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

ABSTRACT

Aims

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

Design

Qualitative study.

Methods

Participants 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.

Results

Participants' 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’.

Conclusion

Participants 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.

1. Introduction

Nursing students experience greater stress and difficulties than students in other majors owing to the heavy burden of theoretical education and practical training, strict policies and higher ethical expectations (Yoo 2019). In particular, clinical practice can cause anxiety, tension and discomfort for nursing students who are developing nursing skills in environments with which they are not familiar (Song and Lee 2020). Consequently, nursing students typically experience persistent academic stress and confusion about their professional identity, which can lead to maladjustment, suspension and even dropout in the long term.

Problem‐solving is a crucial competency of nursing students and self‐directed learning training is essential for enhancing this competency (Kim and Shim 2018). Accordingly, nursing education settings often emphasise fostering problem‐solving skills in diverse and complex situations rather than relying solely on lecture‐based instruction (Diño and Ong 2019).

Reflection activities are an effective educational method for self‐directed learning in problem‐solving (Shapiro et al. 2006). Learners can restructure their knowledge and experiences by acquiring or applying new knowledge through reflective thinking to achieve goals (Rodgers 2002). Such reflection is essential for enhancing expertise because it helps to better understand and advance nursing practice (Walsh et al. 2024). Reflection is effective not only for improving nursing competency but also for promoting individual growth (Altimier and Lasater 2014; Jho 2021; Walsh et al. 2024).

Various strategies have been proposed to promote reflective learning, including mentoring, small group discussions, portfolios and reflective records (Chun et al. 2018). Specifically, a reflection journal is used not only as a learning tool to actively promote reflection but also as an evaluation method (Boud 2001). As an evaluation tool, it is useful in guiding students' self‐directed learning by managing their learning activities and results (Lee and Lim 2013). To obtain meaningful reflection, a corresponding strategy is needed. Accordingly, instructor feedback could maximise learning motivation and effectiveness (Chretien et al. 2008) and therefore plays an important role in improving reflection capacity and inducing additional reflection.

2. Background

Previous studies on reflection activities were primarily quantitative, confirming the effectiveness of reflective journaling (Altimier and Lasater 2014; Jho 2019), while few qualitative studies have explored nursing students' experiences of reflective journaling and instructor feedback in nursing education (Altimier and Lasater 2014). International qualitative and mixed‐methods studies have similarly reported that reflective journaling supports reflective thinking, critical reflection and meaningful learning among nursing students in non‐Korean contexts (Murillo‐Llorente et al. 2021; Walsh et al. 2024), underscoring the relevance of this topic beyond a single national setting. A deeper understanding of these experiences may provide valuable insights into how reflective journaling supports student learning and engagement in nursing education and may help address this gap in the literature. Therefore, this study aimed to explore nursing students' perceived experiences and perceptions of writing reflection journals during class and provide implications for reflection‐based teaching and learning strategies in nursing education.

3. Methods

This study used a qualitative approach and focus group interviews to explore the experiences of nursing students who wrote reflection journals during their classes.

3.1. Participants

The researchers recruited participants through the department bulletin board or from among those who expressed their willingness to participate through social networking services. Students who expressed interest in participating signed a written consent form and proceeded with the study and none withdrew during the course of the study.

The number of participants was determined according to data saturation (Guest et al. 2020), the point at which no new information emerges. After the final focus group interview, no new themes or meaningful information were identified and the research team agreed that data saturation had been achieved. Participants were 18 fourth‐year female nursing students who wrote a reflection journal in a nursing class at D University in J City, South Korea. Eligible participants were students who had completed the course and submitted reflective journals throughout the 10‐week semester. None of the participants had any prior experience with reflective journaling.

Each week after class, participants filled out a reflection journal and submitted it. The class was conducted for 10 weeks, during which the instructor used concept maps to explain and review discussion topics each week. The reflection journal contained questions in three areas based on previous studies and was designed to promote students' self‐awareness of learning, metacognitive evaluation and learning planning (Kang and Jung 2009). The reflection journal prompts were informed by Gibbs (1988) reflective cycle and developed through discussions and consensus among the three researchers. The research team consisted of three doctoral‐level psychiatric mental health nursing scholars, each with extensive experience in psychiatric mental health nursing and qualitative research. The course instructor, who was not affiliated with the research team, was a professor specialising in mental health nursing with extensive experience in nursing education.

