Author: David Foley, PhD, MSN, RN-BC,CNE,MPA
Title: Research Associate and Faculty
Institution: Case Western Reserve University and Hondros College
Coauthors: Morgan Wiggins
Advanced Practice Providers, Continuing Education, Faculty Development Strategies, Graduate Students, Interprofessional, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, Quality and Safety, RN to BSN, Staff Development
Global QSEN Competency Objective (GQCO): The purpose of this role play on providing appropriate care to a transgendered patient is to give nurse educators (clinical/classroom faculty, practice-based nurse educators, and staff development personnel) with an immersive situation to promote critical/analytical thinking and opportunities for affective development as framed within the QSEN competencies of Patient-Centered Care, Evidence-Based Practice, Safety, Teamwork and Collaboration. The questions that are embedded with the role play should thus be used to provide learners with opportunities to demonstrate a practical understanding of these QSEN competencies in a non-threatening setting with feedback provided by peers, co-participants, or facilitator.
Unit Learning Objectives:
As an immersive exercise, this role play thus promotes both critical thinking and affective development by placing leaders within a low-incidence/high-risk clinical scenario involving serious breaches in therapeutic communication and care practices for Amy, a 43 year-old transgendered patient with a history of Major Depressive Disorder (MDD) and previous suicide attempts who is currently experiencing an exacerbation of COPD and is thus being admitted to an inpatient Medical Unit. Four key QSEN Competencies (Patient-Centered Care, Evidence-Based Practice, Safety, and Teamwork/Collaboration) provide the framework for reflective thought and discussion:
1. Through analysis, reflective thought, and discussion the learner will affirm the importance of utilizing effective evidence-based practice and clinical interventions for transgendered patients.
2. Through analysis, reflective thought, and discussion the learner will identify opportunities to enhance effective teamwork/collaboration during a low-incidence/high-risk in which a transgendered patient displays suicidal risk on an inpatient unit.
3. Through analysis, reflective thought, and discussion the learner will identify opportunities to enhance safety as a primary artifact of a healing, therapeutic milieu for transgendered patients under their care.
Whether in the educational (i.e. classroom or clinical pre-/post-conference discussion), or work-place (i.e. staff development exercise) settings, the QSEN competencies provide an ideal framework to promote opportunities for analysis, reflective thought, and discussion. In the case of this scenario, the lead characters (a 43 year-old transgendered patient) and two nurses working in an inpatient medical setting exchange robust dialogue as they engage in conflict framed by a lack of knowledge of basic, evidence-based care practices for transgendered patients. Serious breaches in therapeutic communication, patient rights, and basic dignity lead to an unfortunate, yet highly avoidable outcome. Finding themselves in an exchange that is spiraling out of control, the two nurse characters fail to engage in effective teamwork-collaboration to seize any number of opportunities to de-escalate a volatile situation that ultimately results in a suicidal act by the patient, whose psychiatric history was grossly minimized. Although many nurses may have professionalism—and basic common courtesy—in caring for transgendered patients Nurse Eric and Nurse Tina must now face the consequences of their actions. This scenario thus focuses on promoting critical thinking and reflective thought to prevent such a highly dangerous scenario from reoccurring.
The mechanics of this role play provide opportunities to engage in a role-play bounded by several QSEN competencies (Patient-Centered Care, Evidence-Based Practice, Safety, and Teamwork/collaboration) in that:
o Questions for group discussion are strategically inserted at the end of the case study and are intended to be discussed—with corresponding instructor/peer feedback—in a synchronous manner.
o Whether in the classroom or clinical setting, learners should be granted no prior access to the scenario but given an approximately one-half hour to read it independently, with peer interaction followed by instructor-facilitated discussion immediately following. At the discretion of the instructor or facilitator, the character descriptions can be distributed to those participants who will portray the characters.
o At the conclusion of the role-play, a written Reflective Journal assignment is distributed and should be completed on/or before a date determined by the facilitator. As it is completed asynchronously, the Reflective Journal gives students a more discrete format to present the thoughts they might not feel comfortable sharing in a public forum and will return to them with written instructor feedback.
• Bios/descriptions for role play characters
Participant reflective journal template
Tips sheet for providing care to transgendered patients
Post-Scenario Evaluative Questions
Nurse Tina and Nurse Eric are interviewed by the hospital’s Risk Management Department the very next week as part of a Root Cause Analysis (RCA). Please project into this situation and imagine you are Nurse Tina or Nurse Eric. How would you respond to the following questions?
• How often have you worked with transgendered patients? Do you perceive to be at least minimally culturally competent in working with the patient population, especially in terms of therapeutic communication and sensitive patient care practices (Obj. 1)?
• Identify opportunities to improve teamwork/collaboration between Nurse Tina and Nurse Eric? How would you assess their communication with each other? (Obj. 1 & 2)
• Given the opportunity to review the entire scenario, what factors ultimately impacted patient safety? (Obj. 3)
• What recommendations would you have for quality improvement to prevent this scenario from happening in the future? (Obj. 3 and GQCO)
1. Written instructor feedback as to evidence of analytical/critical thinking in Reflective Journal questions, each of which is tied to a learning objective/QSEN competency.
2. Student to peer and instructor to peer verbal feedback regarding evidence of affective development as tied to learning objectives/QSEN competencies in classroom sessions, clinical pre-or post-conference discussion, staff development, or any other group as facilitated by a nurse educator.