Background : Transgender and non-binary [trans*] people experience significantly higher rates of depression, suicide, eating disorders, alcohol use, smoking, HIV and other sexually transmitted infections, when compared with cisgender populations. These health inequities have been linked to discrimination in health care settings, limited access to appropriate care, and lack of insurance coverage. Nurses represent the largest segment of the US health care workforce with baccalaureate nursing programs graduating 111,634 nurses in 2014 (AACN, 2015; IOM, 2011). Meanwhile, baccalaureate nursing programs dedicate a median of 2.12 total hours to LGBT-related curricular content (Lim, Johnson, & Eliason, 2015).
Methods : The Transgender Curriculum Integration Project [TCIP] used a student-faculty partnership to develop and integrate content into the existing baccalaureate curriculum at the Johns Hopkins University School of Nursing [JHUSON]. TCIP aims to increase students’ knowledge of trans* health issues and confidence in their ability to provide affirming care to trans* people. A self-administered online survey collected a pre-test and post-test evaluation to measure changes in one group of students’ attitudes and knowledge about trans* health following the implementation of trans* specific course content in four pre-licensure baccalaureate nursing courses (Health Assessment, Psychiatric Mental Health Nursing, Pharmacology, and Nursing in the Childbearing Family). Three evaluation points were used: pre-test (n=80), post-test 1 (n=41), and post-test 2 (n=29).Students who completed each survey received $3 coupon to the coffee shop at JHUSON. The survey was adapted from the UCSF medical school LGBT curriculum evaluation tool – based on the Index of Attitudes toward Homosexuals & Blumenfeld’s framework of homophobia with added context on gender identity beliefs.
Results : Findings indicate that the integrated trans* course content improved student’s knowledge of trans* resources and places for referral (mean difference between pre and post-tests [MD] = 0.177; p=.05); however, students’ comfort around those whose gender presentation was perceived as ambiguous was decreased (MD= -.0145; p=.05).
Conclusions : Increased knowledge regarding trans* resources and places for referral among nurses has the potential to improve access and engagement to trans* affirming and trans* specific care for transgender individuals. The decrease in comfort around persons whose gender presentation is perceived as ambiguous is a common phenomenon related to increased knowledge on a topic – whereas, before receiving additional information a person may have a falsely high sense of comfort or understanding that may be negatively impacted after the information is provided. This study provides a guide for the evaluation of curriculum integration programs targeting cultural-based content implementation in nursing programs.