Abstract

Authentic patient representation is essential for preparing nursing students to provide quality care. This need is significant for populations impacted by legislative restrictions to healthcare. Additionally, inconsistent approaches in clinical simulation can hinder teaching and learning of valuable content. Nurses have extensive experience in ethics and social justice advocacy to improve health outcomes. Community collaborations help nurses better support their patients and novice learner competency. In 2022, clinicians and faculty collaborated to improve gender-inclusive representation in undergraduate nursing curricula and to educate learners about local resources. This standardized patient experience, focused on the care of a transgender and non-binary identifying patient with abdominal pain, is the first simulation in the curriculum which received favorable support from students, study participants and collaborators. This work considered the impacts of integrating best practice and professional ethics in simulation and nursing with community-engaged collaborations to support students practicing trauma-informed care in their first clinical semester. The outcomes provide a template for promoting authentic patient representation for populations in need of visibility. The mixed methods triangulation design to validate quantitative data used one post-simulation survey focused on clinical confidence and bias. The anonymous survey modeled the Simulation Evaluation Tool Modified (Leighton et al., 2015) and included questions focused on nursing skills using Likert scale responses and structured reflections. The study reflects 3 years of data collection with a total of 193 participants. Participants consistently reported improved confidence caring for a patient with a gender-diverse identity, improved advocacy & empathy for their patient, increased awareness of personal bias, appreciation for the experience, and interest in more diversity-focused simulations. These reflections validated the consistent improvement of post-simulation self-reported clinical confidence across all cohorts compared to baseline levels. The outcomes of this work highlight the importance of upholding ethics and best practices standards in clinical learning and offers a replicable approach to improve underrepresented patient populations through community collaboration.

Description

Dedication: To anyone who has felt minimized, intimidated, harmed, or ignored by the barriers within the American healthcare system, this work is for you. You are seen, you matter, and we can change this together.

Dr. Karen Giuliano, PhD Advisor and Committee Co-Chair

Dr. Celeste Surreira, DNP, Committee Co-Chair

Dr. Hyeyoung Park, Member

Dr. Ryan Wells, Member

Author Details

Lindsay N. Dubois, PhD, MSN, BSN, CHSE teaches in the undergraduate program in the Elaine Marieb College of Nursing at the University of Massachusetts Amherst. Her clinical expertise is in reproductive health and clinical simulation as a Certified Healthcare Simulation Educator (CHSE). Her research focuses on improving patient representation in simulation through community engagement and consistent application of ethics and best practice standards. In 2026 her dissertation work, in collaboration with faculty and community clinicians, received the UMass ADVANCE Equitable Practices in Collaboration (EPiC) Award and she was the recipient of the Elaine Marieb College of Nursing PhD Program Excellence in Research Award. She is the chair of the Leadership Succession Committee for the Sigma Theta Tau Honor Society for Nursing’s Beta Zeta at Large Chapter. This committee supports new graduate nurses with mentorship and leadership opportunities.

Sigma Membership

Beta Zeta at-Large

Type

Dissertation

Format Type

Text-based Document

Study Design/Type

Clinical Practice Guideline(s)

Research Approach

Mixed/Multi Method Research

Keywords:

Clinical Competence, Clinical Education, Best Practices, Nursing Students, Simulation Methods in Education, Ethics, Nursing Ethics, Trauma-Informed Care, Social Justice, Patient Advocacy

Advisor

Karen Giuliano

Second Advisor

Celeste Surreira

Third Advisor

Hyeyoung Park

Fourth Advisor

Ryan Wells

Degree

PhD

Degree Grantor

University of Massachusetts Amherst

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2026-10-20

Full Text of Presentation

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