The health care environment of the 21st century is extraordinarily demanding. Technology is ever changing, environments are fast-paced, cost-effectiveness is stressed, and patient care has become increasingly complex. Consequently, nursing faculty face significant pressure to educate students who, upon graduation, are ready to meet the multitude of challenges they will encounter in practice. Nurse educators often speak of preparing “safe practitioners” and “critical thinkers,” but it is relatively rare to hear a conversation in which faculty speak of preparing a nurse who is emotionally intelligent. However, faculty often discussed mounting frustrations with students displaying a “disconnect” from the patient, focusing and valuing the “hands-on” skills while overlooking the human beings for whom they are caring. Practicing nurses have also been found to be unprepared to manage emotionally laden situations and complex communication challenges encountered in their practice (Sheldon, Barrett, & Ellington, 2006).
These student behaviors and the experiences of nurses in practice may reflect a crucial omission in our education process. What is often overlooked in nursing education is that emotions are critical motivators in the decisions and actions of nurses. In fact, Freshwater and Stickley (2004) asserted that “every nursing intervention is affected by the master aptitude of emotional intelligence” (p. 93), which is defined as the “capacity to reason about emotions, and of emotions to enhance thinking” (Mayer, Salovey, & Caruso, 2004, p. 197). Nursing literature acknowledges the importance of emotional intelligence in nursing (Bellack, 1999; Cadman & Brewer, 2001; Evans & Allen, 2002; Freshwater & Stickley, 2004) and suggests an integration of emotional intelligence into nursing curricula that will provide students with opportunities to understand themselves and their relationships with others.
Furthermore, emotional intelligence competencies have been included in the recommendations of the Fuld Leadership Initiative for Nursing Education for Baccalaureate Nursing Curricula (Bellack et al., 2001). Despite the seeming consensus regarding the importance of emotional intelligence competencies, effective strategies to uncover and foster such competencies are rarely addressed in the nursing literature.
Reflection is increasingly being advocated as a strategy for developing emotional competencies (Horton-Deutsch & Sherwood, 2008).
Reflection is like the academic process of describing, analyzing, synthesizing, and evaluating with the addition of self-awareness. Reflection includes the emotions and feelings that are an integral part of practice but are often ignored.
A variety of strategies are commonly used to develop reflective skills, with diverse forms of reflective writing being used regularly. These methods often include all of the components of reflection noted above. Unfortunately, both students and faculty frequently lack comfort with, competence in, or valuing of the self-awareness component integral to reflection. Even when structured guides are provided, this crucial element is often overlooked. However, self-awareness is the foundation for higher-level emotional competencies; therefore, it is imperative that faculty address limitations in this basic building block of self-awareness, as well as facilitate student cognizance and development of other higher-level emotional competencies.
What appears to be lacking is a structure for assisting nursing students in beginning the process of becoming emotionally competent clinicians, a strategy that will also provide the beginning structure for faculty who are committed to fostering emotional competence in nursing education and practice. The purpose of our project was to develop reflective journal prompts for assisting students in recognizing and developing emotional competencies. Our goals were to develop a reflective approach that would assist students in understanding the domains of emotional intelligence and to provide students with a structure to access and stimulate the development of selected emotional competencies. This reflective approach would provide faculty with feedback regarding salient individual and group limitations in emotional competences that would further guide subsequent instructional strategies. The purpose of this article is to report the process and findings of a pilot qualitative research study conducted with two clinical groups of students in a psychiatric nursing course. First, an in-depth description of the development and pilot implementation of these prompts is discussed. Second, content analysis of student responses to these prompts is presented.
Emotional Labor and Nursing Practice
Much of nursing care involves emotionally demanding situations interacting with or involving patients, family members, and other health care providers. Even at an early stage in their education, nursing students begin to sense the emotional demands that are encountered by nurses (Morrissette, 2004). These demands have implications not only for the nurse’s clinical performance and psychological well-being, but also may affect the psychological and physical well-being of the patient (May, 1995). The concept of emotional labor was defined by Hochschild (1983) as “the induction or suppression of feeling to sustain the outer appearance that results in others feeling cared for in a safe place” (p. 246). The maintenance of this labor requires a coordination of mind and feeling, drawing on one’s self and individuality. Numerous encounters requiring emotional labor, along with personal stressors experienced by nurses, places them in jeopardy of facing situations where emotional labor demands exceed the ability to manage them (McQueen, 2004). The ability to manage our emotions while interpreting other people’s emotions is a prerequisite skill for any caring profession (Evans & Allen, 2002).
