Integrating Simulation into a Research Study, Focusing on Obesity Bias and Stigma

Linda Nosaka, DNP, APRN-Rx, AGACNP-BC, is the first Hawai‘i Pacific University Doctor of Nursing Practice student to perform a research activity utilizing simulation modalities in the University’s College of Health and Society (CHS) Simulation Program.

Nosaka conducted her DNP research study entitled “Obesity Simulation Education for Healthcare Provider Students: to Increase Awareness of Obese Bias and Stigma” with the support of CHS Associate Dean and Director, Experiential Simulation Center Jayne Smitten, Ph.D., and CHS Dean Halaevalu Vakalahi, Ph.D. They provided her access to an entire room in the SIM Center, and an Obese Simulation Suit (OSS) was the main prop for her study. Smitten served as project site preceptor and content expert, and faculty member Augustina Manuzak, M.D., Ph.D., held the role of project chairperson.

Nearly 80 HPU students from nursing, public health, and social services took part in the research study as a member of either the Control group, completing the questionnaire survey, or the OSS group, wearing the suit and participating in the obese patient simulation activities. Nosaka used the Anti-Fat Attitudes Test research tool to assess genuine anti-fat attitudes not infected by personal beliefs. She analyzed the statistical scores and the debriefing field notes that helped to guide the discussion.

Through her research, Nosaka found that healthcare provider bias and stigma are influencers of health care planning, and this drives cultural prejudice, affecting health outcomes.

“Historically, nurses have always been at the forefront in helping with health care needs for all demographics,” Nosaka said. “Therefore, a prejudiced perspective is harmful and is uncaring.”

Smitten noted Nosaka’s simulation-specific research activities through HPU’s College of Health and Society as an important milestone that has the potential to impact patient care.

“We are looking forward to future publication of Dr. Nosaka’s research findings in peer-reviewed forums, demonstrating efforts toward improving healthcare via simulation research and education,” Smitten said.

Nosaka reflected on her doctoral research project journey, sharing her hope that future master’s or doctoral nursing students do further studies using the OSS, pointing out that obesity is a health concern that affects all cultures.

Among Nosaka’s goals, she would like to engage with Hawai‘i’s healthcare task force to improve health education in vulnerable populations and acute care settings.

“I am pleased to have the ‘extra tools’ to improve my professional perspective and ability to provide optimal patient care,” she said.

Nosaka, who has been a practicing Registered Nurse for 18 years, started her nursing career in the post-partum unit. For the majority of her nursing career, she has been in critical care, receiving certifications in critical care, cardiac surgery, cardiac medicine, and trauma nursing core. Licensed and certified as an Adult Nurse Practitioner, Nosaka’s first job as a nurse practitioner was in cardiology. She received the Adult-Gerontology Acute Care Nurse Practitioner post master’s certification, and in 2020, she earned the Doctor of Nursing Practice degree from Hawai‘i Pacific University.