflection provided by faculty
skilled in reflection and reflective practice. There was a sense that self-reflection infused
throughout the health professions curriculum serves to strengthen the student’s skill set and
comfort level with self-reflection. Also, used as a strategy throughout a curriculum provides a
talking point for the development of faculty with the evaluation and facilitation of reflection and
reflective practice.
This section has presented a summary of the findings of the study. Revealed were the
personal perceptions of the participants that provided a contextual basis for understanding the
data. There is evidence from the data to suggest that self-reflective journaling is an effective
strategy to help develop reflective practitioners and that the faculty do have a systematic way in
which they evaluate the process of self-reflection and have consensus on the key behaviors that
signal a change in practice after self-reflection occurs.
Discussion of the Results
Examining the relationship of this study to previous studies that consider how faculty
evaluate student self-reflection journals is an important step in the process of disseminating the
findings of this study. The aim of the study was to discover the processes faculty employ to
evaluate student self-reflection journals. The findings of this study had a high correlation with
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the research literature regarding they key elements required to show evidence of levels of selfreflection as defined by Dewey (1933), Schön (1987), Boud & Walker (1995). The next sections
highlight the various ways in which there is parody and divergence between the results of the
study and the education and health professions education literature. Organized by the identified
overarching themes the next section begins with a discussion of the findings of the study and
concludes with an added section that reveals valuable insights offered by the participants
associated with their experiences evaluating students’ self-reflection journals but does not
directly address the research question.
Discussion of the Results in Relation to the Literature
Reflection and reflective practice are common topics within the health professions
education research and academic writings. For the past 84 years, the educational literature
published within the health professions has struggled with understanding reflection and its role in
the development of reflective practitioners. Countless articles have examined the process of
reflection and its role in the development of practitioners that have the ability to solve complex
clinical problems that are unfamiliar to them. Over the past decade, there has been in increase in
the attention paid to the development of checklists, portfolios, and other tools to stimulate,
authenticate, and evaluate reflection in students and practitioners. The mandate from the HLC
(2016) that evidence of student learning outcomes brings to the forefront the challenges
associated with the evaluation of reflection and its impact on the development of reflective
learning. The following paragraphs will examine the results of this study within the context of
the current health professions literature on reflection.
Process. Hindered by the lack of a shared and precise understanding of reflection, the
development of realistic approaches to examine, teach, and evaluate reflection and reflective
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practice remains elusive (Ng et al., 2015). Although real-world applications of reflection appear
in the literature, the lack of a clear definition has led to a dilution of its meaning, which risks it
being equated with simple thinking and rote steps that mimic the reflective process. There was
evidence in this study that the participants had a preconceived idea of what actions constituted a
true reflective process. Their perceptions revealed a high correlation with the consensus
definition written by Ng et al. (2015) and provided a framework upon which to evaluate
students’ journals. However, they shared concerns with the varying abilities of students to
achieve reflection and how to evaluate those students and still facilitate deeper levels of
reflection. The challenges they experienced with the wide variation in students understanding of
self-reflective journals was an influencing factor in the steps taken in the process of evaluation.
As a first step in the evaluation process, all the participants stated that they took a first
pass read of the entire classes’ journals to gain a sense of where the students sat with the content.
In their first pass faculty members sought to understand the content-related component of the
reflection, then considered the process-related reflection, related reflection, the blurring of
content and process related reflection within the context of professional nursing, a change in
viewpoint, and lastly the impact on the self. As Participant B stated, ‘As you consider the whole
class then you see themes, pieces of the content from the module that sticks out, and how they
use that specific content. Next, I look to see how the student felt about the content.” She went on
to say, “Later, I want to hear their response once they try something, did it work? How did they
feel about it? Will they take that into their practice?” Participant C added, “The student should
be reflecting on previous ideas about the content, and then what might have changed, and what
made them change?” She added, “I guess the biggest thing is to [understand] what they went
through during the module concerning the content they were reflecting on.” Participant G noted
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that the goal of self-reflection was to really think internally about the way we do things with
regards to patients and healthcare.” Thus, in their first pass, the participants seemed to be saying
that they were assessing where the students were in the reflective process, were they focused on
content, on their process of self-reflection, the change in their behaviors, or the thoughts
regarding a permanent change in practice. As the faculty described the various ways in which
they reviewed the self-reflection journals, they recognized the correlation between the
participants’ beliefs regarding reflection and the consensus definition presented by Ng et al.
