EFFECT OF STRUCTURED REFLECTIVE JOURNALING ON CLINICAL LEARNING AND PROFESSIONAL SELF-CONFIDENCE AMONG UNDERGRADUATE NURSING STUDENTS: A QUASI-EXPERIMENTAL STUDY

Abstract

Background: Clinical learning is a foundational component of undergraduate nursing education, yet many students experience anxiety, uncertainty, and low professional self-confidence during their first clinical practicum. Structured reflective journaling has been proposed as an educational strategy that may enhance clinical learning and confidence by guiding students to systematically process clinical experiences. However, evidence from tertiary-care teaching hospitals in Pakistan, particularly at the College of Nursing, Nishtar Hospital, Multan, remains limited.

Objective: This study evaluated the effect of structured reflective journaling on clinical learning, professional self-confidence, and reflective thinking among undergraduate nursing students at the College of Nursing, Nishtar Hospital, Multan.

Methods: A quasi-experimental pretest–posttest control group design was used. A total of 120 second-year undergraduate nursing students enrolled in their first clinical practicum were assigned to an intervention group (n = 60) and a control group (n = 60). The intervention group completed structured reflective journals for eight weeks during clinical rotation, while the control group received traditional clinical instruction with routine clinical logs. Data were collected using the Clinical Learning Environment, Supervision and Nurse Teacher Evaluation Scale (CLES+T), a Professional Self-Confidence Scale, and a Reflective Thinking Questionnaire. Independent samples t-tests, paired samples t-tests, analysis of covariance (ANCOVA), and Pearson correlation were used for analysis. Cohen’s d was calculated to determine effect size.

Results: At posttest, the intervention group scored significantly higher than the control group in clinical learning (t = 4.82, p < 0.001, d = 0.88), professional self-confidence (t = 5.16, p < 0.001, d = 0.94), and reflective thinking (t = 6.23, p < 0.001, d = 1.14). Within-group analysis showed greater pre-to-post improvement in the intervention group across all outcomes. ANCOVA controlling for pretest scores confirmed significant group effects. Reflective thinking was positively correlated with clinical learning (r = 0.62, p < 0.001) and professional self-confidence (r = 0.58, p < 0.001) in the intervention group.

Conclusion: Structured reflective journaling significantly enhanced clinical learning, professional self-confidence, and reflective thinking among undergraduate nursing students at the College of Nursing, Nishtar Hospital, Multan. The strategy should be considered for integration into clinical nursing curricula to optimize student learning and professional development.