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Welcome to this episode of the NLN podcast Nursing EDge Unscripted the Surface track and
thank you for joining us. This episode is entitled Awareness and Affirmation: The NLN ACE+ Series for Nurse Educators and Learners, where we will discuss the new NLN Advancing Care Excellence or ACE series of resources that serve to equip nurse educators with the necessary tools to teach care of LGBTQ+ people and help them graduate a nursing workforce that is both knowledgeable and culturally competent to meet the needs of LGBTQ+ individuals and to decrease the
health disparities that they experience. To help us today we have two very special guests, Dr. Beth Hallmark and Dr. John Mikovits. Dr. Beth Hallmark is the director of simulation at Belmont University and an associate professor. Dr. Hallmark has been involved in simulations since 2007. Belmont has a very active simulation program and intentionally integrates the health simulation standards of best practice of which Dr Hallmark contributes her expertise in their
development. Likewise, Beth's expertise inform the development of the NLN ACE+ series that we will explore today. Dr. John Mikovits is an associate professor of nursing at Moravian University. Dr. Mikovits has extensive clinical experience in cardiac critical care at St. Luke's University Health Network that included program development and implementing quality improvement initiatives. In 2016 he joined the Moravian University faculty.
John's areas of expertise and research interests include exploring LGBTQ+ and transgender health with a focus on addressing the disparities in mistreatment often faced by these communities. Dr. Mikovits contributed to the development of the NLN ACE+ series and resources as a content expert. So welcome both of you and thank you for joining me on this conversation. Thanks for having us yeah thank you
great. So uh we'll just jump right in and you know this year or this conversation is really going to be highlighting the importance and the role that the ACE+ series has in our programs and in our classrooms in our simulation labs and so I want to first start by just building a little background and to give our audience some information about the ACE+ series, how it came about and maybe its goal so if either of you want to jump in. Yeah I'd love to thanks.
So initially just the ACE series in general really just to give you a little background is for helping to improve really the quality of care for any vulnerable or under underserved population and so if you're not familiar with the ACE series in general it's really a great resource and you should look at it but in terms of the LGBTQ+ series or the ACE+ series this was really a mandate or a thought from our constituents so the NLN surveyed their members and
this is what came at the top of interesting topics for us to actually do with the next ACE series on. And so I think it's really important that we we recognize that this is really a needed resource for us to have for our constituents um this series was actually funded by the Hearst
Foundations. And so the Hearst Foundations has been a big supporter of the ACE series and they helped fund this and it's important that we recognize that because they recognize the importance of us helping to meet the needs of the
LGBTQ+ individual. The purpose of this project is really to equip nurse educators with the necessary tools to help teach about the LGBTQ+ people and really help us graduate a nurse is prepared and knowledgeable and culturally competent to meet the needs of these individuals and that in turn will help decrease the disparities that they
experience. And I think John can talk a little bit more about that later but that's something that we really recognize as we were developing these wonderful thank you and you know I want to talk a little bit more about the role that this series specifically the ACE+ series has in our nursing programs and in our classrooms, in our learning
environment. And so you know I think there's been an emphasis an increased emphasis on diversity, equity, and inclusion (DEI) and thankfully in our nursing programs in our curricula there's been a very firm...really call to action to increase our DEI content in our programs our content delivery in our curricula and also to really honor I think the DEI values in the way we respond to one another the way we engage with our learners, the way we engage with
everyone really in our organization. And so you know I imagine that while most nurse educators understand the importance of the role of DEI, specifically LGBTQ+ in our nursing programs just by the nature of us being nurses and taking care of our communities I'm not sure that many feel comfortable with teaching these very specific
specialty areas like LGBTQ+. And I don't know that there's comfort in exploring it with our learners and so you know I think managing that discomfort, I'll speak for myself, requires some real skill development and some Advanced teaching skills so I was wondering if you can share your perspectives on the role the ACE+ series plays in our nursing education and what it might mean
for us as nurse educators. Sure I think that's a great question because if the series itself can reach anyone any educator who is a novice in this content area and can beneficial to anybody who's also considered to be an expert in this area so I think that's a great question and really helps expand on what Beth has already said about the ACE+ series and the ACE series in general the overarching goal of this project really is to equip and prepare educators with the tools
that they need to be as successful as possible to teach care of LBGTQ+people and help us prepare the future of nursing our future graduates and the new nursing workforce that's been hopefully going to be prepared both knowledgeably and culturally competent enough to really meet the needs of this
population. We know this population faces some significant health disparities so the more that we can do to prepare the future nursing Workforce the better we will be equipped to minimize some of the health therapies that they face.
