During recent decades LGBT (Lesbian, Gay, Bisexual and Transgender) populations in Taiwan are much more visible and getting more attentions. Institute of Medicine (I.O.M., 2011) indicated that LGBT populations have special healthcare issues and healthcare needs, however, a lack of related research and a lack of knowledge and skills within healthcare providers might result in health inequality among the populations.
I.O.M. (2011) suggested that although nursing students’ attitudes towards LGBT populations might not directly associate with their future actions in providing healthcare services to the populations, their negative attitudes could adversely influence quality of healthcare services delivering to the populations. Lim and Hsu (2016) reviewed 12 papers regarding nursing students’ attitudes towards LGBT individuals and they found that half of the studies suggested nursing students’ negative attitudes, five studies reported positive attitudes and one study reported neutral attitudes. Negative attitudes were indicated to have positive correlation with lack of willingness care for LGBT individuals (Eliason & Raheim, 2000; Röndahl, Innala & Carlsson, 2004). In more recent studies, nursing students’ attitudes toward LGBT populations remain varied. Bilgic, Daglar, Sabanciogullari and Ozkan (2018) surveyed 1321 midwifery and nursing students’ attitudes towards lesbians and gay men. The researchers found that most of the students hold negative attitudes towards lesbians and gay men and nearly three fourths of the students reported that they were not given any information regarding lesbians and gay men at high school or universities. Richardson, Ondracek and Anderson (2017) conducted a descriptive study with 152 nursing students. The study results suggested that all students hold positive attitudes towards LGB individuals but they felt discomfort in providing support to LGB populations because of a lack of knowledge of LGB sexuality, personal and their religious beliefs (Richardson et al., 2017).
Previous Taiwanese research found that LGBT populations’ negative medical experiences and their low utilization rates of healthcare services were highly associated with unfriendly medical environment (Wang, 2013). Healthcare providers’ positive attitudes were associated with their educational level, knowledge regarding LGBT sexuality, their LGBT friends, relatives and/or patients and their positive attitudes were also found to be related to their positive intentions to provide healthcare to LGBT populations (Hou et al., 2006; Yen et al., 2007). In Taiwan, there is a lack of evidence to understand nursing students’ attitudes towards LGBT populations and their intentions to provide healthcare to the populations. The aims of this study were to understand nursing students’ attitudes towards sexual minority populations and their intentions to provide healthcare services to the populations.
Methods:
An online survey was conducted between July 2018-October 2018 via convenient sampling. A total of 292 Taiwanese nursing students aged 20 years and over were recruited from three nursing schools in Taipei, Kaohsiung and Hualien and one online nurses/nursing student chatroom. A questionnaire was developed based on previous Taiwanese evidence, Attitude Toward Homosexuality Questionnaire (ATHQ; LaMar & Kite, 1998) and Attitudes Toward LGBT Patients Scale (ATLPS; Sanchez, Rabatin, Sanchez, Hubbard & Kalet, 2006). ATHQ includes four components regarding Condemnation/Tolerance, Morality, Contact and Stereotypes (focused on lesbians and gay males). ATLPS measures attitudes towards LGBT patients that comprises comfort with LGBT patient encounters, opinions about same sex relationships and views of professional responsibilities. Both scales were modified based on the study purposes and were scored by the respondents on a 5-point Likert Scale ranging from 1 (strongly disagree) to 5 (strongly agree). The questionnaire language was changed to use the term LGBT, a more inclusive term than those contained in the original measure, in order to represent the wider range of sexual minorities. The overall Cronbach’s alpha in this study was 0.88 for the ATHQ and 0.72 for the ATLPS, and these data confirm the reliability of the two tools used (DeVellis, 2012).
A total of 40 questions/statements were included in the questionnaire and it comprised four topics: demographics, attitudes towards LGBT populations and their intentions to provide healthcare services to LGBT populations. Moreover, in order to understand nursing students’ training needs for providing competent culturally care to LGBT populations, three open/ended questions were also included in the questionnaire. Data were analyzed using descriptive statistics.