Traditionally, emotion has been viewed as a barrier to rational thinking and professionalism, giving rise to the idea that feelings are to be controlled. However, Salovey and Mayer (1990) coined the term emotional intelligence and viewed this as a motivating force directing behavior. Currently, theorists and researchers generally describe several models of emotional intelligence. Ability models view emotional intelligence as a general intelligence, a set of mental skills that relate to accurate processing of emotion-relevant information (Mayer, Salovey, & Caruso, 2000). Mixed models of emotional intelligence, such as those proposed by Reuven Bar-On (Brackett & Geher, 2006) and Goleman (1998), focus on self-perceived abilities, skills, and personality traits.
Goleman (1998) stated that emotional intelligence is “the capacity for recognizing our own feelings and those of others, for monitoring ourselves, and for managing emotions in ourselves and in our relationships” (p. 317). Goleman (1998) asserted that emotional competence has its basis in emotional intelligence but is a learned capability leading to outstanding work performance. Thus, individuals have emotional intelligence potential but must learn and develop emotional competencies. Goleman’s (1998) framework of emotional intelligence reflects how an individual’s potential for mastering competencies within the domains of self-awareness, self-management, social awareness, and relationship management translates into professional behavior.
Emotional Intelligence in Nursing Education and Practice
Kooker, Shoultz, and Codier (2007) asserted that the investigation of the relationship of emotional intelligence to the work of nursing is in its early stages. However, four possible implications of emotional intelligence have been elucidated in the extant nursing literature. First, as discussed previously, the emotional work of nursing can be taxing and take a toll on the psychological and physical health of the nurse. Thus, the development of emotional competencies can assist a nurse in achieving balance in providing the emotional care necessary for a patient while recognizing personal limitations and engaging in practice of effective personal coping mechanisms. Montes-Berges and Augusto (2007) found that nursing students with higher emotional clarity scores on the Trait Meta Mood Scale, a measure of perceived emotional intelligence:
clearly identify a specific emotion during stress situations, use less time to pay attention to their emotional reactions and invest correctly the cognitive resources which permit them to achieve more adaptive coping strategies.
Second, self-awareness can improve satisfaction and enrich patient-nurse relationships both for patients and nurses. Emotionally aware nurses are better able to separate their emotions from those of patients. This awareness and processing of emotions fosters the nurses’ ability to remain centered on patients’ needs and to fully engage with patients (Horton-Deutsch & Sherwood, 2008) rather than becoming detached or overwhelmed.
Third, emotional intelligence can facilitate an increase in collaborative practice. Jordan and Troth (2002) reported that nursing students with high emotional intelligence preferred to seek collaborative solutions when confronted with conflict. Through collaborative practice, care can be provided more efficiently and effectively.
Fourth, the literature indicates a positive effect of emotional intelligence on leadership behaviors. A review of the literature on emotionally intelligent nurse leadership revealed positive correlations between emotional intelligence and transformative leadership and positive organizational outcomes (Akerjordet & Severinsson, 2008). Sosik and Megerian (1999) conducted research with managers, employees, and their superiors. They proposed that nurse leaders who maintain self-awareness possess more aspects of emotional intelligence, providing positive role modeling for their subordinates. Cummings, Hayduk, and Estabrooks (2005) indicated that nurses working for leaders who had higher emotional intelligence levels reported significantly less emotional exhaustion, fewer psychosomatic symptoms, and better emotional health.
In addition, in a descriptive exploratory study, Vitello-Cicciu (2001) found that leaders scoring high on characteristics that foster development of emotional intelligence maintained a heightened emotional awareness of self and others compared with those who scored lower. Emotionally aware leaders can readily analyze the emotional side of issues, anticipating how people will react and create initiatives that can assist staff members with the emotional impact of their work. These findings suggest that leadership development of nurses that focus on emotional competencies can provide positive outcomes with staff and, subsequently, patients.
Our literature review of emotional intelligence and emotional intelligence in nursing practice led to four assumptions guiding this project: emotional intelligence is an essential component of nursing practice; emotional intelligence is a set of abilities or skills; emotional competence can be learned and developed; and teaching strategies can be developed to promote emotional competence.
