Surface – Awareness & Affirmation: The NLN ACE+ Series for Nursing Educators and Learners

This episode of the NLN Nursing EDge Unscripted Surface track features guests John Mikovits and Beth Hallmark. The discussion focuses on the NLN ACE+ Series, which equips nurse educators with tools to teach care for LGBTQ+ individuals and address health disparities they face. Drs. Mikovits and Hallmark emphasize the importance of affirming care and integrating LGBTQ+ content throughout nursing curricula rather than treating it as a special topic. They highlight the role of simulation and debriefing in fostering understanding and dialogue about LGBTQ+ health needs. The episode encourages nurse educators to embrace discomfort and engage in continuous learning to provide culturally competent care.

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Transcript

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[Music][Music] 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]