Advancing the quality of care and nursing practice through emancipatory reflection

Reflection is a fundamental skill of health-care professionals and plays an important role in ensuring the quality of care in health-care practice. It is believed that undertaking reflection in practice can help nurses develop an awareness of a sense of personal power and agency, cultivate their critical thinking ability and help them promote their professional development. However, reflection has not been introduced widely as a nursing curriculum in China, and literature shows that some clinical nurses lack critical thinking skills and critical reflective practice skills by reason of not receiving systematic education on reflection when they were at nursing college.Therefore, we present a series of seven articles focused on prevalent and interesting practice-based events to reflect on in this special issue. The main aim is to disseminate reflective methodology and techniques and present examples of reflective writing for nurses.It is expected that these articles will help to lead Chinese nurses to adopt critical emancipatory reflective processes to bring about transformative actions.

Critical emancipatory reflection on a practice-based issue in relation to the working relationship between doctors and nurses in China

Objective: Reflection is viewed as the most significant skill and should be advocated for lifelong learning. In order to grasp the process of reflection and embrace the reflective skill, one of the authors of this paper reflects on a practice-based issue in relation to the communication between doctors and nurses, to gain new understanding and thus improve the authors' clinical practice.Methods: Smyth's framework with four stages is utilized as an ideal framework to guide the author's reflection on the practice-based issue to free the author from her entrenched assumptions and the oppressive forces that limit her practice.Results: The espoused and enacted theory, together with the critical reflection theory, are used to explore the values and beliefs that essentially govern the author's practice and how these are distinct from the author's worldviews. Following this, critical emancipatory reflection is undertaken to explore the dominant power structures within the author's workplace. Furthermore, given the hegemonic and chaotic working context of this issue, hegemony and symbolic interaction theory are applied to unearth the various hidden constraining and oppressive forces. Additionally, socialization theory is utilized to help the author achieve professional identity.Conclusions: Reconstructing the practice-based issue empowers the author to realize that in the future, she should act as a reflective practitioner, creating a daily habit, staying alert to practice, seeing things freshly, finding support systems, improving communication skills, conducting reflective research, and reifying reflective practice. Ultimately, the author will be sufficiently equipped to be able to transform her practice and change its outcomes.

Critical emancipatory reflection on establishing an equal,trusting relationship among surgery participants in clinical practice in China

Objective: Reflection is considered to be one of the important ways to learn from one's experience, and one should be encouraged to apply the skill of reflection in lifelong learning. The author used the critical emancipatory reflection theory to reflect on a practice issue,which was related to the relationship between doctors and nurses, and tries to become a lifelong reflective practitioner in clinical work.Methods: Smyth's reflective framework, which includes the steps describe, inform, confront, and reconstruct, will be used in this article to help the author to understand the process of reflection and improve the skill of reflection. Utilizing Smyth's reflective framework to reflect on an issue in practice allows the author to break the routine way of thinking and learn from experience, as well as providing a higher quality of service for patients.Results: The theory of emancipatory reflection along with the critical reflection theory will be used to determine the beliefs and values that rule the author's action and derive how these are distinct from what the author is supposed to achieve. Besides, critical emancipatory reflection theory will be used to discover the dominant power structures in clinical practice; symbolic interaction and hegemony will be utilized to discover the factors that prevent the author from achieving the desired goals; socialization theory will be applied to facilitate the author in improving the professional identity.Conclusions: Using the critical emancipatory reflection on the issue in practice helps the author to find out the constraints in practice,bridge the espoused value and enacted value, and thereafter undertake transformative changes in practice. Eventually, the author can improve the skill of critical emancipatory reflection and become a lifelong reflective practitioner, and the quality of clinical practice can be improved as a result.

