How virtual simulation games are improving LGBTQIA2S+ healthcare education
As a global leader in healthcare, Canada has shown that it can adapt to the ever-changing needs of its population. However, these changes do not always occur at the rate that is required to provide a comfortable and safe experience for all patients. One group in particular that this concerns are members of Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, Two-Spirit, plus (LGBTQIA2S+) community. Recent studies have demonstrated that LGBTQIA2S+ content in Canadian nursing curriculum is unregulated and insufficient. A major factor that contributes to this is the lag in time that it takes for knowledge from new research to be applied into clinical practice. Currently, it takes an average of 17 years for this translation of knowledge to occur. In our rapidly changing world this can leave healthcare providers vastly uninformed and place our most vulnerable populations in uncomfortable and unsafe situations.
Benjamin Carroll is a registered nurse and PhD student in the Faculty of Health Sciences and one of the creators of the SOGI Nursing Website and Toolkit. Throughout his time at Queen’s, Benjamin has been interested in the co-creation of cultural safety in clinical practice. SOGI (Sexual Orientation Gender Identity) Nursing is a virtual resource which provides training to aspiring and practicing nurses on how to handle a variety of situations with LGBTQIA2S+ patients. The Idea for the SOGI Nursing toolkit was first developed during a CIHR grant “hackathon” that Benjamin attended in 2018, where his team of trainees was tasked with quickly creating innovative and up-to-date educational material on the topic.
“They brought together around 35 of us from across the country whose graduate work all involved the LGBTQIA2S+ community, and introduced us to media people, artists and other experts,” says Benjamin. “We were all interested in cultural humility and creating more accessible environments in primary healthcare, and we thought the best way to get that knowledge out there was to target nurses. Nurses are drivers of primary healthcare, and are often the first people that patients interact with. Therefore, we felt that initially targeting nurses would have the biggest and fastest acting impact.”
After delivering the proposal for an online educational platform, Benjamin and his team put out a bid for the project. It was then that Dr. Marian Luctkar-Flude, Associate Professor in the School of Nursing and Co-President of the Canadian Alliance of Nurse Educators using Simulation (CAN-Sim), and her team of simulation experts proposed the creation of the SOGI Nursing website to include virtual simulation games for its users to play through. This addition has made the SOGI Nursing toolkit perfect to use as an educational tool in nursing curriculum, particularly at the undergraduate level.
“We use the virtual simulation games to represent the stories of different LGBTQIA2S+ individuals and their healthcare encounters in a very authentic way,” says Dr. Luctkar-Flude. “We filmed the games using a GoPro camera from the perspective of the nurse treating the patient. The learner sees a short video clip of the interaction and then the action will stop and there will be a question regarding what the nurse should do next. This form of delivery really places the learner into the nurses’ shoes. Once they select an answer, they will see how the scene plays out and how the patient responds to the words they use, and then we provide a rationale explaining why this was or wasn’t the best approach.”
The SOGI Nursing toolkit is embedded into the nursing curriculum at Queen’s University, Ryerson University, the University of Ottawa, and Cambrian College. It is also open for public use, and in total the website has already been accessed over 300,000 times. The website currently includes educational modules featuring four virtual simulation games, LGBTQIA2S+ resources, and self-assessment tools. However, Benjamin and Dr. Luctkar-Flude are both adamant that in order to incorporate new research, and to reflect the entire LGBTQIA2S+ community, the website needs to continue to grow. More games are currently under development and more resources are being added.
Since the website’s launch, the SOGI Nursing team has continued to push for positive change in healthcare delivery by promoting their product at national and international conferences and publishing academic research on the initiative. Through the integration of academic research, their own lived experiences, and the lived experiences of fellow LGBTQIA2S+ community members, the SOGI Nursing team has become intimately aware of the poorer quality of healthcare that these individuals often receive. As outlined in the virtual simulation games, this can include the use of inappropriate terminology, misgendering, and making harmful and inaccurate assumptions about a patient’s behaviour and health risks.
Benjamin and Dr. Luctkar-Flude both agree that the only way to improve the quality of care is to ensure that all healthcare professionals are trained with the most up-to-date information that is available.
“Improving healthcare for people in our community will improve healthcare for everyone. The whole cultural humility approach that we've taken is really about asking providers to be humble in their interactions with patients,” says Benjamin. “The most important thing for health providers to remember is the patient they’re talking to is an actual person. You have no idea what their lived experiences are, what their support systems are like. We need healthcare professionals to be mindful of this as they interact with their patients.”