Digital Repository Doctoral Projects Spring 2023 Promoting Inclusive Nursing Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients Nancy Weston Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Weston, N. (2023). Promoting Inclusive Nursing Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients. Weber State University Doctoral Projects. https://cdm.weber.edu/digital/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact archives@weber.edu. PROMOTING INCLUSIVE NURSING CARE 1 Promoting Inclusive Nursing Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients by Nancy T. Weston A project submitted in partial fulfillment of the requirements for the degree of DOCTOR OF NURSING PRACTICE Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, Utah April 28, 2023 Nancy T. Weston _______________________________ Nancy T. Weston, DNP Executive Leadership, RN, CNE Kristy A. Baron _______________________________ Kristy A. Baron, PhD, RN _______________________________ Melissa NeVille Norton DNP, APRN, CPNP-PC, CNE Graduate Programs Director April 28, 2023 ____________________________ Date April 28, 2023 _____________________________ Date April 28, 2023 _____________________________ Date Note: The program director must submit this form and paper. PROMOTING INCLUSIVE NURSING CARE 2 Abstract Purpose: Nursing education should reflect the needs of the population it serves. People identifying as lesbian, gay, bisexual, transgender, and queer (LGBTQ+) have increased over the past few years, with continued growth expected. Consequently, nursing faculty need the necessary knowledge, skills, and attitudes to teach nursing students to provide quality nursing care to LGBTQ+ patients who are less likely to receive equitable health care because they are members of a diverse population. Therefore, addressing their healthcare needs in the nursing curriculum is essential in alleviating healthcare barriers and biases. Methodology: The equity, diversity, and inclusion (EDI) guidelines were presented to the nursing faculty, applied by simulation course chairs in clinical simulations, and used to review the associate degree nursing (ADN) program student application to encourage qualified applicant diversity. Qualtrics quantitative pre- and post-survey questions were offered to nursing faculty to assess faculty comfort in teaching nursing students how to support LGBTQ+ healthcare needs and the importance of including EDI in the nursing curriculum. In addition, the simulation course chairs and ADN director were asked verbal qualitative survey question(s). Results: Overall, nursing faculty were receptive to increasing EDI in the curriculum, simulation, and ADN application. Implications for practice: Utilizing the Nursing EDI Guidelines for the LGBTQ+ Population increase faculty awareness and address healthcare disparities to bridge a nursing education gap. The guidelines are a resource accessible online, aiding nursing faculty in incorporating EDI into the nursing curriculum. Keywords: LGBTQ+, EDI, faculty education, resource, nursing curriculum PROMOTING INCLUSIVE NURSING CARE 3 Table of Contents Promoting Inclusive Nursing Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients 5 Background and Problem Statement ........................................................................................... 5 Diversity of Population and Project Site ..................................................................................... 7 Significance for Practice Reflective of Role-Specific Leadership .............................................. 8 Literature Review and Framework ................................................................................................. 8 Search Methods ......................................................................................................................... 10 LGBTQ+ Population ................................................................................................................. 10 Health Risks .............................................................................................................................. 11 Risk and Resilience Factors ...................................................................................................... 12 Discussion ................................................................................................................................. 14 Implications for Practice ........................................................................................................... 15 Framework and Project Application ............................................................................................. 16 Framework Description ............................................................................................................. 17 Framework Application to Project ............................................................................................ 17 Project Plan ................................................................................................................................... 18 Project Design ........................................................................................................................... 19 Needs Assessment/Gap Analysis of Project Site and Population ............................................. 19 Cost Analysis and Sustainability of Project .............................................................................. 20 Project Outcomes ...................................................................................................................... 21 Consent Procedures and Ethical Considerations ....................................................................... 21 Instruments to Measure Intervention Effectiveness .................................................................. 21 Project Implementation ................................................................................................................. 22 Project Intervention to ADN Faculty ........................................................................................ 22 Product Intervention into Curriculum.................................................................................... 23 Interventions Align With Short-Term and Long-Term Outcomes ........................................ 