June 10, 2020By Lance Baily

Healthcare Simulation is a Powerful Tool to Train For Cultural Competency

When using Healthcare Simulation to educate and train for culture competence, the research evidence is overwhelmingly clear: the potential exists for the use of high-fidelity patient simulation as an effective teaching strategy for cultural competency training. Providing learners with the opportunity to engage and provide care for patients from different cultural backgrounds, ethnic heritages, gender roles, and religious beliefs is crucial to preparing them for the realities of their professional careers; one where they care for the patients that represent the entirety of their community. Here then we present numerous journal articles which highlight the benefits of using medical simulation to teach cultural competency, as well as provide some resources such as simulation scenarios to help simulation programs include such diversity training in their permanent curriculums.

Using Clinical Simulation to Enhance Culturally Competent Nursing Care: A Review of the Literature (San): Increasing multicultural diversity generates a challenge on providing culturally competent (CC) care for both nurses and patients. Multicultural nursing education is the key to achieve new perspectives in nursing care, and therefore, it has gained importance lately. As nurse educators play a significant role in developing the nursing workforce to meet cultural awareness, knowledge, and competency in students, they must appropriately provide culturally specific nursing care, which is customized to fit the patient’s own cultural values, beliefs, traditions, practices, and lifestyles. Clinical simulation is an effective educational tool in nursing education to master the principles of CC nursing care.

Here, the author conducted a literature review to identify the best practices in the utilization of simulation to enhance CC nursing care. Results revealed that the use of simulation can support CC nursing care by providing a safe environment to conduct a cultural assessment, elicit students’ attitudes toward cross-cultural situations, and improve communication, critical thinking, and nursing skills. With these skills, one can recognize cross-cultural issues in interviewing, communicating medical information, and providing treatment and CC nursing care for patients from diverse ethnic and racial backgrounds. Gaps in research still exist regarding the effectiveness of clinical simulation to enhance CC nursing care.


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The Use of High-Fidelity Simulation to Teach Cultural Competence in the Nursing Curriculum (Roberts et al.): The United States population is undergoing a major demographic shift, by the year 2050, it is predicted that minority populations will constitute half of the general population. This evolving population change is significant due to the overwhelming burden of disease that minorities face in the nation. Cultural competence training is currently being used to prepare practitioners to provide care to a diverse population in an effort to eliminate health disparities. With the increasing demands of the nursing curriculum and the limited time frame to prepare competent clinicians, the search continues for innovative strategies that will produce culturally competent providers.

Patient simulation is a technique that replicates real-world scenarios in a controlled and nonthreatening environment. However, despite the legal and moral obligations that nurses have to provide culturally competent care, a lack of evidence exists regarding how to properly integrate simulation methods for cultural competence training into the nursing curriculum. In the nursing curriculum, patient simulation has been used mainly to teach the biomedical aspects of care with less focus on the psychological, cultural, and environmental context. The potential exists for the use of high-fidelity patient simulation as an effective teaching strategy for cultural competence training.

Cultural Respect Encompassing Simulation Training: Being Heard About Health Through Broadband (Lau et al): Cultural Respect Encompassing Simulation Training (CREST) is a learning program that uses simulation to provide health professional students and practitioners with strategies to communicate sensitively with culturally and linguistically diverse (CALD) patients. It consists of training modules with a cultural competency evaluation framework and CALD simulated patients to interact with trainees in immersive simulation scenarios. The aim of this study was to test the feasibility of expanding the delivery of CREST to rural Australia using live video streaming; and to investigate the fidelity of cultural sensitivity – defined within the process of cultural competency which includes awareness, knowledge, skills, encounters and desire – of the streamed simulations.

Cultural sensitivity education using live video-streaming and simulation can contribute to health professionals’ learning and is effective in improving cultural competency. CREST has the potential to be embedded within health professional curricula across Australian universities to address issues of health inequalities arising from a lack of cultural sensitivity training.