The reflective journaling activity included a section on instructor feedback, to facilitate ongoing reflection and learning (Table 1). At the beginning of the course, the instructor explained the reflective journal writing process and feedback procedure, providing additional explanations when needed after reviewing the students' reflective journals. Instructor feedback was provided for each reflective journal and focused on students' levels of reflection, integration of nursing knowledge and development of learning strategies, while encouragement was provided to support their continued engagement in reflective learning. For example, students received feedback such as, ‘You clearly reflected on your learning experience. To deepen your reflection, consider explaining how the nursing concepts discussed in class relate to this experience and how you would apply them in future clinical practice’. The same feedback criteria and principles described in Table 1 were applied to all students throughout the course. In summary, students' reflection activities were promoted through instructor feedback that addressed areas requiring further development. Students who demonstrated reflective engagement across all areas received praise stamps as encouragement.

TABLE 1.

Reflection journal composition.

Phase/no	Theoretical grounding (Reflective prompt)	Expected depth of response	Feedback & evaluation criteria
Knowledge Awareness (Description & Feelings)	Q1. What concrete nursing concepts or topics did you learn this week? Describe what you clearly understand and what remains uncertain.	Description and Feelings: Students should list specific nursing theories and evaluate their level of understanding accurately.	Clarity of Self‐Awareness: Assesses whether the student can differentiate between thoroughly understood concepts and gaps in knowledge.
Metacognitive Evaluation (Evaluation & Analysis)	Q2. What specific nursing knowledge or clinical rationale was most critical for your learning this week? How does this connect to your existing knowledge?	Deep Contextualisation: Students must link current clinical knowledge with prior learning and explain the scientific rationale behind nursing interventions.	Conceptual Integration: Assesses the ability to integrate new nursing knowledge with existing academic and clinical frameworks.
Strategic Planning (Conclusions & Action Plan)	Q3. What should I study more about the learning topic and how do you plan to supplement it? What are your specific learning strategies for next week?	Generalisation and productivity of new knowledge: Students must formulate an explicit, actionable study plan (e.g., textbook review) to overcome identified weaknesses.	Action ability of strategies: Evaluate the specificity of self‐directed learning outcomes and plans presented by students
Instructor Feedback & Synthesis (Cooperative Reflection)	Q4. Instructor's Evaluation & Feedback:·Praise Stamp (for full engagement)·Qualitative Guidance (for expanding critical thinking)	Reflective Metacognition: Students review the instructor's comments to guide subsequent reflections and support reflective thinking and clinical reasoning.	Constructive Alignment: Feedback focuses on reinforcing positive learning habits and guiding deeper critical thinking for skipped or weak areas.

3.2. Data Collection

The data collection period was from February 1 to February 15, 2021. To ensure homogeneity, participants comprised 5–7 students with similar class environments and the focus groups were divided into three groups based on the criteria of a structured format and topics with moderate complexity (Morgan and Scannell 1998). Focus group interviews were conducted online (Zoom) by one of the researchers, a female professor with a PhD in psychiatric mental health nursing, a board‐certified Psychiatric Mental Health Advanced Practice Nurse (APN) and a board‐certified Level 1 Mental Health Nurse (a national qualification under Korea's Mental Health Welfare Act). She had extensive experience conducting qualitative research and was concurrently serving as the director of a community mental health centre. The interviews were conducted approximately 6 weeks after class completion, following the participants' graduation. The interviewer was not involved in participants' course grading or academic evaluations. Prior to the interviews, participants were reminded that participation was voluntary and that they could freely express their views without any academic consequences. Participants were asked to participate in a place that was comfortable and unaffected by the external environment. Interviews were conducted 1–2 times per group; each interview lasted 60–90 min and the content was recorded using an online video conferencing system. The researcher retained the recorded file and deleted it after notifying the participants of analysis completion.

