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So welcome to this episode of NLN podcast Nursing EDge Unscripted. I'm your host, Dr. Steven Palazzo, a member of the editorial board of Nursing Education Perspectives. In this episode, we will discuss the effects of simulation on nursing students ethnocultural empathy. My guest today is Dr. Fabiola Lalande, an associate professor at the Richard and Sheila Young School of Nursing at Regis College in Weston,
Massachusetts. We will discuss their article, "The Effects of Reverse Role Simulation on Nursing Students Ethnocultural Empathy, A Quantitative Study." This article can be found in the current November December issue of Nursing Education Perspectives. So I'd like to welcome our guest today, Dr. Lalande. How are you? I'm good, well thank you for having me here today. You're welcome. We're absolutely pleased to have a discussion with
you. Could you briefly start out by describing your study and the scale of ethnocultural empathy that you use to measure your outcome variables? Sure. To to really explain this study, I would have to give you a little bit of a background about how that study came and the idea of studying new ways of teaching cultural competence is something I have been thinking about for a little while.
And as an immigrant, you can notice by my accent, I've been always bothered with the discrepancies in health and health care services that minorities experience. And as a nurse educator, I really couldn't understand why we can't really fill that gap and that even though we are putting so much effort into teaching cultural competency in nursing education we still haven't reached the
goal. And what is it that we are missing, right. So as I was really diving more into the subject and end up coming across multiple articles saying that when you ask a health care provider what is cultural competence and they would talk about knowing norms and customs of specific culturally diverse groups, and but when you ask that for the patients themselves, they would talk a lot about the attitude of the health care providers. So that was really what I was
thinking, maybe that's what's missing. We are not really teaching changes in attitude and empathy for these patients, because...for these students, I'm sorry, because we are focused on teaching them norms and customs of different specific groups and that's not really helpful. That's not what the patients are looking for. And with that being said, patients have always mentioned empathy, empathetic care. And I was thinking how can we
teach that in nursing school. That's such a hard thing to teach, right, to help students develop. And that's how I thought about coming up with this reverse role simulation because we know that empathy is also, it's a innate trait, but it's also a skill that can be trained and enhanced with practice and but to have that happen, you have to either have a a strong connection with the person, like a mom watching a baby crying, she will feel that pain or have experienced that thing
yourself, that situation. For example, if you watch somebody getting hit in the nose and you can feel their pain, right, so you need to experience that yourself. Doing the reverse role simulation would put the patient in bed in the experience and the percept, the perspective of the patient and really so they could feel how it feels to be in that situation and see if that would cause any change in their ethnocultural empathy towards patients
from different backgrounds. So that was the idea behind this study. The study was really a pilot study where we would measure the students empathy towards ethnically diverse patients. And we measured their empathy levels before and after the simulation. The tool that we used to measure their empathy is called the Scale of Ethnocultural Empathy by Dr. Wang. And that tool was designed to specifically measure individual's ability to empathize with people from different ethnic and
cultural backgrounds. More specifically, the scale is divided into four subcategories and they will look into this person's ability to understand shared feelings, respond to feelings, and experiences of individuals from diverse backgrounds. The the study really showed that their empathy before and after the simulation had increased a lot and
that was very interesting to see. That's great. So tell us a little bit about how you the process and how you created the role reversal simulation. And if you could speak to what were some of the difficulties you encountered creating this type of simulation? Sure. Creating the simulation itself was a challenge because I knew that to to really cause a change in empathy we would have to dive and make a story that the students would really have that feel.
Right. And really feeling the patient's shoes. And for that I would really have to tap in their effective learning, really get their emotions to be flowing throughout the simulation. So reverse role simulation was a great way to start in the reverse role simulation instead of the students who usually come to simulation thinking they're going to be the nurse themselves they are placed in bed and say today you are the patient, right.
And you are receiving the care. And plotting the scenario was really the challenge because we would like to immerse them, the students, into the patient perspective without really creating any, trying to avoid creating any stigma, cultural stigma or stereotypes, right. So we needed to invent a scenario where they would feel very unfamiliar with the care being provided to them and for that we had to come up with fictional medications and
we used fictional names for the medications. We had a fictional medical approaches to treat a broken arm because in the scenario the patient... the patient, which was the student, right, the student was hiking and the patient fell and woke up in
a hospital with a right arm pain. And they are receiving care, but the provider don't speak the same language as them, the roles look different, the treatments are different, and they are trying to communicate that they have an allergy, but the provider fully are not really grasping of what they are trying to say. We are not providing any ways that they can get a translator at that
point. And just getting those feelings flourishing and having the students feel like the patients actually feel when they are in that situation. And that was really I think the hardest part was to put everything together. But then after that, I think everything flowed pretty well. It sounds like it.