(2015). Although they did not use the same prescribed language developed by the researchers
their description of the process had a high correlation.
The second step in the process of evaluation was looking either at the specific criteria
outlined in the grading rubric, or the participants understanding of the guiding question. For
participants who looked to the guiding question to evaluate the students’ journals, they placed a
greater weight on the inclusion of the content and its relationship to the reflection. They focused
on the specifics of the new information and the students’ assumptions or experience with the new
information. As noted by Participant C shared, “The student should discuss what they know
about the topic before reading about the topic, and then to evaluate the student’s learning after
the fact.” This part of reflection seems consistent with content-related reflection, and as
Participant C elaborated, “focusing on some of the key concepts of the content and connecting it
to what they are doing in their current job is helpful. Although the participants’ understanding of
the elements of reflection aligns well with Ng et al. (2015), the required number of reflective
criteria needing to be present to receive a passing score on the journal assignment is unclear.
The conundrum for faculty with assigning a grade for reflection journals seemed unsettling. As
noted by Participant E, “You grade it based on touching on all the key points you want them to
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focus on rather than what the content is at that specific entry.” Participant G added, “I would
still go back and look at the grading rubric and the criteria that was supposed to be included, that
guided them in the assignment when posting the grade.” However, she shared her uneasiness
with this process by saying:
Sometimes they struggle with self-reflection and I want to give the students some leeway
and flexibility but their analysis is superficial. So, it is hard as the faculty member, I
struggle because I want to help them learn the process not mark them down. You need to
help them by providing direction, or asking clarifying questions, to help move them to the
next level. There needs to be some back and forth between the faculty member and the
student.
Captured and articulated by Dewey (1933) and supported by recent studies by Dolmans
(2013) and Moussa-Inaty (2015) is the belief that a dialogue with students that helps drive the
student to higher levels of reflection. Dewey (1933) asserted that the faculty member should act
as a coach to the student by examining through a new lens, the relationship between methods
employed and results achieved. Dewey’s writings suggested that there are two dimensions to the
educational process: (a) the psychological make-up of the students, inclusive of their capabilities,
habits, and interests, and (b) the reshaping of perceptions through the sociological context, in this
case, the nursing metaparadigm. He further advanced the notion that relationship between the
faculty member and the student profoundly affects students’ ability for transformation. MoussaInaty (2015) theorized well-written reflection journals create a bridge between the student and
faculty member that allows the faculty member to see inside the experience of the student from
his or her lens. The relationship between the student and faculty member facilitated the sharing
of feedback. The study results indicated that written feedback to the student from self-reflective
writing has a positive influence on the quality and development of reflection. He went on to
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describe that feedback focused on the level of student reflection as opposed to feedback on the
experience had a positive impact on the quality of later reflections.
Understanding and evaluating students’ reflective ability lies at the heart of evaluation in
Higher Education. Over the past two years, the medical education literature contains a greater
number of studies, seeking to reach a consensus definition of reflection and reflective practice
while seeking strategies to promote reflection and assess the relationship between self-reflection
and positive patient outcomes. Reflective journaling as a tool to promote reflective practice is
gaining renewed interest. However, there are continued challenges with the methods to evaluate
self-reflective writing. The reality that reflective writing is not easily quantifiable and the
process for evaluation is not clear does not invalidate its usefulness as an educational tool. In the
next section are the key words, phrases, and behaviors the participants in this study identified as
evidence of reflection when evaluating student self-reflection journals.
Key criteria. Reflective writing can be quite complex and difficult to assess. Students
come to the learning environment with various understandings of what constitutes a reflective
practice as well as, not fully appreciating the value of developing reflective practice skills or the
skills needed to engage in reflection (Josephsen, 2013; Moussa-Inaty, 2015; Pai, 2015). The
participants in this study shared this concern described by Participant G who discussed students’
assumption that their opinion was reflective practice, “Students say to me how can you say my
self-reflection is not clear enough, it is my thoughts and feelings, and my opinion.” While
students do not fully understand reflection faculty also have varying understanding of reflection
as demonstrated with the statement by Participant C. “I think the idea of a reflection journal is
that they are able to express their own subjective idea. So, if they do that there is no wrong
answer.” With the lack of clarity from both students and faculty on the key components of
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reflective practice this study sought to better understand how faculty evaluate reflective journals.