The NLN ACE+ series really has some really really well-developed case scenarios that touch on a lot of major components of health of LGBTQ+ people therapeutic communication and also providing affirming care and while we use three scenarios to kind of cover these content areas it's still not enough to cover all the needs of LGBTQ+ people but it really gives a good foundational understanding to the basics of providing equitable health, having therapeutic communication, and having
affirming care for patients who really need it. There's some really well-developed teaching strategies that are provided that are incredibly helpful and there's loads of additional resources that can be utilized to support faculty who are using these theories the resources are from well-known, reputable affirming LGBTQ+ centers and non-profits throughout the United States.
And they have some really good resources that we also use to help develop some of these scenarios but one of the things that you actually just said that kind of struck a chord with me is that
you mentioned discomfort. And I think there's always going to be topics that we come across in life in nursing and education that are going to be uncomfortable for us to talk about I don't think that means that we need to avoid them, I think that's just going to perpetuate some of the disparities that are already facing these
communities. So if there's one goal that I would have from this whole series it's that I want faculty to become more comfortable talking about these things that are uncomfortable because if we continue this avoidance pattern then we're only going to perpetuate the disparities that these
folks are already facing. So I'm really hopeful that this series that our team put together can really start to create some of these really important conversations about the health needs of this population and really provide some of those resources for faculty and students to start preparing and providing affirming care to these individuals. You know, John...oh go ahead Beth.
Well I was just gonna say that as part of this team my expertise was minimal at best in this area and John and a couple of other people had a lot of expertise in this area and I would say generationally I'm older than most of the people that were well another person was too, but we were we really didn't understand the language the vocabulary the appropriate words to be affirming
and I learned so much. And one thing I said we just presented on this at the NLN (Education Summit) and one thing that I learned while I was doing this and I mentioned this at the NLN was you know no matter what your background is or what you believe, what your political background, your faith background, these are people and it's so important for us to care for people as nurses no matter what we believe and what we should what we what I learned in this situation and going
through this is the compassion based on the
things I heard that these people didn't get. The experiences that John and another expert really told us some of the things that they go through and those disparities are not they're not, I mean, they are health disparities in terms of getting care, and but it's it's it's not just disparities, it's mistreatment in some cases too and I learned so much about that and the compassion that you have as a nurse for people in general was really to me just really brought forward.
So John I was actually wondering because I keep hearing mention of the disparities that this community faces. Could you expand on those disparities to shed some light on them, like Beth had just mentioned like mistreatment being one of them, but can you expand and maybe even give a few examples or describe what this might feel like experientially from a person of this community?
Sure I think Beth actually hits the nail on the head with the the mistreatment because that really perpetuates everything else right so if someone's mistreated because someone doesn't know how to care for them properly whether it's intentional or unintentional or they have a bias against someone in this community that's going to prevent them from seeking care into the future right if you're not going to go to a place where you're being you
know treated poorly or not treated appropriately. So it really just perpetuates the disparities that they're already facing because providers don't have the necessary knowledge to provide some really foundational
basic care for this population. So a lot of it is avoidance of care fear of seeking care and then all those preventative things that should be screened for these people it goes overlooked so when they eventually need care, it's beyond the point where we're looking at prevention, secondary treatment, and we're at the tertiary care now because they have been avoiding health care for so long because of just the way they were
treated. And that's a very broad statement that doesn't apply to everybody, but that's really a good general gist of you know some of the major things that kind of put this population at risk. And I think two of our cases really demonstrate that in the way we develop them and so the there's three different cases and two the two adult cases both of them had delayed care because of the way they had been treated in the past. You know, this conversation also links me to I've
heard the word affirming a few times. Can you expand on the the role affirming has and what it means and how we can do that as a nurse educators? I think most important to think about when it comes to affirming care is it really it's just care that's designed to support and affirm one's identity, right. It's as simple as that you know if someone identifies as male and they look female then treat them how they identify, right.
