Development and psychometric properties of the tool for assessing LGBTQI+ health training (TALHT) in pre-licensure nursing curricula

Nursing care of transgender persons: A systematic mapping study

AIM

To identify, organize, and report findings of published literature related to the delivery of nursing care for transgender people.

BACKGROUND

Transgender people describe negative interactions with healthcare providers, which have led to delayed care and suboptimal health outcomes. Nurses report being unprepared to care for transgender patients despite published standards for delivery of gender-affirming care. Previous studies indicate focused transgender nursing care education improves positive healthcare experiences and reducing disparities for transgender people.

DESIGN

A systematic mapping strategy was employed to perform this mapping study.

METHODS

Using the search terms transgender, transgendered, gender-nonconforming, nonbinary, gender identity, nursing care, nurse attitudes, health care delivery/disparities, patient-centered care, and gender-affirming care a literature search was completed within CINAHL Complete, MEDLINE Complete, and Psychology and Behavioral Sciences Collection. Of 1250 articles identified, duplicates were removed before the titles, abstracts, and full text were screened for relevance.

RESULTS

A final sample of thirteen studies focusing on transgender patient care, practicing nurses' experiences, and nurse education was analyzed. The findings confirmed a dearth of primary research related to nursing care of transgender people.

CONCLUSIONS

Little research has been conducted in the last five years regarding nursing care provided to transgender people and nurse education regarding aspects of transgender and gender-affirming care. Despite increased research, innovative interventions remain imperative to address the gap in nursing education regarding gender-affirming health care.

Delivering transgender-specific knowledge and skills into health and allied health studies and training: a systematic review

Many transgender individuals face inequities, discrimination, and sometimes even a lack of transgender-specific knowledge in health care settings. Educational curricula can address such disparities and help future health professionals to become more knowledgeable, confident, and well-prepared for addressing the needs of transgender individuals. This systematic review aims to summarize current training interventions about care of transgender individuals for health and allied health students, and to analyse the effects of the respective intervention. A total of six databases (Pubmed, MEDLINE, Scopus, Web of Science, Embase and SciSearch) were screened for original articles published between 2017 and June 2021. Search terms and eligibility criteria were pre-specified, and after a structured selection process 21 studies were included into further analysis. Extracted data contained information on general study properties, population, design, program format and outcomes of interest. A narrative synthesis was used to summarize detected results. Study quality was assessed for each individual study. A self-developed 18-item checklist combining criteria of two prior published tools was used to assess overall quality of quantitative studies. For qualitative studies a 10-item checklist by Kmet et al. [HTA Initiat, 2004] was applied. Eligible studies were designed for multiple health or allied health profession students, and varied widely regarding program format, duration, content, and assessed outcomes. Almost all (N = 19) interventions indicated improvements in knowledge, attitude, confidence and comfort levels or practical skills concerning care for transgender clients. Major limitations included the lack of long-term data, validated assessment tools, control groups and comparative studies. Training interventions contribute to prepare future health professionals to deliver competent and sensitive care and which may improve the prospective experienced health care reality of transgender individuals. However, currently there is no common consensus about best practice of education. Additionally, little is known about whether detected effects of training interventions translate into noticeable improvements for transgender clients. Further studies are warranted to assess the direct impact of specific interventions in the light of the respective target populations.

The Mastery of Competencies for the Care of LGBT+ People by Different Health Professionals

This study aims to compare the mastery of competencies in assisting the LGBT+ population of Brazilian health professionals. Data collection occurred in a face-to-face and virtual manner, in the first semester of 2018. The health professionals answered a socio-demographic and functional questionnaire, in addition to the questionnaire Measurement of Training Needs for Health Care for the LGBT+ Public. The data was analyzed using Mann-Whitney and Chi-square tests. The project research was submitted to and approved by the IMED Research Ethics Committee (CAAE 69116917.6.0000.5319). The sample (n= 380) was made up mostly of psychologists (42.3%), female (81%), heterosexual (73.2%), aged between 26 and 35 years (36%), Catholic (41%), living in the south region (36.9%), and working in the profession for ten years or more (34.3%). Skills gaps on the LGBT+ theme was identified, especially in topics such as "approach to the patient's sexuality," "interference of religious beliefs in care," "care with the genitalia and breast of the trans individual," among others. Professionals trained in psychology and non-heterosexuals had a greater mastery of the theme than the others. The fragmentation of knowledge and skills hinders the full and equal access to the health system, and continued educational actions are recommended.

Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis

INTRODUCTION

Existing literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co-occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring.

DESIGN/METHODS

Partial least square path modeling followed by response-based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)-based TW (N = 1418; 46.2% White non-Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post-traumatic stress and psychological distress).

RESULTS

The final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW.

CONCLUSION

Our findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co-occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real-world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti-racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts.

CLINICAL RELEVANCE

This study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post-traumatic stress disorder and psychological distress. Specifically, interventions should take an anti-racist approach and would benefit from incorporating social support-building activities.

Nurses' implicit and explicit attitudes towards transgender people and the need for trans-affirming care

Background

The primary objective of this study is to investigate the implicit and explicit attitudes of healthcare professionals - in particular nurses - towards transgender people. This is especially important in light of recent calls for improved trans-affirming care provision by healthcare professionals to generate quality healthcare access and outcomes for transgender people.

Methods

We use publicly available data from the transgender version of the Implicit Association Test from 2020 to 2022. We focus on differences between three subsets of participant: (1) non-healthcare professionals (N = 177,810), (2) non-nursing healthcare professionals (N = 22,443) and (3) nursing healthcare professionals (N = 11,996). We present the results of parametric statistical tests (t-tests) and an ordinary least squares regression, to analyse the robustness of our results when controlling for a host of sociodemographic characteristics.

Results

We find that non-healthcare professionals have significantly lower implicit bias towards transgender people compared to healthcare professionals. Further, within healthcare professionals, we find nurses have significantly higher implicit bias towards transgender people compared to non-nurses. We show how implicit bias and explicit attitudes are highly correlated. Further, we provide evidence that healthcare professionals - but in particular nurses - conflate sex and gender identity.

Conclusion

Whilst nurses continue to have higher levels of implicit and explicit bias towards transgender people there remains a need to globally establish additional enhanced trans-affirming care training provision for nursing and medical students.

Enhancing cultural competence in caring for lesbian, gay, bisexual, and transgender patients: An online training program for Taiwanese student nurses and nurses

BACKGROUND

Health disparities exist among lesbian, gay, bisexual, and transgender (LGBT) populations worldwide. However, student nurses and nurse staff have limited knowledge and skills in providing culturally competent nursing care for LGBT patients in Taiwan.

OBJECTIVES

This paper describes the development, implementation, and evaluation of an online training program for the cultural competence of student nurses and nurses in Taiwan.

DESIGN

A one-group pre-/post-test study design.

SETTINGS

The study was conducted in five nursing schools, 10 nursing associations, and 37 long-term care facilities. Two prominent online bulletin boards (PTT Nurse and Dcard Nurse) and one Taiwanese nursing group on Facebook were used to recruit participants.

PARTICIPANTS

In total, 301 student nurses and nurses participated in the study and responded to pre- and post-test questionnaires.

METHODS

An online training program for culturally competent nursing care was developed and implemented. The pre- and post-test questionnaires contained three sections: (1) demographics, (2) knowledge of LGBT health, and (3) the Sexual Orientation Counselor Competency Scale. Three open-ended questions were included in the post-test questionnaire to evaluate the online training program.

RESULTS

The online training program significantly improved the participants' knowledge and cultural competence skills. However, their attitudes towards cultural competence did not change after the program was implemented. Regarding qualitative feedback of the online training program, feedback on the strengths and limitations of the program was summarized under three themes: program content, website design, and online modules.

CONCLUSIONS

The results suggest the importance of an online training program which may contribute to reducing health disparities among the LGBT population.