Presented in the following section are the results of the study with regard to the key criteria
faculty seek when evaluating self-reflective journals.
Theories on reflection espoused by Dewey (1933, 1938), Schön (1987), and Mezirow
(2000) underscore the individual must be open to learning and inquiry into their assumptions and
biases. Participants in the study also found the need for openness to learning as the first step in
reflection although they expressed it differently as expressed by Participant E:
But this one particular student mentioned how she signed up for the course and really did
not expect to learn anything. She thought it would be the same thing she already learned,
and she just needed to get through the course. She then wrote how amazed she was with
what she learned in the course. She now understood why she did certain steps in the
physical assessment. She was open to the learning and she was transformed.
Throughout the analysis of the data, there was a recurrent theme that some students were open to
learning new material others were just doing what they thought they needed to do, as
summarized by Participant D, “For instance, somebody will write in the journal, well I am not
sure how this impacts me, so I wrote about the drivers of healthcare. And now I know I was
right.” A key component to refection is the willingness to be open to new information.
Participant B shared her happiness when a student wrote, “If a really liked this class and I want
to learn this information and try to apply this at work.” As noted in a recent paper by Wass and
Harrison (2014), it is critical to understand the agency of the learner within the development of
reflective practice and address their needs from their starting point. Openness is the starting
point for reflective practice and opens the door for insight which is another critical component to
reflective practice.
Nguyen et al. (2014) acknowledge the varying levels of reflection and may begin with
content related to the self and individual actions. Insight is critical to the ability to consider the
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assumptions under which we operate within the world. Consistent with the writings of Bulman
and Schultz (2013), participants in the study concurred with the authors regarding the
requirement for self-reflective learners to demonstrate insight into their behaviors. Participant D
noted, “They do not have the time or the perspective to assess and evaluate how they could have
done things differently.” Participant B was very clear that not all students have insight, “They do
not have a lot of insight into their own behaviors, and so I do not know if we need to back it up
and explain a little bit for the students.” As noted by Participant B as well as others in the study,
students may need some guidance with self-reflection and the process of reflection. As stated by
Wass and Harrison (2014), the ultimate goal of reflection makes it a meaningful process, not a
routine. The goal is to empower the individual not restrict them. Using critical thinking
provides a vehicle to increase the agency of the student and is the next key factor faculty seek
when evaluating self-reflective journals.
The participants in the study cited evidence of critical thinking in the students’ journals
when students’ presented information about prior experiences with the content and their thoughts
regarding the application of the new content into practice. Participant E wrote, “It’s whether
they’ve done the critical thinking and what you’re looking at is the student actually looking at the
content, looking at their practice and making the connections and that’s when you are evaluating
the process not the content.” Different authors throughout the literature describe critical
reflection and thinking as a process of moving beliefs of a condition to an emerging condition
connecting initial understanding with deeper understanding transferring intuitive types of
knowledge into conscious knowledge linking theory to practice (Kuennen, 2015). However, in
each study reviewed there was the notion that there had to be some recognition of knowledge of
prior experiences and a process of considering new knowledge and making a connection to the
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application of the new content into a current experience. The process of critical thinking
suggested the metacognitive processes needed for reflection, but through the literature, authors
discussed the need for students to be aware of their feelings and how they motivate behavior and
change.
Bassot (2016) described the role of feelings in reflective practice in a cumulative way.
Working in the clinical area new experiences can trigger feelings regarding prior experiences.
