Clinical errors are the third highest cause of death in developed countries and it is estimated that 10-16% of people will experience a serious adverse event during their healthcare experience1 with recent measurements suggesting that in the USA adverse events may be the third leading cause of death in the USA1. Adding to the complexity of adhering to best practices in patient safety is the fact the USA is known as a cultural melting pot for the world. A recent Census Bureau Report (2015), noted that as many as 350 different languages are spoken in homes throughout the USA, indicating the need for culturally sensitive care for individuals within our borders. Research has identified that clinical encounters which do not acknowledge and address cultural factors, contribute significantly to adverse patient outcomes and health inequality.2Thus, practical strategies for improving the delivery of culturally competent care are needed. There is a paucity of evidence to support best teaching and learning strategies to address cultural competence in undergraduate nursing education.4 One strategy is known as Tag Team Simulation – an innovative strategy aimed to ensure observers and participants remain actively involved and engaged throughout a simulation exercise.
The purpose of this pilot study was to assess the effect of a culturally sensitive simulation-based pedagogical strategy on student learning in a large classroom setting. Historically, this type of learning has been undertaken in lecture type formats. In addition to adhering to student-centeredness as a focus of teaching/learning for the contemporary student, this format provides application to individuals and simulates holistic healthcare for future patients that emerging professionals will be caring for.
Methods: This quasi-experimental approach, using a pre-test post-test design with a non-equivalent simulation (n=43) and non-simulation (n=73) group was a replication of a study, which originated in Australia, and mimics an approach called Tag Team Patient Safety Simulation (TTPSS). A scenario was enacted in a large classroom targeted at teaching Ethics and Social Issues to junior level nursing students (n=116). The scenario focused on the cultural needs of Nasifah, a 67-year-old woman with advanced metastatic liver cancer requiring home-based palliative care who was being cared for by her children. The nurse makes a home visit to conduct a culturally sensitive assessment to assist with her care. Challenging conversations were navigated not only by the participants, but with help from observers through the engagement of antagonist and cue cards.
Results: Results revealed the simulation-based strategy improved student understanding of working with culturally sensitive populations, however, this improvement had no greater learning effect than with the traditional based pedagogical strategy.
Conclusion: While this showed an improvement in student sensitivity, we feel that repeated efforts with student engagement may not only foster learning, but increase retention as well. Thus, future efforts will employ a repeated measures approach and will comport with deliberate practice as relates to student learning.