Using a Flipped Classroom and Role-Play to Introduce Nursing Students to LGBTQIA+ Patient Care

ABSTRACT

This project used a flipped classroom method to introduce prelicensure baccalaureate nursing students to the concept of sexual orientation and gender identity and increase student knowledge and comfort in the care of these individuals. Teaching-learning strategies included self-instruction via video and classroom activities of group discussion and role-play. The educational activity used a pre- and posttest design to evaluate learning outcomes. After implementation, students reported a greater understanding of the needs of lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual (LGBTQIA+) patients. The results suggest that even a short introduction to the LGBTQIA+ patient's needs could increase nursing students' knowledge.

Continuing education with a holistic approach to the Brazilian LGBT+ population through use of the m-health App

AIM

This article aims to discuss the development of a continuing education course for health care professionals to provide competent healthcare assistance to the Brazilian LGBT+ population and the implementation of this course using a m-Health solution.

BACKGROUND

There is a scarcity of continuing education courses in the Brazilian context that update provides evidenced-informed education to ensure health care professional competence in the delivery of health care to LGBT+ individuals.

METHODS

Based on Bloom's taxonomy, with a main focus on the cognitive domain, the course "Ally: A Holistic Approach to the LGBT+ Individual'' was developed in five months. This was based on the Nurse's Health Education for LGBT Seniors (HEALE), the Curriculum Implementation and Institutional Climate manual, Changes to Improve Healthcare for LGBT People, Gender Nonconforming or Born with DSD" and the National Comprehensive Health Policy for LGBT+ People, among others.

RESULTS

Comprising six modules: i) human sexuality; ii) equitable care and appropriate terminology; iii) public health policy for the LGBT+ population; iv) cultural skills for health professionals; v) aging and health care for the LGBT+ population; and vi) mental health of LGBT+ people. Content validity indexing was established using an expert panel and was Ally was supported by a m-Health Solution called "Over the Rainbow'' and totals of 60 h of education.

CONCLUSIONS

This m-Health solution and continuing education course for health professionals can be an opportunity to change health professionals' practice to offer more equitable health care for the LGBT+ population.

Teaching LGBTQ+ Health, a Web-Based Faculty Development Course: Program Evaluation Study Using the RE-AIM Framework

BACKGROUND

Many health professions faculty members lack training on fundamental lesbian, gay, bisexual, transgender, and queer (LGBTQ+) health topics. Faculty development is needed to address knowledge gaps, improve teaching, and prepare students to competently care for the growing LGBTQ+ population.

OBJECTIVE

We conducted a program evaluation of the massive open online course Teaching LGBTQ+ Health: A Faculty Development Course for Health Professions Educators from the Stanford School of Medicine. Our goal was to understand participant demographics, impact, and ongoing maintenance needs to inform decisions about updating the course.

METHODS

We evaluated the course for the period from March 27, 2021, to February 24, 2023, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. We assessed impact using participation numbers, evidence of learning, and likelihood of practice change. Data included participant demographics, performance on a pre- and postcourse quiz, open-text entries throughout the course, continuing medical education (CME) credits awarded, and CME course evaluations. We analyzed demographics using descriptive statistics and pre- and postcourse quiz scores using a paired 2-tailed t test. We conducted a qualitative thematic analysis of open-text responses to prompts within the course and CME evaluation questions.

RESULTS

Results were reported using the 5 framework domains. Regarding Reach, 1782 learners participated in the course, and 1516 (85.07%) accessed it through a main course website. Of the different types of participants, most were physicians (423/1516, 27.9%) and from outside the sponsoring institution and target audience (1452/1516, 95.78%). Regarding Effectiveness, the median change in test scores for the 38.1% (679/1782) of participants who completed both the pre- and postcourse tests was 3 out of 10 points, or a 30% improvement (P<.001). Themes identified from CME evaluations included LGBTQ+ health as a distinct domain, inclusivity in practices, and teaching LGBTQ+ health strategies. A minority of participants (237/1782, 13.3%) earned CME credits. Regarding Adoption, themes identified among responses to prompts in the course included LGBTQ+ health concepts and instructional strategies. Most participants strongly agreed with numerous positive statements about the course content, presentation, and likelihood of practice change. Regarding Implementation, the course cost US $57,000 to build and was intramurally funded through grants and subsidies. The course faculty spent an estimated 600 hours on the project, and educational technologists spent another 712 hours. Regarding Maintenance, much of the course is evergreen, and ongoing oversight and quality assurance require minimal faculty time. New content will likely include modules on transgender health and gender-affirming care.

