Nursing scholars and allied health care professional researchers have conducted studies that assess the education students and practitioners receive about diverse gender, sex, and sexual communities (DGSSCs). They found that professionals working in these fields are not sufficiently educated in how to provide safe and sensitive care to DGSSCs nationally and globally (Craig, Dentato, Messinger, & McInroy, 2016; Daley & Macdonnell, 2015; Kashubeck-West, Szymanski, & Meyer, 2008; F. A. Lim, Brown, & Kim, 2014; Morrison & Dinkel, 2012; Rodriguez, Holvino, Fletcher, & Nkomo, 2016; Singer, 2015; Toronto Long-Term Care Homes & Services, 2008; Von Vogelsang, Milton, Ericsson, & Strömberg, 2016). In an effort to investigate whether binary or heteronormative assumptions may account for this trend (MacDonnell, 2014; Motschenbacher & Stegu, 2013), we used an inductive method to analyze how gender, sex, and sexuality were conceptualized in fifteen nursing articles. These articles included national and international publications that specifically focused on creating a more inclusive healthcare environment for DGSSCs. Based on this analysis, we provide recommendations on the use of more inclusive language and thinking, as they relate to diverse client populations, nationally and globally.
Gender, sex, and sexual identities are diverse and not static. A number of scholars have provided detailed definitions of various terms related to gender, sex, sexuality (Merryfeather, 2011; Merryfeather & Bruce, 2014; Schindel, 2008; Stryker, 2008). Hence, handouts will be provided to participants, which include salient definitions.
Delving into Nursing Research – Nursing Background
There is evidence of a shortage of health and social care providers who are competent in and knowledgeable about lesbian, gay, bisexual, transexual, and queer (LGBTQ) health (Carabez, Pellegrini, Mankovitz, Eliason, Ciano, et al., 2015; Kellett & Fitton, 2017; Lim et al., 2014; Lim, Johnson, & Eliason, 2015; Von Vogelsang et al., 2016), let alone those identities and orientations that fall outside of these categories. Lim, Brown, and Kim (2014) assert that, “It is estimated that by 2050, LGBT people ages 65 years and older will account for one of every 13 elders at US” (p. 27),and yet health professionals appear to lack sufficient knowledge about how to support these communities. Similarly,Merryfeather (2011)documented her four decades of witnessing horrific experiences that transgender individuals were subjected to at the hands of health and social care professionals.
Studies also show that there is a lack of institutional support to ensure that health and social care professionals are educated about the needs of DGSSCs (Daley & Macdonnell, 2015; Klotzbaugh & Spencer, 2014)and about the use of inclusive language when providing care for diverse populations. In a study of attitudes of nurse educators, one researcher found that majority of participants indicated that it was important to teach nurses and nursing students about LGBTQ needs, but they felt that nursing professors were not prepared to do so (Sirota, 2013). The lack of inclusive language in teaching material, such as nursing textbooks, is one reason that nursing professors might not be prepared(Merryfeather, 2011). One example is the research textbook titled, Nursing research: Generating and assessing evidence for nursing practice (Polit & Beck, 2017), which is assigned to undergraduate and graduate nursing students. The authors of this textbook use binary and heteronormative language when discussing gender; for instance, they state, “When categorical variables take on only two values, they are dichotomous variables. Gender, for example is dichotomous: male and female” (Polit & Beck, 2017, p. 48). As an undergraduate teacher and PhD student, I have noticed nursing scholars, researchers, and faculty members use this same binary language as it pertains to gender. Our aim in this presentation is to demonstrate that, even articles that attempt to be inclusive of DGSSCs, are influenced by heteronormative language.
Methods:
An electronic search of articles that focus on nursing education and gender, sex, and sexual inclusivity was conducted using databases of ProQuest, CINHL, Google Scholar, Pubmed, and EbscoHost. Fifteen articles that addressed the education of nurses or nursing students about DGSSCs were selected for this review and eleven of them relied on survey analysis. We used an inductive analysis coding method to assess how gender, sex, and sexuality were conceptualized in the fifteen articles (Thomas, 2003).
Results:
The analysis indicated that the fifteen articles could be grouped into three broad categories. The first group included those studies in which survey participants were only given the binarized gender option of selecting male or female (men or women) (Echezona-Johnson, 2017; Rondahl, 2009; Röndahl, 2011; Unlu, Beduk, & Duyan, 2016).
The second group included studies that attempted to be inclusive by going beyond the gender binary and heteronormative thinking. Studies in this group included those that attempted to be inclusive but did not use the collected data on gender, sex, or sexual identity in their analysis (Cornelius, Carrick, & Patterson, 2015; Hardacker, Rubinstein, Hotton, & Houlberg, 2014; Strong & Folse, 2015), those that partially used the collected demographic data (Chapman, Watkins, Zappia, Nicol, & Shields, 2012; Dinkel, Patzel, McGuire, Rolfs, & Purcell, 2007; Sirota, 2013), and one study that asked and incorporated sex and sexual orientation responses in the data analysis (Lim et al., 2015a). However, in the latter study, Lim et al (2015a) failed to ask participants about their gender identity.
The third group included four articles in which the researchers’ survey questionnaires did not ask participants about their gender, sex, or sexual identity. In these cases, asking demographic questions was not relevant to the purposes of the research. These authors (Carabez, Pellegrini, Mankovitz, Eliason, Ciano, et al., 2015; Carabez, Pellegrini, Mankovitz, Eliason, & Scott, 2015; Carabez, Pellegrini, Mankowitz, Eliason, & Dariotis, 2015; Walsh & Hendrickson, 2015)provided a new perspective on the necessity of asking these demographic questions.
Conclusion:
After carefully analyzing the selected research articles – each of which sought to educate nurses about DGSSCs and enhance inclusivity - heteronormative language was evident in eleven out of fifteen of them. There was also evidence of researchers confusing the differences among gender, sex, and sexual orientation (Dinkel, Patzel, McGuire, Rolfs, & Purcell, 2007; Hardacker et al., 2014; Lim et al., 2015; Sirota, 2013)as evident by the categorical options provided to participants. We suggest that researchers ask participants about their gender, sex, and sexuality to ensure inclusivity of all diverse individuals. That said, a clear limitation of this analysis is that it focused on published research articles. For future study, we recommend a more comprehensive review of the existing literature, which is not limited to only published articles.
After the presentation of the above findings, we will ask audience members some questions to elicit discussion about how researchers can be more inclusive of DGSSCs in their research processes, which have implications for nursing education, practice, and policy. For example, how are participants’ demographic data, related to gender, sex, and sexual identities, used in the analysis? Are researchers using terms such as LGBTQ that exclude those who do not identify as LGBTQ?