Reflective practice developed from early theoretical foundations for adult education. Schon began to apply these concepts to transform professional education in 1983. He and others recognized the imperative for professionals to translate and test knowledge into evidenced based practices. Reflective practice, particularly in nursing education which continuously assesses learners’ capacity to translate theory to practice, integrates experiential learning theory (Kolb, 1984) with Schon’s work. Reflective practice engages learners in active learning as they sift through what they know (evidence) within the context of a given situation, therefore, learning becomes contextual. As the learner reflects on knowledge/evidence considered within the particulars of a situation that they move beyond passive content memorization to deep learning in which they base critical decisions in complex situations on what is urgent and pertinent to the situation. Reflective practice contributes to knowledge development by accessing and building on knowledge and lessons from experience. It involves learning how to think to discriminate beliefs based on tested evidence (Schon, 1983) and builds a spirit of inquiry open to asking questions to reframe a situation. Reflective practice can be a tool for clinicians to consider the multitude of standards and clinical guidelines to determine the most effective management plan for an individual patient.
Method:
As the basis for the partnership, the Thai Ministry identified inclusion criteria for faculty selection based on learner preference, strength of teaching performance indicators, goals and plans for implementing reflective practice, and ability to pass the English test required for visa entry to the United States. Faculty spent three weeks in the US for the structured intervention. The project design was based on the primary principles and concepts of reflective practice, building from basic to applied, in structuring the intervention guided by experiential learning activities: frameworks and models as foundation to reflective practice; using aesthetics to develop emotional intelligence for improving awareness of self, others and context; testing interactive pedagogies such as creating case studies and applying to clinical problems; applying to quality and safety competency development; committing to personal action plan for implementation in Thailand.
Results
The intervention has been completed by 157 faculty in 7 cohorts. Each returned with a portfolio of teaching strategies for implementation. Working in small groups, faculty developed and presented case studies based on a selected clinical topic and QSEN competencies to their cohort for feedback and discussion, so that each faculty had five case studies to further integration of reflective practice in their teaching. Faculty participants also demonstrated application of reflective strategies (i.e., Visual Thinking Strategies, Centering Mindfulness using Clay, Walking the Labyrinth, Telling my Story, High and Low Fidelity Simulation, etc.) and evaluated their effectiveness. Faculty developed assessment tools to measure learner achievement. Content analysis of Actions Plans developed by faculty participants revealed four themes: Focus on narrative pedagogy to transform their teaching, Integrate quality and safety competencies in curricula, Reframe learner assessment strategies to reflect changes in teaching, and Design faculty development as train the trainer to further develop reflective educators.
Conclusion
Global partnerships further develop nursing education through bidirectional learning. Course instructors developed greater understanding of cultural implications in applying narrative pedagogy for person centered application both with learners and patients. Instructors also gained knowledge and experience in working with English second language learners. Thai faculty have continued to flourish as they returned to their home school, and have formed regional counsels devoted to reflective practice which sponsors an annual conference, which has catalyzed research collaborations among faculty to build their own evidence base for reflective educational interventions. The Thai Ministry of Public Health is supporting the creation of a Thai Center for Reflective Practice for regional collaboration and communication.