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Sensitivity Training

Wednesday, July 15, 2009 - Sensitivity Training

Nursing students practice cultural competence in simulation labs.

By Andrea R. Hale and Nikki Llorin, ADVANCE for Nurses, July 15, 2009

Understanding and maintaining sensitivity toward patients from diverse backgrounds is important in delivering nursing care, but can sometimes be overlooked.

At the Goldfarb School of Nursing (GSON) at Barnes-Jewish College, St. Louis, nursing students learn how to care for different types of patients throughout their programs. Part of their curriculum includes working in GSON's clinical simulation labs, which resemble a hospital environment and include a wide range of patient simulators -- high-tech mannequins on which nursing students practice and strengthen various clinical and cultural competence skills before they encounter real patients.

Faculty and clinical simulation lab staff work hand in hand to create learning opportunities in the simulation labs. "Our job is to assist the faculty by setting up scenarios and bringing the simulators to life," said Debbie Sutter, BSN, RN, clinical simulation lab facilitator. "I use my background in nursing to control the physiological mechanics of our high-fidelity simulators on a daily basis."

The simulators are treated as real patients and have different hairstyles, ethnicities, and incorporate several other physical differences. Each patient has its own identity and is given a name, medical history, dietary restrictions, as well as a religious and cultural background. There are two-way mirrors separating the simulation lab facilitators and faculty from the students and patients. Behind the glass is a control room where Sutter and her colleagues are able to control the overall movement, sound and behavior of each patient.

"We are the 'man behind the curtain' and can make a patient cough, talk in a different language, as well as get sick and vomit," said Sutter.

Tina Ahearn, BSN, RN, another clinical simulation lab facilitator, played an instrumental role in incorporating diversity and inclusion into the simulated environment. Ahearn's background is in international health care and has previously worked to provide case coordination for foreign nationals seeking medical care within the Washington University Medical Center. "Health care systems around the world are vastly different from ours," she said. "I worked with patients and their families to help them better understand the U.S. health care system." Ahearn applies the skills and knowledge gained from her previous job to the simulation labs.

The scenarios developed in the simulation labs allow students to identify and respect different cultural nuances so they become aware of them once they start working with real patients. In one of the classes, Health Assessment, the simulation lab staff let the students identify cultural characteristics that are unique to each patient. Students are exposed to several different worldviews with patients ranging from Middle Eastern, Indian, Jewish, African American, Hispanic and Caucasian. Scenarios also include interacting with military veterans and those with physical or visual impairment. All simulators are dressed in the appropriate garb and regalia to make them as lifelike as possible. The patient rooms also have "props" to indicate a patient belonging to a particular culture, and even patient binders are translated into multiple languages.

"One example of a scenario that we are developing involves Muslim patients," said Ahearn. "We show the importance of cleansing themselves before prayer, so we may include a prayer rug and holy beads in the scenario so that our students learn about these rituals to provide the best care possible."

The simulation lab at GSON offers nursing students a low-stakes and safe learning environment where facilitators and faculty can expose them to almost any scenario imaginable. They learn how to handle family members, perform health assessments, employ therapeutic communication, as well as how to incorporate concerns surrounding patient safety and quality of care.

The simulation program is one of the few that incorporates patients with different cultural backgrounds. Even though the program continues to be successful in teaching nursing students how to provide culturally competent care, there are still some improvements Ahearn would like to see.

"We would really like more input from faculty and our hospital colleagues in developing the curriculum and incorporating more scenarios each semester," said Ahearn. "It would allow us to reach out and be a strong resource for our colleagues and communities by helping them understand individuals with culturally diverse backgrounds."