For this project, the most recent formulation of emotional intelligence by Goleman, Boyatzis, and McKee (2002) was used as a framework for the development of reflective journal prompts. They proposed four clusters or domains of general emotional intelligence abilities comprising a total of 18 different competencies (Table 1). Ten progressive, guided journal prompts were created to assist students in recognizing and developing greater competence in the four domains of self-awareness, social awareness, self-management, and relationship management described by Goleman et al. (2002). These prompts were developed to facilitate progressive building of emotional intelligence selected competencies in each of the domains. In the self-awareness domain, the competencies of emotional self-awareness (identification of thoughts and feelings) and accurate self-assessment were deemed most essential. The competence of empathy was the focus of concern in the social awareness domain. Prompts addressing self-management and relationship management domains focused on competencies of emotional self-control, developing others abilities, and conflict management, respectively. Examples of the progressive prompts are displayed in Table 2.
Table 1: Goleman’s Emotional Intelligence Framework Domains and Competencies
Table 2: Emotional Competence Reflective Prompts
After university institutional review board approval was obtained, students were introduced to the prompts as a component of their psychiatric nursing course. Informed consent was obtained to allow for duplication and analysis of student responses to journal prompts. All students enrolled in two clinical groups (N = 16) within an associate degree program provided consent. Students responded to one prompt in writing per week. Prompts used earlier in the semester focused on the self-awareness and social awareness cluster, with later prompts moving to an increased emphasis on self-management, with an introduction to relationship management. Thus, the prompts were designed to guide students in a progressive movement from self and awareness of thoughts and feelings that are fundamental to a more complex, higher level of emotional awareness.
A more in-depth description of four of the specific prompts further elucidates this strategy. In prompt two, students are asked to select and reflect on an experience encountered within clinical time. This self-awarenesss domain prompt directs students to identify their thoughts, feelings, and physical response in a situation. By focusing students on distinguishing thoughts from feelings and identifying physical responses to situations, the prompt introduces students to accessing internal states and initial identification of relationship of internal state to situations encountered.
By the time that prompt five is introduced, a foundational platform of self-awareness has been structured. Prompt five continues to focus on self-awareness, as well as exploring self and relationship management domains of emotional intelligence. This in-depth reflection on a frustrating or anger-filled experience facilitates students’ exploration of their actual versus desired response. Prompt five assists in the discovery of possible disconnects through students’ reflection on strategies to effectively manage a response for a desired outcome. This prompt, a student favorite, frequently leads to rich discussions focusing on the relationship between managing self to managing relationships, both personal and professional. In addition, the potential implications of an inability to manage one’s emotional self are revealed when completing this prompt.
A combination of self-awareness and social awareness domains of emotional intelligence are imbedded in prompt seven. Students reflect on a clinical experience from their own perspective, as well as from their imagined perspective of a client involved in a clinical encounter or situation, using first-person voice for both perspectives. Stepping back from a situation to explore similarities and differences in perspective of the situation creates an opportunity for students to move beyond their personal experience and fully understand their clients. Creating opportunities to assist students in fully understanding a client’s experience exposes the students to the concept of empathy. Development of empathy and empathic response, a foundational competence in the social awareness dimension, is requisite for the provision of care. Through this prompt, students are guided toward recognition of the relationships between empathy, the client-nurse relationship, and excellent nursing care.
The final prompt, prompt ten, is a meta-reflection on all previous responses. Students are asked to reflect on their growth in self-awareness through progression of the prompts. Critical reflection results as students reread all previous entries. Self-awareness expands as patterns and trends in thoughts, feelings, and responses are uncovered. Identification of these patterns and trends can lead to personal insights for reinforcement or changes in behaviors. Suggestions from students for additional prompts are solicited for the faculty to gain additional student perspective of meaningful prompts.
Analysis of student responses to the prompts served several purposes:
- To assess the effectiveness of each prompt in providing a stimulus for self-reflection related to the targeted competencies.
- To provide a beginning assessment of student strengths and challenges in relation to the targeted competencies.
- To identify any needed changes in wording to increase clarity of the prompts.
