Reflective Practice: Transforming

Education and Improving Outcomes

Sara Horton-Deutsch, PhD, PHMCNS, RN, ANEF

Professor and Watson Caring Science Endowed Chair University of Colorado-Denver

2014 Nurse Educator Conference in the Rockies

Pictures taken my Karen Hinz kmhinz@centurylink.net

Outline

Part I: Creating an Environment for Reflective Learning

Part II: Guiding Reflective Learning through Models and

Frames

Part III: Assessing and Evaluating Reflective Learning

2

Part I: Creating an Environment for

Reflective Learning

4

Why is this so important?

And…. • Advances in science, technology, health care, and the nature

and settings of practice alter how nurses practice

• Transmitting core professional values, providing appropriate

care and keeping patients safe requires nurses have a

complex array of skills

• Changes in practice mandate changes in education

• Reflective learning helps to bridge the gap between education

and clinical practice

5

Transitioning from…

•Episodic care

•Hierarchical silos

•Nurse supports primary

care provider

•Disciplinary silos

•Teacher-centered

•Focus on entry into

nursing

6

• Integrated care

•Team-based care

•Nurse is primary care

provider

• Interprofessional Learning

• Learner-centered

•Focus on professional

lifetime

So, what gets in the way?

How has the “quick fix” driven our approach to education?

What has happened to our ability to dwell in unknowing, to live inside a question and coexist with the tensions of uncertainty?

Does creativity flourish in certainty or in questions? —Inspired by Sue Monk Kidd

“When we keep the line moving forward at the expense of inward motion something

deep within us walks backward”

G. K. Chesterton

7

What do our students need

from us?

• Authentic

Presence

• Our being

• Practice of

genuineness

8

• Self knowledge

• Ability to self reflect

• Being in the moment

• Caring communication

Engaging in more human-centered processes

Attending to value-laden lived experiences

Possessing mindfulness and incorporating mindfulness-based

approaches to complement more traditional approaches to

education

And…

Creating space for reflection in the

traditional classroom or online:

How do we Create Authentic Presence?

The Value of Mindfulness

• Help us to build both insight

and empathy

• Supports the development of

ongoing skills of self-

awareness as well as well as

others

• Supports efficiency in

communication and problem

solving

• Patient satisfaction is rooted

in the relationship between

the practitioner and patient

“A teacher can help anyone

on the path to awareness.

The most valuable teacher

is not the one with the

deepest knowledge or the

most eloquent. It is the one

who points you in the

direction that enables you

to see.”

Anonymous

Attend to themselves with care and compassion and don’t

judge others harshly

Deconstruct their own experiences so they are able to

respond thoughtfully to others

Are aware of own self-care needs, practice self-care and

transfer this care into education and training of others

Mindful Educators

1. Mindful Meditation –Mindfulness of Sounds and Thoughts

2. Student response

3. Review Agenda for Class and Take Questions

4. Watch Video on Heart Math http://www.heartmath.org/about-us/about-

us-home/hearts-intuitive-intelligence.html

5. Dialogue

•What did you learn?

•Why is it important?

•How will you apply it in your practice?

•What more do you want to know?

6. Class topic: Domestic Violence and Abuse: Watch Ted Talk – Jackson

Katz, PhD MVP Strategies-FiDi Women

Sample Class Outline

7.Dialogue 8.Take a few minutes to write some of the strengths of the bystander intervention approach

to prevention, and the opportunities you see? 9.Think about your organizations (current work or clinical practice site) current initiatives and

how the bystander approach has the potential t enhance and amplify these initiatives? What individual changes in attitudes or beliefs that you can promote by incorporating this

model? What is one thing you can do? What do you need to make it happen? Practice Role Playing What Questions are you left with?

10.Contemplation Exercise: “Sufficient energy is needed to actualize caring for and compassion toward clients. Compassion comes from an open heart as well as willingness to take action to relieve pain and suffering. Compassion is the element of caring that spurs the professional helper to go the extra mile, to advocate, and to show up in the face of difficulty. If our energy is compromised or dispersed, we may fall short of our clients’ needs despite our actual intentions. In the way we bring our mind to single-pointed attention in Zen, we must bring our mind-body into dedicate action on behalf of our clients. “ Bein, 2008, p. 84-85).

Class Outline Continued

Modeling the Way

What unique gifts and talents do you have that you bring to the classroom?

“By being present, learners bring clarity to what they are

sensing, thinking, wanting and willing to do. Integrating

mindfulness into educational pursuits lays the foundation

for reflective learning.”