CONCLUSIONS

Teaching LGBTQ+ Health improved participants' knowledge of fundamental queer health topics. Overall participation has been modest to date. Most participants indicated an intention to change clinical or teaching practices. Maintenance costs are minimal. The web-based course will continue to be offered, and new content will likely be added.

Knowledge, behaviours, and training related to 2SLGBTQIA+ health education amongst entry-level physiotherapy students in Canada: results of a nationwide, cross-sectional survey

BACKGROUND

Individuals who identify as 2SLGBTQIA+ report worse health outcomes than heterosexual/cisgender counterparts, in part due to poor experiences with healthcare professionals. This may stem from inadequate 2SLGBTQIA+ health and inclusiveness training in health professional student education. The purpose of the study was to evaluate knowledge, behaviours, and training related to 2SLGBTQIA+ health education and inclusiveness for entry-level physiotherapy students in Canada.

METHODS

We conducted a nationwide, cross-sectional survey with physiotherapy students from accredited Canadian physiotherapy programs. We administered the survey through Qualtrics and recruited students through targeted recruitment emails and social media posts on Twitter and Instagram between August and December 2021. Survey responses are reported as frequencies (percentage). We also completed multivariable logistic regressions to evaluate associations among question responses related to working with 2SLGBTQIA+ individuals (i.e., communication, feeling prepared and assessment competency). Covariates included training hours (< 10/10 + hours) and 2SLGBTQIA+ identity (yes/no).

RESULTS

A total of 150 students responded to the survey, with 35 (23%) identifying as 2SLGBTQIA+ . Many students felt confident in communicating effectively with clients who identify as 2SLGBTQIA+ (69%). However, only half (47%) felt comfortable assessing clients who identify as 2SLGBTQIA+ . Routine practice of inclusive behaviours such as using pronouns, considering identities are fluid and a patient's gender identity and/or sexual orientation may shift from one visit to the next, and considering trauma-informed care practices were reported from less than half of the students (< 45%). Around 29% of students reported no 2SLGBTQIA+ training in their physiotherapy program, while 47% reported 0-10 hours, and 24% reported 10 + hours of training. Students with 10 + hours of training had 92% higher odds of feeling competent in assessing 2SLGBTQIA+ clients, compared to those with < 10 hours of training.

CONCLUSIONS

Entry-level physiotherapy students in Canada show a lack of understanding and awareness for 2SLGBTQIA+ health and inclusive behaviours which can meaningfully impact patient experience. Students report feeling incompetent when working with 2SLGBTQIA+ patients, which may be associated with lack of 2SLGBTQIA+ training in their programs. Greater efforts and attention towards increasing 2SLGBTQIA+ health education and inclusivity in Canadian entry-level physiotherapy programs is critically needed.

LGBTQI+ representation in pre-licensure nursing textbooks: A qualitative descriptive analysis

BACKGROUND

To improve health equity, nursing curricula should include content specific to the needs of marginalized and underserved communities, such as lesbian, gay, bisexual, transgender, queer, and intersex groups (LGBTQI+). Harmful and absent academic discussions of LGBTQI+ patients lead to provider discomfort and inadequacy in treating this patient population. Nursing schools are well-positioned to increase comfort with LGBTQI+ content as part of pre-licensure curricula. This article presents a systematic evaluation of LGBTQI+ content in nursing pre-licensure textbooks and the nature and quality of the representations.

METHODS

A qualitative descriptive analysis of LGBTQI+ content from 14 nursing-specific textbooks required by a pre-licensure degree program at the Johns Hopkins School of Nursing was conducted by a student-led team with faculty oversight. A priori and iterative search terms were used to identify and extract text segments that referenced LGBTQI+ content in each textbook. An iterative codebook was developed, codes were applied, and analysis of the information and context in which the terms were presented was performed.