Prompts were analyzed using the emotional intelligence framework and selected competencies created by Goleman et al. (2002
). Analysis of student responses focused on evidence of each of the targeted competencies, rather than content themes. Beginning with prompt one (Table 2
), the authors analyzed all student responses (N
= 16) to that prompt before progressing to the following prompts. The authors searched and highlighted key phrases and words highlighting the targeted competencies in each student entry. Analyses were then conducted across all journal prompts to identify key areas of student strength and challenges in reflecting on emotional intelligence competencies (Table 1
Consistent with project goals, representative excerpts from student responses demonstrating targeted competencies of each of the four domains of emotional intelligence are presented.
Effectiveness of Prompts in Providing a Stimulus for Self-Reflection
The results of this analysis con-firmed that all prompts elicited responses reflecting aspects of the designated target competencies. Identification of thoughts and feelings, as well as accurate self-assessment, are the targeted competencies in the domain of emotional self-awareness and are major competences addressed in prompt two. In response to this prompt, one student described her initial meeting with a client and the client’s seeming confusion about initialing of a consent form. In describing her thoughts about the situation, she journaled:
Thoughts: I was thinking, “Oh darn” because for a moment I didn’t know what to do. Then, I realized that I was being dumb and that my client needed my help.
Feelings: I was nervous, I must admit. The whole experience was a bit overwhelming. After resolving the small problem, I felt proud of myself for noticing the client was upset and [for] reacting in a positive way.
Difficulties identifying thoughts and feelings: I think that my thoughts were harder to distinguish. Thoughts to me are fast—happen in the moment—and are quickly forgotten, while feelings are what I easily remember and store for later reflection.
Relationship between thoughts and feelings: My feelings and thoughts were directly related.... I was unsure of what to do and after calming my client, I also calmed down and reevaluated my negative thoughts. I don’t think I was aware of this at the time because I usually do not reflect on my thoughts and feelings and often push them to the back of my mind.
Impact of awareness: Becoming aware of my thoughts and feelings about this situation helped me to understand that I usually overreact and if I just took a moment to step back and evaluate the situation I would save myself from a lot of unnecessary emotions.
The competence of empathy was the focus of concern in the social awareness cluster. Prompt nine directs students to write about a clinical experience from their perspective and from their imagined perspective of the client, using the first-person voice. One student’s response demonstrates the effectiveness of the prompts focusing on empathy:
Your Perspective: An upset client was being loud and obnoxious. The client was yelling and it seemed like she was mad at me. She wanted me to agree with her about her treatment. I was very frightened. I didn’t know exactly what to say and I was afraid to move or get up. My mind kept racing with thoughts of what I should say to her. I was searching for the right thing to say and she got more and more agitated as I just sat there and didn’t respond to her.
Client Perspective: I am scared. They are going to ship me off to that place where lesbians are and they do horrible things to me. Please help me. Agree with me and go tell the staff. Be my advocate. Please help me. I just want someone to understand what I am going through. No one listens to me here.
Analysis: The client was feeling scared and all that I saw was anger and loudness. Our two perspectives were far from each other. It is easy to judge a client in this situation. I didn’t understand how the client was feeling inside. I felt like she was mad at me. Her body language was extreme and she was very anxious. The client was desperately looking for assistance. I feel if I would have understood completely what was bothering her from the beginning I might have been more understanding of her situation.... If I would have taken the time to find out what her situation was I might have reacted differently to her. By analyzing this situation I realized how easy it is to misunderstand a client, especially an irate and almost uncontrollable client.
Prompts addressing self-management and relationship management clusters focused on competencies of emotional self-control, developing others abilities, and conflict management, respectively. Prompt five stimulates reflection on the competence of emotional self-control by asking the students to describe a situation in which they experienced frustration and anger toward another individual. One student described her response:
I didn’t [respond]. I have a tendency to internalize my feelings until someone guesses that something is wrong with me or I can’t handle it any longer.... I would have liked to have told this student of my problem.... I have problems with confrontation—I don’t like putting others in that situation, or myself for that matter.... If this happens again I will have to confront my peer.... If I am unable to do my job, something needs to be said.
Prompt five was also structured to enhance student understanding of the competence of conflict management. In reflecting on a situation in which she experienced anger and how her understanding might lead to changes in behavior, a student wrote:
Then I could approach whoever I am angry at, let them know how what they did made me feel, and that I would appreciate it if the behavior stopped.