Someone's gay, someone's lesbian, someone's bi, you know, whatever maybe treat the person as they are right, you know so really affirming care is just designed to support and affirm an individual with however they identify personally.
That's great and I like this word support and affirm because to me that feels like some tangible steps you know as a nurse and we can teach that to our learners she because I think sometimes the vocabulary and the words that we use I think it matters and so this idea of supporting and affirming and meeting people where they are and how they identify is I think how our identity is really important to us and I think no matter who we are and if our identity
is threatened or mistreated, it goes way beyond the surface and it becomes a much deeper felt issue and again that leads to what I'm hearing you say are these disparities of prevent or not going for care, not returning for care ,and then problems getting out of control. So I think this support and affirmation seems pretty critical and honestly very basic like we should be doing this
for everybody. It seems very intuitive, but it doesn't always come out maybe in the words we choose or maybe our tone and our body language, is that accurate in my reading that it really is, it really it should be simple it should be simple care?
So you know the other thing I want to talk about is about how we can as nurse educators integrate these tools and resources into our curricula and you know I think nursing curricula has a long-standing history of being a content overloaded. I think we might even need to come up with a new term because I think it's more than even
overload if we can brainstorm that later. But I think there are several priority areas that are receiving this non-negotiable pressure to be integrated and that's such a DEI in general but I don't think and there are many others like climate change and and disaster preparedness, you know there are many topics that are becoming high priority and what I'd like to say is that how do we address these priority areas LGBTQ+ care specifically
and balance the demands of our already overloaded curricula with really integrating these
needs very well. How do we do that? So that's a great question and I want us to think if you look at the cases just based on the diagnosis of the patient that we developed so one case is colon cancer one case is a wound and one case is a MVA or a bicycle accident so if you think about how you can integrate those into your curriculum and then the patient is the patient and how they identified how we affirm that is to me the answer.
You don't have to do a special series on LGBTQ+, you integrate that within what you're already doing because these are people and you don't have to...you shouldn't, I mean you can, you know select them out, but I don't think you should because they're people and they have the same diseases that we have or if we identify as something totally different. So that is my answer
to that. I don't know if John has any other ideas, but you that's one of our problems in nursing we keep adding and adding and adding but really you can include that within what you're already doing. Yeah, I agree with that 100% Beth because we need to really just integrate it throughout the curriculum. It can't be, it can't be a discussion for a day it can't be a special topic course you know it really needs to be integrated
throughout. If you look at our textbooks and the lectures that we have there's so heteronormative, gender normative, and you know everything every person looks the same right there's very little diversity in the images that we use in the patient populations that we talk about so we need to integrate that into into whatever topic it may be, not just have a special discussion about this population because usually those special discussions that we have just
again perpetuate some of those stereotypes you know looking at LGBTQ+ population and talking about mental health, HIV, and AIDS. That's not it right...it is so much more than that. So I think Beth is spot on with the need to really integrate these topics throughout the curriculum and you know I think when we think about the teaching strategies to make this outcome of integrating you know the care of these populations into everything
that we do into all populations. I think I'm a little bit biased that simulation as a teaching strategy is one that's really helpful to do this kind of integration because simulation comes with debriefing and debriefing is a learning dialogue where there can be an exchange of ideas and a you know the diversity of thought and perspectives can be shared and brought to the surface and unpacked and I think that comes back to like kind of looping
us back to the skill set needed to do this work. So what what are your thoughts on that on you know using simulation and debriefing is one way to help bring light to the these topic areas and what is the skill set needed you know if not simulation? Well I think of course because simulation is what I do I absolutely agree that this is a great place but again it doesn't have to be a
simulation about a LGBTQ+ patient. It can be a concept so we could be doing a concept on say infection and the patient has a wound infection, say it's Jayla and she's she's one of the...she's the transgender patient and she has a wound and
it's infected. Well, we're talking about the concept of infection and the patient happens to be transgender and we include it that way but back to the debriefing that is where when we palleted these that was some of the conversations that the students were able to have because some of the objectives for the actual simulations are related to affirming care, etc., but it might not be that that might not be your objective but that happens to be the patient is transgender so
of course it can be brought into your debriefing and included especially if it is a topic that's uncomfortable for students which I do find that students these these topics are more comfortable for students to talk about than they are for a 58
year old me. I do think but you have I think it's just as much a learning care for the faculty as it is for the students really to be honest with you, yeah I think the briefing is really a key component to having a better understanding of this population because I don't want to say it forces the conversation, but it provides the opportunity to have these conversations which often are avoided so I think it's a really good learning opportunity for both students and faculty to
really have these conversations together and talk about why these are important conversations to be having about this population. Yeah and I would even you know I agree with you John to take that a step further that really we should should I try to avoid that worth it's it's a it's a dirty word in my mind because when we put things like should it kind of puts expectations but we I think we can consider having dialogue as a teaching strategy
in the classroom in our offices. It's not just in debriefing and simulation we can use debriefing strategies all you know in every opportunity with our learner so I would even take it a step further to say it doesn't certainly doesn't have to be a simulation but it does create this space to have a dialogue, which is I think very helpful. One thing that I think is important for everybody to know about the cases if you're not familiar with the
ACE.S cases is it the monologues are so powerful for people to hear. We just finished getting the last monologue for these and we worked really hard not we but it was it was an effort to get the appropriate voices and that was something that was really important to make sure that they were accurate for the patients and they're so powerful.
