An Evidence-Based International Collaborative Model for Teaching Reflective Practice

Saturday, 21 July 2018

Gwen Sherwood, PhD, RN, FAAN, ANEF
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Sara Horton-Deutsch, PhD, MS, BSN, RN, ANEF, FAAN
College of Nursing, University of Colorado-Denver, Aurora, CO, USA

Outcomes of a six year collaboration between a School of Nursing and the Thai Ministry of Public Health provides an evidence base for teaching reflective practice, creating mindful learning environments, and modeling teacher and learner interaction based on experiential learning, so that health professions educators can transform their own teaching.

For six years we have partnered with the Thai Ministry of Public Health to offer a three week course in Reflective Practice for Thai health professions educators. Over six years, 113 participants have completed the course. Through the experience of applying reflective practice both as the teaching strategy but also as the outcome goals has further established cultural sensitivity and understanding between eastern and western approaches, honed teaching strategies that promote a reflective classroom, and stimulated sustained collegial relationships.

Reflective practice is built on the premise that effective clinical practice requires more than simply applying learned knowledge or content in practice. The clinician must sift through evidence to make critical decisions in complex situations recognizing what is urgent and pertinent to the situation. Reflective practice helps access and build on knowledge and lessons from experience. It is the active, persistent and careful consideration of beliefs supported by knowledge and the resulting conclusion. Reflective practice involves learning how to think to discriminate beliefs based on tested evidence (Schon, 1983). It builds a spirit of inquiry, an openness to asking questions to reframe a problem. In this way, reflective practice calls upon an evidence based approach to practice, whether one's work is in a clinical or other setting.

Reflective practice helps clarify experience. Any situation can be framed from multiple perspectives reflecting individual values, beliefs, and attitudes. The process of rational thinking delays action until the situation is better understood. Johns (2009) proposes it is one’s ability to access, make sense of and learn through experience in one’s work towards a more effective experience. Reflective practice can be a tool for clinicians to sift through the multitude of standards and clinical guidelines to determine the most effective pain management plan for an individual patient.

Reflective practice provides a structure for nurses and other health professionals to examine the spectrum of the pain experience. Reflective practice is a questioning approach that goes beyond surface to ask questions that clarify meaning. Decision making in practice relies on content reflection of what we know in the context of a situation, then process reflection—thinking about the strategies we can use to solve the problem rather —and premise reflection that questions assumptions we make within the situation. Assumptions often lead us astray because we fail to ask questions that can clarify meaning and sense-making. Reflective practice has been applied to multiple clinical situations including developing the QSEN (Quality and Safety Education for Nurses) (Cronenwett et al, 2007) competencies recognized internationally. Reflective practice can help guide implementation of clinical standards as the clinician reflects on the available evidence in light of patient preferences and values, such as the patient experiencing pain because only the patient can fully describe their experience.

With this backdrop of the critical nature of reflective practice, 113 health professionals, 90 nurses, 5 pharmacists, 1 physician, and 17 public health professionals completed the three week course. The interactive presentation will present outcomes from the project. Qualitative analysis of two types of feedback demonstrates the effectiveness of the collaboration that transcends national borders and culture. Themes from participants focus on Integration of reflective practice in their work, Changes in attitudes towards work, Fostering inquiry in practice to stimulate research, and Development of student learning activities. Participants shared action plans to demonstrate achievement of course objectives for application. Themes from the Action Plans include Applying reflective practice to integrate quality and safety, Using story to implement student centered teaching, Faculty development for unfolding case study application in simulation, and New approaches to learner assessment.