Student responses to prompt 10, in which they are directed to review all of the prior prompts and identify themes or patterns, also demonstrate the effectiveness of the prompts as a stimulus for reflection on emotional intelligence competences. Several students were able to identify patterns in their behavior and noted in their final journal entries that “I have learned to get to feelings behind behaviors.” A second student noted, “I am quick to take on other people’s feelings.” Another student identified “a battle with assertiveness,” with areas of growth being the “ability to recognize my thoughts and feelings and the importance of taking responsibility for my actions and not others’ responses.” Another student reflected, noting:
[a] greater ability to recognize my strengths and weaknesses. In my journal entries I tend to teach myself. I say one thing and over the course of the entry I learn from it. Each week I think I became more aware of myself and others.
Assessment of Student Strengths and Challenges in Relation to Targeted Competencies
Prompts were found to provide mechanisms for faculty to assess strengths and weaknesses of individual students with respect to the emotional intelligence target competencies. Analysis suggested some interesting preliminary findings regarding the student group’s strengths and focus areas for development in each emotional intelligence domain. Student responses to prompts focused on the self-awareness domain suggested that although students cognitively recognized the relationship between thoughts, feelings, and personal health and self-care, many had difficulty perceiving emotions as valuable and useful information, both personally and in relation to provision of nursing care.
With regard to social awareness, most students were able to identify another individual’s thoughts and feelings in a situation and subsequently communicated an understanding of the emotional experiences of others; however, this understanding was fairly superficial. Students demonstrated difficulty in accessing the felt emotional experience of the patient at a deeper level, as well as identifying the potential impact of making judgments in relationships. Student responses to prompts suggested a challenge to self-management and relationship management in that most responses suggested a compartmentalizing of personal feelings, client feelings, and nursing care. In other words, even when personal feelings and client feelings were identified, the recognition of these emotions of self and other did not influence descriptions of nursing responses and behaviors in the described situation. This discovery validated the previous resultant analysis within the self-awareness domain, in which a devaluation of emotions by most students was evident. These themes also provided direction for revisions of initial prompts.
Identification of Needed Changes in Prompts to Increase Clarity
Initial analysis of the prompts provided directions for revisions, not only to increase clarity but also to increase the effectiveness of the prompt in targeting the desired competencies and assisting students in making further connections between the journaling and future experiences and goals. For example, analysis of student responses to prompt five revealed that students had difficulty discussing ways of coping with feelings of anger, and instead focused on ways of avoiding conflict situations or “fixing” the situation. Consequently, the prompt was revised to include “Discuss one strategy for coping with the emotion you experienced in a future situation.” Likewise, to address the compartmentalization seen in student responses to prompt nine, as discussed in the previous section, the following statements were added to the prompt, “Reflect on your feelings as the nurse, hearing the client voice his or her experience” and “How did the awareness of your own feelings impact your response to the client?” Other prompts were similarly revised based on the authors’ initial analysis.
Implications for Teaching
Although the prompts were found to provide an effective teaching strategy, faculty did encounter some challenges in the process of implementation. Some students found completion of their responses to the prompts to be time intensive and, in some cases, emotionally draining. Similarly, the provision of timely and thoughtful faculty feedback that would assist students in further understanding and reflecting on emotional competencies was also time consuming for faculty. Most importantly, the authors discovered that for the prompts to be effective tools for promoting emotional competencies, all clinical faculty must value emotional intelligence development as a necessary focus for nursing education, as well as be committed to a consistent and continuous process of fostering emotional intelligence. Development and use of both quantitative measures, such as Likert scales, and qualitative approaches, such as focus groups, to further assess student and faculty experiences in use of these prompts is warranted.
The experience of the authors also suggests that faculty must become more transparent with regard to teaching-learning goals and approaches, as well as spend additional clinical time helping students make the connections between their responses to these prompts and the challenges encountered in the clinical arena. Exploration of the meaning of an experience to nurses and identifying both their thoughts and corresponding feelings requires both time and distance. In the moment of an encounter, it is difficult for a student or nurse to identify the impact of the experience. Creation of psychological space is crucial for fostering a safe environment for students to explore thoughts and feelings, which often are confusing or perceived as negative. Creating trusting relationships with students, as individuals and in groups, will promote the essential platform for facilitating open dialogue. Faculty and students are encouraged to explore and discuss emotional competence as an ongoing process rather than just an assignment. Furthermore, as role models, faculty must be willing to share, communicate, and develop their own emotional competencies alongside their students.