Clinical experiences center around care provided to individual patients. Those past experiences
were either positive or negative. New situations within the clinical environment can trigger
those experiences which may not be present in the conscious mind, but they do influence the
actions we take in a current situation. It is critical that students pay attention to those feelings so
that they might understand how those feelings are influencing the current situation. BradburyJones et al., (2010) in their study of the Peshkin approach to reflection described inextricably
bound to nursing practice are the emotions of the nurses and as such, and an exploration of one’s
feelings remains critical for reflective practice. The role of feelings and emotions frequently
occurred in the data analysis; participants sought a description of students’ feelings in their
reflective journals. Participant A characterized students experience with a new situation this
way, “There’s a reaction in the emotional being because they have to decide if there is any
discard, what they thought they knew and understood, take on this new situation.” Participant G
added, “Something like the Affordable Care Act affects us personally and professionally and we
need to reflect on that before action to determine it still positive and good for the person doing
the reflection.” Student’s cognitive thoughts, feelings, and emotions are all integral to the
critical analysis needed to make decisions regarding patient care when confronted with new
experiences. The reflective journal is a tool that allows students a thoughtful, deliberate way to
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consider prior experiences, assess new knowledge for its application to practice, resolve any
conflicting feelings within one’s self, and take informed action. Although a popular strategy to
support the development of reflective capacity, do faculty find credibility and value in reflective
journaling as a strategy to reach the intended learning outcome in the development of reflective
practitioners?
Highlighted in this section were the key criteria the participants considered a requirement
for evidence of reflection in student self-reflection journals. An underlying assumption in both
the health professions education and the participants in this study was the focus on clinical
experiences. In a health professions transformative learning environment, self-reflection is a
strategy employed to promote the development of reflective practitioners who can respond the
ever-changing and dynamic world of healthcare delivery. As expressed by Participant D in
discussing newly graduated nurses, “They’ve been nurses for like 8 weeks? I am not sure they
have the ability to have insight.” Bound contextually by its connection as a strategy to develop
reflective practitioners, and influenced by the broader conversation regarding assessment and
evaluation the concept has moved away removed from the theoretical framing advanced by
educational theorists (Ng et al., 2015). The authors argued that the process of breaking down the
elements of reflection into measurable, discrete units risks the very essence of reflection,
whereas an expanded view of reflection from the educational theory perspective lends itself to
implementation at any level of the educational process.
Value of self-reflective journaling. Although the writing of reflection journals and
evaluation of those journals is a complex issue, it remains popular as a teaching strategy aimed at
the development of reflective practitioners. Despite the challenges associated with reflective
journaling, the wide variation in definitions and understandings of reflection, evidence from this
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study revealed that the participants found great value in the learning outcomes associated with
reflective journaling. Participant B offered, “Reflection is valuable not just for the students but
for the nurses I manage many of whom do not have a baccalaureate degree. Many are being
forced to go back to school and reflecting on how a baccalaureate degree adds to their practice is
really good exercise.” The data revealed that the participants felt reflection was a skill that
increased over time as students progressed through the curriculum. Participant E stated,
“Initially students don’t get it but by the time they get to the end of the first term and say, “it was
so neat when I read this I had no idea if it would work, I tried it and it made a difference!”
Hailed as one of the satisfiers for the participants was how reflection opens students’ eyes and
how it made them feel as a facilitator of learning. Participant G shared, “It was just so
outstanding, it was just absolutely incredible to me that someone could articulate changes in their
practice in one term.”
In considering the value of self-reflective journals, Participant A offered, “There is an
important point when evaluating students’ journals, we have to understand that it comes from the
student’s perspective and they may not be at the place we would like them to be.” Participant G
added. “We have to let them go through the process, to meet them where they are so that we can
help move them to the next level. And they are all at different levels, just as we are as faculty.”
It is important to remember that reflective writing addresses a specific context, and as such, the
construction of reality to bound by the contextual setting (Moussa-Inaty, 2015). The way that
reflection unfolds varies according to the contextual factors, in this study it was the academic
setting. The academic setting provides a way to teach students the process of reflection, it
provides some built-in buffers, whereas reflection in the clinical setting is contextually
determined and the factor of timing overshadows other factors. This leads back to Argyis and
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Schön’s (1974) reflection-in-action and reflection-on-action. In the academic setting, and with
the use of reflective journaling which allows increased time for deliberation. Conceptually
considered a process, without any predetermined extrinsic outcome, the focus of assessment and
evaluation of reflection lies with the process, not outcomes (Ng et al., 2014).
This section was a presentation of the data concerning the current health professions
literature. Patient care occurs within a complex adaptive system, with multiple providers whose
professional behavior is context specific, culturally sensitive, and highly individualized.
