As a nursing educator, preparing nursing students for care of an aging population is challenging. New nurses entering practice need to understand the complex physical, psychological, and spiritual needs of older adults, while also considering the importance of generational, cultural, and individual differences of older adults and their families. It is also important for new nurses to recognize and advocate for vulnerable and underserved older adult groups, such as the Lesbian, Gay, Bisexual, and Transgender (LGBT) community. Many LGBT older adults have faced discrimination throughout their lifetime, including within the healthcare system, resulting in fears and avoiding seeking care. Knowledge is necessary to improve understanding and elimination of biases and assumptions, and nursing students need to be aware of how these beliefs can lead to inequitable and inadequate care. Nurse educators can play an important role in bridging this knowledge gap by providing accurate information, addressing biases and guiding students towards acceptance and inclusiveness when providing care. One method to achieve this was to develop an educational initiative to help students become knowledgeable about the unique health and social issues older adult LGBT families’ experience in accessing health services, and nursing students’ role as care providers and advocates for LGBT families.

A three-part case study was introduced to undergraduate nursing students of a transgender individual (male to female, identifying as lesbian) along with her lesbian partner. This scenario included aging and mental health issues along with health and cultural issues unique to the older adult LGBT population including fears of being “out” to care providers, fears of discrimination in healthcare settings, isolation from biological family, and the challenges of hormone therapy with aging. A guest speaker, a mother and retired registered nurse, was also invited to share her family’s experience of her son’s transition from female to male, helping to make the experience more meaningful and real. Students also reflected on their own knowledge, beliefs, and values by completing an anonymous questionnaire using an online poll prior to receiving education on LGBT health considerations including how lifelong stigma and discrimination experiences can impact health.

Students’ narrative comments were analyzed before and after regarding their ability to identify LGBT health disparities, demographics and terminology, inclusive care provision strategies, sensitive communication, and assessment of comfort levels providing nursing care for the LGBT community. Feedback from students indicated the case study provided them with additional knowledge on LGBT culture and transgender older adults that helped increase empathy, utilize critical thinking skills, and increased preparation for practice.  Students also indicated how the case study connected classroom theory and experiences from the guest speaker, realistically replicating real life issues and the comprehension necessary for caring for the LGBT population.  Students’ survey responses further indicated significant increases in abilities to describe LGBT health disparities, demographics, strategies for creating welcoming environments and self-perceived effectiveness of being able to communicate with LGBT people sensitively. The most notable finding was a significant increase in students’ reported comfort levels in providing nursing care to the LGBT community following the implementation of the case model.

The case study assisted students to understand the importance of support in the health and wellbeing for older LGBT adults and also helped students to think in a holistic way, as well as consider their patients’ feelings and perspectives.  Students valued having a community member as a guest speaker, indicating it provided a real-life perspective.   Including an older adult transgender family promoted student learning and insight into aging as well as how being from a sexual and gender minority effects health and quality of life.  Students were able to develop skills for providing inclusive and equitable care for LGBT persons, resulting in steps being taken  towards decreasing prejudice, improving the attitudes and knowledge of nurses towards LGBT patients, and potentially improving quality of life for the entire LGBT community.  The case study also challenged students to reflect on any personal assumptions and biases, and helped students to understand older adult LGBT family dynamics and their unique health and social issues. Improving students’ knowledge and comprehension increased confidence, and empowered students to be strong and effective advocates when providing family nursing care for LGBT older adults.

About the Researcher

Nadine Henriquez is a Registered Nurse and an Assistant Professor in the Department of Nursing, Faculty of Health Studies, at Brandon University, Brandon, Manitoba, Canada.

Acknowledgements:

I would like to thank Kathy Bull, for sharing her knowledge and experiences; Dr. Kathyn Hyndman and Kathryn Chachula for writing and dissemination assistance, and Dr. Nora Ahmad for statistical analysis support.