Elsevier

Nurse Education Today

Volume 116, September 2022, 105443
Nurse Education Today

Research article
Nursing students' knowledge gained about female genital cutting/mutilation through dramatization simulation with a standardized patient: A quasi-experimental study

https://doi.org/10.1016/j.nedt.2022.105443Get rights and content

Highlights

  • Over 500,000 women in the U.S. have undergone female genital cutting in their country of origin or are at-risk.

  • Dramatization simulation provides students the opportunity to recreate unusual clinical events.

  • A standardized patient and student actors dramatized the patient-provider encounter with a prepared script.

  • This study was the first to use dramatization simulation to teach nursing students about female genital cutting.

Abstract

Background

Female genital cutting is a culture bound ritual involving excision of the female genitalia. Little is known about nursing students' knowledge and perceptions of female genital cutting and no studies using simulation to teach this topic exist.

Objective

The aim of this study was to examine the impact of a dramatization simulation on nursing students' knowledge about and perceptions of female genital cutting.

Design

A quasi-experimental pretest posttest study with a convenience sample.

Setting

Two Bachelor of Nursing schools in Northeast Ohio, United States.

Participants

35 third year undergraduate students.

Methods

Students were divided into an intervention group (n = 14) and a wait list control group (n = 21). The intervention group took a pre-test, did a reading assignment and then attended a virtual, dramatization simulation session with a standardized patient; a Muslim woman with a personal history of female genital cutting. They took the posttest within the next week. The control group took the pretest, did the reading assignment, and then took the posttest, followed by the simulation. The survey instrument used for pretest and posttest was the Knowledge, Perceptions, and Practice Questionnaire on Female Genital Cutting for Healthcare Professionals in the United States. Debriefing was a critical part of the simulation.

Results

The knowledge of female genital cutting of the nursing students in the intervention group increased more than that of the students in the control group (change score 3.57 and 2.05 respectively). Students' perceptions of female genital cutting were not significantly changed by intervention type.

Conclusion

This study was the first of its kind to measure nursing students' knowledge and perceptions about female genital cutting before and after a dramatization simulation. A standardized patient dramatization simulation including focused debriefing may be an effective education strategy to teach nursing students about female genital cutting.

Introduction

Female genital cutting (FGC), also known as female genital mutilation, is a culture bound ritual which involves excision of the female genitalia (Atkinson and Geisler, 2019). The World Health Organization classifies FGC into four types, varying by degrees of severity of excision. Type 1 is a partial or total removal of the clitoral glands. Type 2 is the partial or total removal of the clitoral glands and the labia minora. Type 3, also known as infibulation, is the narrowing of the vaginal opening through the creation of a covering seal. Non-medical procedures including cauterization, pricking, and piercing of the genitalia are classified as Type 4 (WHO, 2019). The tradition of FGC is common in various countries in West Africa, East Africa, the Middle East, and Asia. People from those countries have immigrated to Europe, Australia, New Zealand, and North America, taking with them beliefs related to the importance of FGC including marriageability, beauty and cleanliness, restraint of sexual activity, and respect for tradition (WHO, 2018). Over a half a million women and girls in the United States have either undergone FGC in their country of origin or are at-risk for excision in the future (Atkinson and Geisler, 2019; Goldberg et al., 2016). Health care professionals unfamiliar with the procedure and its health-related consequences are more and more likely to encounter women who were cut prior to immigration to countries where FGC is rarely done.

Section snippets

Literature

Extensive reviews of the literature by Evans et al. (2019), Abdulcadir et al. (2017), and Dawson et al. (2015) revealed that healthcare professionals (HCPs) were not comfortable dealing with FGC, particularly because they were unsure of culturally appropriate ways to care for women who had been cut (Levy et al., 2021). One reason may be because FGC has been a rare topic in nursing education.Donnenwirth et al. (2021) found that <30 % of nursing schools in the United States include any

Simulation

Simulation activities have become commonplace, educating nursing students in a wide variety of clinical skills. Recreating real-life situations such as combat scenarios, search and rescue missions, and other simulations has long been used as a training modality in the military (Couperus et al., 2020). In healthcare, medicine was the first to adopt simulation into practice (Bryant et al., 2019). Nursing schools quickly moved to add simulation as a creative technique to help students learn real

Methods

This quasi-experimental study was conducted with a convenience sample of 3rd year undergraduate students attending the bachelor's degree in the sciences of nursing programs at two comparable schools of nursing in the Midwestern United States. One faculty researcher volunteered students in the school of nursing where she taught as the intervention group; students in the other school of nursing were assigned to the wait list control group. A wait list control group strategy was used in this study

Demographics

All 35 participants were students in the 3rd year of a 4-year bachelors of science in nursing Bachelor of Nursing program. Participants in the intervention group (n = 14), ranging in age from 20 to 24 years old, were all females, 13 (93 %) were Caucasian and 1 (7 %) was another ethnicity. Participants in the control group (n = 21) ranged in age from 20 to 31 years old; 18 (86 %) were females, and 18 (86 %) were Caucasian, 2 (10 %) were African American, and 1 (4 %) was another ethnicity. The

Discussion

This is the first study among nursing students measuring their knowledge and perceptions of FGC before and after a dramatization simulation with a standardized patient. Knowledge about FGC increased among students in both the intervention group and the control group, but the increase was greater for those in the intervention group. This indicates that the reading assignment helped students to learn facts about FGC but that the simulation advanced their knowledge even more. Perceptions of FGC

Conclusions

This study was the first of its kind to use dramatization simulation with a standardized patient as part of an educational intervention teaching nursing students about FGC. Reading assignments may help increase students' knowledge of FGC but the addition of dramatization simulation appears to boost knowledge acquisition to a greater degree. A standardized patient dramatization simulation including focused debriefing appears to be an effective education strategy to teach nursing students about

CRediT authorship contribution statement

R Hess – conceptualization, methodology, data curation & analysis, writing original draft, editing.

R Ross – methodology, data interpretation, writing revisions, editing.

R Wyss – conceptualization, intervention facilitation, data collection, visualization, writing - editing final draft, funding acquisition.

J Donnenwirth – conceptualization, intervention facilitation, data collection, writing – reviewing final draft.

Funding

This research was funded by the Pi Chi Chapter of Sigma Theta Tau International, Malone University.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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