Curriculum Design and Simulation and Assessment and Evaluation in Nursing Education (Due 24 hours)

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SampleKathy_Awkard_Transgender_Simulation_Design_Template_Revised.pdf.pdf

1 © 2015, National League for Nursing. Adapted from Child, Sepples, Chambers (2007). Designing simulations for nursing education.

In P.R. Jeffries (Ed.) Simulation in nursing education: From conceptualization to evaluation (p 42-58). Washington, DC: National

League for Nursing.

This Simulation Design Template may be reproduced and used as a template for the purpose of adding content for specific

simulations for non-commercial use as long as the NLN copyright statement is retained on the Template. When used for this

purpose, no specific permission is required from the NLN.

Simulation Design Template

Date:

Discipline: Nursing

Expected Simulation Run Time: Approx. 15

mins.

Location: Community Clinic or

Primary Healthcare Provider Office

File Name: Care to the Trans* and Gender Non-

Conforming Identified Patient

Student Level: Adapted to Cover All Levels

Guided Reflection Time: Approx. 45 mins.

Location for Reflection:

Admission Date: | Today’s Date: XX/XX/XX

Brief Description of Client

Name: Joe Ramirez

Gender: MtFTG Age: 25 Race: n/a Weight: n/a Height: n/a

Religion: n/a

Major Support: Parents & Girlfriend Support Phone: 301-XXX-XXXX

Allergies: NKDA Immunizations:

Primary Care Provider/Team: No current primary provider. Has been under the care of an endocrinologist, Samuel

Gordon, MD, for masculinizing hormone therapy treatments.

Past Medical History: Relatively healthy. Taking testosterone therapy for over 1-year.

History of Present Illness: Presents today to obtain a flu-shot and annual physical

Social History: In a committed heterosexual relationship for approximately two years. Feels supported in relationship

with his girlfriend. Otherwise history unremarkable.

Primary Medical Diagnosis:

Surgeries/Procedures & Dates: Mastectomy and Chest Reconstruction

Nursing Diagnoses: discuss with participants in debriefing

2 © 2015, National League for Nursing.

Psychomotor Skills Required Prior to Simulation:

Review and practice effective inter-professional communication tools and strategies; namely, ISBARR

Review strategies for therapeutic communication in the patient care setting, and practice those strategies;

Review and practice patient assessment skills.

Cognitive Activities Required Prior to Simulation: [i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)]

I. Pick at least one (1) of the following nursing articles to read prior to the simulation.

Caring for....Transgender Patients:

http://www.nursingcenter.com/cearticle?an=00152258-201411000-00006

Addressing Health Care Disparities in the Lesbian, Gay, Bisexual, and Transgender Populations: A Review of

Best Practices

http://journals.lww.com/ajnonline/Fulltext/2014/06000/CE___Addressing_Health_Care_Disparities_in_the.21.a

spx

Culturally Sensitive Care for the Transgender Patient:

http://www.nursingcenter.com/cearticle?an=01271211-201505000-

00005&Journal_ID=682710&Issue_ID=3106455

Open the Doors for LGBTQ Patients:

http://www.nursingcenter.com/cearticle?an=00152193-201308000-

00014&Journal_ID=54016&Issue_ID=1573627

Providing Care to GLBTQ Patients:

http://www.nursingcenter.com/cearticle?an=00152193-201212000-

00009&Journal_ID=54016&Issue_ID=1467700

Treating Transgender Patients With Respect:

http://www.americannursetoday.com/viewpoint-treating-transgender-patients-respect/

Nursing Care of Transgender Patients:

http://nursing.advanceweb.com/Features/Articles/Nursing-Care-of-the-Transgender-Patient.aspx

3 © 2015, National League for Nursing.

II. Review the information contained in Injustice at Every Turn: A Report of the National Transgender Discrimination Survey (2011). This is a most comprehensive

investigation and published report on transgender and gender non-conforming matters related to

health and the social determinants of health; namely, education, employment, family life, housing,

public accommodation, identification and documentation, policing and incarceration. Please pay

particular attention to the identified health section, although all factors addressed in this report have

health implications:

Injustice at Every Turn: A Report of the national Transgender Discrimination Survey:

http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf

Simulation Learning Objectives

General Objectives:

1. Describe barriers faced by transgender and gender non-conforming patients in the context of receiving

care in a community health clinic;

2. Identify the various roles of a nurse in the context of providing care to a transgender patient in the context of a community health clinic;

3. Evaluate the effectiveness of the nurse in carrying out those roles in the context of patient care in this interaction;

4. Identify tools to incorporate into nursing care to develop a practice that is sensitive, informed, affirming and empowering to the transgender and gender non-conforming patient.

