Exploring Nursing Students' Attitudes, Beliefs, and Knowledge of Lesbian, Gay, Bisexual, and Transgender (LGBT) Issues

Sunday, 22 July 2018: 1:30 PM

Rosanna McMaster, PhD
Faculty of Medicine and Health Sciences, Yamaguchi University, Ube, Yamaguchi, Japan
Kei Adachi, PhD
Faculty of Health Sciences, Graduate School of Medicine, Yamaguchi University, UBE, Yamaguchi, Japan


Nurses’ attitudes, knowledge, and beliefs have an impact on the care which lesbian, gay, bisexual and transgender (LGBT) people receive. No research exists on Japanese nursing students’ attitudes, beliefs, and knowledge of LGBT. The purpose of this study is to explore final-year nursing students’ understanding of LGBT issues.

Approximately 7.6% of the Japan population, that is, 1 in every 13 people or 9.67 million people considered themselves to be part of a sexual minority, the term encompassing people identifying as LGBT (Dentsu Diversity Labo, 2015). These numbers have increased since the last survey in 2012, where 5.2% of the population or 1 in 20 people identified as either LBGT (The Tokyo Foundation, 2015). Therefore, issues relating to the LGBT population cannot be ignored. Although there is an increasing interest in LGBT celebrities in the Japanese media, as well as in Tokyo ‘Rainbow Pride’ parades that celebrate diversity, there is misunderstanding concerning LGBT issues and fear of discrimination that lead people to conceal their sexual orientation within the community.

Stigma, intolerance and prejudice worldwide against people who identify as LGBT is particularly important as health care concerns are not being addressed. A comprehensive literature review found that minority stress caused by anti-gay stigma is related to physical health disparities (Lick, Durso & Johnson, 2013). There are clear recommendations for the need to reduce health disparities among gender and sexual minority groups (Williams & Mann, 2017) as clinical consultations which are homophobic and transphobic are a challenge faced by sexual minorities in many countries (Chatterjee, 2014). In the UK, experiences of discrimination and marginalization for people who identify as LGBT in health care persist despite recent governmental change (Bristowe et al., 2017).

Although there are a number of international studies undertaken researching LGBT issues, in Japan, the research is limited. One study by Ikuta et al (2016) examined the prevalence of LGBT among university students, suggesting that it was the first study among youth undertaken in Japan, and recommended further investigations are needed as these individuals are at risk of both mental and physical concerns. Furthermore, whereas people who identify as LGBT have the same concerns as non-LGBT people, they may face additional challenges of the complexity of the coming-out process, as well as social discrimination and bias against sexual and gender minorities (Reitman et al., 2013). In a current integrative review, Stewart and O’Reilly (2017), concluded nurses’ attitudes, knowledge, and beliefs have an impact on the care which LGBT people receive. In order to make society better for people who identify as LGBT, it is important for nurses, who care for them in hospitals and communities, to understand issues that concern this group within the health care sector (Dorsen & Devanter, 2016).


A convenience sample of eligible participants were recruited from all final year 4th year graduating nursing students undertaking the Bachelor of Nursing course. A questionnaire was used to determine the knowledge, attitudes, and beliefs of final year nursing students understanding of Lesbian, Gay, Bisexual, and Transgender (LGBT) issues. The questionnaire consisted of Demographics of the participants and a modified scale related to participants’ attitudes towards people identifying as LGBT, including attitudes to nursing health care. After dividing participants into three groups using Recognition of LGBT in Demographics G1: Knew term and meaning, G2: Knew term but not meaning, G3: Did not know, a one-way analyses of variance were conducted to compare the attitudes towards LGBT of these groups. All mean scores of Attitudes towards LGBT of three groups were high.


The questionnaire was undertaken by 80 students and the return rate was 69 students (86% response rate). Demographic results included the average age of the respondents: 21 years, of which 92.8% of students described their sexual orientation as being heterosexual, 2.9% as bisexual and 4.3% preferring not to answer. Most of the participants did not identify with a religion 91.3%. Nearly half of the participants (47.8%) were aware of and recognized the term LBGT with 14.5% knowing the term but not the meaning, with 37.7% not knowing the meaning. Their information source was mainly from the television (63.8%) or from social media (30.4%). The majority of participants (72.5%) did not have any friends, acquaintances, significant others, co-workers, neighbors, teachers or others who identified as LGBT. There was no significant difference in attitudes towards Gay, Lesbian, and Bisexual. However significant difference between G2 and G3 was found in attitudes towards Transgender (T2). Factor analysis of the Nursing care attitudes toward LGBT patients scale identified two factors which accounted for 61.12% of the variance (Table 3). Factor 1 was characterized as ‘Deny nursing care’ and Factor 2 was ‘Provide usual nursing care’.

The open-ended question asked of the students whether more information concerning LBGT people was needed and why. This question elicited five categories of answers: Because people who identify as LGBT are increasing there is a need to: Increase knowledge: more opportunities to learn and more lectures needed/Improve confidence in how to interact/Deepen understanding as low awareness of issues and recognition needed/Lessen deep-rooted prejudice, bad attitudes and confusion. These would all lead to better individual nursing care.

Although many students have little opportunity to interact with people identifying as LGBT, the students tended to accept them willingly. It is clear that the difference of recognition didn’t affect nursing attitudes and care for LGBT patients. Furthermore, ‘transgender’ is an unfamiliar term to the students although the term is used in media and on social network sites. Therefore, the significant difference regarding attitudes on transgender appeared only as probable. Furthermore, the participants wanted further knowledge and information given to them concerning LGBT health care which is consistent with a study undertaken by Strong and Folse (2015) in the U.S.A. which recommended that content concerning LGBT healthcare needed to be incorporated in nursing undergraduate curricula to improve LGBT patient care, through promotion of sensitivity and cultural competence.


This was a small-scale study in rural Japan on a sample of final year nursing students. It was not intended to be generalizable to other Japanese nursing students. There is a need for further education concerning people who identify as LGBT in undergraduate curricula for student nurses. Future research is required related to LGBT healthcare for undergraduate nursing students including comparisons with larger, urban university final year graduates as well as international comparisons.