Date of Award


Document Type


Degree Name

Doctor of Philosophy


Leadership PhD

First Advisor

Shirley A. Freed

Second Advisor

William H. Green

Third Advisor

Larry Burton


Method. Two case studies describe the experiences of (1) 17 students who worked individually in the hospital clinical setting and who answered specific questions about problem solving in a written journal and (2) 20 students who were paired in the clinical setting and who answered the same questions together in a journal shared by the pair. In both case studies the experience was 9 weeks. The written journal questions were designed around a problem-solving process and thoughts and feelings about the clinical experience. A rubric adapted from Boud, Koegh, and Walker’s (1985) reflective model was used to analyze the journal responses. Other sources of data included observations, interviews, and reflections by the investigator.

Results. A problem-solving process was documented in reflective journals in both cases. However, the presence of reflection in the paired experience was significantly higher than levels of reflection of students functioning as individuals in their clinical experience. Themes emerging from the journals demonstrate that dialogue effectively reduced anxiety and increased perception of learning. Journal writing both individually and in pairs does assist students to link theoretical knowledge with experience, and though reflection has traditionally been considered an individual process, this study indicates that benefits in reflecting together in a journaling process appear to be greater.

Conclusion. The cross-case analysis reveals there are connections between dialogue within journaling and problem solving, reflection, and critical thinking. This study suggests that the clinical environment can be organized by pairing students and having them reflect in journals to increase learning and critical thinking.

Subject Area

Nursing--Study and teaching, Nursing students--Evaluation.


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