It sounds like a wonderful experience though, right, being in a situation that maybe many of us haven't been in before and you know, like you said, tapping into that empathy and really understanding the perspective of another person who may have a difference in communication, difference in language, difference in culture, and you know like you said, being transported into a health care environment that you're unfamiliar with, right.
Right. And especially knowing that our workforce, nursing workforce, is pretty homogeneous if you think of it. We don't have a lot of diverse within nursing and giving that experience to our nursing students might create that needed shared experience between the student and the patient so that when they are providing care they can feel what the patient would feel like. Yeah, exactly. And how did
the students respond to the simulations? Now that is I think a very interesting question because of course, we use a very specific tool to measure the level of empathy before and after, but I do think that the most interesting portion of this study was not documented. It was really what they talked about in debriefing saying like how they were fearful of the care that they were receiving and not because the nurse was mean or anything, but because they couldn't trust that they knew
that they had an allergy. Or that they knew what the patient needed. And that was very interesting because, at that point, honestly, I was wishing I did a qualitative study as well. But it was really a regret of mine of not going for a mixed study instead but. Well, we don't know sometimes, right.
And sometimes it's just you want to just get your study through and it's easy to do a pre-test post- test and if you don't make it too complicated you can get it through and do the work and it
gave you enough information, right. You said it's a pilot study so it gave you enough information that you're thinking about those things like, oh, I could do this again and ask questions and have more qualitative focus to it, because you know, as we know ,debriefing is usually the really richest part of a simulation. Yeah. And a lot of stuff comes out during a debrief that can be really
rich. That's true. That's very true. And it was, it was actually very interesting to hear how distrust came as one of the main things and I didn't see that coming, you know, but then of course it makes sense. It does make sense, right. Think about if I mean, I was trying to think if I go somewhere to a different country that I don't know much about and I'm working and I become injured or ill and people are speaking to me in a
language I don't understand. I mean, when you don't understand what someone's saying, right, how do you know that you're getting the care that you think
you need or that they're not missing something? It has nothing to do about their actual qualifications or expertise it's just that piece is missing, that communication, where I know when I go somewhere here I can understand everything someone's saying and I can understand what they're going to be doing and if there's something I can advocate for myself because I understand what's being said. And if something's being missed, you
know, and you just don't know. Right. If you could recommend just one strategy to integrate ethnocultural empathy simulation into a nursing program, what would that be? What would be your one piece of advice, one strategy that could help somebody think about doing it next semester or the semester after? Well I would say for for you to start small but make intentional changes.
It needs to be, really, you need to tap into the effective learning, use experiential learning is really what going to cause a change in empathy. And I focus on ethnic, ethnocultural empathy, but that can be really used towards any targeted
population that you think of. And just, it doesn't need to be something as elaborated if the school doesn't have enough money to get a 3D or a VR, maybe we could do start small, just putting the patient, I have done that in the past of having a patient, a student research a culture that they would play the role of the patient, so that's simulated patient, and then when they come in they play that role and they need to really use that
culture as part of their role. And then come be the student, they're going to be the nurse and then debriefing the two perspectives at the end is something that was very interesting too. What else would you like us to know about your study, about your experience? Well, I think that this is a field that we still have a lot to learn so I certainly think that it can be expanded in so many different ways, like starting with the qualitative
information that would be beautiful to have. We could use similar simulations towards different targeted populations that would be also something very I think useful in that field. We really don't know, as nursing faculty, we really don't know how to teach empathy, how to help students enhance
their empathy. Right. Well, I would imagine you'd be receptive to those who might be listening and be interested in this type of work and expanding on the work that you did or partnering with you to explore some of these variables within their own school. That would be beautiful. That would
be very great. It would be nice to really start expanding and getting different group of students, right, because my study was done in a northeastern portion of the country, but it would be nice to get different subjects for the study. Well I want to thank you so much for joining us for this really important conversation. I appreciate your time and your expertise in broadening our understanding of this topic and how we can begin to introduce
this in our own institutions. And to our listeners, if you not had the opportunity please look for the author's work, "The Effects of Reverse Role Simulation on Nursing Students' Ethnocultural Empathy, A Quantitative Study," in the November December issue of Nursing Education Perspectives. And I want to thank all of you for listening and I want to especially thank you, Dr. Lalande, for joining us and sharing just a little piece of your work that you're doing. Very inspirational.
Well thank you for having me. [Music]