A structured questionnaire, including an introduction, main questions and conclusions, was used (Table 2). Interview questions were developed based on the purpose of the study and previous literature on reflective journaling. During the interviews, the researchers recorded the main points of the content, topics, physical expressions and atmosphere (e.g., participants' facial expressions and gestures) based on the participants' statements. That is, the participants' verbal aspects were summarised and the non‐verbal aspects were recorded in a field notebook. The researcher immediately transcribed the video recordings and analysed the content by repeatedly reading the transcripts and reviewing them for hidden meanings. Furthermore, the interviews' field notes and transcribed content were compared and interpreted together. Interviews were conducted in Korean and quotations presented in this manuscript were translated into English.

TABLE 2.

Research question and methodological approach. Main questions: What is your experience with writing a reflection journal in class?

Phase	Interview questions	Methodological approach
Introduction	• What comes to mind when you think of reflections or reflection journals? • What did you expect from a reflection‐based class?	[Baseline Assessment & Rapport Building] The opening questions are designed to capture participants' raw and unfiltered preconceptions before the curriculum effect takes place, setting them on a neutral basis without giving specific directions.
Main Questions	• What qualities do you think are needed for effective reflection? • What do you consider the student's role in a reflection‐based curriculum? • What do you think is the most important aspect of reflection?	[Conceptual differentiation to prevent duplication] Ask questions to clearly describe individual/environmental competencies, structural roles within the curriculum and psychological key aspects of reflection, aiming at a distinct dimension of reflective experience.
	• Please tell us about any changes, impacts, or challenges you experienced through the reflection‐based curriculum.
	• What conflicts did you experience in your reflection activities? • What did you think was helpful during the reflection activity? • Please let us know if you faced any problems or considered any improvement plans during the reflection activities.	[Multidimensional evaluation of the phenomenon] Addressing ‘conflict’ of experience in real time during interviews, approaching helpful parts as educational benefits and separating ‘problems/improvements’ into future oriented structural feedback.
Conclusion	• Please tell us what you felt during the reflection activities. • If you have any additional comments, please provide them.	[Closing & Participant Confirmation] It allows participants to organise their comprehensive feelings about the overall reflection activity on their own and provides an opportunity to check whether their actual intentions are accurately reflected.

3.3. Data Analysis

Data analysis was performed using Krippendorff's (1989) qualitative content analysis method, which draws repetitive and valid inferences from textual data and participants' situations. An inductive approach was used to allow categories and themes to emerge from the interview data. After reviewing the interview transcripts, field notes and emerging themes, the three researchers agreed that thematic saturation had been achieved, as no new themes or meaningful information were identified.

First, participants' interview transcripts were repeatedly read and reviewed, while underlining any data related to the experience of writing a reflection journal. Second, statements considered meaningful were extracted from sentences or phrases related to the reflective journal writing experience. Third, 13 condensed meaning units were identified by grouping them into common attributes by comparing and reviewing meaningful content and original data while reading the data repeatedly. Fourth, content classified as subtopics was compared and integrated into four sub‐themes. Finally, the meaning of the final reflection experience was derived through the organised themes. For example, the statement ‘I felt pressured to organise myself systematically’ (Group B, Participant N) was coded as a condensed meaning unit reflecting task‐related burden and disorganisation, which was subsequently grouped under the sub‐theme ‘Challenges of academic stress and learning burden’. The coding process and data interpretation were reviewed and discussed by the research team until consensus was reached. Any disagreements in coding or interpretation were resolved through iterative re‐examination of the original transcripts and repeated discussion among the three researchers. Throughout the analysis, the three researchers, who had professional experience in nursing education and mental health nursing, engaged in ongoing reflexive discussions to examine how their disciplinary backgrounds and prior assumptions about reflective journaling might influence coding and interpretation, thereby minimising potential interpretive bias. The data were analysed manually, without using qualitative data analysis software. This study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (Tong et al. 2007).

3.4. Ethical Considerations

This study was conducted after obtaining approval (No. DUC‐2020‐12‐001‐02) from the Institutional Review Board of D University. Participants signed a consent form indicating their willingness and voluntary participation and were informed that they could withdraw from the study at any time. They were also informed that the interview content would not be used for any other purpose and that confidentiality would be protected by not including any identifiable participant information in the material. Participants were informed that all information shared during the focus group interviews would remain confidential and would not be disclosed outside the interview setting. Throughout the study, participants were informed that the research data would be stored on a locked device and saved in a password‐protected file that could not be accessed through the Internet. Finally, they were informed that all data would be discarded after study completion.