RESULTS

The research team observed gaps and notable patterns in distribution of LGBTQI+ terms and health content areas across the textbooks reviewed. The majority of LGBTQI+ search terms were identified in the following health content areas: social determinants of health, sexual/reproductive health, pediatric sexual & gender diversity, intersectionality, and infectious disease. Based on qualitative descriptive analyses, the data were organized into the following categories: a) Language; b) Medicalization; c) Vague, Incomplete, or Lacking Specificity; and d) Comprehensive Approach.

CONCLUSION

Findings highlight the need for increased academic exposure for pre-licensure nursing students regarding the care of LGBTQI+ patients. Thoughtful inclusion of LGBTQI+ content may better foster the delivery of evidence-based care for this patient population. These findings underscore the need for improved nursing curricula to support nurses in delivering affirming care for LGBTQI+ populations.

The views and experiences of midwifery academics regarding LGBTQ+ health education in pre-registration programmes in the United Kingdom and Ireland: Qualitative findings from a mixed-methods study

AIM

The purpose of this study was to identify the current LGBTQ+ health content within midwifery pre-registration programmes and identity education best practice and innovation.

BACKGROUND

There have been significant developments in some countries in protecting the rights of LGBTQ+ people. LGBTQ+ people are and do become parents and require access to maternity services. Yet some report heteronormative assumptions, negative and discriminatory attitudes from midwives that results in barriers to service access and feelings of exclusion.

DESIGN

This mixed-methods study involved a quantitative and qualitative design. The qualitative findings are reported here.

METHODS

All 135 Schools of Nursing and Midwifery across the United Kingdom and Ireland were invited to participate in an online survey and qualitative interview. Thematic analysis of the qualitative data from 29 survey responses and seven midwifery follow-up interviews were conducted.

RESULTS

Three themes identified following data analysis: (i) preparing midwifery students for practice; (ii) the diverse family unit; and (iii) safety, privacy and respect.

CONCLUSIONS

The findings provide insights into the challenges of meeting the education needs of midwifery students, with an opportunity to develop and implement a curriculum that is reflective of the needs and concerns of LGBTQ+ people within pre-registration midwifery programmes.

The Inclusion of LGBTQ+ Health across the Lifespan in Pre-Registration Nursing Programmes: Qualitative Findings from a Mixed-Methods Study

Poor physical and mental ill-health is experienced by many LGBTQ+ people, compounded by a reluctance to access healthcare services. This reluctance is attributed to experiences of heteronormative assumptions and negative attitudes encountered. Despite increasing recognition of the need to include LGBTQ+ health in undergraduate healthcare programmes, inconsistencies and gaps in content, skills development, and assessment are still apparent. The aim of the study was to identify LGBTQ+ health content within nursing and midwifery pre-registration programmes and identify education best practice and innovation. A mixed-methods study involving a quantitative and qualitative design was undertaken. The qualitative findings from a nursing perspective were extracted from the dataset for further detailed analysis and are reported in this paper. Information about the study and an online survey were distributed to 135 Schools of Nursing and Midwifery in the UK and Ireland. Individual semi-structured online interviews took place with academics. Qualitative data from 29 survey responses and 12 follow-up interviews were thematically analysed. Eight of the 12 follow-up interviews were held with nursing academics and following data analysis three themes emerged: (i) LGBTQ+ health across the lifespan; (ii) taking the initiative for LGBTQ+ health inclusion; and (iii) identifying and overcoming challenges. The findings highlight the endeavours by nursing academics to integrate LGBTQ+ health within pre-registration programmes to meet the education needs of students and the opportunity to develop curriculum content to address the needs and concerns of LGBTQ+ people across the lifespan.

Embedding LGBTQI+ competency into nursing education: Formative evaluation of an interdisciplinary project

BACKGROUND

In order to avoid perpetuating inequities faced by lesbian, gay, bisexual, transgender, queer, intersex, and other minority (LGBTQI+) communities, future nurses need to recognize and resist discriminatory, oppressive, heteronormative and cisnormative health and social systems.