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How to Address Minority Health Disparities Through Healthcare Simulation (Laerdal Medical): Here the team from Laerdal how a culturally-competent provider focuses on each patient’s cultural differences, needs, values, preferences, and individualized care provisions. This type of patient-centered care is a method of reaching the best possible patient outcome, but it requires an ongoing and reflective learning process. For providers to develop cultural competence, they must continually adapt the way that they communicate with, assess, and diagnose their patients. As such, clinical simulation is a highly-praised method of training healthcare professionals. Those who are proponents of using simulation often celebrate the opportunity it gives learners to interact with a “real” patient. To improve diversity training and increase the realism of a simulation, it can help to use a patient profile that includes racial, ethnic, socioeconomic, geographical, and religious differences.

Effect of the Diverse Standardized Patient Simulation (DSPS) Cultural Competence Education Strategy on Nursing Students’ Transcultural Self-Efficacy Perceptions (San): In order to eliminate health disparities, enhance patient outcomes, recruit a diverse workforce, and prevent multicultural workplace conflicts, cultural competence in nursing care should be at the core of nursing education. Nursing students find it challenging to provide culture-specific care for patients representing diversity in ethnicity, race, language, socioeconomic status, religion, gender, sexual orientation, immigration history, and lifestyle and frequently lack confidence (self-efficacy) in their knowledge, skills, and abilities. Thus, nurse educators are challenged to find evidence-based teaching learning strategies and diverse clinical experiences to adequately prepare students to meet the needs of a changing world, and it is essential to determine the effectiveness of specific strategies for cultural competence education.

Healthcare simulation, which offers the opportunity for students to practice nursing skills in a risk-free, controlled environment and helps develop self-efficacy (confidence) within the nursing rol, has only fairly recently been implemented for cultural competence education. Standardized patients (SPs) are used as one simulation strategy to teach a variety of skills in nursing, medicine, and other health professions. SPs, sometimes referred to internationally as simulated patients, are individuals who are taught to simulate patients with health concerns or conditions and 2 then participate as patients in students’ simulated clinical experiences targeting specific objectives and outcomes. Standardized patient simulation can be adapted to incorporate different cultural values, beliefs, practices, and lifestyles to assist students to develop cultural competence and transcultural self-efficacy.

Game-Based Teaching and Simulation in Nursing and Health Care (Bauman): It is important to provide nursing students with opportunities to practice culturally competent communication in order to help them develop relevant communication proficiency. Creating safe and appropriate environments where learning can occur is crucial. Simulation, specifically gaming and the use of virtual reality can provider learners with a safe environment to practice behavioral or non-technical skills related to clinical care prior to taking care of actual patients, particularly when addressing content that can be emotionally charged. Simulation and game-based teaching and learning can help healthcare providers learn more about the cultural context of the communities they serve, and communities learn more about how the healthcare deliver system works. This sort of collaboration will improve access to and quality of care through improved cultural competence.

CIRRIE Interprofessional Simulation Cases for Cultural Competence: The Center for International Rehabilitation Research Information & Exchange (CIRRIE) develops curricula and educational materials on cultural competency for rehabilitation service providers working with the growing population of immigrants in the U.S. CIRRIE considers knowledge of cultural views on disability and rehabilitation to be a type of international knowledge of direct benefit to service providers working with foreign-born clients. Previous work focused on workshops on “culture brokering” for in-service training, a monograph series, and curriculum guides. The traditional approach of training rehabilitation professionals in cultural competence is typically classroom based instruction utilizing interactive case studies.

This approach provides background ability, but seldom involves the learner in synthesizing and integrating what has been taught in relation to the real life clinical environment. Simulation provides opportunities to create clinical events that are infrequent occurrences in clinical field work and bring to life paper cases. Simulation bridges the gap between academic preparation and the work environment of rehabilitation. This project creates simulated clinical encounters with manikins and standardized patients for cultural competence training of rehabilitation students or providers.

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