Effects of a Self-Reflection Program Combined with Positive Reflection from Peers and Instructors on Nursing Students’ Self-Awareness in the Psychiatric and Mental Health Nursing Practicum Course

Abstract

Introduction Self-awareness is considered a fundamental attribute for nurses, significantly influencing the development of personal characteristics and serving as a key component in effective nursing practice. This is particularly crucial in psychiatric and mental health nursing practicum course, where the use of self as a therapeutic tool is crucial. Self-awareness forms the foundation of the learning process, enabling nursing students to recognize and understand their own emotions, thoughts, feelings, needs, and behaviors, as well as to communicate and regulate themselves more effectively in various situations. This study investigates the effects of a self-reflection program combined with positive reflection from peers and instructors on the self-awareness of nursing students enrolled in a psychiatric and mental health nursing practicum. This course presents real-life, challenging situations that encourage students to develop deeper self-understanding, which in turn enhances their ability to empathize with and understand the thoughts, emotions, feelings, and needs of patients and their families.

Objectives This study aims 1) to compare the mean self-awareness of nursing students before and after participating in the self-reflection program combined with positive feedback from peers and instructors, and 2) to compare the mean self-awareness between the experimental group and the control group after the program.

Design This study employs a quasi-experimental design with a two-group pretest and posttest that integrates Satir’s model of emotional care with experiential learning as the conceptual framework for the self-reflection process. The aim was to develop self-awareness among nursing students through their experiences in the Psychiatric and Mental Health Nursing Practicum. The developed self-reflection program combined with positive reflection from peers and instructors consists of four steps: 1) Identifying the situation, problems, or behaviors that cause internal impact, 2) Reflecting feelings related to the event identifying all emotions, both negative and positive, 3) Analyzing, synthesizing, and conceptualizing the learning points, alongside exploring thoughts, perspectives, beliefs, expectations, and personal changes through self-questioning. This step emphasizes experiential transformation leading to positive learning, and 4) Yearning and applying, which involves recognizing growth, identifying learning outcomes, and applying them to real life and nursing practice.

Methodology The sample consisted of 64 third-year nursing students enrolled in the Psychiatric and Mental Health Nursing Practicum course during the 2024 academic year. Participants were selected through purposive sampling and assigned to either the experimental group or the control group, with 32 students in each group. The experimental group received a self-reflection program combined with positive reflection from peers and instructors, delivered both individually and in groups. In contrast, the control group engaged in routine self-reflective report writing, with instructor feedback provided through written comments. The research instruments included 1) a personal information questionnaire, 2) a self-awareness scale with a Cronbach’s alpha coefficient of .77, 3) a self-reflection form, and 4) a self-reflection program incorporating positive feedback from peers and instructors. This program was developed by integrating Satir’s self-reflection framework with experiential learning strategies. Data were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation. Independent t-tests were used to compare mean scores between groups, while Paired t-tests were employed to compare within-group differences in the experimental group.

Results The experimental group had a significantly higher mean self-awareness after participating in the program compared to before (t = -11.380, p < .001). 2) The experimental group also had a significantly higher mean self-awareness than the control group (t = -6.685, p < .001).

Recommendation Educational institutions and instructors should incorporate the process of self-reflection combined with positive feedback from peers and instructors into the teaching and learning process, in order to support nursing students in enhancing their experiential self-awareness.