OBJECTIVES

To share the development, embedding, and formative evaluation of an interdisciplinary project to improve LGBTQI+ health content across an undergraduate nursing curriculum.

METHODS

This paper describes a collaborative interdisciplinary project to embed LGBTQI+ health content across a 3-year undergraduate nursing degree. An anonymous cross-sectional online survey was sent to 87 student nurses enrolled in the final semester of their undergraduate degree. The survey included six Likert scale-type questions and five open-ended questions. Qualitative data were analyzed by inductive, reflexive thematic analysis.

RESULTS

Most students rated the topic relevant 'extremely' relevant (77 %) to nursing. Students' self-reported comfort discussing LGBTQI+ health in class varied from 'extremely' (42 %) through to 'not at all' (6 %). Thematic analysis of student responses to open-ended questions identified five themes: (1) Becoming aware of LGBTQI+ diversity; (2) Personal values and beliefs; (3) Learning in order to improve clinical encounters; (4) Inconsistency and a lack of incorporation across the curriculum; and (5) (Dis)comfort in the learning environment.

CONCLUSIONS

Opportunities to better embed LGBTQI+ competency included clear acknowledgement of wider systems of power and oppression, integration and consistent modeling by nursing faculty, and linkage of content to other equity issues to address the intersectional nature of inequities.

"I'm Not Just the Nonbiological Parent": Encountering, Strategizing, and Resisting Asymmetry and Invalidation in Genetic/ Gestational Parent Status Among LGBTQ Parents

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) families have expanded our understanding of who counts as family, to include legal as well as chosen ties. Yet, nonbiological parents in LGBTQ families are vulnerable to invalidation and erasure in social institutions, including health care, legal, and educational settings, where genetic and gestational linkages are privileged. The current study was guided by a queer phenomenological perspective to examine how LGBTQ parents experience and respond to dominant norms related to family relatedness and membership and thus queer the family. This mixed-methods study sampled 250 LGBTQ parents (including cisgender women and trans/nonbinary participants) to examine the question: In what ways does genetic asymmetry matter for families? The qualitative and quantitative analyses yielded three primary findings that revealed experiences of erasure and discrimination, as well as proactive strategies and active resistance used to counteract these difficulties. Themes were organized by (a) encountering marginalization and invalidation: health care, schools, and beyond; (b) strategic actions and discursive practices toward parental equality; and (c) confronting and resisting the need for legal, symbolic, and parenting strategies. This study documents ways in which nonbiological LGBTQ parents, in particular, embrace and resist societal norms for biological connectedness. Implications for nursing professionals include our finding that reproductive and perinatal contexts were particular sites of invalidation, necessitating education about the range of queer, nonbiological, and trans/nonbinary parents so that all parents are included in professional health care encounters.

Interdisciplinary clinicians' attitudes, challenges, and success strategies in providing care to transgender people: a qualitative descriptive study

BACKGROUND

Access to clinicians competent in transgender health remains a significant barrier and contributor toward health inequity for transgender people. Studies on access and barriers to care have predominantly evaluated transgender patients' perceptions, but scant research has included the perspectives of clinicians.

AIMS

We conducted a qualitative study to explore how clinicians (meaning physicians and advanced practice providers, in this paper) in the United States: (1) attain and utilize information, (2) perceive barriers and facilitators, and (3) understood gaps in their professional training, in regard to practicing transgender health care.

METHODS

A Qualitative Descriptive approach guided our conventional content analysis of field notes and interviews with clinicians within a parent study that explored health care access among transgender adults. Transcripts were coded into meaning units that were iteratively abstracted into themes. Standard measures were performed to promote the trustworthiness of the analysis and reduce bias.

RESULTS

Participants (n = 13) consisted of physicians (n = 8), physician assistants (n = 3), and nurse practitioners (n = 2). The majority were women (n = 11), identified as White (n = 9), cisgender (n = 13), and ages ranged from 31 - 58 years. Five main themes were identified: (1) Knowledge Acquisition: Formal and Informal Pathways to Competency; (2) Perceived Challenges and Barriers: I didn't know what I was doing; (3) Power to Deny: Prescriptive Authority and Gatekeeping; (4) Stigma: This is really strange, and I can't really understand it; (5) Reflections: Strategies for Success, Rewards, and Personal Motivations.

