IU School of Nursing

Bryan White, MSN, RN, TCRN, CCRN, CEN, and Marian Gilhooly, MSN, RN, RN-BC, CNE, both nursing educators at the Indiana University School of Nursing, are driven by a shared vision: to enhance nursing education by integrating a wider variety of cultural experiences into simulation-based learning. Their project, supported by the Rose M. Mays Excellence in Teaching Diversity Fund, aims to prepare nursing students for the complexities of healthcare in a diverse society. 

Their journey began months before they applied for the diversity fund. As experienced simulation educators, White and Gilhooly observed a concerning trend in their simulation labs. Most of the simulated patients were Caucasian middle-aged men, regardless of the disease or condition being studied. This lack of diversity didn’t reflect the variety of patients students would encounter in real-world settings. Recognizing this gap, they set out to develop simulations that mirrored the true diversity of America’s population. 

The goal of their project extends beyond traditional clinical skills training. These simulations aren’t about mastering technical skills like taking blood pressure or checking heart rates. Instead, they focus on communication and understanding the unique needs of underserved populations. The simulations are designed to help students interact with patients from different backgrounds, reflecting various ages, races, sexualities, and gender identities. This approach aims to foster empathy, cultural competence, and the ability to provide equitable care. 

So far, White and Gilhooly have adapted two simulations from the National League for Nursing’s ACES+ program to utilize for this initiative. The first features a nonbinary high school student navigating their gender identity. This scenario has already been piloted by students and incorporated into capstone courses for senior-level nursing students. The second simulation involves an African American transgender woman who is also a sex worker. Both simulations use Standardized Patients—real people trained to portray patients—rather than manikins, to create authentic interactions and evoke genuine emotions in students. 

This use of Standardized Patients was a deliberate choice made after collaborating with simulationists at IU’s Fairbanks Simulation Center.  White and Gilhooly were advised that Standardized Patients offer students the best opportunity to practice communication skills in a realistic setting. They believed that the presence of a live person would challenge students to confront any discomfort and learn how to engage respectfully and effectively with diverse patient populations. 

To prepare students for these simulations, White and Gilhooly developed comprehensive resources, including a Canvas site and community resource guides. These materials provide students with the knowledge and tools needed to succeed in the simulations, such as information about LGBTQ+ resources and services for underserved communities. 

The feedback from students has been overwhelmingly positive. Many have expressed that the simulations provided valuable insights and allowed them to practice skills they had never encountered before. One student, from a small town in Indiana, shared that the experience of using correct pronouns was new to her, and the simulation challenged her to think differently about patient care. Another student, faced with a scenario where a doctor misgendered a patient, took the initiative to advocate for the patient, demonstrating the kind of leadership and empathy that White and Gilhooly hope to cultivate. 

Bryan White emphasized the importance of these simulations in nursing education. "We want our students to leave the program with the confidence and competence to handle any situation with empathy and professionalism. It’s not just about learning how to take care of a patient’s physical health; it’s about understanding their unique experiences and advocating for them in a way that makes them feel respected and valued." 

Looking ahead, White and Gilhooly plan to develop two more simulations by the end of 2024, focusing on implicit bias and racism. These will be piloted in the spring of 2025 and integrated into relevant courses. Their ultimate goal is to create a curriculum that equips nursing students with the skills and knowledge to care for all patients, regardless of their background. 

The funding they received has been crucial in supporting these initiatives, including the ability to hire Standardized Patients and a planned summer reading program for students. The chosen book, "Why Fish Don’t Exist," challenges readers to think beyond categories and boxes, aligning perfectly with the project’s objectives.  Marian Gilhooly explains, “We are especially excited to offer students a common-read experience in order to build community among our students and faculty, as well as learning more about the history of Indiana University and our evolving understanding of human culture as it relates to patient care.” In the future, students who complete the reading and all simulations may be awarded a certificate recognizing their dedication to understanding, and caring for, diverse populations. 

For White and Gilhooly, this project is more than just an academic exercise; it’s about transforming nursing education to better serve the entire U.S. population. By combining the power of simulation with a commitment to diversity, they are preparing the next generation of nurses to provide compassionate, culturally competent care.