Simulation Scenario Objectives:

1. Demonstrate therapeutic communication skills with the patient; 2. Recognize and demonstrate behaviors that create a safe, welcoming and professional working

environment;

3. Demonstrate effective communication within the context of interprofessional collaboration (Identify, Situation, Background, Assessment, Recommendation, Read back);

4. Demonstrate proper assessment techniques in carrying out the tasks of providing care to the trans* identified and gender nonconforming patient;

5. Identify primary nursing diagnoses and/or collaborative issues in the context of the scenario.

4 © 2015, National League for Nursing.

References, Evidence-Based Practice Guidelines, Protocols, or

Algorithms Used for This Scenario: Coleman, E., Botking, W., Botzer, M., Cohen-Ketteris, P., DeGuypere, G., & Feldman..., J. (2012). Standards of Care for the Health of Transsexual. Transgender and Gender Non- Conforming People, 7th version. Retrieved 2015, from http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1351&pk_association_webpag e=3926 Hein, L., & Levitt, N. (2014). Caring for... Transgender patients. Nursing Made Incredibly Easy!, (12)6, 29-36. doi:10.1097/01.NME.0000454745.49841.76 Hill, M., & Mays, J. (2013). The gender book (1st ed.). Houston, Texas: Marshall House Press. Makadon, H., Mayer, K., Potter, J., & Goldhammer, H. (2015). The Fenway guide to lesbian, gay, bisexual, and transgender health (2nd ed.). Philadelphia, Pennsylvania: American College of Physicians. Teich, N. (2012). Transgender 101: A Simple Guide To A Complex Issue. New York: Columbia University Press. Resiner, S., Bradford, J., Hopwood, R., Gonzalez, T., Makadon, H., Todisco, D., Cavanaugh, T., VanDerwarker, R., Grasso, C., Zaslow, S., Boswell, S., and K. Mayer (2015). Comprehensive Transgender Healthcare: The Gender Affirming Clinical and Public Health Model of Fenway Health, Journal of Urban Health (92) 3. doi:10.1007/s11524-015-9947-2 Schroth, L. (Ed.). (2014). Trans bodies, trans selves: A resource for the transgender community (1st ed.). New York, New York: Oxford University Press. The Agency for Healthcare Research and Quality: Improving Cultural Competence to Reduce Health Disparities for Target Populations (2016) Retrieved 2016 http://www.ncbi.nlm.nih.gov/books/NBK361126/ The health of lesbian, gay, bisexual, and transgender people building a foundation for better understanding. (2011). Washington, DC: National Academies Press. Retrieved 2015, from http://www.nationalacademies.org/hmd/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and- Transgender-People.aspx The Joint Commission: Advancing Effective Communication, Cultural Competence, Patient- and Family- Centered Care: A Field Guide. (2014). Oak Brook, IL: The Joint Commission. Retrieved 2016 from https://www.jointcommission.org/lgbt/

5 © 2015, National League for Nursing.

6 © 2015, National League for Nursing.

Fidelity (choose all that apply to this simulation)

Setting/Environment:

ER

Med-Surg

Peds

ICU

OR / PACU

Women’s Center

Behavioral Health

Home Health

Pre-Hospital

Other: Primary Care Setting—Health Clinic or

Physician’s Office

Simulator Manikin/s Needed:

Props:

Signage to create an environment that looks like a

clinic setting;

Legal Identification Cards: Driver’s License for a

gender other than the person playing the role of the

patient.

Equipment Attached to Manikin:

IV tubing with primary line

fluids running at mL/hr

Secondary IV line running at mL/hr

IV pump

Foley catheter mL output

PCA pump running

IVPB with running at mL/hr

02

Monitor attached

ID band

Other:

Equipment Available in Room:

Bedpan/Urinal

Foley kit

Straight Catheter Kit

Incentive Spirometer

Medications and Fluids: (see chart)

IV Fluids

Oral Meds

IVPB

IV Push

IM or SC

Diagnostics Available: (see chart)

Labs

X-rays (Images)

12-Lead EKG

Other:

Documentation Forms:

Provider Orders

Admit Orders

Flow sheet

Medication Administration Record

Graphic Record

Shift Assessment

Triage Forms

Code Record

Anesthesia / PACU Record

Standing (Protocol) Orders

Transfer Orders

Other: New Patient Intake Forms

Recommended Mode for Simulation:

(i.e. manual, programmed, etc.)

Student Information Needed Prior to Scenario:

Has been oriented to simulator

Understands guidelines /expectations for

scenario

Has accomplished all pre-simulation

requirements

All participants understand their assigned

roles

Has been given time frame expectations

Other:

7 © 2015, National League for Nursing.

