Reflective Practice in Nursing & Cultural

Competency Education

Yolanda Ogbolu, PhD, CRNP-Neonatal

Assistant Professor &

Deputy Director Office of Global Health

University of Maryland Baltimore, SON

APHA conference 2014

Learning Objective

Participants will be able to:

Describe how bias/stereotyping can be addressed in cultural competency education of health professionals using reflective practices

3

Cultural Competency in Nursing Education

Nursing Education and Practice

Integration of cultural competence in graduate

nursing education deepens the development of the

leadership role in eliminating health disparities.

This leadership role encompasses:

1. Socially and empirically derived understanding of complex causes of disparities;

2. Implementing culturally competent nursing care;

3. Addressing social justice;

4. Advocating for patients and policies that advance health care;

5. Developing competency in collaboration with patients, key persons, agencies, and various stakeholders;

6. Attitude modification and personal transformation; and

7. Contributing to culturally competent scholarship.

Source: American Association of Colleges of Nursing

http://www.aacn.nche.edu/education-resources/cultural-competency

Reflective Practice in Nursing

Reflection “on action” Unconsciously embedded into performance

Reflection “on practice” Post-event reflection, examines action after

the performance

Action commitment Limited use in public health, cultural

competency, and unconscious bias education

Jayatilleke, N. M. (2011). Reflection as part of continuous professional development for public health professionals: a literature review. American Psychologist, 69(7), 669-684.

Reflective Practice & Nursing Increasing interest ,publications ,research &

practice in public health, health professional and nursing education

Evidence related to benefits and challenges

Individual (internal process) Examination of one’s moral consciousness, convictions,

ethical dilemmas leading to a conclusion

Interprofessional team (outward process)

Sharing of multiple perspectives may lead to deeper reflective practiceMann, K. G. (2009). Reflection and reflective practice in health professions. Advances in

Health Science Education, 14, 595-621.

Gustafsson C, A. M. (2007). Reflective practice in nursing care: Embedded assumptions in qualitative studies. International Journal of Nursing Practice, 13, 151-160.

Cultural Competency Education Cultural competency Course

(Elective, online & face/face course)

Reflective self-assessment exercise

Reflective narratives following immersion experiences

Longitudinal reflection opportunities

Interprofessional Educational Opportunities(IPE sessions)

High Fidelity Simulation Reflective debriefing following culturally based

simulation

Cultural Competency CourseSelf Assessment of Biases

Self examination of personal biases and stereotypes based on one’s class, race, religion, gender, ability, and/or sexual orientation

Interprofessional team & online cultural competency course

Reflective responses:

“Empowering”, “eye opening”, “this is something that I will take to clinical practice and recommend all health professionals do”;

“This exercise allowed me to better understand how my stereotypes and biases impact my patients”

“The exercise opened my eyes to how I might knowingly or unknowingly discriminate against patients in the healthcare setting.”

Picture from http://www.continental-languages.com/ Bridging the communication gap

High Fidelity Simulation in Nursing

Mitigates the gap in theory to practice and behavior change Uses reflection, critique, correction, evaluation

and open post reflection

Used at individual and team level to: Realistic clinical experience as a trigger

In a safe environment for errors without social or service responsibilities

9

Evaluation of High Fidelity Simulation with Reflection

Undergraduate nurses & Interprofessional teams

Case scenario grounded in the provision of culturally and linguistically appropriate services

Multidisciplinary team and Live “patients “

Evaluation of behavior change possible using an Objective Structured Clinical Evaluation (OSCE) Tool

Scenario developed by Jana Goodwin, PhDc, CRNP , University of Maryland School of Nursing, Shady Grove Department

http://fpb.case.edu/News/2010/macygrant.shtm

Summary

Reflective Learning can:

Lead to a deeper of understanding of one’s unconscious thoughts, attitudes, and biases

Promote self awareness, confidence, and growth

Serve as a tool to elicit ongoing change and improvements in clinical effectiveness and quality service

Build on a developmental process of reflective learning from everyday experiences

Key Points for Discussion

Given what is known about reflection, how we incorporate it into unconscious bias education?

What strategies can be use to expand the evaluation of reflection beyond traditional qualitative assessments?

Reflection is proposed to assist in the development of culturally competent care, but what are the specific processes that can be measured?

What strategies can be utilized to measure and evaluate reflection in real life settings, individually or as part of an interprofessional team, to reduce unconscious bias and improve patient outcomes?

What are the potential effects of promoting reflection?