The Effect of Reflective Writing Interventions on Critical Thinking Skills

The importance of critical thinking as an outcome for students graduating from undergraduate nursing programs is well-documented by both the American Association of Colleges of Nursing (AACN) and the National League for Nursing (NLN). Graduating nurses are expected to apply critical thinking in all practice situations to improve patient health outcomes. Reflective writing is one strategy used to increase understanding and ability to reason and analyze. The lack of empirical evidence regarding the effectiveness of reflective writing interventions on increasing critical thinking skills supports the need for examining reflective writing as a critical thinking strategy. The purpose of this study was to test the effectiveness of a reflective writing intervention, based on Paul’s model of critical thinking, for improving critical thinking skills and dispositions in baccalaureate nursing students during an eight-week clinical rotation. The design for this pilot study was an experimental, pretest-posttest design. The sample was a randomly assigned convenience sample of 70 baccalaureate nursing students in their fourth semester of nursing school at two state-supported universities. All participants were enrolled in an adult-health nursing course and were completing clinical learning experiences in acute care facilities. Both groups completed two critical thinking instruments, the California Critical Thinking Skills Test (CCTST) and the California Critical Thinking Dispositions Inventory (CCTDI), and then the experimental group completed a reflective writing intervention consisting of six writing assignments. Both groups then completed the two tests again. Results showed a significant increase (p=0.03) on only the truthseeking subscale on the CCTDI for the experimental group when compared to the control group. Some other slight differences on subscale scores could be accounted for by the institution, age, ethnicity, and health care experience differences between the control and experimental groups. Strengths of this study included the innovative intervention and the convenient format of intervention administration, completion, and submission. Limitations of the study included institutional differences, the eight-week commitment, and the lack of control of some aspects of the study environment. Evaluation of the qualitative data, replication in a larger sample, inclusion of different levels of students, and alternative design of assignments are all areas for future research.