This research focused on the use of writing to increase reflection and problem solving in the clinical setting. Two groups of associate degree students provided clinical care and maintained journals, answering a series of focused questions. One group of students worked as individuals in the clinical setting; the other consisted of students working in pairs. There were significant differences between levels of reflection of students who worked in pairs and those who were not paired. Three major themes were found in students' journals: emotions, connections between theory and practice, and learning.
Key Words Clinical Education - Collaboration - Critical Thinking - Teaching Strategies - Reflection
QUOTING FRANCES BACON, BROWN REMINDS US THAT "neither the hand nor the mind alone would amount to much without aids and tools to perfect them" (t, p. 4). Clinical learning activities are the heart of nursing programs, shaping the student into the professional nurse. Since nursing students spend two thirds of their class time in clinical practice, it is important that their practical experience be connected with their theoretical learning. The challenge for nurse educators is to develop tools for clinical education that actively involve students in learning experiences, with faculty serving as facilitators (2,3). * THE PURPOSE OF THIS RESEARCH WAS TO DESCRIBE STUDENTS' CLINICAL REFLECTIVE PROCESSES AS THEY WORKED INDIVIDUALLY AND IN PAIRS, SOLVING PROBLEMS WHILE CARING FOR PATIENTS. It was assumed that working in pairs would increase students' levels of reflection and that writing journal entries together would lead to additional learning. Students would discover that their peers were a good resource for knowledge and problemsolving skills and they would enhance each other's technical skills (4-6). THEREFORE, two primary research questions were asked: In what ways do journals provide evidence of reflection on the clinical experience? And how is the clinical experience altered when students are paired for their clinical practice?
Review of the Literature REFLECTION, LEARNING, AND CONNECTING THEORY TO PRACTICE Although experience alone does not always result in learning, reflection and experience together seem to transform experience into learning and knowledge (7). Boud, Keough, and Walker (8) note that "reflection is an important human activity in which people recapture their experience, think about it, mull it over, and evaluate it. It is this working with the experience that is important in learning" (p. 19). Boud and Fales point out that reflection does not necessarily happen automatically, but is a process that can be intentionally taught (9).
Schön (10) argues that a reflective practicum can help form a bridge between the worlds of theory and practice. Although he talks primarily about professionals using reflection as a part of practice, reflection helps students learn about their own reality, which then helps them link the theories they are learning to clinical experience. Wong states that "reflective education aims to help students take each client encounter as unique and constantly arrive at a new or revised interpretation of the meaning of an experience" (11, p. 447).
Boud et al. suggest that reflection is enriched when it is not a solitary act: "When a group participates in a common event, each person will experience it in a particular way and will have an interpretation of aspects of that event which may differ from that of others. Formulating and articulating experience transforms it in ways that can allow us to see it anew" (8, p. 11).
JOURNALING AS REFLECTIVE PRACTICE Journal writing is used in clinical education as a tool for developing reflection and clinical reasoning and as a strategy for bridging the gap between theory and practice (12-15). Facione and Facione (16) state that journal writing provides evidence of critical thinking. Degazon and Lunney (17) discuss the use of metacognition as a tool for self-modification. …