Although the described prompts were designed specifically for students enrolled in a psychiatric nursing course, the use of modified versions or similar reflective prompts can be effective in promoting emotional competence in a variety of nursing education courses and contexts. For example, prompts two, four, and seven could be used in any clinical course as an individual written reflection or discussed as a group within a postconference experience. A mixture of individual written and group discussion prompts may provide nurse faculty with an additional mechanism for assisting students with the process of self-evaluation. In addition, prompt nine could be modified to describe any health or illness experience of a patient or family. The use of such a prompt in every clinical arena, or consistently throughout a course or curriculum, could assist in promoting and reinforcing empathetic response in students. Used as a group discussion experience, prompt nine could provide rich reflection that may serve to enlighten students who appear to be disengaged from their client or nursing care.
Beyond the developed prompts, short reflective prompts based on classroom, clinical, or personal experiences could be sprinkled within courses to assist students in focusing on emotional self-awareness and social awareness. This can be particularly useful when a discussion is deemed necessary to understand another’s perspective, the class or group is too focused on a task or skill to be performed, or there is a desire to energize a class that appears disengaged from the care of nursing.
In addition, with the infusion of more simulation experiences into curricula, it is important to not overlook the potential experience of the patient. Reflective activities could be used both before and after simulation, facilitating a student response that encompasses the human element of caring in the experience. Because simulation experiences are often completed in groups, reflective prompts could be developed for use with students individually after an experience, when faculty are involved in providing feedback to other individual students or tending to necessary equipment issues.
Nursing leadership and management courses could also benefit from the integration of reflective activities such as these as a means to develop emotional competencies. A leadership reflective journal could be completed throughout the length of a leadership course or throughout the senior year for nursing students. Progressive prompts targeting self-management competencies would assist students in focusing on the higher-level competencies of effective relationship management. For example, the use of prompt nine integrates conflict situations that could be modified to include several different situations and individuals, such as peers, staff, other disciplines, physicians, and even families. Use of a summative, reflective final response prompt could reveal the student’s self-evaluative abilities and demonstrate understanding of the relationship of emotional competence and their nursing care.
Further work investigating the process and effectiveness of these prompts in promoting the development of emotional intelligence competencies of nursing students is warranted. One possibility is the measurement of student emotional intelligence before and after use of the prompts within a specific nursing course or throughout the curriculum. Does use of these reflective prompts promote student valuing of emotional intelligence competencies as a vital aspect of nursing care?
In striving to maintain the essence of nursing in the 21st century, the ability of a nurse to emotionally connect with another human individual cannot be minimized. This emotional connection is what patients long for from the nursing profession as they manage their health care. Technology is ever changing, environments remain fast-paced, cost-effectiveness is stressed, and patient care has become routine; however, the emotional connection in the relationship between nurses and their patients is what draws and sustains nurses in their practice. Managing this emotional connection between patients and situations can be problematic for nurses both personally and professionally. As health care becomes more modernized, technology based, and efficient, nursing education must focus on the emotional work of nursing.
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Goleman’s Emotional Intelligence Framework Domains and Competencies
|Self-awareness domain||Social awareness domain|
| Emotional self-awareness|| Empathy|
| Accurate self-assessment|| Organizational awareness|
| Self-confidence|| Service|
|Self-management domain||Relationship management|
| Emotional self-control|| Inspiration|
| Transparency|| Influence|
| Adaptability|| Developing other’s abilities|
| Achievement|| Change catalyst|
| Optimism|| Conflict management|
| Initiative|| Teamwork and collaboration|
Emotional Competence Reflective Prompts
|Journal prompt 1 (self-awareness domain)|
|What are your feelings as you begin this clinical experience? Make sure you identify feelings, not thoughts. Complete the following statement: “I feel...” What past experiences, perceptions, and thoughts might be contributing to the above feelings? What personal qualities, strengths, and talents do you bring to this clinical experience? Identify one goal for the semester related to your personal self-awareness and growth.|
|Journal prompt 2 (self-awareness domain)|
|Describe a situation you experienced in clinical this week: Describe your thoughts in this situation. Describe your feelings in this situation. Describe the way your body felt physically in this situation. What was more difficult to identify—your thought or feelings? Explain why you think this may be. How do your feelings relate to your thoughts in this situation? Were you aware of this at the time? Reread and reflect on your entry. Identify one specific strategy you will use to focus your attention on your internal states during your next clinical day.|
|Journal prompt 3 (self-awareness and social awareness domains)|
|Judgment is making opinions as to the value of someone or something, considered to be lacking in tolerance and objectivity.|
Describe in detail a situation in which you felt you were being judged. Describe how you felt about this.