23 Project Timeline ........................................................................................................................ 23 Project Evaluation ......................................................................................................................... 24 Data Maintenance/Security ....................................................................................................... 24 Data Collection and Analysis .................................................................................................... 24 Findings ..................................................................................................................................... 25 Strengths ................................................................................................................................ 29 PROMOTING INCLUSIVE NURSING CARE 4 Weaknesses ............................................................................................................................ 29 Quality Improvement Discussion ................................................................................................. 30 Translation of Evidence Into Practice ....................................................................................... 31 Implications for Practice and Future Scholarship ..................................................................... 31 Sustainability ......................................................................................................................... 32 Dissemination ........................................................................................................................ 32 Conclusion................................................................................................................................. 33 References ..................................................................................................................................... 34 Appendix A ................................................................................................................................... 39 Appendix B ................................................................................................................................... 44 Appendix C ................................................................................................................................... 56 Appendix D ................................................................................................................................... 60 Appendix E ................................................................................................................................... 61 Appendix F.................................................................................................................................... 63 PROMOTING INCLUSIVE NURSING CARE 5 Promoting Inclusive Nursing Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients Throughout adolescence and into adulthood, lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people in the United States are discovering who they are and learning to accept themselves (Chaudoir et al., 2017). Unfortunately, they are more likely than their heterosexual peers to experience social stressors and health disparities during this time, increasing their risk of compromising their physical and mental health (Chaudoir et al., 2017; Daly, 2020). Protective factors help LGBTQ+ people to build resilience and develop coping resources to decrease the severity of social stressors and health disparities (Asakura, 2019; Hatchel et al., 2019). LGBTQ+ people are a marginalized population more likely to experience barriers to equitable healthcare. Hence, nursing program administrators are responsible for overseeing protective factors in their programs' admission process for prospective student nurses and the curriculum content for current student nurses (Collins, 2020). Student nurses must be taught to provide equitable and inclusive care for all patients to eliminate health disparities in LGBTQ+ patients and facilitate achieving the best possible health outcomes (Gianelis & Butler, 2022; HealthyPeople 2020, 2022a). Background and Problem Statement Nursing students require adequate diversity training in nursing school programs to provide equitable and inclusive care to all patients. LGBTQ+ patients are a diverse population and are more likely to experience negative experiences when accessing health care, resulting in a lack of treatment, a delay in treatment, or undertreatment of acute and chronic illnesses. In addition, equitable healthcare is not being provided in various healthcare facilities in rural and urban communities across the United States (Daly, 2020; Gianelis & Butler, 2022; University of PROMOTING INCLUSIVE NURSING CARE 6 Alberta, n.d.). Addressing the equity, diversity, and inclusion (EDI) problems of LGBTQ+ patients remains essential to alleviate barriers to obtaining health care. Nursing students must obtain education to become strong nurses and nurse leaders providing competent care for all patients. Knowledgeable and supportive educators teaching nursing students the elements of inclusive assessments and comprehensive care help remove barriers and biases to address this healthcare gap. People identifying as LGBTQ+ or those questioning their gender identity or sexuality are more likely to experience stigma-related stress and discrimination, increasing their risk of mental health problems. Depression and anxiety are more prevalent, leading to negative coping behaviors such as suicidality, drug use, and risky behaviors (Hatchel et al., 2019; Pachankis et al., 2020). This issue contributes to Utah's ranking as one of the top ten states for suicide death, with 24.7 deaths per 100,000 people in 2017. Utah’s suicide death rate is above the national average of 16.5 deaths per 100,000 people in 2017 (Utah Suicide Prevention Coalition, 2020). LGBTQ+ people are more likely to experience adversity due to their gender expression or sexual orientation. (Asakura, 2016; Baams, 2018). An individual's ability to cope with adversity is due to personal characteristics, environment, and the relationship between both. Coping strategies manage stressors, but stressors experienced by LGBTQ+ youth are a more significant burden and are a greater challenge