Factors Predicting Nursing Students' Reflective Thinking Skills


  • Jaruwan Suppasri Boromrajonani nursing college, Trang.
  • Phatcharapon Tulyakul


Reflective thinking skills, Learning style, Debriefing


The aims of this research study were to determine reflective thinking skills (RTSs) and to explore factors predicting RTSs among nursing students. Participants of this study were 205 sophomore, junior, and senior nursing students who were studying at Boromarajonani College of Nursing, Trang and received reflective thinking learning styles. The instrument of this study consisted of three parts: 1) demographics, 2) the VARK questionnaire - Thai version, and 3) the RTSs questionnaire. Demographics and VARK learning styles were analyzed by using frequency and percentage. Whereas, RTSs scores were analyzed by mean and standard deviation. T-test, ANOVA, and Pearson's correlation were used to test the factors' correlation and Multiple Regression Analysis was used to analyze for predictive factors. The findings were:1) Most participants had reflective learning experiences throughout using dialogue. 2) Most participants reported themselves as having Kinesthetic learner preference. 3) The RTSs mean score among these participants was 45.55 (S.D. = 6.09). 4) Student's class year was negatively related to dialogue, but it was positively related to journaling. Moreover, debriefing was significantly associated with the RTSs, and 5) A debriefing was the only predictor which explained 2.6% of the variance in reflective thinking skills. The predictive equations in unstandardized and standardized scores were RTSs = 44.701 + 1.869 (Debrief) and ZRTSs = .803 (ZDebrief). According to the results of this study, nursing instructors should attempt to integrate debriefing in all nursing courses continually and comprehensivelyin order to enhance students' RTSs.


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Akossou, A. Y. J., & Palm, R. (2013). Impact of data structure on the estimators R-square and adjusted R-square in linear regression. International Journal of Mathematics and Computation, 20(3), 84-93.

Almigbal, T. H. (2015). Relationship between the learning style preference of medical students and academic achievement. Saudi Med, 36(3), 349-355. doi:10.15537/smj.2015.310320.

Boonthum, A., Yutthawisut, S., Boaleung, T., Kaewprom, C., & Rungruang, K. (2015). Development on reflective clinical skills of nurse students. Journal of Prapokklao Hospital Clinical Medical Education Center, 32(3), 244-255. [In Thai].

Boonvas, K., Khumtorn, L., & Suppasri, J. (2016). Enhancing reflective learning practices: implication for faculty development program, Southern College Network, Praboromarajchanok Institute. Nursing Journal of the Ministry of Public Health, 26(3), 130-143. [In Thai].

Bootsri, W., Lohapiboonkul, N., & Harasan, P. (2018). Learning to solve community problem by reflective thinking: family and community nursing course. UMT Poly Journal, 16(1), 287-294. [n Thai].

Burns C. L. (2015). Using debriefing and feedback in simulation to improve participant performance: an educator's perspective. International Journal of Medical Education, 6, 118–120. doi:10.5116/ijme.55fb.3d3a.

Burruss, N., & Popkess, A. (2012). The diverse learning needs of students. In D. M. Billings & J. A. Halstead (Eds.), Teaching in nursing: A guide for faculty (pp. 15-33). MO: Saunders

Chaisung, P., & Thepsatidporn, S. (2015). Identifying the learning styles of nursing students at St.Theresa International College. Retrieved 15 January 2019 from mis.cola.kku.ac.th/files/ gs28_ attachment_files/files/348/ ED_032.pdf?. [In Thai].

Cherubim, S., Triudomsri, S., & Chaiyawut, P. (2019). Effects of practical teaching with reflection on clinical skilled nursing and satisfaction in nursing for principles and techniques in nursing. Udonthani Hospital Medical Journal, 27(2), 150-157. [In Thai].

Cheuaiam, S., Triudomsri, S., & Chaiyawut, P. (2019). Effects of practical teaching with reflection on clinical skilled nursing for principles and techniques in nursing. Journal of Health Research and Innovation, 2(1), 143-152. [In Thai].

Chiarana, C. (2013). Electronic learning portfolio for studying basic concepts in nursing science. Retrieved 15 January 2019 from http://sutir.sut.ac.th:8080/sutir/bitstream/123456789/ 4663/1/Fulltext.pdf. [In Thai].

Decker, S., Fey, M., Sideras, S., Caballero, S., Rockstraw, L., Boese, T., …Borum, J. C. (2013). Standards of best practice: Simulation standard VI: The debriefing process. Clinical Simulation in Nursing, 9(6), 27-29. doi:10.1016/j.ecns.2013.04.008.