3.5. Rigour and Trustworthiness

To establish the trustworthiness of the findings, the four criteria proposed by Lincoln and Guba (1985)–credibility, transferability, dependability and confirmability–were applied. To ensure credibility, the analysis results were shared with four participants to confirm that their interpretations accurately reflected their experiences. Transferability was ensured by presenting the study results to two people who had experienced similar learning environments but were not the study participants, who verified whether the results were meaningful and applicable. Based on a review of prior studies (Birt et al. 2016; Lloyd et al. 2024), the number of participants for member checking was determined by the extent necessary to verify the accuracy of the analysis results and their consistency with the participants' experiences. Transferability was further supported by providing detailed descriptions of the study context, participants and procedures, enabling readers to judge the applicability of the findings to other settings. Given the exploratory nature of this qualitative study, this scale of verification was considered appropriate to support the credibility and transferability of the findings, consistent with Lincoln and Guba (1985). To ensure dependability, two nursing researchers with extensive experience in qualitative research were consulted on the entire process and results. Finally, to ensure confirmability, three researchers continuously discussed, compared and analysed the data throughout the analytical process. Furthermore, efforts were made to minimise bias by adhering to established qualitative research procedures and approaching the data with an open and reflective perspective throughout the analysis.

4. Findings

Analysis of nursing students' experiences with writing reflection journals identified 13 condensed meaning units organised into four sub‐themes and one overarching theme (Table 3).

TABLE 3.

Nursing students' experience of writing reflection journals in nursing classes.

Condensed meaning unit	Sub‐theme	Theme
Feeling burdened by new assignments	Challenges of academic stress and learning burden	Increased metacognition about nursing
Needing detailed instructions
Desiring recognition and praise
Being reinforced by the instructor's feedback
Emphasising the importance of a positive attitude	Perceived development of efficient learning strategies
Enhancing efficiency through preparation
Fostering focus in the class itself
Developing the ability to summarise class content	Perceived enhancement of metacognitive awareness
Achieving exam readiness naturally, free from concerns
Experiencing improved exam performance
Developing a systematic approach to learning methods
Developing the habit of finishing work without procrastinating	Experienced a variety of achievements
Feeling a sense of pride from reviewing reflective journals

4.1. Sub‐Theme 1: Challenges of Academic Stress and Learning Burden

Participants were concerned not only about the burden of the task itself but also about having to perform new and unfamiliar tasks every week. Furthermore, they felt burdened by accurately comprehending their own situations through a given reflection topic. Participants struggled to proceed with the new assignment type, the format to write it in and what to include. Although guidance on reflective journal writing was continuously provided, they did not find it sufficient. As reflection journal writing was repeated, participants became more interested in the professor's feedback, worked hard to compare the professor's feedback with that of other students and received praise. After writing the reflection diary, the professor's feedback motivated the participants to learn and, consequently, they experienced changes in their level of knowledge and depth of reflection.

I'm not the type to study while arranging things, but I'm the type to just memorise things; so, at first, I was a bit burdened and worried. I felt pressured to organise myself systematically. (Group B, Participant N).

I'd have liked you to tell me how to write it more accurately at first. If you had presented the framework more clearly from the beginning, I think it would have helped me figure out what to add, what to omit and what is more important than that. (Group C, Participant G).

I was so envious when I saw the kids receiving the professor's stamp of praise and I worked hard thinking that I must obtain this, too; if other friends did not receive the stamp, there were many friends who envied those who received it. (Group A, Participant C).

I was glad that the professor continued to give feedback and that there was such a thing as receiving the advice and improving a little. (Group C, Participant L).

4.2. Sub‐Theme 2: Perceived Development of Efficient Learning Strategies

Participants felt burdened by the reflection journal writing task and attempted to change their resulting negative emotions by thinking about what they had learned from the experience. Participants prepared for efficient reflection by identifying their level of knowledge through pre‐learning before writing a reflection journal or by organising their environment to improve their concentration. Participants felt that diligently listening in class for effective reflection was helpful for learning by checking their class attitude and concentrating during class time.

Since it is a given, I think I need to have a positive attitude. (Group B, Participant D).

I have to write a reflection journal after the class, so I have no choice but to listen to the class diligently and I think it works well for that part. I think I got better at studying while keeping a reflection journal. (Group A, Participant C).

