Reflective Writing: Creating a Mindful Practice (Part 2: Keeping a Reflective Journal)

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Introduction

This series, presented by Stacy Nigliazzo of the Humanities Expression and Arts Lab at Baylor College of Medicine, focuses on the profound benefits of medical humanities and narrative practice, particularly reflective journaling, for healthcare professionals.

The initiative aims to foster mindfulness, cultural humility, emotional awareness, and personal resilience among caregivers.

Key Objectives and Benefits

The primary objectives of engaging in reflective writing are:

• To understand the benefits of medical humanities and narrative practice concerning the caregiver and human condition.
• To recognize and appreciate ambiguity and diverse forms of expression and viewpoints in creative work.
• To encourage the commencement of a personal journal as a means of fostering mindful practice through reflective writing.

For caregivers, maintaining a reflective journal specifically encourages:

• Mindfulness.
• Cultural Humility.
• Emotional Awareness.
• Personal Resilience.

Guidelines for Journaling

Reflective journaling does not necessitate formal instruction or standardized requirements. Instead, the following guidelines are suggested:

• Embrace Imperfection: Do not be deterred by the idea of a journal being "too nice to mess up." Life is messy, and a journal should reflect this reality.
• Freedom of Expression: Avoid "dear diary" entries or strict word counts. Complete sentences are not required.
• Stream of Consciousness: Approach journaling as a "stream of consciousness tool," reflecting the often-disorganized nature of human thought, which comes in flashes, colors, and sudden recollections.
• Capture Impressions: Aim to record just two or three impressions from each day – something significant, memorable, or a new learning.
• Diverse Formats: Entries can be varied, including sketches, cut-outs, single words, or short phrases. Consistently recording even two impressions daily can result in 60 reminders per month of one's experiences and self.

As essayist Joan Didion noted, writing serves as a vital connection to one's past self, preventing the feeling of forgetting "who we were".

Illustrative Journal Entries and Their Significance

The sources provide a rich array of sample journal entries from the presenter and her colleagues, showcasing the diverse applications and profound impact of reflective writing:

• Commemorating Daily Life: Entries can capture the mundane yet comforting aspects of daily life, such as a "Starbucks double shot" or the joy of a new film release. These entries highlight that journals do not solely have to focus on work or sadness but can also celebrate positive experiences.
• Processing Difficult Experiences:
  • Emotional Release: An ER physician's drawing of a hospital on fire, titled "The night is dark and full of terrors," after a tough shift, illustrates the raw emotional processing possible through visual expression. This entry, despite its simplicity, is profoundly meaningful and memorable, embodying the principle that a journal can be "messy".
  • Humanity in Crisis: A unit secretary's drawing of a Christmas tree next to the charge desk, with the caption "Christmas music + coffee + intubation = happy holidays er," captures the blend of personal joy and demanding professional reality during a tough flu season in the ER.
  • Witnessing Suffering: The presenter's personal entry, where a clerk drew her leaving the unit with an infant who had died, wrapped in a white sheet, revealed the often-unseen impact of caregivers on others. The clerk's observation that the presenter "had no face" underscored the emotional depersonalization that can occur in such moments.
  • Grief and Resilience: A pharmacist friend's entry about her petroleum engineer family member learning to walk and speak again after a stroke, where she affirmed, "You are not completely broken. Completely broken people do not know they are broken," demonstrates the power of empathy and perspective.
  • Personal Struggle amidst Professional Life: An electronic entry from a nurse's journal, celebrating her son Luke's acceptance to medical school, yet simultaneously acknowledging her brother's cancer and her own overlooked mortality, exemplifies how journals capture life's complex tapestry of joy and sorrow.
• Reflecting on Pandemic Experiences:
  • Foreshadowing and Observation: During the pandemic, the presenter traced the etymology of "corona" back to "Corax" (crow), drawing a crow's foot as a "foreshadowing of things to come," reflecting on the initial uncertainty and eventual accuracy of her premonition. This entry also shows flexibility in format, drawn on a torn piece of paper and later pasted in.
  • Simple Truths: A one-word entry, "Tylenol," succinctly conveys the common hospital experience of managing pain.
  • Comfort in Mundane Joys: An ER physician's avid baking during the pandemic, shared with colleagues, and the resulting "Dr. Berg's coconut cake" entry, highlight the importance of finding comfort and joy amidst challenging times.
• Capturing Unique Patient/Care Experiences:
  • Patient Communication: A patient unable to speak due to a stroke repeatedly wrote "home" on a piece of paper, demonstrating the journal's ability to document critical patient communication and memorable care outcomes.
  • Unexpected Diagnosis: A paramedic friend's sketch commemorating his cryo OnX ascending aortic prosthesis after an emergency EKG during a shift revealed a congenital heart defect, showcasing the journal as a record of personal health journeys intertwined with professional life.
  • Children's Perspectives: Artwork drawn by young children of a patient in police custody, facilitated by a nurse, and later pasted into the nurse's journal, illustrates the impact of compassionate care on vulnerable individuals and the diverse forms journal entries can take.
• Historical and Familial Legacy:
  • Marie Curie's Journal: Marie Curie's "radioactive journal" contained both lab notes and personal reflections, including poignant letters to her deceased husband Pierre, and her defiant note about being congratulated by "imbeciles" on succeeding him as a physics professor. This underscores the historical significance and deeply personal nature of such records.
  • Family Heritage: The presenter's cherished American Pocket Medical Dictionary, owned by her grandfather (a surgeon in the 1940s), highlights the desire for historical context and personal insights that reflective journals can provide for future generations. The act of him merely writing his name in the book made it precious.

The Importance of Legacy

The act of keeping a journal is not just for the present self but also for the future, serving as a legacy for loved ones. It offers insights into one's thoughts, learning, and enduring experiences, allowing others to understand who that person was.

In conclusion, reflective journaling, free from rigid rules, offers caregivers a powerful tool for self-awareness, emotional processing, and a means to document their unique journey, fostering mindfulness and resilience while leaving a meaningful legacy for those who follow.

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