DISCUSSION

Clinicians gained a sense of comfort and competence with mentorship, self-directed learning, clinical experience, and person-centered, harm-reduction approaches. Stigma, bias, and structural-level factors were barriers to providing care. This study offers a unique perspective of clinicians' motivations and strategies for providing gender-affirming care and elucidates how stigma impacts the delivery of gender-affirming care.

A systematic mapping literature review of education around sexual and gender diversities

Education around sexual and gender identities is highly important to understand diversity and prevent discrimination, violence, and even murder. Nevertheless, educational institutions around the world are lacking a curriculum that explicitly includes diversity and acknowledges the LGBTQ+ community, a minority that over the years has been facing consequences from this exclusion. This study presents a detailed description of the process applied to analyze the studies using a systematic mapping literature review, as well as the positive results found from those educational institutions that started their path to inclusion around sexual and gender diversities through their curricula. The research questions targeted in this work are: What is being taught in educational institutions regarding sexual and gender diversities? What are the approaches used inside the classrooms to teach sexual and gender diversities? Which students are receiving education regarding sexual and gender diversities? Is there a technological approach and/or tool used to teach sexual and gender diversities? After applying the filtering processes, 69 studies were selected from five different online libraries: ACM, DOAJ, Lens.org, SCOPUS, and SpringerLink. The conclusions made from the findings of this review are that those studies that do tackle concerns around the topic have proven to benefit the LGBTQ+ community, the education around sexual and gender diversities predominates within the healthcare field, there are a lack of studies around this topic in Latin American countries, and technological tools are minimally used during the teaching processes.

Development and psychometric properties of the tool for assessing LGBTQI+ health training (TALHT) in pre-licensure nursing curricula

BACKGROUND

There is a lack of comprehensive lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) content in pre-licensure nursing curricula. LGBTQI+ people commonly experience mistreatment from nurses and healthcare providers due to a lack of knowledge or personal biases. To date, few instruments exist to guide LGBTQI+-specific curricular improvement.

OBJECTIVES/DESIGN/SETTING/PARTICIPANT/METHODS

Johns Hopkins School of Nursing LGBTQI+ Health Initiative and Emory University School of Nursing developed the Tool for Assessing LGBTQI+ Health Training (TALHT) to assist in evaluating gaps and redundancies in LGBTQI+ health content within pre-licensure nursing curricula. Face and content validity were evaluated among experts in LGBTQI+ health, curricular development, nursing education, and measure development (N = 22). The TALHT was modified based on expert feedback and a pilot with pre-licensure faculty (N = 13) to evaluate utility and acceptability of the refined measure.

RESULTS

Face and content validity evaluation of the 60-item iteration of the TALHT showed that the majority of items were consistently relevant among external expert reviewers. However, the clarity and readability of items were lacking. We triangulated the quantitative and qualitative data from experts to adapt and reduce the number of items in the TALHT to 20 items. Pilot testing of the revised 20-item measure found that utility and acceptability of the tool were rated highly among pre-licensure faculty.

CONCLUSION

The validation of the TALHT comes at a time when this type of instrument is clearly needed. The Future of Nursing 2020-2030 report calls for nursing education to incorporate competencies in caring for diverse populations to promote health equity. The Essentials: Core Competencies for Professional Nursing Education calls for a transition to operationalization of competency-based nursing education. The TALHT provides faculty and programs with a valid and reliable means to operationalize implementation of those competencies as they pertain to LGBTQI+ health.

Moving Dietetics Forward with Queer Pedagogy: A Post-Structural Qualitative Study Exploring the Education and Training Experiences of Canadian Dietitians for LGBTQ Care

BACKGROUND

Lesbian, gay, bisexual, trans, and other sexually and gender diverse (LGBTQ) people often experience health disparities and disparities in accessing safe health care. Yet dietetic curriculum and training opportunities for LGBTQ care is limited.