Schon, 2003

Mindful Learners

19

How do you know when students are really present in the classroom? How do you know they are engaged in learning?

What ideas are emerging for you in regards to creating an environment for reflective learning?

Question

Part II: Guiding Reflective Learning through Models and

Frames

Appreciative Inquiry

Discovery What gives life to your classroom?

Dream What can you imagine for your classroom?

Destiny Make the plan happen?

Design How will you make it happen?

Mode of Instruction

Traditional: Expert to Novice

AI: Open Learning Partnership

Objective evaluation and assessment

Educator directed learning experience

Focus on what learners do incorrectly

Educators set rules of

behavior

Mutual openness to examine new ideas

Educators and learners determine successful strategies for learning

Focus on what learner desires

Educators and learners follow steps of AI to establish elements of engagement

Framing your Course through Elements of Engagement

Be present and on time

One person speak at a time

Listen with compassion and

curiosity; ask for what you need and offer what you can

Share ideas and experiences

Articulate positive expectations

Encourage listening, attending and being present

(Horton-Deutsch and Ironside, 2010).

View learning as circular, nonhierarchical, and nontheoretical

Flexible and accommodates teaching and learning

Get students actively involved with learning in new ways

Viewed as the fundamental purpose of education itself

Include service learning, practice or patient-based learning,

collaborative learning, simulation and practica

Coupled with AI helps to generate questions, narratives, and

innovative ideas for student and faculty development.

Pedagogies of Engagement

Shulman’s Table of Learning

Gibbs - Reflective Cycle (1988)

Boyd and Fales - Stages of Reflection (1983)

Mezirow - Levels of Reflectivity (1981)

Johns - Model of Structured Reflection (2006)

Frameworks for Facilitating

Reflection

Gibbs Reflective Cycle

Description What

happened?

Feelings What were

you thinking and feeling?

Evaluation What was good and

bad?

Analysis/Conclusions

What else could you

have done?

Action If it arose

again what would you

do?

How might you use reflective models and frames in your classroom and/or clinical settings?

Question

Part III: Assessing and Evaluating Reflective Learning

Rethinking Assessment and Evaluation

“Reflective practice is based

on the fundamental principle

of continuous learning through

a process of self assessment

and integration of knowledge with experience.”

Horton-Deutsch, Sherwood, & Armstrong (2012)

◦ Why am I in this class, program, profession?

◦ What choices did I have to make to be here?

◦ What do I expect that I can take with me?

◦ What am I willing to invest?

Self Assessment: Onset of Program

Why am I here?

What are my goals for learning?

What commitment do I make to engage in learning

to achieve my goals?

Self Assessment: Onset of Class

In what ways did class achieve my expectations?

What did I learn?

How will I use what I learned?

Self Assessment: End of Class

Write for one minute the most important lessons you learned today. Why were these lessons important, and how can they help you? What else do you need to explore to

further grow in this area?

Daily Reflective Writing Exercise

Rethinking Assessment and Evaluation

“As such, it highlights the

responsibility of professional

nurses to adopt an open

attitude and lifelong

commitment to assessing and

continuously improving their work.”

Horton-Deutsch, Sherwood, & Armstrong (2012)

Does the learner seek alternatives?

Does the learner view the experiences from various perspectives?

Does the learner use a framework or theory?

Does the learner compare and contrast?

Does the learner put the experience into different or varied context?

Does the learner ask what if..?

Does the learner consider consequences?

General Reflective Questions for Didactic

or Clinical Learning

Action research projects

Case studies, with unfolding elements

Narrative and story

Critical incidence analysis

Skill-based assessment

Computer-based learning and assessment exercises

Writing tasks, poetry, biographies, reflective essays,

journals and portfolios

Teaching Strategies that Encourage

Reflection

A way of organizing the thinking process.

Involves describing the experience objectively; then rigorously examining that experience through the use of prompts that are closely related to the desired learning outcomes; and articulating the learning that arises from that examination.

DEAL Model of Reflection

• Describe experience objectively (What? Where? Who? When?

Why?)

• Examine experience per reflection prompts (by category of

learning including) Personal Growth

Civic Engagement

Academic Enhancement

• Articulate Learning What did I learn?

How did I learn it?

Why is it important?

What will I do because of it?

DEAL

Goal: To learn more about yourself and to consider what

change or changes you want to make as a result.

What were your attitudes, assumptions, and interpretations in the

encounter?

How did you contribute to, react in, or interpret the situation?

What did you learn about yourself? Your assumptions of other

people? How you believe people felt? Ways in which you did or

did not have difficulty interacting with others?