Demirel, M., Derman, T., & Karagedik, E. (2015). A study on the relationship between reflective thinking skills towards problem solving and attitudes toward mathematics. Procedia-Social and Behavioral Sciences, 197(2015), 2086-2096.

de Santos Martins Perixoto, N. M., & de Santos Martins Perixoto, T. A. (2016). Reflective practice among nursing students in clinical teaching. Revista de Enfermagem Referência Journal of Nursing Referência, 4(11), 121-131.

Dube, V. & Ducharme, F. (2015). Nursing reflective practice: An empirical literature review. Journal of Nursing Education and Practice, 5(7), 91-99.

Embo, M., Driessen, E., Valcke, M., & van der Vleuten, C. P. (2015). Relationship between reflection ability and clinical performance: a cross-sectional and retrospective-longitudinal correlational cohort study in midwifery. Midwifery, 31(1), 90-94. doi: 10.1016/j.midw.2014.06.006.

Fragkos, K. (2016). Reflective practice in healthcare education: An umbrella review. Education Sciences, 6(27), 1-16. doi:10.3390/educsci6030027

Fleming, N. (2012). Teaching and learning styles: VARK strategies. Retrieved from www.vark-learn.com

Ghanizadeh, A., & Jahedizadeh, S. (2017). Validating the Persian version of reflective thinking questionnaire and probing Iranian university students' reflective thinking and academic achievement. International Journal of Instruction, 10(3), 209-226. doi:10.12973/iji. 2017.10314a.

Guvenc, Z., & Celik, K. (2012). The relationship between the reflective thinking skills and emotional intelligences of class teachers. International Journal of Humanities and Social Science, 2(16), 223-234.

Hamilton, D. F., Ghert, M., & Simpson, A. H. (2015). Interpreting regression models in clinical outcome studies. Bone & Joint Research, 4(9), 152–153. doi:10.1302/2046-3758.49.2000571

Ibrahim, R. H., & Hussein, D-A. (2016). Assessment of visual, auditory, and kinesthetic learning style among undergraduate nursing students. International Journal of Advanced Nursing Studies, 5(1), 1-4. doi:10.14417/ijans.v5il.5124.

Jermtaisong, R. (2015). Factors effecting the reflective thinking of student teachers of Rajamangala University of Technology. Journal of Teaching and Education, 4(1), 232-237.

Kaewprom, C. (2013). The development of reflective thinking among nursing students by using reflective journal in health education and health counseling course. Journal of Phrapokklao Nursing College, 24(2), 12-20. [In Thai].

Khumtorn, L. Suppasri, J., & Akarasuwankun, T. (2017). Nursing care of persons with psychiatric problems: The development of a practicum course to promote reflection skills among nursing students. The Southern College Network Journal of Nursing and Public Health, 4(1), 16-27. [In Thai].

Leopold, L. (2012). In the classroom: prewriting tasks for auditory, visual, and kinesthetic learners. TESL Canada Journal, 29(2), 96-120.

Lew, D. N. M., & Schmidt, H. G. (2011). Writing to learn: can reflection journals be used to promote self-reflection and learning? Higher Education Research & Development, 30(4), 519 –532.

Lobo, D. J., Noronha, J. A., & Prakash, R. (2013). Efficacy of reflective learning package on reflective writing, and critical thinking ability of undergraduate students on head injury in selected nursing college of Udupi district. International Journal of Nursing Education, 5(1), 48-53.

Loftin, C., Campanella, H., & Gilbert, S. (2011). Ethical issues in nursing education: The dual-role research. Teaching and Learning in Nursing, 6, 139-143. doi:10.1016/j.teln.2011. 01.005

Mahasneh, A. M. (2013). The relationship between reflective thinking and learning styles among sample of Jordanian University students. Journal of Education and practices, 4(21), 51-55.

Maskey, C. L. (2011). An evaluation of the relationship between reflection judgment and critical thinking in senior associate degree nursing students. Doctoral dissertation (Nursing), Indiana University, Indianapolis, IN, USA.

Naghdipour, B., & Emeagwali, O. L. (2013). Assessing the Level of Reflective Thinking in ELT Students. Procedia - Social and Behavioral Sciences, 83, 266 – 271.

Na Nakorn, P. (2011). Learning by reflective thinking. Journal of Research and Curriculum Development, 3(2), 1-20. [In Thai].

Nantasenee, S., Wongwiseskul, S., Sukcharoen, P., & Techangkul, L. (2018). Development of learning and teaching process for nursing students at Suandusit University. Boromarajonani College of Nursing, Uttaradit Journal, 10(2), 166-179. [In Thai].

