Cultural Simulations, Authenticity, Focus, and Outcomes: A Systematic Review of the Healthcare Literature

(Innovative educational activities using a model to improve cultural competency among graduate students.)SG(i)Nil specific (ii)Not reportedEstablished game Barnga, nil else specifiedEvaluating cultural competence in undergraduate nursing students using standardized patients.SP(i)Nil specific
(ii)INACSL guidelinesContent expert reviewed scenario (time unclear), Experienced sim facilitator, cculturally diverse SPs willing to engage in sensitive scenarios- (specifics of actual SP's not provided).(, Chun M.B.J. Young K.G.M. Honda A.F. Belcher G.F. Maskarinec G.G. The development of a cultural standardized patient examination for a general surgery residency program.)SP(i)Nil specific,(ii)Not reportedScenario reviewed by Samoan interpreter (time unclear), Samoan SPS recruited, also acted in
family roles, patient interpreter involved in scenarios.(Claramita M. Tuah R. Riskione P. Prabandari Y.S. Effendy C. Comparison of communication skills between trained and untrained students using a culturally sensitive nurse–client communication guideline in Indonesia.)RP and SP demo(i)Nil specific (ii)Not reportedInstructor expert in LGBTQ healthcare, sim-manager expertise in INACSL guidelines, Local SP's(Englund H. Basler J. Meine K. Using simulation to improve students' proficiency in taking the sexual history of patients identifying as LGBTQ: A pilot study.)Student RP(i)Nil specific,(ii)Not reportedNil specific and no report to indicate instructions given for RP(Everson N. Levett-Jones T. Lapkin S. Pitt V. Riet P. Rossiter R. Courtney-Pratt H. Measuring the impact of a 3D simulation experience on Nursing Students' cultural empathy using a modified version of the Kiersma-Chen Empathy scale.) , Immersive 3D*(i)Nil specific
(ii)SIM quality standardsLocal migrant and refugee centre clients co-designed and filmed 3D simulations which included language, environments, symbols incongruent with Anglo-Australian culture(Fink M. Linnard-Palmer L. Ganley B. Catolico O. Phillips W. Evaluating the use of standardized patients in teaching spiritual care at the end of life.)SP(i)Nil specific
(ii)Not reportedReligious experts (Catholicism, Judaism, and Islam), involved in the co-construction of scenarios, acted as visitors in the scenario and contributed to debriefing.(Fioravanti M.A. Puskar K. Knapp E. Kane I. Terhorst L. Mitchell A.M. Lindsay D. Creative learning through the use of simulation to teach Nursing Students screening, brief Intervention, and referral to treatment for alcohol and other drug use in a culturally competent manner.)HFS and VV(i)Nil specific
(ii) INACSL standardsMultiple diverse scenarios designed in conjunction with addictions institute, students asked to engage respectfully.()HFS(i)Nil specific
(ii)INACSL standardsFaculty experienced in SIM, INACSL, NLN standards and literature review guided scenario development, co-created with students from similar cultures (extent unclear).(Garrido M. Simon S.R. Purnell L. Scisney-Matlock M. Pontious S. Cultural nursing androgogies with foreign-educated physicians enrolled in BSN to MSN program.)HFS(i)Nil specific
(ii)INACSL standardsFaculty experienced in SIM and INACSL standards, students coached to RP family member using scripts, cultural and religious props in room e.g sacredheart the Quran, voodoo doll.(Greenawalt J.A. Hawkins P.M. Using an interactive framework to assess a cultural simulation for Learning: Tag Team Patient Safety Simulation.)SG- TTPSS(i)Nil specific (ii) Advocacy-enquiry modelBased on prior work, nil else reported.())HFS and RP(i)Nil specific (ii)Not reportedStudents RP spiritual advisors,translators, family (preparation NR), manikin and religious props.Determining the effects of simulation on Intercultural competency in undergraduate Nursing Students.HFS and VV(i)Nil specific,(ii)DGJ (Rudolph J.W. Simon R. Rivard P. Dufresne R.L. Raemer D.B. Debriefing with good judgment: Combining rigorous feedback with genuine inquiry.)VV of nurse and patient from different cultures to prompt participants to consider culture.(Increasing certified Nurse-midwives' confidence in managing the obstetric care of women with female genital mutilation/cutting.)Task trainer(i)Nil Specific (ii)NASomalian culture broker shared personal insights into female genital mutilation/cutting(Effects of a cultural competence education programme on clinical nurses: A randomised controlled trial.)Student RP(i)Facilitators trained in cultivating CC,(ii)Not reportedCourse content modified based on review by educational experts(how this applied to RP scenarios and preparation for RP unclear).