Nursing students report a lack of knowledge regarding LGBT issues in healthcare (Cornelius & Carrick, 2015). This is particularly concerning given the current demographic change in nursing. With the impending aging and retirement of the “baby boomers” comes a new group of nurses that are ill-prepared to manage the healthcare needs of this population. This is further compounded by the aging of LGBT patients, which will represent between two and nine million people by 2050 (Lim & Bernstein, 2015). With this estimated population growth, it can be asserted that one in 13 elders will identify as LGBT. The question simply becomes: is the future nursing work force prepared to tackle the changing patient population?
Heteronormativity, or the assumption that everyone is heterosexual until told otherwise, permeates the healthcare environment (Rondahl, 2011). This leads to a disconnect between patients, their partners, and healthcare providers. The fear of orientation disclosure easily perpetuates poor health outcomes and increases health disparities among this growing population. It is imperative that nursing students understand the theoretical frameworks that apply to encounters with this population, namely queer theory. However, it is more important that pre-licensure nursing students understand the historical context of homosexuality and implications for bedside nursing practice. Prior to 1973, homosexuality was listed by the American Psychological Association as a psychiatric condition. In fact, it wasn’t until recent history that homosexual acts were deemed illegal in the United States. Understanding these contexts will help students gain an appreciation for the disconnect and distrust of the medical arena by LGBT identified individuals.
Integration of LGBT healthcare within the framework of vulnerable populations into the nursing curriculum could facilitate the connection of future nurses with their patients. When surveyed, 87% of heterosexual nursing faculty stated that they had zero to limited knowledge of LGBT healthcare issues (Lim, Johnson & Eliason, 2015). With such a disparity in faculty knowledge, there leaves little room to catalyze a new breed of nurses truly trained in cultural competence including the LGBT community.
A recent pilot was performed at a large private university in the mid-Atlantic states. As part of a junior-level course in psychosocial nursing, students learned about psychosexual disorders. Topics covered the concepts of sex and gender as two different entities with the superimposition of sexual orientation. Health disparities among LGBT identified individuals was also discussed as well as the transgender transition process. The presenters also shared their stories of interaction with the healthcare team.
The following week, a four-item questionnaire was provided to the students with optional participation. The students were simply asked to identify “take away” moments from the lecture. There was no limit to what they could write and the subjects had optional de-identification. After de-identification, the results were made available to the guest lecturers. The results of which were then coded and frequency distributions calculated. With 52 respondents, 84.62% stated that they were unaware of gender being outside the binary, or that gender identity was different than sex. Another 69.23% of nursing students noted that having a lecture in this type of material will inform their practice and enhance their desire to be advocates for LGBT patients. 21.15% of students noted that LGBT issues had not been previously addressed in their nursing curriculum.
This pilot data has wide reaching implications for nursing education and nursing practice. Using the information gleaned from the literature and the data above, it is evident that a need for LGBT health concerns is present for both faculty and students. The lecture above is a starting point for integration of LGBT health concerns into the prelicensure curriculum. Maruca, Diaz, Stockmann, & Gonzalez (2018) note that students appreciated LGBT content in practice through the use of simulation to enhance their learning. Combining didactic information with the use of simulation could prove mutually beneficial for patients and students as they become new-to-practice nurses. In addition to the above, encouraging the growth of a more diverse and LGBT faculty could prepare the next generation of nurses to be more competent in nursing care provision of this vulnerable population.
Ultimately, nurse educators are charged with connecting patients and communities, collaborating with other disciplines, and being a catalyst to make a change in the world. It’s time to start somewhere and the pre-licensure nursing curriculum is the place for this change to occur.