Critical emancipatory reflection on a practice-based issue in relation to nurses' communicative role with unsatisfied clients in Chinese hospitals

Objective: This study aims to use reflective theory and critical emancipatory theory to explore nurses' communicative role with unsatisfied clients.Methods: This paper begins with the broad issue, and the analysis will engage Smyth's cycle, which includes describing, analyzing,exploring, and reconstructing.Results: Critical emancipatory reflection is essential to make changes in the professional practice of nursing, because it is of primary importance for the professional learning and development of a nurse.Conclusions: Critical emancipatory reflection helps a nurse to analyze the constraints, including historical, sociocultural, political, and personal aspects.

Listen and talk to the older patients:a critical emancipatory reflection on the practice of communication issues

Objective: Reflection is a process of deliberating thinking and examining one's practice in the past and thereby encouraging nurses to make improvements in future care delivery. This work outlines a piece of reflection involving the practice of communication between nurses and the elderly, to emancipate the authors from their constraints, help to find values as practitioners, and gain a greater understanding of the nurse-patient relationship.Methods: Using Smyth's four-stage model as a guide, as well as empirical and theoretical knowledge on nurse-patient relationships, this paper presents a deep reflection on the relationship that the authors developed with elderly patients and their families, encountered during the practice as a nurse. By applying the four main stages consisting of describe, inform, confront, and reconstruct, this model enabled the authors to frame, describe the practice issue, and explore the meaning behind it, which helps to facilitate a structured reflection.Results: Critical emancipatory reflection, in association with the Espoused theory and Theory-in-use, as well as reflexivity, critical social theory, and hegemony, was applied to uncover the various power relationships and constraining forces in the authors' practice involved in communicating with the elderly, such as the underlying false consciousness, hegemony, hidden assumptions, influential values, and dominant power structure, which are subtle and persuasive. By applying this process of critical reflection, transformative practice could be achieved.Conclusions: The process of critical reflection facilitated the development of the abilities required to develop and maintain the nursepatient relationship. It helps to enhance the care of old patients and their families, which illuminates the future nursing practice.

Emancipatory reflection on a nursing practice-based ethical issue about nurses' paternalistic decision-making for patients

Objective: This study aimed to demonstrate and promote the skill of critical emancipatory reflection through reflecting on a nursing practice-based ethical issue about nurses' paternalistic decision-making for patients. Meanwhile, critical awareness will be developed and the underlying issues of paternalism in nursing decision-making will be analyzed. Then, by applying the procedure, improvement in nursing decision-making practice will be expected.Methods: Taylor's model of emancipatory reflection with four steps, including construction, deconstruction, confrontation, and reconstruction, is utilized to guide the author's reflection.Results: Guided by the socialization theory, the author's personal and professional socialization is seen to be associated with the formation of the value of paternalism. The theory of reflexivity is applied to unearth the related issues, including deeper personal value,work environment, as well as historical and cultural contexts. Moreover, the power derived from policy, work relationship, and nursing administration, which could induce paternalism in the author's nursing decision-making practice, was critically debated using the hegemony theory. Finally, new insights into paternalism will be achieved, which enable change in terms of how to facilitate patients' autonomous decision-making.Conclusions: The process of refection makes it clear that respecting patients' right and performing patient-centered caring are the bases to change the paternalism existing in the nursing decision-making practice currently. The reconstruction step assists the author in terms of how to value the patients' autonomy and balance patients' safety and choice, rather than being overprotective; carry out risk assessment, and search for strong evidence to counterbalance the positive and negative aspects of risk-taking; communicate with patients appropriately in a manner that they can comprehend; spend more time to explore patients' preference and choice; make every effort to elevate the patients' decision-making capacity; implement patient-centered care and shared decision-making in nursing practice; consult with other colleagues and obtain the required support when limitations or challenges exist; try to justify and avoid hidden paternalism behind policy or guidelines; deal with the power in hand well and fairly; and also positively face the powers that constrain the author.