OBJECTIVE

The objective of this research was to explore the perspectives and professional training experiences within LGBTQ-focused topics of Canadian dietitians in order to inform future curriculum and pedagogy.

DESIGN

This research is framed within poststructuralist philosophies. Semi-structured qualitative interviews were conducted.

PARTICIPANTS/SETTING

To be eligible, participants needed to be dietitians within Canada who had an interest in discussing gender and sexual diversity within the profession. Although the research call was open to all Canadian dietitians who wanted to discuss gender and sexual diversity within the profession, only dietitians who self-identified as allies to LGBTQ groups ended up participating in this project. Of the sixteen dietitians who participated, eleven participants self-identified as members of LGBTQ groups and five self-identified as straight. All participants took part in online interviews done in private locations of their choosing from September 2020 to January 2021.

ANALYSIS

A systematic thematic analysis was conducted.

RESULTS

Three themes, including 1) Understanding the ethics of dietetic education, 2) Recognizing the cis- and hetero-normativity of dietetic education, and 3) Moving forward with queer pedagogy, were noted from the data.

CONCLUSIONS

Participants explored the lack of LGBTQ focus and content during their professional training and believed such gaps were problematic to the caring philosophies of dietetics. Participants offered insights into how dietetic educators can disrupt ingrained cis- hetero-normativity and rigid binary gender norms within dietetics education and curriculum.

Assessing knowledge, attitudes and beliefs of nurses about LGBTQ older adults using a documentary video

BACKGROUND

Statistics reveal that lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults experience health disparities and barriers to accessing healthcare because of discrimination and fear of disclosing sexual orientation. Nurses receive limited education on LGBTQ health issues and even less information specifically about LGBTQ older adults. This study exposed novice nurses to the documentary, Gen Silent, which details LGBTQ older adult experiences.

OBJECTIVES

The objective of the study was to increase participants' understanding of LGBTQ older adult health disparities and experiences.

DESIGN

A one-group, pre-/post-test design was conducted to test the effect of the documentary on knowledge and attitudes about LGBTQ older adult issues.

SETTINGS

The project was set in five academic and community-based hospitals located in the mid-Atlantic region.

PARTICIPANTS

A total of 379 nurses attending a nurse residency program participated in the study.

METHODS

A questionnaire including a 16-item standardized scale and an open-ended question asking how participants would change their practice was administered before and immediately after the intervention. We assessed change in pre- and post-test knowledge scores using Wilcoxon Sign Rank test and summarized themes of the open-ended question.

RESULTS

Findings revealed statistically significant increases in 9 of the 16 items on the scale showing an increase of knowledge and inclusive attitude. Answers to the open-ended question revealed that most participants would ask patients for preferred pronouns and take steps to increase their own understanding of LGBTQ patients and their needs.

CONCLUSION

This research supports the use of a documentary as an intervention to facilitate education related to LGBTQ older adults. Further research is needed exposing healthcare professionals of varied experience in diverse healthcare settings to LGBTQ education.

LGBTQ+ Psychosocial Concerns in Nursing and Midwifery Education Programmes: Qualitative Findings from a Mixed-Methods Study

LGBTQ+ people experience significant physical and psychosocial health issues and concerns, and encounter barriers when accessing healthcare services. We conducted a mixed-methods research study across all Schools of Nursing and Midwifery in the United Kingdom and Ireland using a survey and qualitative interviews. This was to identify the current content within nursing and midwifery pre-registration programmes in relation to LGBTQ+ health and to identity best practice and education innovation within these programmes. The survey was completed by 29 academics, with 12 selected to participate in a follow-up in-depth qualitative interview. Analysis of the data from the survey and interviews identified five themes: there is variable programme content; academics are developing their own programmes with no clear consistency; LGBTQ+ health is being linked to equality and diversity; there are barriers to education provision; and these is some evidence of best practice examples. The findings of the study support the need to develop and implement a curriculum for LGBTQ+ health in nursing and midwifery pre-registration programmes with learning aims and outcomes. Academics need support and tools to prepare and deliver LGBTQ+ health content to nurses and midwives as they ultimately have the potential to improve the experiences of LGBTQ+ people when accessing healthcare.