Nurturing empowerment rather than restraint is the lesson of the day in the health professions
educational practices, the risk of restraint due to the limitations of their assumptions and biases
needs attention (Wass & Harrison, 2014). With the clinical focus on evidence-based practice that
requires practitioners to consider the scientific evidence looking through the lens of the
individual patient preferences and values, practitioners must adapt their methods to appreciate all
of the components or care. There is sufficient flexibility within existing frameworks of
reflection to meet both the individual, professional, and societal contexts. Reflective journaling
is one strategy that holds promise to facilitate individual students’ reflective capacity. However,
as evidenced by this study and the literature, there needs to be a consensus on the meaning and
methods of evaluation.
Discussion of the Results in Relation to the Conceptual Framework
This study focused on the use of self-reflection journals as an educational strategy aimed
at the development of reflective practitioners. Self-reflective journals are a deliberate teaching
strategy used to facilitate the integration of theory to practice, while increasing student’s
development of insight, stimulating cognitive awareness and finely honing critical thinking
(Barbour, 2013; Bulman & Schutz, 2013). As the chief architect of the concept of reflection,
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Dewey (1933) put forth the idea that individual’s perceptions of the self and the societal context
in which they operated were central to the educational process. He noted that the role of the
faculty was to select certain influences on the students and assist the student in assimilating those
influences within a social context that would make them successful. Dewey’s understanding of
the role of the faculty member and the relationship between the student and faculty member set
the stage to use King’s theory of goal attainment.
Learning employs both a metacognitive and a social process. The relationship between
the faculty member and the student is critical to increasing the capacity for reflection in students
(Wass & Harrison, 2014). In King’s model, the relationship between the nurse (faculty) and
patient (student) is central to the attainment of goals (learning outcomes). Dewey believed that
all learning comes from experience and that the concepts of continuity and interaction are
fundamental to learning. Dewey (1933) described continuity as the process learners need to
connect what they have learned from the past and see the possibility for future implications.
Dewey described interactivity, stating that an experience is what it is due to a transaction taking
place between the individual and what at the time constitutes the environment (Merriam &
Bierema, 2014). He went on to say that, construction of meaning from experience is both
individually and socially constructed, the instructor’s role is to facilitate meaning making from
the experience for future application.
The transaction between the client (student) and nurse (faculty member) lies at the heart
of King’s theory of goal attainment. This notion of transaction is a foundational unpinning of
King’s model, and she became familiar with the term after reading Dewey’s theory of knowledge
(King, 1981). King’s philosophical assumptions include that human beings are social, spiritual,
sentient, ration, reactive, controlling, purposeful, and action oriented (King, 1981, p. 143).
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Essential elements of transaction are perception, communication, and transaction and that
implicit in this process are mental acts of judgement on both members of the dyad. For this
study, it was important to understand how the personal and professional perceptions held by the
faculty member influenced their actions. An understanding of the student’s system and the
expectations of the faculty role from the broader social system (education and nursing), influence
of the transaction between student and faculty member as they work to achieve their goal
(learning outcome). As explained by Participant C, “The faculty member should ask clarifying
questions and help move the student to a new level of understanding. The faculty member can
evaluate the student’s willingness to be open to learning and evaluate their level of reflection.”
Participant B expanded on the relationship between the student and faculty member and its role
in increasing levels of reflection, “I think once I get to know them that relationship builds they
are more comfortable and because we have a relationship I can provide more personal feedback
because there is a trusting relationship. The creation of a trusting environment is a prerequisite
for reflective learning and developing the relationship between the faculty member and the
student (Schaub-de Jong; Schӧnrock-Adema; Dekker, Verkerk & Cohen-Schotanus, 2011).
In King’s model, the patient (student) and the nurse (faculty member) have a purposeful
relationship aimed at meeting the healthcare goals (learning outcomes). Both the patient
(student) and the nurse (faculty member) come with their own set of perceptions and beliefs
(assumptions) exploration of those perceptions seeks to remove the barriers and allow attainment
of new understandings and the achievement of the intended goal. Participant C noted, “The best
thing to do is to really think through the assignment as if you were a student. Participant A
shared her role with mentoring new faculty, and she shared. “Sometimes a student will write
something, and the faculty member will write ‘good job’ and give them full points. But they
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should either provide further insight or acknowledge the process the student has gone through.”