A critical reflection on improving effective team communication

Objective: This paper aims at critically reflecting on the author's personal experience in the context of communication within a nursing team and exploring relevant existing constraints with a view to improving practice and achieving more effective outcomes in team communication.Methods: Critical emancipatory reflection is used to evaluate and interpret the author's practice. Smyth's model serves as a framework to guide critical reflection step by step in this paper. Relevant theoretical perspectives help to make sense of the author's performance in terms of team communication.Results: It is identified via emancipatory reflection that the author endorses the ideas of equality, respect, trust, and collaboration, which were formed and established during the process of professional socialization. However, different constraints, such as sociocultural,historical, political, and personal factors, impede the author from performing more effectively in terms of team communication.Reconstruction provides the author opportunities to take actions to rectify constraints and avoid the reemergence of previous situations in the future.Conclusions: Reflection is an effective way to gather knowledge and develop comprehensive understanding of practice. Alternative actions for effective team communication are recommended, including formulating ground rules for discussion, guiding nurses in the correct way, transforming conflicts within a team, being an active and reflective listener, and motivating nurses to actively create.

Critical reflection on the role of theater nurses in a multidisciplinary team for perioperative care in China

Objective: The aim of this article is to reflect on the role of theater nurses in a multidisciplinary team, understand the factors that have influenced theater nurses' practice, and improve the authors' clinical practice ultimately.Methods: The author used Smyth's model to guide the process of reflection on the practice issue. Critical reflection, critical emancipatory theory, reflexivity, and critical social theory were used to help the author analyze the factors that have affected theater nurses' practice in the organization.Results: There are gaps between the espoused and enacted theories. A theater nurse's practice is determined by multiple factors, such as political, structural, social, historical, cultural issues, and so on. The hierarchy of the health context could hinder possible changes in theater nurses' practice. To better understand our practice and implement transformation, we should shape a supportive environment,bear in mind the practice motto of "patient-centered" care, and improve our knowledge and reflection skills.Conclusions: Reflection plays a significant role in the advancing of practice among theater nurses and needs to be combined with clinical practice. To provide the best service of care to perioperative patients, a theater nurse should have an insightful understanding of the factors that have influenced her/his behaviors historically, socially, and culturally. By improving their critical reflection skills,practitioners could gain knowledge from experience.

Learning in Times of Crisis： Rural Grassroots Movement in Mexico

This paper discusses transformative learning in relation to environmental crisis in rural communities in Guanajuato （Mexico）. Environmental pollution and resource depletion have triggered reflection and perspective transformation across groups of rural communities. The study is qualitative and results are based on lengthy interviews, within a well-known context for the researcher. This article is the reflection on how transformative learning took place looking fol; lessons to be learnt for communities facing environmental challenges.

The Philosophy of Social Segregation in Israel＇s Democratic Schools

Democratic private schools in Israel are a part of the neo-liberal discourse. They champion the dialogic philosophy associated with its most prominent advocates--Martin Buber, Emmanuel Levinas---together with Paulo Freire＇s critical pedagogy, the humanistic psychology propounded by Carl Rogers, Nel Noddings＇s pedagogy of care and concern, and even Gadamer＇s integrative hermeneutic perspective. Democratic schools form one of the greatest challenges to State education and most vocal and active critique of the focus conservative education places on exams and achievement. This article describes the dual discourse connected to the schools. The first is the inner dialogical, which is devoted to student freedom and progress, the child being placed at the center. The second is the exterior discourse, which represents the school as a place of counter-education that provides personal and group development and comprises a site of liberty and choice. The schools in Israel are described as test case and indicating the existence of a sophisticated form of deception via the use of alluring terminology. The democratic private schools should be recognized for what they really are--agents of commodification that undermine democracy rather than enhance it.

Transforming Practice through Reflection in Patient Education

Objective:This paper is a report about transforming patient education practice,to get further transformation of patient education.Method:Smyth’s critical emancipatory reflective framework was used to guide the reflective practice.Results:Many reasons influence the patient education practice including nurses’worldview,historical,economic and social reasons.Conclusion:Nurses should empower themselves as well as patients,and patient education should be based on patients’needs and their belief,the responsibility of nurses should be guiding and teaching.