1. 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

2. 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 3

4. 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.

5. 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 practice Mann, 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.

6. 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

7. Cultural Competency Course Self 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.”

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

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

10. 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

11. 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?