Participant G added, “Faculty seem unsure if the expectation of them is to evaluate the student’s
reflection or is it to facilitate deeper levels of reflection.” Faculty perceptions regarding
reflection are an important element in the evaluation process. Reflection is a process that
happens along a continuum. However, faculty sometimes grade the assignment as if there is an
expected outcome (Ng et al., 2015). The influence of the faculty’s perceptions and assumptions
regarding the evaluation of self-reflection journals is beyond the scope of this study; however,
there is evidence in the data to suggest this might be an area that warrants further study.
Limitations
A qualitative design is adaptable and evolving, responsive to changes in the conditions of
the study with the researcher serving as the primary instrument allowing for maximum
responsiveness and flexibility in the collection of data (Merriam & Tisdell, 2015). Acting as the
primary research instrument carries with the task a certain amount of skills and expertise insights
from the participants without steering them in any particular direction. That requires significant
experience, and the researcher in this study is a novice and had a professional relationship with
the participants that proved more challenging than anticipated in the interview process, so as not
to lead the participants. Also, a qualitative study seeks the collection of data consisting of thick,
rich descriptions of the issue under study to increase understanding. Expertise needed to
deconstruct the and break them down into critical pieces of data only comes with increasing
experience with the process, this was the researcher’s first experience with this process and was a
limitation of the study.
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The findings from this qualitative study add to the body of knowledge regarding the
processes faculty employ to evaluate self-reflective journals in an online RN-BSN program in
the evaluation. The smaller sample size used for this research raises the question if the sample
was too small to obtain an adequate amount of data and thus a limitation of the study (Creswell,
2013; Merriam & Bierema, 2014)? Qualitative researchers seek to uncover a deeper meaning or
rich description of the topic under investigation; thus, a larger sample size would prove to be too
cumbersome and may not have would not be productive with a qualitative methodology due to
the potential loss of detail and rich descriptions (Merriam & Bierema, 2014). The data
collection process stops with the achievement of thematic saturation, when no new information
emerges from the interviews (Creswell, 2013; Merriam & Bierema, 2014).
A purposeful sampling method was used which allowed for selection of participants who
met the inclusion criteria to provide informative, rich descriptions regarding their experiences
with the evaluation of self-reflection in an online RN-BSN program (Creswell, 2013; Merriam
& Tisdell, 2015). Some may argue that the small sample size and the strict inclusion criteria are
a limitation of the study. However, nurse educators who have extensive experience with the
evaluation of online RN-BSN student self-reflective journals student have a unique perspective
in reviewing the content of RN-BSN students' journals and bring professional expectations of
the nurse educator into the evaluation process. The overall purpose of this study was to gain a
better understanding of the process faculty employ to evaluate student self-reflection journals in
an online RN-BSN program. Therefore, purposeful sampling of the nursing faculty who have
extensive experience with the deployment of self-reflection journals systematically in an online
program of study was not a limitation.
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Seen by some as a limitation the researcher, as the chief architect of an online RN-BSN
program who uses self-reflective journals throughout the curriculum, has her own feelings,
perceptions, experiences, and biases regarding the evaluation of self-reflection journals.
However, bracketing these feelings before and during interactions with the participants was the
rule of the day. The researcher is the instrument in qualitative research (Creswell, 2013), so it is
vital that this researcher acknowledged her perceptions of the knowledge, skills, and value of
the deployment of self-reflective journals throughout a RN-BSN program of study aimed at the
development of reflect practitioners. The subsequent section will present the implications of the
results of this study for the profession of nursing education.
Implication of the Results for Practice
The call to find teaching strategies that promote the development of reflective
practitioners continues in all of the health professions professional practice disciplines. The
ever-changing healthcare landscape that sees new developments in healthcare research, changes
in healthcare policies, and changes from patient to consumer of healthcare requires practitioners
to respond to increasingly complex care issues that need integration into the health sciences
disciplines with the disciplines from the humanities and finance. Reflective practice as a concept
provides a framework upon which to educate providers with the attitudes, skills, and behaviors to
meet current and future healthcare demands. Finding strategies that promote the development of
reflective practitioners remains a high priority. In today’s landscape of higher education,
educational content is delivered in a variety of formats including on-ground, online, and blended
learning, requiring teaching strategies be adaptable to various modes of delivery. Self-reflective
journals have the potential to be a key strategy in the development of reflective practitioners that
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is applicable in both the clinical and academic settings and possesses the ability to be deployed in
all educational delivery models.