I think pre‐learning is the most important thing before writing a reflection journal. I can reflect on it only when I have learned, to some extent, on my own and have a concept. (Group B, Participant D).

4.3. Sub‐Theme 3: Perceived Enhancement of Metacognitive Awareness

Participants usually focused on understanding and memorising content to prepare for the test; however, by writing a reflection journal, they developed the necessary learning skills to grasp their knowledge level and organise their learning content. As the reflection journal writing experience was repeated, they learned to accurately identify the areas in which they were lacking and the necessary skills for supplementary study, so that the arrangement of related content became clear and they could take the exam without concern. By writing a reflection journal, participants learned the contents that were organised based on their knowledge level and introspection activities regarding the elements that were lacking helped them obtain results as much as their attempts and experiences in improving their level of achievement. Participants who were unclear about organising a large amount of information before the national nursing exam and how to prepare found that reflection journal writing helped them organise their learning activities, which served as a guide for them.

I think it was good because I was able to organise what I knew and what I lacked while writing. (Group B, Participant D).

Even if there are many test ranges, I think it helped me to worry a lot less by writing a reflection journal and taking classes. (Group B, Participant R).

I'm definitely satisfied. The mock test score is the highest because it comes out as much as I worked hard. (Group C, Participant B).

There was something vague about studying, but, as I did a reflection journal and studied for the exam, the whole thing was sorted out and it became a guide on how to study. (Group A, Participant A).

4.4. Sub‐Theme 4: Experienced a Variety of Achievements

Participants changed their habit of writing assignments or reports on the eve of class; instead, they experienced a sense of achievement and acquired an effective learning attitude by organising and checking their learning content through reflection on the day of class completion. Participants viewing the completed reflection journal felt that they had acquired intellectual property and felt a sense of accomplishment because they had endured a difficult process and completed the assignment. Participants initially expressed resistance due to the burden of the new reflection task; however, they were motivated by the instructor's feedback and overcame negative emotions to acquire efficient task achievement‐oriented learning strategies. Consequently, they were equipped with a new learning method (e.g., planning what to do and how to do it) and described a perceived increase in their metacognitive awareness, as they felt a sense of achievement (e.g., developing learning habits without procrastination).

I'm originally a lazy person, but since I feel a sense of accomplishment by writing it without delaying, I think I feel that I can finish my work quickly like this, little by little. (Group B, Participant E).

I organised everything from start to finish. I feel a sense of joy when I flip through the reflection journal. The fact that it's all filled up… I'm so proud that I got the stamp. I think that's why it's good. I felt a great sense of accomplishment. (Group C, Participant F).

4.5. Overarching Theme: Increased Metacognition About Nursing

The four sub‐themes collectively reflected participants' increased metacognitive awareness regarding their learning and nursing education through a progressive learning process associated with reflective journaling. Although participants initially experienced academic stress and learning burden associated with reflective journaling, they gradually developed effective learning strategies. Through repeated reflection, they became more aware of their strengths, limitations and learning needs, which reflected increased metacognitive awareness. As participants experienced a sense of achievement from their learning efforts and progress, they gained a deeper understanding of nursing and greater awareness of how to direct and regulate their own learning. These experiences were integrated into the overarching theme of ‘Increased metacognition about nursing’.

Reflective journaling played a significant role in helping me to understand what is important in nursing. (Group A, Participant K).

Writing reflective journals helped me understand how to study nursing, identify areas in which I was lacking and make plans for my learning. (Group A, Participant J).

5. Discussion

This study aimed to understand and explore nursing students' experiences of writing reflection journals in nursing classes. Through data analysis, the overarching theme of ‘Increased Metacognition about Nursing’ and four interrelated sub‐themes were identified. Although presented separately for clarity, these sub‐themes represent interconnected aspects of participants' experiences rather than completely independent categories. Each sub‐theme is discussed below.