If you have an opportunity and you're listening to this to go and listen to those I think they'll draw you in and you began to have care for the for the patient already just based on the monologue.
That's great I think because it makes that human connection you can hear a voice, you can hear a tone of voice you can hear I think you can hear emotion you know, I think it helps definitely we've actually started adding monologues to all of our sims regardless based on this model because it really helps the students buy into it that's great... I did my thoughts coming back to me...Beth you had talked about this idea of you had mentioned that you feel like with
your generation, you know with your age that you may not know as much and that it's really a learning curve on both sides for faculty and for our learners. I would you know I just wanted to comment on that I learn the most from my children I have Gen Z's I'm raising, little Gen Z's at home and they teach me you know about a lot of of things about LGBTQ+ about the language, about the community and that's who I'm learning from and I just want to take that I don't take it for
granted. I have a lot of gratitude for that and I think as educators if we create this space for dialogue we can become the learner just as easily as our learners can learn from us you know we might know how to provide wound care but we may not know the the most up-to-date language to use with our community and I just appreciate it yeah and we have to give each other grace to learn that and to take but to
be intentional about it. I think that's one thing too and there are some really great resources that John and the team have have put in there for us to learn those things and I think it's important that before we implement the strategies into our teaching that we take time to be prepared before we run the sim or we would do it in a classroom or whatever because the students will often know more than we will about this and we want to make
sure that we are doing the best that we can do to honor this these patients that's great so can I ask a little logistics question with the ACE+ series are there resources explicitly outlined for the educator to review with regard to language and a terminology and things like that content expertise. Yeah perfect and they're provided.
It's not a resource that we created, it's a resource that we've provided that with a hyperlink so it's constantly updated as terminology changes so you'll always have the most update terms that are being used vocabulary that's fantastic. So with this I would like to transition to some of our what I think are fun rapid fire questions. Are you ready for that? Yeah. Sure. [Music] First you can go first. Oh I was gonna say
John first. I'll go first like this yeah, all right Beth, so if you were to write a memoir what would you title the book? "Why I care." So I think that that's just related to my background why I wanted to be a nurse related to some medical problems I have and my family's had and then why I continue to care for my family and then for others. So awesome. What is on the top
of your reading list right now for fun? Yeah this is a question I can't answer because when I try to read I fall asleep so there's really not much I'm caring for elderly family members right now and so 24/7 either work or caring for them so I don't read right now but one day maybe I'll go back to reading again. Wonderful. What is your favorite quote? My favorite quote is character is when it's what you do when no one else is watching.
I love that, and if you could have dinner with one person dead or alive who would it be? The pious person to me would say Jesus but it would be my grandmother really so that's who I would want to see that's who I'd want to who died when I was, I don't know 25.
Yeah you know, I think those special relationships they never leave us and I know I have a very special relationship too with my grandparents and I'm with you that's who would be at my dinner too so we could have a little grandparent dinner party that would be so fun it would be it would be. John can I throw these questions your way? Sure. Same questions? Yeah. Yeah okay. So if you were to write a memoir what would you title the book?