Padden, M. L. (2011). The effects of guided reflective journaling on nursing students’ level of reflection, self-awareness, and perceived clinical decision-making skills. Doctoral dissertation (Nursing), Widener University, Chester, PA, USA.

Pawuttipattarapong, S. (n.d.). VARK questionnaire. Retrieved 10 March 2017 from http://vark-learn.com/home-thai. [In Thai].

Pianpeng, T., & Koraneekid, P. (2014). Effect of reflection using video based on Gibbs’ cycle in the electronic portfolio on the level of reflective thinking of teacher students. An Online Journal of Education, 9(4), 150-163. [In Thai].

Postholm, M. B. (2018). Reflective thinking in educational settings: An approach to theory and research on reflection. Educational Research, 60(4), 427-444. doi:10.1080/00131881.2018.1530947

Rea, L. M., & Parker, R. M. (2014). Designing and conducting survey research: A comprehensive guide (4th ed.). San Francisco: John Wiley & Sons.

Rees, K. L. (2013). The role of reflective practice in enabling final year nursing students to respond to the distressing emotional challenges of nursing work. Nurse Education in practice, 13(1), 48-52.

Saraketrin, A., Rongmuang, D., & Chantra, R. (2019). Nursing education in the 21st century: Competencies and roles of nursing instructors. Journal of The Royal Thai Army Nurses, 20(1), 12-20. [In Thai].

Sinthuchai, S., Dejpituksirikul, S., & Yoksuriyan, P. (2018). Reflective practice in nursing education. Journal of The Royal Thai Army Nurses, 19(2), 15-23. [In Thai].

Suworawatanakul, W., Natchamnong, S., & Leaungsomnapa, Y. (2015). The effects of developing reflective thinking skills and levels of reflection using reflective thinking learning program on nursing student, Boromarajonani College of Nursing Changwat Nonthaburi. Journal of Phrapokklao Nursing College, 27(1), 61-71. [In Thai].

Thaewopia, S., Thongnarong, P., & Wichai, S. (2017). Learning style of nursing students at Boromarajonani College of Nursing Khon Kaen. Journal of Nursing and Health Care, 35(2), 227-235. [In Thai].

Thiamwong, L., Sonpaveerawong, J., McManus, M. S., & Suwanno, J. (2014). Usefulness and barrier of reflective practice in nursing students. Journal of The Police Nurse, 6(2), 121-133. [In Thai].

Tripp, R. C. (2011). Learning style differentiation between Hispanic and non-Hispanic college students in selected institutions in the North Carolina Public University system. Doctoral dissertation (Education), University of Nebraska, Lincoln, NE, USA.

VARK Learning Limited. (2018). Statistics: VARK and validity. Retrieved 10 March 2017 from http://vark-learn.com/introduction-to-vark/research-statistics/.

Virasiri, S., & Praekao, P. (2003). Learning styles of sophomore nursing students at Khon Kaen University. Journal of Quality Management, Khon Kaen University, 4(1), 10-19. [In Thai].

Visudtibhan, P. J., & Disorntatiwat, P. (2015). Learning style preferences of nursing students at Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. Nursing Journal of the Ministry of Public Health, 21(1), 70-82. [In Thai].

Wallman, A. Lindblad, A. K., Gustavsson, M., & Ring, L. (2009). Factors associated with reflection among students after advanced pharmacy practice experience (APPE) in Sweden. American Journal of Pharmaceutical Education, 73(6), 1-11.

Wanchai, A., Saengpak, C., & Leaungsomnapa, Y. (2017). Learning and teaching methods by using reflective thinking technique in nursing education. Journal of Health Science Research, 11(2), 105-115. [In Thai].

Wattanawilai, C., & Thepphawan, P. (2017). Reflective thinking and mind mapping on problem-solving skills of nursing students. Journal of Medicine and health Sciences, 24(1), 1-12. [In Thai].

Weber, S. S. S. (2013). Can preservice teachers be taught to become reflective thinkers during their first internship experience? Doctoral dissertation (Education), Liberty University, Lynchburg, VA, USA.

Wichainate, K. (2014). Reflective thinking: teaching students to develop critical thinking in nursing practice. Journal of The Police Nurse, 6(2), 178-199. [In Thai].

Wright, S., & Stokes, A. (2015). The application of VARK learning styles in introductory level economics units. Issue in Educational Research, 25(1), 62-79.




How to Cite

Suppasri จ. ., & Tulyakul พ. . (2019). Factors Predicting Nursing Students’ Reflective Thinking Skills. Journal of Nursing and Health Sciences, 13(4), 64–77. Retrieved from https://he01.tci-thaijo.org/index.php/NurseNu/article/view/218658