Nursing Reflection on Metacognition in Nursing Students

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Students need self-regulated learning (SRL) strategies to effectively navigate in their learning journey. The three-phase, cyclic process of SRL is consistent with metacognition process (Ormrod, 2016). Previous research in SRL has shown that students often do not spontaneously use metacognitive skills during learning, which in turn, leads to poorer learning outcomes (Winne & Hadwin, 2008; Zimmerman, 2008). Research showed that metacognition and SRL could be mutual enhanced with carefully designed teaching-learning strategies. Enhanced reflective thinking habits promote students’ strategic regulation of approaching for learning, development of SRL and life-long learning (Christoph Sonnernberg & Maria Bannert, 2015). There is limited evidence using SRL strategies to support nursing students’ development of metacognition.

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Cognition and Metacognition in Nursing Students

Both critical thinking and reflective thinking are necessary for effective clinical reasoning (Kuiper and Pesut, 2002), and desired characteristics of professional practice for nurses. Self-reflection, as a key ingredient in metacognition, is able to enhance students’ learning and understanding of knowledge and skills, promote students’ commitment to learning and ownership of experience, promote critical thinking, foster self-regulation and deep approaches for learning (Bandura, 2008). Critical thinking is cognition, which “involves disciplined, intellectual process of applying skilful reasoning to guide action” (Paul, Ennis & Norris, 1993). Research showed that critical thinking requires commitment in reflective thinking over practice and experience (Benner, 1984; Liimatainen et al, 2001).

Research viewed reflective ability vary according to individual and situations, and could be developed in three levels, from superficial to descriptive and to deeper level (Moon, 2004). Health professional practitioners are believed to develop ongoing competence and continued learning through two types of reflection, “reflection-in-action” and “reflection-on-action”, gaining experiential knowledge from experience and practice (Schon, 1987). Mezirow (1981) defined three levels of reflectivity as first, non-reflection, awareness of judgements, observation, and descriptions; second, evaluation of planning, and assessment of decisions; and third level the process of reflection which includes assessment of need for further learning. A few studies measured and reported lower levels of reflectivity in undergraduate nursing students including the inability in self-assessment for competency, lack awareness of limitation and inadequacy of routine practice (Wong et al., 1995; Maltby, 1995; Liimatainen et al., 2001). Identified factors influence the acquisition and development of metacognition in nursing students in clinical learning include environment, time, maturity, nature of clinical experience, self-denial of not knowing and satisfaction with level of performance, individual learning style, student-teacher relationship, effective guidance and supervision as well as organisational culture (Kuiper and Pesut, 2002).

Guided Reflection in Developing Metacognition in Nursing Students

Guided, or structured reflection seems to be beneficial to nursing students whose skills to analyse practice may not yet in place. Empirical evidence showed that there is a need for carefully constructed design and strategies guide junior nursing students’ reflection by mentor throughout the clinical learning (Johns, 2000). There have been a few research models and frameworks recommended for various purpose. Several qualitative studies (Landeen et al., 1997; Wong et al, 1995) applied the two-level reflective model of Argyris and Schon (1974) in helping to guide and prompt nursing students’ reflective process with teaching learning tools such as questionnaires, diaries and journals. They reported varying degree of improvement of reflective thinking skills in students according to different subject and support from teacher. Liimatainen et al (2001) reported senior level students who did guided reflection over a 3-year period of study demonstrated increased level of reflectivity.

Past research aimed to develop nursing students’ formal SRL mainly focused on introduction of educational intervention to encourage SRL initiatives or curricular change. A limited number of researches emphasized that SRL strategies could be individual and contextual, and vary according to learning environment, students’ culture background, communication skills, epistemic belief, learning goals in promoting metacognitive skills development. Kuiper (1999) designed, tested and applied a self-reflective SRL in model based on a few other frameworks and theories to enhance student nurse, newly graduated nurses and senior nurses’ metacognition development in a few studies (Kuiper and Pesut, 2002; Kuiper, Pesut & Kautz, 2009). The findings showed that this model positively influenced reflective thinking and led to increased critical thinking over time in nursing students and different levels of nurses.  

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