Increasingly within the health professions literature are studies and publications aimed at
finding a consensus definition of reflection, consensus on the identification of the levels of
reflection, a recognition that reflection is a skill that needs development in practitioners, and
faculty needs development in how to evaluate and facilitate students’ level of reflection. The
findings of this study provided both some answers and highlights issues needing further research.
There was a consensus of the participants in this study that self-reflective journals are a valuable
teaching strategy and are skills that need continuous development. Participants agreed that the
strategy employed in the online environment allows for deliberate and thoughtful writings by the
students and feedback by the faculty.
Revealed in the data was the belief that the online environment does allow for the trust
building required to facilitate the open and honest communication between faculty member and
student. There was also an agreement with the participants that for reflection to occur, the
student needs to be open to learning, possess insight, have a reservoir of experiences to draw
upon for examination, revisit assumptions, attempt to apply new knowledge, recognize their
feelings regarding the change, decided for future action. The participants demonstrated
unanimity with the need for both students and faculty to be provided guidelines on reflective
journaling to help students and faculty understand the expectations. The actual process of
evaluation found variation and disagreement on the value of rubrics, guiding questions and the
need to evaluate the process of reflection rather than the outcome. There also was some lack of
clarity on the percentage of the grade assigned to self-reflective journaling. Discussed in the
next section are the recommendations for further research.
130
Recommendations for Further Research
This study highlights the value of the systemic use of self-reflection journals in an online
RN-BSN program proved a valuable teaching strategy, but it also highlighted opportunities for
further research. This study focused on the processes faculty employ to evaluate student selfreflective journals in an online RN-BSN program. It would be interesting to repeat this study
with the same participants now that another two years have passed since the initial data
collection to compare the results of the data. A question raised by one of the participants that
warrants further exploration is the perception of students in an online program that incorporates
student self-reflective journals and its value in their educational development. Considering the
student population served by the participants in this study understanding from the employer’s
perspective did the education, and the skill of self-reflection influence the behaviors of the nurses
in the clinical setting. Much of the literature in higher education aims at the development of
teaching strategies that provide measurable outcomes of student learning. Increased attention is
ideal in the education research on the actual process of evaluating student self-reflection levels
with an eye toward understanding the relationship between increased levels of self-reflection and
positive patient outcomes.
Conclusion
The focus of this study sought to discover the processes faculty use to evaluate student’s
self-reflection journals. The dissertation began with an introduction to the problem and why it is
important for consideration within the health professions education. To understand the current
state of the practice, a review of the education and health professions literature examined the
concept of self-reflection and its applications in the health professions discipline was highlighted
131
in Chapter 2. Research articles throughout the health professions disciples revealed a wide
variation in the understanding of the concepts of reflection, reflective practice, reflective
journaling as a teaching strategy to develop reflective practitioners, the value of reflective
journaling in the online environment, and the identification of levels of reflection as the basis for
evaluation of self-reflective journals. Any evaluation process requires an understanding of the
content of the evaluation, by who, and for what reason. To provide a framework that would
address what was being evaluated (learning outcomes) by who (nursing faculty) for what reason
(student development of reflective practice skills), and working in concert with Fawcett, an
expert in nursing conceptual models, King’s theory of goal attainment provided a framework for
the study. In considering King’s model for application to this study, the discovery of King’s
association with Dewey’s description of transaction further strengthened the resolve to use this
model to guide the study.
As discussed in Chapter 3, the wide variation in the understanding of reflection, and the
teaching strategies required to facilitate the development of reflective practice, a qualitative
methodology proved the model best fitting the study’s aims. Chapter 4 presented the data, and
Chapter 5 considered the results of the study about the current state of the le and the conceptual
model, inclusive of the limitations of the study, and recommendations for further research. The
dissertation process has positively contributed to the development of this novice researcher and
contributed to the body of knowledge regarding the process faculty use to evaluate student selfreflection journals.
132
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