By Kristen Mitchell
A team of researchers led by the George Washington University School of Nursing is working on a project to teach psychiatric mental health nurse practitioner students about gender-affirming mental health care and assess the impacts of virtual standardized patient simulation and case-based learning on their knowledge, attitudes, beliefs and behaviors.
By comparing two different educational models, researchers led by Associate Professor Rhonda Schwindt, are working toward developing best practices for graduate clinical education related to affirming mental health care for transgender and gender expansive individuals. This project is funded by the National League for Nursing.
GW Today spoke with Schwindt about the goals of the project and the importance of providing affirming mental health care:
Q: Can you explain why it’s critical that health care providers are equipped to provide affirming care?
A: Limited access to affirming care combined with exposure to stigmatizing and discriminatory experiences has resulted in significant mental and physical health disparities in the LGBTQIA population. Often, patients have to assume the role of teacher during their interactions with health care providers. While we learn from our patients every day, it is not their responsibility to teach us what high-quality, affirming care looks like.
Q: Can you tell me about the project you are currently working on?
We are conducting a multi-site, mixed-methods study to compare the impacts of two teaching and learning approaches on the knowledge, attitudes, beliefs and behaviors of psychiatric-mental health nurse practitioner students, and to analyze their perceptions about the experience. Our study will generate data to guide nurse educators in their selection of effective, evidence-based teaching strategies and support curricula changes that align with the professions’ commitment to diversity, inclusivity and health equity.
Q: Can you explain the two educational models you will be comparing?
A: Virtual standardized patient simulations in which students engage with a transgender or gender expansive person are a highly authentic teaching strategy. However, integrating these experiences into nursing curricula can be a resource-intensive endeavor. In contrast, case-based learning activities are designed to help students connect theory to practice by challenging them to make clinical decisions in the context of written narratives. It is a readily accessible, time- and cost-effective approach, but may not be as impactful.
Q: Where does this project stand right now?
A: Phase 1 of the project, which consisted of pre-intervention preparation, has been completed. Intervention testing and data collection is scheduled for this summer at GW, and at our partner institution, University of California, San Francisco, for early fall. Data analysis will take place shortly thereafter followed by the dissemination of our findings.
Q: How have you involved members of the LGBTQIA community in your research?
A: Educators, providers and researchers risk further marginalizing LGBTQIA people if they presume to know their lived experience. For this project, our educational materials were reviewed by people who identify as transgender or gender expansive and our standardized patients are members of the community. We also had the privilege of working with a trans activist who graciously shared her experiences with the health care system. Her narrative accounts further enhanced the authenticity of our work.
Q: Can you talk about the impact of discrimination in health care?
A: Healthcare providers, individually and collectively, have a long history of pathologizing diverse sexual orientations and gender identities based largely on religious, medical, social and legal stigmas. While we’ve made progress, the pathology narrative continues to influence many providers’ decision-making and approaches to care. The lack of culturally-informed providers along with daily exposure to discrimination, bias and anti-LGBTQIA rhetoric and legislation, has resulted in significant health disparities. Health care providers must be willing to examine their own implicit and explicit biases, push for enhanced emphasis on LGBTQIA health during degree education, and join the LGBTQIA community in the fight to eliminate social injustices and health inequities.