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ABSTRACT
Reflective journaling is a strategy used often in clinical education to gain insight into students' clinical thinking; however, studies indicate that students may benefit from guided reflections. Numerous tools have been used to structure student reflection with varying results. This article describes the outcomes from using the Guide for Reflection based on Tanner's Clinical Judgment Model. The Lasater Clinical Judgment Rubric, created from the Model, is used to evaluate development of clinical judgment and provides language to communicate about clinical thinking with students. Senior immersion course competencies, also developed with language from Tanner's Clinical Judgment Model, offer a comprehensive package that fosters students' clinical judgment development, faculty-student communication about clinical judgment, and evaluation of students' clinical thinking.
Reflective journaling has long been a strategy used in nursing education, especially in precepted clinical experiences, to allow faculty to understand and evaluate students' clinical thinking. Although literature about reflection identifies learning as greatest following a critical incident (Brookfield, 1987; Dewey, 1997; Johns, 2004), many student journals demonstrate minimal reflection about learning, instead focusing on the chronological details of clinical experiences.
Recently, the Guide for Reflection (Nielsen, Stragnell, & Jester, 2007), based on the Tanner (2006) Clinical Judgment Model, was developed and reported. The Lasater (2007a) Clinical Judgment Rubric, also based on Tanner's (2006) Model, offers guidelines and language used to provide feedback to students. The purpose of this article is to highlight the outcomes from faculty and student perspectives, based on nearly 2 years of implementation of the Guide for Reflection (Nielsen et al., 2007) and Lasater's (2007a) Clinical Judgment Rubric in evaluating students' clinical thinking through journaling.
Literature Review
Early in the 20th century, Dewey (1997) stated, "reflective thinking alone is educative" (p. 2). Over time, others concurred, adding that reflection is essential to learning from experience, particularly in those situations in which the issues are ill defined, multilayered, and complex (Boud, Keogh, & Walker, 1985; Brookfield, 1987; Schön, 1987). What better descriptors for patient situations requiring clinical judgments? The nursing literature often identifies clinical learning as richest when reflection follows a trigger incident (Benner, 1984; Benner, Tanner, & Chesla, 1996; Tanner, 2006).
Reflective Journaling
A recent review of reflective journaling practices in nursing education identified numerous strategies (Craft, 2005). Faculty practices differ regarding...