Examining for Personal Growth

Goal: To learn about change agency or approaches taken to

meet collective objectives, across various levels of

community (from what is happen in their service experience

to what is happening in society at large).

What are we trying to accomplish?

What approaches did we take and why?

How do we change to a systematic approach?

Examining for Civic Engagement

Goal: To learn the academic material of the course or

discipline better than you might have otherwise as you

experience it in the context of practice.

Academic concept that applies? How does what I read in a book or

talked about in class emerge in my work?

How is the material the same or different from what I experienced in practice? Why?

What are the reasons for those differences?

How can what I learned about the material be used by me or others

and are there any challenges associated with doing so?

Examining for Academic Advancement

Complete all three steps in written form, producing what

is called a “DEAL essay”

Describe and Examine orally (in pairs or in groups) and

then Articulate Learning in written form either in class or

as a homework assignment.

Describe online, Examine orally in class, and then

Articulate Learning individually as a homework

assignment.

Or any other combination that works for you.

To complete the DEAL Model, students

can:

Case Study: Haunted by Saul

Think of a personal (self, family member, or friend) or professional

experience with substance use. Write the narrative/story of the

experience. This should be a thick description of the experience. A

thick description is defined as “…describing a phenomenon in

sufficient detail one can begin to evaluate the extent to which the

conclusions drawn are transferable to other times, settings, situations,

and people” (http://www.qualres.org/HomeThic-3697.html).

Now give the experience a name. The name should reflect the

experience.

For example, Jane named her narrative of caring for her patient;

Haunted by Saul.

DEAL Exemplar: Describe

Where you see a blank, insert the name you gave the experience. The purpose

of this is to externalize the experience for examination purposes as well as deconstruct (critique dominant understandings of a particular topic—in this example we are looking at substance use).

If __________ could talk to me what would it say to me? (Jane’s sentence would read: Example: If Haunted by Saul could talk to me, what would it say?

What are the main themes related to __________ embedded in the narrative? What does __________ have you thinking about illness? What does __________ have you doing about or in relation to illness? Does __________ encourage particular ethics/values about illness? Now, reflect on your answers and write a reflective summary statement.

Deal Exemplar: Examine

What did I learn? About myself? Substance use? What I thought I thought? Etc…

How did I learn it? (Be specific. It is not sufficient to merely state,

I reflected or wrote. Think about what it was with regard to the assignment, afterwards conversation, reflection, etc… that prompted your learning.)

Why does it matter? (personally and professionally) What will I do in the future, in light of it? (personally and

professionally)

Deal Exemplar: Articulate Learning

What’s missing from this analysis?

What most needs further scrutiny?

What are the chief critiques pf what I’ve been saying?

What unresolved questions am I left with?

What are the most troubling questions raised?

Continued

Self-reflect on this story from one of the 3 perspectives. ◦ What stands out in the story? What did you notice?

Share your thoughts with one other person. ◦ Each person share their view for 1 minute of uninterrupted time.

Move into large group discussion and consider assumptions. ◦ What assumption did you hold about Saul? ◦ What assumptions where challenged/disturbed?

◦ What new perspectives or interpretations of the topic could be considered?

◦ What are the most pressing questions I am left with?

Group Activity: Think, Pair, Share

Appreciate Philosophy

Openness between learner and educator

Attend to fairness

Open dialogue to continuously analyze and

reframe learning goals

Focus on assessing how well learner internalized

what was learned and translated into changes in

behavior

Reflection to Inform Evaluation

What went well for you in class (clinical) today?

What do you want more of?

What, if anything, is frustrating you?

What are you still worried about?

Reflective Class Evaluation

What gave this course energy?

What made it come alive for you?

What were the most successful experiences you had in this course?

What was happening?

Who was involved?

What did they do?

What was your role?

How will this inform your work as you move forward in the program?

Appreciative Approach to Course

Evaluation

Question for Reflection

From what we have talked

about today what new

teaching and learning

strategies are emerging for

you?

Ash, S.L., & Clayton, P.H. (2009). Generating, deepening, and

documenting learning: The power of critical reflection in applied

learning. Journal of Applied Learning in Higher Education,1(Fall), 25-48.

Paul, R. & Elder, L. (2005). Critical thinking: Tools for taking charge of

your learning and your life, 2nd Ed. Columbus:

Pearson/Prentice Hall.

Sherwood, G. & Horton-Deutsch, S. (2012). Reflective Practice:

Transforming Education and Improving Outcomes. Indianapolis: Sigma

Theta Tau International.

References: