Simulation Design: Addressing Care of a Transgender Patient

Just Another Patient? Student Reflections on Providing Mental Health Care to Transgender and Gender Expansive People During Simulated Encounters

AIM

This study analyzed psychiatric-mental health nurse practitioner (PMHNP) students' reflections following a virtual simulated encounter with a patient who identified as transgender or gender expansive (TGE).

BACKGROUND

To reduce mental health disparities, PMHNP students must be prepared to deliver affirming care. Engaging in and reflecting on simulated encounters with standardized patients can improve PMHNP students' affirming care competency.

METHOD

A thematic analysis process was used to analyze student reflections during simulation debriefings.

RESULTS

Five themes emerged: application of affirming care principles, recognizing minority stressors, treating all patients the same, desire to learn more, and valuing authentic practice.

CONCLUSION

PMHNP students' reflections on the experience of providing care to a standardized patient who identified as TGE support the use of virtual simulations to prepare future providers to deliver affirming, person-centered care.

Impact of a Virtual Patient Simulation on Nursing Students' Attitudes of Transgender Care

BACKGROUND

Transgender individuals experience considerable prejudice and bias, creating barriers to health care.

PURPOSE

The purpose of this study was to determine the effect of a virtual patient simulation scenario of caring for a transgender adult on nursing students' attitudes and beliefs about transgender people.

METHODS

A validated 29-item instrument developed to assess an individual's view of transgender identity was administered in a pre-/posttest nonequivalent-groups design to junior- and senior-level nursing students.

RESULTS

Statistically significant differences were found between the control and treatment groups for the subscale human value.

CONCLUSIONS

Findings support experiential learning in nursing as an effective tool in teaching cultural competence and sensitivity when caring for transgender patients. Attitudes and beliefs of senior nursing students and junior nursing students toward transgender individuals differed, with senior students being more receptive.

Gender Diverse Representation in Patient Simulation: A Scoping Review

PURPOSE

Despite recent advocacy for transgender and nonbinary (TGNB) health competencies in medical education, there is little guidance on how to represent diverse gender identities for clinical skills training. Published literature is one of few resources available to inform educators' decisions, so this study aims to summarize how medical education scholarship portrays TGNB identities in patient simulation.

METHOD

This scoping review used PRISMA guidelines with search strings encompassing diverse gender identities and patient simulation. This search was completed in July 2021, and all years of publication were included. The authors completed a 3-tiered review to identify relevant studies and then extracted data to summarize how TGNB patients were portrayed and training outcomes.

RESULTS

After screening 194 total articles, 44 studies met the criteria for full review. Of these, 22 studies involved TGNB simulated patient cases. Within these, 15 (68%) reported the specific gender identities represented in the patient case, revealing mostly binary transgender identities. Sixteen studies (73%) reported the gender identities of all actors who portrayed the patient. The identities of all patients and actors matched in only 10 articles (45%), indicating that most programs portray TGNB identities with cisgender or unspecified standardized patients. Nearly all studies reported desirable learner outcomes. Several noted the advantage of authenticity in recruiting TGNB actors and the need to achieve more accurate representation of TGNB patients.

CONCLUSIONS

Educators are increasingly representing TGNB identities in clinical skills training. These results show a lack of nonbinary representation and discrepancies between TGNB patient cases and standardized patient identities. These data also suggest that simulation programs need and desire better recruitment strategies within TGNB communities. Because TGNB communities are not a monolith, reporting out and analyzing gender identities of simulation cases and people hired to portray TGNB patients helps ensure that TGNB care is taught effectively and respectfully.

Health History Skills for Interprofessional Learners in Transgender and Nonbinary Populations

INTRODUCTION

Transgender and nonbinary peoplehave been identified as vulnerable and clinically underserved and experience health disparities. Lack of health care provider knowledge about transgender and gender diverse populations is a barrier to care, impacting health outcomes. The aim of this project was to develop, implement, and evaluate a simulation learning activity for midwifery and women's health nurse practitioner students and obstetrics and gynecology residents to interact with transgender and nonbinary individuals, with the goal of enhancing health history taking comfort and skills.

METHODS

A partnership was formed among University faculty and simulation educators, a community clinic providing gender-affirming care, and members of transgender and gender diverse populations who served as patient-teachers. Two cases frequently encountered in clinics providing care to transgender individuals were developed for the simulation. Learners were divided into interprofessional groups of 3 and completed one of 2 case scenarios with a patient-teacher. Learners and patient-teachers debriefed after the simulation to discuss and reflect on the experience.

RESULTS

Thirty-three learners participated in the simulation, 12 midwifery students, 16 women's health nurse practitioner students and 5 obstetrics and gynecology residents. Significant differences were observed for all comfort and skills questions, showing increased perceived comfort and skills from pre- to postsimulation. There were no significant differences in attitude responses.

DISCUSSION

We successfully created and implemented a new sexual and reproductive history taking skills simulation in partnership with community clinic staff and transgender and nonbinary persons. The session was well received by learners and patient-teachers. Learners demonstrated significant improvements in comfort and skills in history taking in this setting and provided favorable feedback about the experience. This simulation can serve as a guide to others providing education to future midwives, women's health nurse practitioners, and obstetrician-gynecologists.

The influence of the oncology-focused transgender-simulated patient simulation on nursing students' cultural competence development

BACKGROUND

Disparities experienced by transgender patients, especially in cancer care, leads to poorer outcomes and overall health. Simulation, using transgender simulated patients (SPs) with a focus on cancer care can be an effective way to foster cultural competence nursing education.

METHODS

Guided by the National League for Nursing (NLN)/Jeffries Simulation Theory and Cultural Competence and Confidence Model, this grant funded pretest (n = 48) and posttest (n = 41) comparison group, quasi-experimental study aimed to understand changes in students' transcultural self-efficacy (TSE) following the transgender-simulated patient simulation (TSPS) focusing on an oncological emergency management. Developed by following recommended guidelines and standards, the TSPS had content validity review and pilot testing. It aimed to improve students' knowledge, skills, and attitudes with regard to providing culturally congruent nursing care. The statistical methods included paired sample t-tests, independent t-tests, and correlation analyses.

RESULTS

Students who participated in the TSPS intervention had significantly higher posttest TSE scores (P < .05).

DISCUSSION

SP methodology can be an effective way to foster cultural congruence in nursing care. The findings contribute to the importance of continuous efforts for the inclusion of lesbian, gay, bisexual, transgender, queer (LGBTQ) topic in nursing education to enhance culturally congruent care.

The needs of LGBTI+ people within student nurse education programmes: A new conceptualisation

There is a growing body of international research evidence highlighting concerns around social exclusion and discrimination, significant health inequalities and health needs, and barriers to accessing effective healthcare for LGBTI + people. However, ways in which the healthcare needs of LGBTI + people can be addressed in student nurse education programmes have yet to be fully explored. The aim of this discussion paper is to present the evidence to support the inclusion of LGBTI + health throughout the nursing curriculum. A new conceptualisation of the full and effective integration of LGBTI + health content across and within the nursing curriculum is proposed. This can be achieved by further developing theory, skills simulation and practice learning opportunities. There is a need to ensure that nursing students are positioned and adequately prepared to effectively address concerns of social justice, reducing health inequalities, and providing responsive person-centred care for LGBTI + health service users.

Transgender Standardized Patient Simulation: Management of an Oncological Emergency

Introduction: This article describes the development process of Transgender Standardized Patient Simulation (TSPS) as an innovative cultural competence education and its pilot testing as part of the students' program of study. The multidimensional education strategy, TSPS, aimed to improve students' knowledge, skills, attitudes, and confidence in providing culturally sensitive care to a transgender patient experiencing an oncological emergency. Methodology: The design of the TSPS followed the cultural competence and confidence model and international simulation guidelines. Content validity of the TSPS was established. As our usual simulation assessment survey, the adapted simulation effectiveness tool-modified was used to evaluate if the TSPS met with students' learning need. Results: Participants (n = 32) strongly agreed that the TSPS met with their learning expectations and needs and improved their ability to provide culturally sensitive care. Discussion: Training and practice in this area is much needed and well-received by nursing students and faculty.

Transgender Simulation Scenario Pilot Project

Background

Transgender people often experience inequities, discrimination, and violence within health care environments by ill-informed health care professionals. Simulation has been beneficial in increasing students' knowledge about transgender health issues.

Methods

A transgender simulation scenario was piloted with pairs of students completing an anesthesia preoperative interview with a transgender patient who presents for an emergent surgery. Thirty (42%) of graduate nursing students enrolled in a Doctor of Nursing Practice nurse anesthesia program voluntarily participated in a transgender pilot simulation.

Results

Twenty-eight of 30 participants (93%) completed a presimulation and postsimulation survey with the majority (68%) reporting after the simulation that they had ongoing feelings of incompetence related to the health care needs of transgender patients.

Conclusion

Expanded didactic lessons and simulation experiences that include transgender content can increase comfort levels for both patient and provider as we strive to shift the paradigm toward health care equity for all.