Let's see, we'll go with "An unfinished painting." I guess kind of like life is and always has been kind of a work in progress never really finished always more work to be done another another stroke to be had if that makes sense. It definitely does. I just I love consuming art of all kinds. What is
on the top of your reading list right now? So I am currently reading a book called "Like Streams to the Ocean," which came after a book that I most recently read and absolutely loved called "To Shake the Sleeping Self" by the Jedidiah Jenkins.
It's just a book about this guy who was kind of terrified about being stuck in that stereotypical life of you know, you gotta go to high school, you gotta graduate, you got to go to college, you got to get married, you gotta get a good job you have to have kids, you have to have a dog like the white picket fence this American Dream type of wife, and he went on a 16-month um bicycling trip from Oregon down to Patagonia and Chile and he
really just you know had a lot of self-reflection and like a really honest memoir about himself on his own internal journey and struggles but it really spoke me because it talked about his struggle to reconcile his sexual identity while living in a very conservative Christian upbringing and really his value in travel as a way to really make connections with life. I thought it was just a really good a good read. That's fantastic, can
you repeat the title again? Sure it's To Shake the Sleeping Self and the author is Jedidiah Jenkins.
You know the guard to some of the authors in their memoir talking about their sexual identity, you know, I think about sometimes we could as nurse educators, I think for our learners sort of have some book club type of activities where we can take these books that really make a very big impression on our lives and it does make me think though, Beth wait, can you imagine telling nursing students I want you to read your 500 pages in your nursing textbook and oh by the way read this
book but you know because who who you know I don't know any nursing students that willingly say that they have any time to read, but I do think about though how these books can have such a different perspective that a textbook doesn't give and how they make an impression on us and you know how we could share that with our learners so I don't know I don't know if we if that's possible but I just on top of our content overload maybe not well you know thank you some universities
actually have a book like their freshman book or something like that and I think that's a great way to do it early before they get into their nursing career possibly for their nursing classes. So John I just thank you for sharing that book I wrote it down because I'm certainly going
to check it out. What is your favorite quote? I don't necessarily have a favorite quote but one of my good friends we recently shared with me one that said, "you can't change the people around you, but you can change the people around you,"
and that really stuck with me. I thought that was a typo at first until I really stepped back and like thought about it it makes sense and it's something that's applicable in so many different situations in life, that you, I mean you really can't change to people around you - they're who they are. You change, they change, but you can't change them. But you can change the people around you meaning that you know if you're surrounded by people who don't lift you up,
you can change them find new people. The people around you really bring happiness to you and especially be a priority in anyone's life so that that quote kind of spoke to me and I have it written down like in a note my phone just looked at it and reference it every now and then because well I don't have a favorite quote. I think that's gravitating up the list to become one
of my favorite quotes. That's great, you know and John I appreciate that that quote because I know in my looking back I remember the very moment I learned that act like that exact lesson that you can't change people somewhere maybe in my young formative years I kind of thought that I could make you know change a relationship or change you know how somebody viewed me or whatever, we think we can change people and I remember realizing you can't and I remember exactly I think
what I was wearing what day it was when I learned that lesson I think because it was so powerful and it was a relief to know like one thing to take off my list of things to do. If you could have dinner with one person dead or alive who would it be?
I would definitely say my grandfather on my father's side because he passed away when I was two so I have really non-existent memories of him other than one where I remember running into my aunt's house through the front door around the corner and up onto his hospital bed with him in it when he was sick at the end of his life and I think it'd just be awesome to have a conversation with him because I think he really helped shape my dad to become who he is and I think a long but
good dinner conversation with him would really give me a good understanding maybe the parts of who I am I don't know. I think that's a great question but I don't think I've changed my answer. I think definitely my grandfather on my father's side. That's great. I think there's definitely a theme here of the three of us that I think it sounds like we really can honor the you know how people's influences on us and how we're sort of who has such an impact on us and how we're sort
of formed. So all right, well, thank you very much for joining me in this conversation. I appreciate learning more about the ACE+ program and thank you for sharing your wisdom. Thank you. Thanks for having us. Thank you for joining us on this episode of NLN Nursing EDge Unscripted Surface. We hope you join us next time. Until then, remember, whether your water is calm or choppy, stay connected, get vulnerable, and dare to go beneath the surface. [Music]