(Maruca A.T. Diaz D.A. Stockmann C. Gonzalez L. Using simulation with nursing students to promote affirmative practice toward the lesbian, gay, bisexual, and transgender population: A multisite study.)HFS(i)Nil specific (ii) All facilitators trained in DML(Using debriefing for meaningful learning to foster development of clinical reasoning in simulation.)Simulation designed by expert mental health nurses adhering to NLN framework, (A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing.) reviewed by two certified simulation educators and prescribing registered nurse.(Mauro A.M.P. Tracey D.L. LoGrippo M.T. Anderson S. Bravo A. Byrne C. Escallier L.A. Simulation Innovation to redesign the Baccalaureate curriculum to address population health.)HFS and VV(i)Nil specific (ii) Brief =structured debriefingSims planned using NLN framework, clinical and consultant with CC expertise.(Meinema J.G. Haafkens J.A. Jaarsma D.A.D.C. Van Weert H.C.P.M. Van Dijk N. Development and evaluation of a Culturally Appropriate Hypertension Education (CAHE) training program for health care providers.)Student RP((i)Facilitators formally trained in CC theory and principles (ii)Not reportedContent based on prior studies with Ghanaian and African-Surinamese patients, expert train the trainer approach.Min-Yu Lau P. Woodward-Kron R. Livesay K. Elliott K. Nicholson P Cultural respect encompassing simulation training: Being heard about health through broadband.SP's online(i)Nil specific
(ii)Not reportedScenarios co-created and individualised with SP's from 18 ethnic groups, e.g., Aisan, African, middle eastern, European and aborignal, SPS's trained for role and to deliver feedback (time unclear).()SP(i)Nil specific
(ii)Not reportedAn established SP programme prepared culturally diverse SP's, some co-creation of cases in association with SPs (no specifics provided), SP center with realistic ambulatory care set up.(Ndiwane A. Baker N.C. Makosky A. Reidy P. Guarino A.J. Use of simulation to integrate cultural humility into advanced health assessment for Nurse Practitioner students.)SP(i)Nil specific, (ii)Not reportedDiverse SPs recruited, training, feedback and exemplar recording provided (time unclear)(Effect of the Diverse Standardized Patient Simulation (DSPS) cultural competence education strategy on Nursing Students' transcultural self-efficacy perceptions.)SP(i)Nil specific,(ii)NR but NLN and INACSL standards used to design/implement SBL8 hours training per SP, trained in two scenarios framed in ASPE standards (Lewis K.L. Bohnert C.A. Gammon W.L. Hölzer H. Lyman L. Smith C. Gliva-McConvey G. The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP).) content validity of scenarios formally evaluated of scenarios by 5 experts in transcultural nursing.(The influence of the oncology-focused transgender-simulated patient simulation on nursing students' cultural competence development.)SP(i)Nil specific (ii) As aboveTranswomen SP training, rehearsal, and feedback (5 hours using ASPE standards).()Lecture V RP V SP(i) Facilitators comfortable discussing cultural humility ii) not reportedNil reported(Cultural competence clinic: An online, interactive, simulation for working effectively with Arab American Muslim Patients.)Screen-based interactive(i)Nil specific
(ii)Not reportedContent informed by literature review, input from cross-cultural consultants, focus groups with local Arab American Muslim community members, physicians, and patients.()SP(i)Nil specific
(ii)Not reportedCultural and linguistic diverse SP's, expert review of scenarios (no expansion), one hour SP training with rehersal and adjustment of scenario, environmental authenticity.(Weideman Y.L. Young L. Lockhart J.S. Grund F.J. Fridline M.M. Panas M. Strengthening cultural competence in prenatal care with a virtual community: Building capacity through collaboration.)VV and VSP discussion boardsNo facilitation, virtual patients were not trained and experienced some negative interactions, no faculty moderation of board.Faculty, in collaboration with community participants, co-created virtual patients (no expansion), representatives of the Amish (who had left but still had strong ties) and African American community assumed the roles of the virtual patient for online discussion boards()Table-top Sim student RPFacilitators experienced and cognisant of the potential emotional responces of participants (ii) No model,question examples provided.Established table-top approach (communityAction.org/povertysimulations), representatives of community agencies involved, no service users. Students were advised to engage respectfully as a learning experience not a game.Summary
SP = 12, HFS = 7 SG = 2, RP = 5, 3D = 2, Screen-based = 1, TT = 1Papers referring to Sim standards (n = 6), specific debrief model (n = 3), specific CC expertise of facilitators (n = 4).

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