Describe in detail a situation in which you had judged someone else. Describe how you feel about this.
How did judging another impact your sense of self in a positive way? In a negative way? How might judging another have impacted that person’s sense of self in a positive way? In a negative way? Describe how being judged affected your subsequent behavior?
Reread and reflect on your entry. Describe any insights related to the relationships between making judgments and experiencing empathy for others.
|Journal prompt 4 (self-awareness and self-management domains)|
|Experience: Describe a situation in which you did not meet your personal expectations for your clinical performance.|
|Reflection: Thinking about it now, were your expectations realistic or unrealistic? Explain. Were your expectations healthy or unhealthy? Explain. How might you respond to a peer who voiced these expectations for himself or herself? What are the similarities and differences between how you might respond to a peer and the way in which you responded to yourself (your self-talk)?|
|Implications: What might be the overall health implications for you if you repeatedly engage in the self-talk you described so it becomes a pattern?|
|Journal prompt 5 (self-awareness, self and relationship management domains)|
|Situation: Think about a situation in which you experienced frustration or anger. Identify behaviors of others in this situation that you reacted to with frustration or anger.|
|Response: How did you respond? How would you have liked to respond?|
|Analysis: Explore and discuss reasons for the differences and similarities in your actual and desired responses in this situation.|
|Future Implications: Discuss one strategy for coping with the emotion you experienced in a future situation.|
|Journal prompt 6:Self-Care for the Healer(Wells-Federman, 1996) (self-awareness and self-management domains)|
|Read the handout Self-Care for the Healer. Describe one new insight you have about the relationship between your self-care and your effectiveness as a nurse. Identify one specific, measurable and realistic strategy related to your self-care that you could implement during the clinical day.|
|Journal prompt 7 (self-awareness and social awareness domains)|
|Identify an incident/happening/event occurring during the clinical day. This should be an experience you had which also involved a client. Write about the incident using the following format.|
|Your perspective: Write about this experience from your perspective. What happened? What were your thoughts and feelings about what happened? What was this experience like for you?|
|Client perspective: Think about a specific client involved or participating in this experience. Try to imagine how the client experienced this event/incident. Use your knowledge of the client as well as your knowledge of the client’s illness to assist you in identifying the likely perspective of the client. Write about this experience as if you were this client, using first person. For example, “I was scared by all the noise in the Occupational therapy room...”|
|Analysis: Describe the similarities and differences in the two perspectives. How does imagining a client’s perspective in this situation assist you to better identify and empathize with the client’s needs? How do you see this as affecting your care? Reread your entry. What do you think you can do now to further develop your empathic responsiveness to clients?|
|Journal prompt 8 (self-awareness and social awareness and self-management domains)|
|You have beliefs about yourself that you are certain about, some that you are less certain about, some that are projected by others, and some that you just simply accept. (Beliefs should be described as qualities and not as roles you have.) Complete the following statement: “I believe that I am...” How do you know this about yourself? Provide examples that demonstrate this. What is a belief that others have about you? What are your thoughts and feelings about this belief by others? How much are our own beliefs a reflection of our experiences versus others’ opinions? Identify one belief held by others which you think is inaccurate. Describe how you will positively manage your sense of self when others perceive you inaccurately.|
|Journal prompt 9 (self-awareness and social awareness domains)|
|Imagine you are a client with a chronic mental illness. You live with a sense of hopelessness every day. In the first person, describe your experiences, thoughts, and feelings. You are the nurse. Reflect on your feelings as the nurse, hearing the client voice his or her experience. Describe how you need to be (present) with this client. How will you respond verbally to the client? Identify what you would actually say (in quotations). How did the awareness of your own feelings impact your response to the client?|
|Journal prompt 10 (journal summary)|
|What patterns or trends did you identify in your journal responses? Do your entries demonstrate a growth in self-awareness? If so, describe this. If not, why do you think this might be so? Which prompt stimulated the greatest amount of reflection and self-awareness? Why do you think this might be so? Evaluate your identified specific strategy in entry #6 related to your self-care during your clinical day. Did it work? If so, describe. If not, describe what changes need to be made. What suggestions do you have for clinical journal prompts that might benefit reflection, increase self-awareness, and be of benefit to you?|