First, ‘Challenges of academic stress and learning burden’ encompassed situations where reflection journal writing was performed for the first time; students found the process burdensome and confusing. Although reflective writing initially introduces cognitive burden and uncertainty regarding task formatting, integrating reflective journals helps students process anxiety, reframe affective responses and gradually transition from stress to active learning engagement (Murillo‐Llorente et al. 2021). As the journaling process was repeated and accompanied by structural support, participants in this study similarly described a shift from initial academic stress toward positive engagement. As emphasised by Chretien et al. (2008), professors' participation through reflection‐related feedback may facilitate positive learning experiences and support students' engagement in reflective activities. In summary, a teaching‐learning method that incorporates both the learner's introspective activity and the professor's feedback reinforces continuous learning motivation and active class participation, which may contribute to changes in students' learning attitudes and perspectives by inducing an inspection and awareness of their own learning attitude (Choi and Kim 2022). However, it has also been suggested that professor intervention can affect reflection and hinder the expansion of participants' reflective thinking (Chretien et al. 2008). Furthermore, prior research has suggested that the presence or absence of professor feedback is not a significant moderating variable (Lee and Lee 2022). Therefore, it has been suggested that if the reflection method and direction are presented in detail (Kim et al. 2017) and professor feedback is provided through a structured reflection journal (Lee and Lee 2022), the level of reflection targeted in the class will be reached. Accordingly, providing clear instructions, examples of reflective writing, orientation and explicit evaluation criteria before reflective journaling may facilitate student engagement and reduce initial confusion regarding the process. Therefore, the reflection process must be investigated through a comparative study based on whether the reflection journal preparation is structured.

Second, in the ‘Perceived development of efficient learning strategies’ sub‐theme, participants acquired effective learning strategies by finding ways to determine what to do and how to write an effective reflection journal. Reflection allows learners to establish specific strategies to solve new problems or tasks and helps them shape their learning strategies (Koszalka et al. 2001). This result is consistent with a previous study (Jho 2021) that found that reflective journal writing provided learning opportunities. However, because a reflection journal lacking detailed presentations of the reflection method and its content could constitute a simple piece of writing, it is important to present an accurate direction to reach the target level of classroom reflection (Kim et al. 2017). Detailed reflections on journal writing can be an effective way to materialise a learning strategy by recognising and evaluating one's current learning situation and modifying or improving learning attitudes that require change.

The participants in the current study focused on class. Immersion promotes empirical engagement and is a powerful motivating force (Csikszentmihalyi et al. 2005). Learning immersion leads nursing students to a voluntary learning process, encourages them to explore and apply efficient learning strategies and promotes learning outcomes in nursing education (Kim 2019). Participants became immersed in the class as they were motivated to perform and complete the reflection tasks. Furthermore, to facilitate reflection on journal writing, a learning environment was created by organising the surroundings before the activities and efficient immersion‐oriented learning strategies were utilised. Therefore, participants perceived reflective journaling as a useful teaching and learning strategy that supported learning immersion in the nursing education context.

The third sub‐theme, ‘Perceived enhancement of metacognitive awareness,’ involved participants' descriptions of feeling more capable in managing their learning processes, perceiving greater preparedness for examinations and increased confidence in their learning. Metacognition allows for coordinating and managing activities by recognising and evaluating one's own knowledge (Flavell 1987). In summary, learners experience self‐reflection by identifying what they know and do not know. During learning, the distinction between ‘what I think I know’ and ‘what I know exactly’ should be clarified (Bang 2022). Metacognition is the overall process of establishing, executing and moving activity plans by complementing unknown aspects through self‐reflection (Bang 2022). Therefore, a clear understanding of the level of knowledge is a prerequisite for expanding metacognition. In this study, after learning was achieved, participants were asked to first reflect on their level of knowledge by asking the question, ‘What did you know or what did you know accurately about the topic?’ This activity was a driving force for improving the participants' metacognitive skills. This result is consistent with a previous study (Suh et al. 2019) where the repeated process of reflection became the basis of problem solving for nursing students with high metacognition. Therefore, it is essential to actively develop and utilise reflection practice strategies to improve metacognitive skills.

Fourth, the ‘Experienced a variety of achievements’ sub‐theme implies acquiring a positive learning attitude and feeling proud about a reflection journal that is written every week. Few studies have specifically analysed participants' reflection journal writing‐related achievements; however, this finding is consistent with previous studies (Jho 2021; Murillo‐Llorente et al. 2021) that examined the development of a self‐fulfilling and non‐delayed habit of learning through reflection journal writing. Participants' learning habits changed in response to an effective learning attitude because they learned to grasp their level of knowledge based on reflection questions while considering a weekly schedule. Furthermore, they felt a sense of joy while observing their weekly accumulated journals and experienced pride because of their professors' feedback. In a previous meta‐analysis of the influence of reflection journals (Lee and Lee 2022), the group that maintained a reflection journal demonstrated higher achievement than the group that did not. The participants' reflection journal writing activities led them to organise the necessary learning content and establish the elements they would have to supplement; consequently, they developed an efficient learning attitude, experienced learning motivation and had a sense of achievement.