since they threaten individual social worth (Chaudoir et al., 2017). Interventions that educate nursing students on the unique healthcare needs of the LGBTQ+ population prepare them with clinical knowledge and experiences that can build caregiver trust and enhance the health and well-being of LGBTQ+ people during healthcare interactions (Daly, 2020). When LGBTQ+ people do not experience discrimination from PROMOTING INCLUSIVE NURSING CARE 7 caregivers, they are more likely to participate in health prevention programs and screenings. In addition, they are more likely to seek timely care for acute and chronic illnesses. A nursing school curriculum that includes instruction on the healthcare needs of different members of the LGBTQ+ community may result in reducing healthcare barriers. According to Daly (2020), LGBTQ+ people are more comfortable seeking health care when asked questions that do not trigger anxiety and gender dysphoria. Culturally competent care includes positive communication. Nurses using the patient's correct name and pronouns or asking them if they are uncertain normalizes conversation and is a positive interaction. Additionally, when initiating sensitive health conversations, patient discomfort is decreased when their caregiver is knowledgeable about their healthcare needs and effectively communicates (Gianelis & Butler, 2022). LGBTQ+ people must feel accepted by the healthcare team when seeking mental and physical healthcare and safe to disclose personal information. For this population to seek timely healthcare, feeling accepted by healthcare providers is vital. When individuals have had a negative healthcare experience or lack protective and resilience factors, they are more likely to demonstrate negative coping behaviors, leading to delayed or refused healthcare treatment (Daly, 2020; Grant et al., 2021). Diversity of Population and Project Site The Annie Taylor Dee School of Nursing at Weber State University (WSU) is a public university in Ogden, Utah, with four program levels accredited by the Accreditation Commission for Education in Nursing (ACEN) (WSU Dumke College of Health Professions, 2022). The program curriculum includes clinical instruction on patient assessment, virtual simulations, and faculty-led laboratory simulations. In addition, students actively participate in faculty-facilitated PROMOTING INCLUSIVE NURSING CARE 8 clinical simulation experiences addressing various patients' physical and mental health needs (HealthyPeople 2020, 2022b; Hendricks, 2022). Significance for Practice Reflective of Role-Specific Leadership The outcome of this project is to support protective factors for LGBTQ+ people seeking health care by educating nursing faculty to train student nurses. In addition, this project reflects the leadership role of the DNP-post master's prepared nurse since this quality improvement project works towards solving a community health need in a vulnerable population (American Association of Colleges of Nursing [AACN], 2021). In the AACN DNP Essentials II and III, the DNP-post-master's nurse is responsible for creating and sustaining strategies that improve patient outcomes and demonstrate sensitivity to diverse patient populations (AACN, 2021). LGBTQ+ people are a diverse patient population. The project aims to design, direct, and evaluate a quality improvement project addressing this population's student nurse education gap. As a result, this project supports the role of the DNPpost-master's nurse (R. Holman, personal communication, April 2022). Consequently, by implementing evidence-based interventions that support improvement in healthcare outcomes, nursing students receive an education that teaches how to address health disparities and remove healthcare barriers for LGBTQ+ people (Gianelis & Butler, 2022; HealthyPeople 2020, 2022a). Literature Review and Framework This literature review aims to identify ways to achieve the best outcomes by decreasing adversity and stressors experienced by LGBTQ+ people seeking health care. The literature suggests that supporting patient protective factors may aid in building resilience, which may help alleviate discomfort and anxiety when accessing health care. In addition, addressing barriers to accessing and receiving equitable and inclusive health care for LGBTQ+ people can decrease PROMOTING INCLUSIVE NURSING CARE 9 discrimination, increase access to health care, and meet their healthcare needs (Gianelis & Butler, 2022). Unfortunately, LGBTQ+ people are a stigmatized minority group with unique challenges and high-stress levels. Some of their challenges result from minority stressors such as stigma, violence, prejudice, bullying, discrimination, and rejection from family, peers, community, and healthcare providers. Social experiences influence everyone, but those who identify as a gender or sexual minority are likely to have more significant negative experiences seeking and receiving health care and greater challenges to effective coping (Chaudoir et al., 2017; Grant et al., 2021; Snapp et al., 2015; The Trevor Project, 2021). Nursing programs that promote diversity in their student population and train student nurses to provide culturally competent and inclusive care support evidence-based health care. (Collins, 2020; Gianelis & Butler, 2022; Grant et al., 2021). Student nurses who train to provide for the healthcare needs of LGBTQ+ people increase their knowledge and learn to create positive patient healthcare experiences. Positive experiences increase patient comfort and encourage them to continue receiving healthcare treatment (Daly, 2020). In addition, by identifying and using resources that help LGBTQ+ people cope with minority stress, they are better prepared to navigate adversities (Asakura, 2016, 2019). The literature supports a greater risk for adverse mental and physical health outcomes in LGBTQ+ people seeking health care. Solutions to help this population build resilience and improve health outcomes are reducing barriers and addressing disparities. Access to health services is a barrier to health care that may improve by addressing social determinants of health affecting LGBTQ+ people. In particular, more culturally competent healthcare providers knowledgeable of the needs of members of the LGBTQ+ community are needed to address preventative