Fluids

IV start kit

IV tubing

IVPB Tubing

IV Pump

Feeding Pump

Pressure Bag

02 delivery device (type)

Crash cart with airway devices and

emergency medications

Defibrillator/Pacer

Suction

Other:

Roles/Guidelines for Roles:

Primary Nurse

Secondary Nurse

Clinical Instructor

Family Member #1

Administrative Clerk/Secretary- this role is

played by a standardized patient

Observer/s: Patient’s in the waiting room

(Student roles)

Recorder

Physician/Advanced Practice Nurse – played by

faculty running sim

Respiratory Therapy

Anesthesia

Pharmacy

Lab

Imaging

Social Services

Clergy

Nursing student assistant

Code Team

Important Information Related to Roles:

8 © 2015, National League for Nursing.

Report Students Will Receive Before Simulation Time:

Joe Ramirez is a 25 year old Latino who identifies as a transgender female to male person (TGFtM). His name

and gender at birth, and as identified on legal documents, is Josephine Ramirez and female. Joe presents at the

clinic for a flu shot and a physical. His last visit with a primary care physician had been several years ago, and

the only other healthcare professional he has seen lately and regularly is his endocrinologist.

Joe has been taking testosterone prescribed by the endocrinologist for well over a year now. Except for a

surgical procedure at 22 (a mastectomy and chest reconstruction), he has avoided most doctors. No other

masculinizing interventions have taken place or are planned at this time. Joe is in a committed relationship with

his cisgender female partner.

The community clinic practice is relatively new--full of young, hardworking nurses and doctors, and unlicensed

assistive personnel. The practice prides itself on a team-based approach to healthcare and is committed to

addressing the needs of ALL patients in the community.

Significant Lab Values: none

Provider Orders: refer to chart

Home Medications: refer to chart

9 © 2015, National League for Nursing.

Scenario Progression Outline

Timing

(approx.)

Manikin/SP Actions

Expected

Interventions

May Use the

Following Cues

0-5 min

Waiting for name to be called for

basic check-in at front desk.

Responds to call.

Waiting for name to be called by

tech for set up for vital signs.

Responds to the call.

Primary RN is

observing the

interaction

between the patient

and staff while

completing other

assignments.

Role member

providing cue: From clerk: Josephine

Ramirez. Repeat the

calling of the name

until there is a

response by the

patient. *

From nursing student

assistant: Josephine

Ramirez. Repeat the

calling of the name

until there is a

response by the

patient. *

5-10 min Patient is appropriate but initially

reluctant to participate in care with

nurse.

Primary RN

introductions; hand

hygiene, therapeutic

communication, as

appropriate for

observable actions of

colleagues, and

proceeds in

ascertaining the

patient’s purpose for

visit, and with

assessment, as

10 © 2015, National League for Nursing.

appropriate.

10-15 min

Primary RN addresses

concerns in ISBARR

format with Doctor/NP

.

Role member

providing cue:

Cue: If RN omits

sections of the

ISBARR, then the

Doctor/NP will ask:

What is the situation?

What is the

background?

What is your

assessment?

What do you

recommend, etc., as

appropriate.

.

11 © 2015, National League for Nursing.

Debriefing/Guided Reflection Questions for This Simulation (Remember to identify important concepts or curricular threads that are specific to your program)

1. How did you feel throughout the simulation experience?

2. Describe the objectives you were able to achieve.

3. Which ones were you unable to achieve (if any)?

4. Did you have the knowledge and skills to meet objectives?

5. Were you satisfied with your ability to work through the simulation?

6. To Observer: Could the nurse have handled any aspects of the simulation differently?

7. If you were able to do this again, how could you have handled the situation differently?

8. What did the group do well?

9. What did the team feel was the primary nursing diagnosis?

10. How were physical and mental health aspects interrelated in this case?

11. What were the key assessments and interventions?

12. What knowledge have you gained as a result of preparing for and engaging in this simulation that has helped you to understand the trans* and gender nonconforming community?

13. What are the skills, strategies, or interventions a nurse could use to address the barriers and inequities that affect trans* identified and gender non-conforming patients? In what ways did you see those skills utilized in this

simulation?

14. What professional nursing values would apply to the situation identified in this scenario (altruism, autonomy, human dignity, integrity, honesty, social justice)? How were those values displayed in the context of this simulation?

15. How has this simulation helped to further develop your understanding of the meaning of nursing and the therapeutic use of self in assisting others—most particularly, the transgender and gender non-conforming population?

16. Is there anything else you would like to discuss?

12 © 2015, National League for Nursing.

Complexity – Simple to Complex Suggestions for Changing the Complexity of This Scenario to Adapt to Different

Levels of Learners

With application of the NCLEX test plan to this simulation, student discussions can be further exploited as a

way of expanding on the complexity of the current simulation as designed:

Safe and Effective Care and Environment: advocacy, case management, client rights, collaboration with

interdisciplinary team members, confidentiality, ethical practice, performance improvement, to name a few.