The overarching theme was ‘Increased Metacognition about Nursing’. Students' metacognition in the nursing field was perceived to increase through improving their metacognitive skills and experiencing a sense of achievement, overcoming resistance to the unfamiliar task of reflection journal writing and identifying and implementing learning strategies to solve problems. This resulted from participants overcoming resistance to reflection by recognising their need for learning and feeling a sense of achievement by performing effective learning strategies on their own. Participants described an increase in their metacognitive abilities and learning through reflection. In summary, by establishing what they knew and needed to learn further while writing in their reflection journals, they perceived an increase in their metacognitive awareness and described selecting and planning an efficient learning strategy to take initiative in their learning. Prior research also reported that students improved their metacognition and experienced self‐directed learning as reflective thinking regarding learning behaviour induced active practice behaviour (Lee and Lee 2022; Murillo‐Llorente et al. 2021). Metacognitive ability facilitates self‐directed learning; therefore, students with high self‐direction have high metacognitive abilities and can clearly grasp what they know and do not know because they experience the reflection process to become the subject of their learning on their own. Improved metacognitive ability helps increase work immersion, the ability to set goals and a sense of community (Bang 2022). In a meta‐analysis of the effects of reflection journals, cooperative reflection was more effective than individual reflection, suggesting that writing a reflection journal in a small group or sharing reflection content online could be more effective (Lee and Lee 2022). Previous studies suggest that cooperative reflection can effectively enhance metacognition and learning immersion and outcomes. Therefore, a comparative study of the reflection process by applying learning activities related to interactions with other learners may help identify a more effective direction for reflection guidance aimed at improving metacognition.

This study had several limitations. First, the findings were derived from a relatively homogeneous sample of fourth‐year female nursing students at a single institution, which may limit the transferability of the findings to students in other academic years, male nursing students and different educational settings. Second, participation was voluntary and all participants had completed the reflective journaling activity before participating in the interviews. Therefore, students who perceived reflective journaling as less helpful or who experienced greater difficulties may have been underrepresented. Consequently, the perspectives of students who discontinued the activity or chose not to participate may not have been fully captured. Future studies should intentionally explore negative or divergent experiences to provide a more comprehensive understanding of reflective journaling in nursing education. Third, data were collected through online focus group interviews and participants' responses may have been influenced by social desirability or the group interview context. Future studies should involve students from diverse institutions, academic years, genders and educational settings and should also include participants with negative or divergent experiences of reflective journaling.

6. Conclusion

This qualitative study analysed the content of focus group interviews to explore nursing students' experiences of writing reflection journals. By writing a class reflection journal, participants perceived that they had established efficient and specific learning strategies through rumination about previously used learning strategies. Furthermore, clearly grasping their own knowledge levels and reflecting on journal writing was associated with a perceived increase in their metacognition regarding the nursing field, as they described experiencing various achievements and improvements in their metacognitive skills. These findings suggest that reflection journal writing may support students' reflective thinking and metacognitive awareness among nursing students and may serve as a useful teaching and learning approach in nursing education.

Author Contributions

Yun‐Jung Choi: conceptualization, methodology, validation, supervision, funding acquisition, resources, writing – review and editing. Mi‐Ra Won: conceptualization, methodology, data curation, investigation, validation, formal analysis, writing – review and editing, project administration. So Yeon Yoo: conceptualization, methodology, validation, formal analysis, writing – original draft, writing – review and editing.

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT: Ministry of Science and ICT) (RS‐2023‐NR076968).

Ethics Statement

The Institutional Review Board of Daewon University College approved this study (Approval No. DUC‐2020‐12‐001‐02) and written informed consent was acquired from all the participants. All procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki.

Consent

Participants signed a written consent form indicating their willingness and voluntary participation and were informed that they could withdraw from the study at any time.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.