June 12, 2020By Lance Baily

How to Use Clinical Simulation to Train for Transgender Patient Care w/ Scenario Template

Continuing from our previous article on why Healthcare Simulation is a powerful tool to train for cultural competency, today we specifically focus on how clinical simulation can be utilized to educate and train for the care of transgender patients. While this group of individuals makes up only a small fraction of the population, they number of persons increasing their visibility in society is increasing — but are frequently surveyed as being misunderstood or mistreated by healthcare professionals. Medical simulation clearly provides a powerful opportunity for educators to introduce learners to simulated patients who represent this minority community. Here below are articles, research publications and scenario templates to help your program use clinical simulation to educate for the care of transgendered patients.

SimTalk Blog: Creating Simulations for Transgender Patient Care

Pocket Nurse’s Dawn Mangine asks “Did you know that it is estimated that the transgender population in the United States is disproportionally affected by mental health issues and homelessness?” She continues: In fact, this population is three times more likely to attempt suicide and twice as likely to be assaulted of victimized. Sadly, transgender people who seek healthcare frequently face discrimination by the very care takers they seek help from, with The National Center for Transgender Equality finding that about a quarter of survey respondents decided not to seek medical care due to fear of being mistreated.

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The good news is that healthcare educators are beginning to address this discrimination by creating simulation scenarios incorporating care for transgender patients. These simulations range from nursing students working with high-fidelity manikins to interprofessional education (IEP) in a hospital setting with standardized patients (SPs). Even more encouraging, these types of educational scenarios will not only serve to decrease discrimination, but will improve healthcare outcomes for patients who identify as transgender, gender non-conforming, and other queer patients.

Indeed, by describing the barriers related to and faced by transgender and gender non-conforming patients in the context of receiving care in healthcare settings, nursing simulation educators can provide tools to develop a practice that is informed, sensitive, affirming, and empowering. Read the full Pocket Nurse SimTalk article for more learning objectives and scenario ideas

Sigma Nursing on Simulation as a Path to Better Care for Transgender Patients

“What if you identify as a man but you need an OB-GYN exam, your Pap smear?” asks Desiree Diaz, PhD, RN-BC, CNE, CHSE-A, assistant professor of nursing at the University of Central Florida College. At a time when transgender issues are seeing increased attention in the United States over laws mandating gender-specific bathrooms—and last summer’s shooting at Pulse nightclub in Orlando, Florida, that targeted the LGBTQ community—Diaz and Maruca say it’s even more important to teach caregivers how to help a population that often shuns healthcare. The UCF College of Nursing is among a growing number of programs that use simulation technology to educate nurses on how to provide care for a myriad of cases. The simulations use a high-fidelity human patient simulator, or manikin, that speaks.

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The simulator describes medical symptoms and acts much like a patient would, enabling nursing students to learn how to provide knowledgeable, compassionate care. What they learned was that as a younger generation of students enters the nursing workforce, there are fewer biases against transgender people. That, however, doesn’t mean they are comfortable or knowledgeable about providing this population with quality care. “We found the students were trans-friendly, but not necessarily trans-educated,” Maruca says. “We want them to go out and be leaders in beginning these discussions.”

Senior Nancy Rupp said that the simulation experience made her feel better prepared, suggesting that “It’s important that we can act like nurses treating him so that if we make a mistake, it’s in a sim, not in the real world,” she says. “This is a situation we might not have the chance to experience in clinicals. It allows us to ask questions and hopefully find you’re prepared for a similar situation later.” Read the full Sigma Nursing article here.

Promoting Affirmative Transgender Health Care Practice Within Hospitals: An IPE Standardized Patient Simulation for Graduate Health Care Learners (McCave et al.): This research paper focuses on  exploring how transgender patients frequently experience discrimination within health care settings due to provider lack of knowledge and bias resulting in poor service delivery. Team-based interprofessional collaboration is becoming a best practice for health professionals to improve patient-centered care and address these health disparities.

Student learners reacted overwhelmingly positively to the activities of the workshop. The averaging of 2 years of data yielded students responses of strongly agree and agree at 90% or higher for all IPEC core competencies, as well as for educational objectives of the workshop. Reducing the structural, interpersonal, and individual stigma experienced by transgender patients requires institutions to offer experiential learning opportunities for future health care providers. This interprofessional education simulation experience focusing on transgender patients calls attention to the negative impact of stigma while also promoting competency in interprofessional practice.

A significant lesson was incorporating into the learning experience the perspectives of transgender individuals as health care consumers from the community. The results support this, with the learners indicating that the transgender panel from the community was valued as very useful or useful. For replication purposes, it is recommended that institutions conduct outreach to local and/or state LGBT consumer-focused organizations when there are existing partnerships. Read the full MedEdPORTAL research article here.

Transgender Simulation Scenario Pilot Project (Muckler et al.): From the INACSL Clinical Simulation in Nursing Journal, this study focused on exploring how 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. 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. Read the full Clinical Simulation in Nursing article here!

SOGI Nursing: The Sexual Orientation and Gender Identity Nursing website is a toolkit for nurses and nurse educators committed to providing resources and education around 2SLGBTQ+ issues in healthcare. The toolkit consists of five lessons, including four virtual simulation games (VSG), of varying lengths, in a variety of settings (i.e. emergency department to community care), and across a range of professional expertise (senior nursing students to nurse practitioners). Visit the SOGI Nursing website to access the toolkit.

Download an NLN Transgender Simulation Design Template Here!

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