Managing Academic Stress and Enhancing Metacognition in Nursing Students Using Reflective Journaling: A Qualitative Study.

aimsTo explore nursing students' reflection journal experiences during nursing classes.

designQualitative study.

methodsParticipants were 18 nursing college students who wrote weekly reflection journals as part of a class assignment and submitted them after each session. The data collection period was from February 1 to February 15, 2021. Data were collected through focus group interviews during which researchers recorded the content's main points, topics, physical expressions and atmosphere (e.g., participants' facial expressions and gestures) based on the participants' statements. Interviews were conducted 1-2 times per group with each lasting 60-90 min. Data were analysed using a qualitative content analysis method that draws repetitive and valid inferences from the text data and participants' situations. Reliability and validity of the results were confirmed based on the criteria presented by Lincoln and Guba. This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

resultsParticipants' perceived experiences were organised into four sub-themes: 'Challenges of academic stress and learning burden', 'Perceived development of efficient learning strategies', 'Perceived enhancement of metacognitive awareness' and 'Experienced a variety of achievements.' The overarching theme was 'Increased metacognition about nursing'.

conclusionParticipants perceived reflective journaling as a meaningful learning activity that helped them manage learning-related burdens, reflect on their learning processes, organise learning strategies and enhance their awareness of their learning and thinking processes. These experiences were perceived as supporting self-directed learning in nursing education. As an exploratory qualitative study, these findings reflect participants' subjective perceptions and should not be interpreted as demonstrating causal educational effects. IMPLICATIONS FOR THE PROFESSION: Utilising reflective journaling can be beneficial for nursing students in managing academic stress and enhancing metacognition about nursing. IMPACT: The findings of this study can contribute to nursing education by offering methods to help nursing students establish a professional identity and manage academic stress, thereby preventing dropout and fostering their growth as nurses. PATIENT OR PUBLIC CONTRIBUTION: This study can contribute to public health by reducing the turnover rate of newly hired nurses and ultimately improving the quality of nursing services.