Pedagogical strategies of LGBTQIA+ education in pre-licensure nursing: An integrative review

Confidence, commitment, and control: Nursing faculty experiences with teaching LGBTQ+ health

AIM

This study was conducted to examine associations between facilitators and barriers to inclusion of LGBTQ+ content in nursing education, as well as to describe the experiences of pre-licensure nursing faculty with including LGBTQ+ content in their teaching.

BACKGROUND

Nursing faculty are charged with preparing students to provide equitable and ethical care for LGBTQ+ patients and populations. Prior research in this area largely focuses on student outcomes related to inclusion of LGBTQ+ topics, rather than on faculty experiences of including this content.

METHODS

Nursing faculty in the United States (U.S.) who teach in pre-licensure nursing programs were eligible to participate. Non-probability purposive sampling and snowball sampling were utilized for this cross-sectional survey study. The survey measured control over curricular content, confidence with LGBTQ+ content, facilitators, and barriers to LGBTQ+ health content inclusion in curricula, and inclusion of LGBTQ+ content. Free-text items explored faculty experiences of including LGBTQ+ content. Descriptive and correlational statistical analyses were performed and directed content analysis was applied to the free-text data.

RESULTS

Respondents (N = 196) were predominantly faculty teaching in pre-licensure baccalaureate programs (70.6 %), representing schools of nursing from 41 U.S. states. Confidence with LGBTQ+ inclusivity (r = 0.669), general authority over curricula (r = 0.240), inadequate training (r = -0.427), and insufficient knowledge (r = -0.383) were all found to have statistically significant associations with LGBTQ+ health content inclusion. Additionally, commitment to LGBTQ+ inclusion was a prominent theme associated with LGBTQ+ health content inclusion.

CONCLUSION

This study reveals the importance of faculty confidence with LGBTQ+ inclusivity within and outside the formal curriculum, as well as commitment to LGBTQ+ inclusion. These key factors may promote greater inclusion of LGBTQ+ health topics across the lifespan and across the curriculum.

LGBTQIA+ healthcare content in pre-registration nursing and midwifery curricula: A cross-sectional study

BACKGROUND

Nurses and midwives are expected to provide inclusive care for LGBTQIA+ populations. However, there is a paucity of knowledge on how well-prepared nursing and midwifery graduates are for this aspect of their role.

AIM

To explore LGBTQIA+ content in pre-registration nursing and midwifery curricula in Australia.

DESIGN

Cross-sectional study.

SETTINGS

Australian higher education institutions offering 86 pre-registration nursing and midwifery programs.

SAMPLE

Publicly available pre-registration nursing and midwifery course programs in Australia as presented in the online course handbooks of 25 randomly selected educational institutions.

METHODS

A LGBTQIA+ terminology matrix was developed to guide data extraction from subject titles, synopses, and learning outcomes. Explicit terms were those strongly associated with LGBTQIA+. Implicit terms were those indirectly associated with LGBTQIA+. Explicit and implicit LGBTQIA+ terms were analyzed for frequencies. Poisson regression was used to compare counts of LGBTQIA+ terms by course, subject, and university.

RESULTS

Among the 1093 subjects, no subject titles included explicit terms and 6 (0.55 %) titles included implicit LGBTQIA+ terminology. Explicit LGBTQIA+ terminology was identified in 54 (4.9 %) subject synopses and implicit terminology was found in 323 (29.6 %) subject synopses. Explicit LGBTQIA+ terms were identified in 14 (1.3 %) learning outcomes while implicit terms were found in 323 (29.6 %) learning outcomes. Group of Eight universities were more likely to use explicit and implicit LGBTQIA+ terminology than non-Group of Eight universities (p < 0.001; p = 0.035). Undergraduate programs included more LGBTQIA+ terminology than postgraduate programs (p = 0.019; p < 0.001). Core subjects were more likely to include LGBTQIA+ content than elective subjects (p < 0.001).

CONCLUSION

Explicit LGBTQIA+ terminology was minimal indicating limited overall content. The study results alert nursing and midwifery educators to take a targeted approach to teaching and learning with a LGBTQIA+ focus to support future nurses and midwives with quality knowledge and skills and ensure equitable and safe care for LGBTQIA+ people.

Undergraduate Nursing Faculty Knowledge, Beliefs, and Experiences with Teaching LGBTQ+ Content: A Scoping Review

BACKGROUND

Nursing education research about inclusion of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) health content in undergraduate nursing curricula primarily focuses on student learning outcomes. There is less research evidence about the experiences of nursing faculty with teaching LGBTQ+ health topics.

PURPOSE

The purpose of this scoping review was to identify current evidence about pre-licensure, undergraduate nursing faculty knowledge, beliefs, and experiences with teaching LGBTQ+ content.

METHODS

Six EBSCO databases were searched for manuscripts published between 2012 and 2023. Peer-reviewed articles, published in English, describing studies of pre-licensure, undergraduate nursing faculty knowledge, beliefs, and experiences with teaching LGBTQ+ health content were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews was used to guide inclusion of studies for review.

RESULTS

The literature search yielded 612 results, of which 58 were selected for full text screening. Twelve total studies were retained for this scoping review.

CONCLUSIONS

Faculty knowledge related to LGBTQ+ health is framed by a "deficit narrative," emphasizing physical and mental health risks and negative outcomes. Faculty beliefs are often measured with instruments that reflect cisnormativity or heteronormativity. There is an ongoing need to research the experiences of inclusion of LGBTQ+ content by pre-licensure, undergraduate nursing faculty.

Culturally sensitive emergency care for sexual and gender minority youth: A quality improvement initiative

BACKGROUND

Despite evidence of the impact of provider implicit bias and overt discrimination experienced by sexual and gender minority youth (SGMY), evidence surrounding sexual and gender minority cultural sensitivity training for pediatric emergency health professionals is limited. No targeted training existed to improve the clinical preparedness of healthcare professionals serving SGMY by increasing providers' knowledge and attitudinal awareness in a pediatric emergency department at a large, urban pediatric hospital in the Southeastern United States.

METHODS

The Institute for Healthcare Improvement's [15] Model for Improvement informed the project and was completed in four Plan-Do-Study-Act cycles. A cross-sectional, pre-test post-test design was used to gather demographic data, administer the LGBT-DOCSS questionnaire, and collect participant feedback on the training session. The LGBT-DOCSS results were analyzed using an independent samples t-test.

INTERVENTIONS

Evidence-based pedagogical strategies were utilized for a 60-minute staff training session. Staff (n = 25) had six opportunities to attend one of the training sessions over a period of 4 months.

RESULTS

Self-selection and voluntary participation contributed to recruiting participants who demonstrated high baseline LGBT-DOCSS scores, particularly on the subscales that measure knowledge and attitudinal awareness. After the sessions, participants showed an increase in LGBT-DOCSS scores with a statistically significant increase in the clinical preparedness subscale.

CONCLUSIONS

This project was the first at the institution to focus on culturally sensitive emergency care for sexual and gender minority youth. The content was well received by staff, who demonstrated increased clinical preparedness after the training. Implementing the training as a required component of new nurse orientation and onboarding is the next step in creating a safety culture for SGMY in the PED setting.

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.