Results:
The majority of the respondents were female (234/292; 80.1%), were heterosexual (226/292; 77.4%), were single (154/292; 52.7%), studied in Taipei (North Taiwan), had clinical practice experiences (278/292; 95.2%), had experiences of approaching LGBT populations (247/291; 84.9%) and had no religion (131/292; 44.9%).
The majority of the respondents hold positive attitudes towards LGBT populations. Nearly 92 percent of the respondents reported that homosexuality was not sinful (271/292; 92.8). They could be a roommate (253/291; 86.6%)/neighbor (272/292; 93.2%)/colleague (275/290;94.2%) with LGBT populations. Of the 292 respondents, over 90 percent thought that LGBT individuals could take important job positions (268/91.8%), they had equal rights in any aspects (274/292; 93.8%) and they were parts of society (279/292; 95.5%). The majority of the respondents also accepted that their colleagues (275/292; 94.2%) or friends (275/292; 94.2%) were LGBT individuals. However, only 74.3 percent (217/292) of the respondents reported that they accepted their LGBT family members and 73.3 percent (214/292) thought LGBT populations were competent to be parents.
Regarding intentions to provide healthcare to LGBT populations, over 90 percent (275/285; 94.2%) of the respondents reported that they were willing to provide equal healthcare services to LGBT populations. However, only 84.9 percent (248/285; 84.9%) reported that they had abilities to provide LGBT populations healthcare, 28.1 percent (82/285) indicated that it was difficult to collect LGBT populations’ medical history and 14 percent reported it was difficult to perform physical examinations on LGBT populations. Of the respondents, 91 nursing students (31.2%) concerned they would have higher infection rates because of taking care of LGBT populations.
In this study, three open-ended questions regarding knowledge, skills and equipment/environment the respondents needed in order to provide care to LGBT populations were asked. In terms of knowledge, knowledge about LGBT populations’ physical and psychological needs (n=53), information about sexually transmitted diseases and safe sex (STD, n=25), general information about LGBT sexuality (n=14) were indicated. Four respondents also reported their needs of knowledge about gender quality and information about Taiwan LGBT organizations. Regarding skills, communication skills (n=77), empathy skills (n=10), caring skills (n=6) and skills of taking medical history and conducting physical examinations (n=4) were reported. In terms of equipment and environment, 77 respondents reported the importance of privacy (private communication space) and friendly medical environment. However, 15 individuals expressed that there were no differences regarding healthcare issues and healthcare needs between heterosexual and LGBT populations.
Conclusion:
The study results suggested that the majority of the Taiwanese nursing students hold positive attitudes towards LGBT populations and were willing to provide healthcare to the populations. These results were found to be varied from previous Taiwanese research (Yen et al., 2007). Yen and colleagues (2007) surveyed 1824 nurses and found the nurses hold negative attitudes and their negative attitudes were associated with their low intentions of tanking care sexual minority patients. We considered the varied results might reflect current visibility and acceptance of LGBT populations in Taiwanese society. In more recent research, nursing students’ attitudes were found to be more positive although they still felt less confident to provide care to LGBT populations (Richardson et al., 2017).
Regarding nursing students’ competency of providing healthcare to LGBT populations, over 84% of the participants in this current study reported that they were competent to provide healthcare services to LGBT individuals. However, the results were found to be different from Taiwanese sexual minority populations’ views and experiences of medical environment (Wang, 2013; Wang, 2017). We considered the students’ lack of knowledge of LGBT healthcare issues and needs, insufficient clinical practices experiences and lack of experiences of taking care LGBT patients might associate with the results. For example, one female nursing student in this study reported that she had an experience of conducting a physical examination on a lesbian patient. She found it was very difficult to approach the patient, because her partner did not allow the student touching her partner’s body. However, we did find about two fifths of the students (39.7%) reported their training needs regarding LGBT healthcare information and healthcare skills, particularly communication skills, in this current study.
Although nursing students’ attitudes and intentions towards providing healthcare to LGBT populations are getting much more positive during recent years, their abilities of providing culturally competent care to LGBT populations still need to be understood in order to reduce health inequality among LGBT populations.