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The feasibility of online modules and virtual simulation games to teach nurses about cultural humility, sexual orientation, and gender diversity

Study Lead
Study Lead
Associate Professor
Jane Tyerman, RN, PhD, CCSNE Assistant Professor, University of Ottawa, School of Nursing
Deborah Tregunno, RN, PhD Associate Professor, Queen’s University, School of Nursing
Erin Ziegler, PhD, NP-PHC Assistant Professor, Ryerson University, School of Nursing
Benjamin Carrol, RN, MNSc, PhD student Queen’s University, School of Nursing
Chris Shortall, BScH, MSc Memorial University of Newfoundland
Lillian Chumbley, MA E-Learning Specialist, Trent University

What? The lesbian, gay, bisexual, transgender, queer, intersex, and two-spirit (LGBTQI2S) community has gained increased visibility in society, yet still they represent one of the most marginalized populations in healthcare. To address the lack of provider experience and knowledge, and the barriers LGBTQI2S patients face in healthcare, we have developed an educational toolbox including four virtual simulation games that take place in primary care settings. We anticipate these games will provide healthcare providers with increased resources and knowledge to address the specific needs of LGBTQI2S people. 


Why? Discrimination, lack of provider knowledge and experience, deficiency of services, and structural barriers contribute to marginalization and healthcare barriers faced by LGBTQI2S people.  LGBTQI2S people have higher rates of trauma, substance abuse and mental health problems. While most healthcare issues LGBTQI2S people face are similar to the general population's, they also have unique healthcare needs which healthcare providers may have limited ability to address. There has been an historical lack of LGBTQI2S-specific content in nursing and healthcare education. 


How? We collaborated with content experts to determine the number, type, and learning outcomes of games to be developed. Each virtual simulation game (VSG) was developed by a team made up of researchers, content experts, the LGBTQI2S community, and healthcare providers. The VSGs were filmed using authentic actors and from the view of the nurse interacting with LGBTQI2S patient, to allow the learner to immerse themselves in the scenario and make clinical decisions.


Results: Usability testing was conducted, and feedback was used to revise the website that houses the games and resources. An evaluation study is underway to assess the impact of the games on cultural humility and perceived competence caring for LGBTQI2S patients. 


Impact of findings: We created an open access resource to support nurses and nursing students across the world in examining their own biases and increasing their cultural humility in clinical practice. The website was launched in October 2020 and has been accessed over 775 000 times since then. Through learning cultural humility, healthcare providers' biases are challenged through reflection and the practice of open communication, improving care for the LGBTQI2S. We have received positive feedback from participants about the website and virtual games. 

Funded By
Canadian Institute of Health Research (CIHR)
Canadian Association of Schools of Nursing (CASN) Pat Griffin Scholar Award