Health Promotion and Maintenance: developmental stages and transitions, health promotion and screening,

lifestyle choices, self-care, techniques of physical assessment, to name a few

Psychosocial Integrity: coping mechanisms, cultural awareness and influences on health, family dynamics,

support systems, therapeutic communication and therapeutic environment, to name a few

Physiologic Integrity: non-pharmacologic comfort interventions, therapeutic procedures, to name a few.

The administration of an IM injection is one of the skills addressed in this simulation. This could be modified

to address the IM injection of testosterone to this patient.

Discussion of the intersectionality issues that present in this simulation (Latino, African-American, Catholicism,

Living with disabilities). For example, while there are particular health implications and social determinants

that impact health affecting the transgender and gender nonconforming population, the goal of achieving

optimal health may be further affected by ethnicities, faith, disabilities, etc. Thus, the fact that the patient

identifies as transgender is simply one way to describe him/her. Engaging in a discussion about other factors

impacting health outcomes can enhance the complexity of the simulation.

This simulation, while taking place in the community setting, is adaptable to the inpatient setting with some

modifications.

Supplementing the discussion with additional required resources either before or after the simulation may also

impact its complexity. Some of those resources are noted below:

13 © 2015, National League for Nursing.

Online video Resources to Access:

Re-Teaching About Gender & Sexuality from the Youth Perspective:

https://youtu.be/51kQQuVpKxQ

Buck Angel's PSA for Cervical Exams:

https://youtu.be/X_uNFmZHvO0

Buck Angel's PSA for Prostate Exam:

https://youtu.be/YK2fFjDlDE4

Southern Comfort Movie Trailer:

https://youtu.be/R6JIWD2DNyY

Southern Comfort: The Documentary:

https://youtu.be/IH0L3wlV0hg

Australian Rugby Team demonstrating testicular exams:

https://vimeo.com/74742259

The Trans* experiment at Montgomery College:

https://www.youtube.com/watch?v=JO3cIuBHf-U

Online nursing articles to access:

Caring for....Transgender Patients:

http://www.nursingcenter.com/cearticle?an=00152258-201411000-00006

Culturally Sensitive Care for the Transgender Patient:

https://www.nursingcenter.com/CEArticle?an=01271211-201505000-

00005&Journal_ID=682710&Issue_ID=3106455

Treating Transgender Patients With Respect:

http://www.americannursetoday.com/viewpoint-treating-transgender-patients-respect/

Nursing Care of Transgender Patients:

http://nursing.advanceweb.com/Features/Articles/Nursing-Care-of-the-Transgender-Patient.aspx

14 © 2015, National League for Nursing.

12 Tips for Nurses and Doctors in Treating Transgender Patients:

http://commonhealth.wbur.org/2014/11/treating-transgender-patients-tips

Caring for Transgender Patients at the Johns Hopkins ED:

http://www.hopkinsmedicine.org/news/articles/caring-for-transgender-patients

Movies in Popular Culture that Address the Topic of Transgender Issues:

The Danish Girl

The Dallas Buyers Club

Transamerica

Boys Don't Cry

Paris Is Burning

The Crying Game

The Adventures of Priscilla Queen of the Desert

All About My Mother

Television Programs in Popular Culture that Address Transgender Issues:

Orange Is the New Black

Transparent

Trade Books on the Topic of Being Trans* or Transgender Health:

Mock, J. (2014). Redefining realness: My path to womanhood, identity, love & so much more. New York, New

York: Atria Paperback.

McKenzie, M. (2014). Black Girl Dangerous: On Race, Queerness, Class and Gender. Oakland, CA: BGD

Press, Inc.

Schroth, L. (Ed.). (2014). Trans bodies, trans selves: A resource for the transgender community (1st ed.). New

York, New York: Oxford University Press.

Teich, N. (2012). Transgender 101: A Simple Guide To A Complex Issue. New York: Columbia University

Press.

15 © 2015, National League for Nursing.

Selected Resources on Transgender Health:

National LGBT Health Education Center: www.lgbthealtheducation.org

The Fenway Institute: www.thefenwayinstitute.org

GLMA: Health Professionals Advancing LGBT Equality: www.glma.org

CDC: Lesbian, Gay, Bisexual, and Transgender Health: www.cdc.gov/lgbthealth

Center of Excellence for Transgender Health: www.transhealth.ucsf.edu

National Center for Transgender Equality: www.transequality.org

World Professional Association for Transgender Health: www.wpath.org

DC Trans Coalition: https://dctranscoalition.wordpress.com/about-dctc/

I AM Transpeople Speak: http://www.transpeoplespeak.org

Healthy People 2020: http://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-

transgender-health

16 © 2015, National League for Nursing.

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