and ongoing mental and physical healthcare needs (HealthyPeople 2020, 2022b). PROMOTING INCLUSIVE NURSING CARE 10 Search Methods Articles were selected identifying disparities, discrimination, interventions, and solutions faced by people identifying as LGBTQ+ using the library database resources of Stewart Library at WSU. Nine articles met inclusion requirements using the search terms clinical practice guidelines, evidence-based treatment, lesbian, gay, bisexual, transgender (LGBT), LGBTQ+, resilience, resiliency, sexual minority, youth, and well-being. Articles were excluded if they did not relate to the LGBTQ+ population. In addition, articles were selected identifying inclusive health care for LGBTQ+ people using the library database resources of Stewart Library at WSU. Eleven articles met inclusion requirements using the search terms diversity, equity, inclusion, inclusive health care, and curriculum changes. Articles were excluded if they did not relate to nursing education. LGBTQ+ Population Youth identifying as LGBTQ+ live throughout the United States, including Utah. For example, the UCLA Williams Institute of Law (2020), using data from the CDC's nationwide Youth Risk Behavior Survey, reported that an estimated 9.5% of youth aged 13 to 17 in the United States identified as LGBTQ+ in 2017. In the United States, there are approximately 1,994,000 LGBT youths, including 24,000 in Utah. In addition, using the CDC's nationwide Youth Risk Behavior Survey, Murez (2021) reported that youth aged 15 to 17 self-identifying as non-heterosexual between 2015 and 2019 increased from 8.3% to 11.7%. This increase can be linked to better self-reporting since youth have more access to information that helps them understand their identity. In addition, it may be that these youth are experiencing less stigma related to their sexual identity. PROMOTING INCLUSIVE NURSING CARE 11 Adults identifying as LGBTQ+ in the United States are approximately 4.5% of the population, according to Collins (2020) and Gianelis and Butler (2022). Gianelis and Butler also reported that 0.6% identify as transgender or nonbinary. According to a 2021 Gallup poll of more than 12,000 adults in the United States, 7.1% self-identified as LGBTQ+. This percentage doubled from the first Gallup poll measurement in 2012. Greater acceptance and legal protection from discrimination for LGBTQ+ people are factors in increased self-reporting. In addition, the increase reflects more younger adults than older adults identifying as LGBTQ+ (Jones, 2022). Reporting data from the 2020 National College Health Assessment Survey, Gianelis and Butler (2022) report that nearly 20% of respondents identified as LGBTQ+. Of those who identified as LGBTQ+, approximately 30% are between 18 and 24. Since campus culture is associated with the percentage of LGBTQ+ students, the percentage can vary widely between college campuses. The pace of adults in the United States identifying as LGBTQ+ has grown over the past few years, and as more youth reach adulthood, additional growth is expected. Health Risks Asakura (2016) identified that 59% to 81% of LGBTQ+ youth reported verbal abuse and 24% to 38% reported physical abuse related to their sexual orientation or gender expression. In addition, Hatchel et al. (2019) reported that the CDC lists suicide as the second leading cause of death in youth aged 15 to 24, with LGBTQ+ youth more likely to attempt suicide. The Trevor Project (2021) identified that compared with their heterosexual peers, LGBTQ+ youth are four times more likely to attempt suicide, with at least one estimated suicide attempt every 45 seconds in the United States. In 2021, 42% of LGBTQ+ youth and 14% of their heterosexual peers seriously considered suicide. Asakura (2016) identified that 36% to 65% of transgender youth considered suicide from studies published in 2013 and 2015. PROMOTING INCLUSIVE NURSING CARE 12 Hatchel et al. (2019) presented a meta-analysis of 44 studies over 20 years looking at suicidality in LGBTQ+ youth. They reported that lesbian, bisexual, gay, and queer (LBGQ) youth were three times more likely to present with suicidal thoughts and behaviors, and transgender youth were also at a higher risk. The knowledge gained by this study aids in identifying and understanding suicidality contributing and preventing factors, which is a step towards suicide prevention and intervention. Additionally, transgender youths and those who do not identify with any gender are 2 to 2 1/2 times more likely to experience depressive symptoms and suicidality than their heterosexual peers (Asakura, 2016, 2019; McInroy, 2020; The Trevor Project, 2021). Risk and Resilience Factors The literature showed that LGBTQ+ youth and young adults' resilience influences the risk of adverse mental and physical health outcomes. Tankersley et al. (2021) conducted a systematic review of 44 peer-reviewed articles worldwide looking at risk and resilience factors for mental health among transgender and gender-nonconforming children, adolescents, and young adults under 25. They reported that these youth could thrive if accepted and permitted to be themselves. Although transgender and gender-nonconforming young adults might not be experiencing mental illness, external stressors, and life events, they should be considered when providing mental health care to them. In addition, Bridge et al. (2022) conducted semi-structured qualitative interviews with 20 sexual minority young adults between 16 and 24, assessing selfesteem. They found that LGBTQ+ youth have similar adolescent development experiences to their heterosexual peers. Common issues for all youth were forming their identity, having confidence in their body, and building relationships with peers. LGBTQ+ youth were more likely to experience conflict with parents, substance use, and sexual activity, resulting in greater PROMOTING INCLUSIVE NURSING CARE 13 exposure to abuse, violence, and stigma (Baams, 2018; Hatchel et al., 2019; Tankersley et al., 2021). These common issues could create low self-esteem due to a feeling of not belonging, failing to meet standards, and experiencing negative feelings regarding their sexual identity (Bridge et al., 2022). Snapp et al. (2015) supported Bridge et al. (2022) findings with a crosssectional study of 245 LGBT young adults 21-25 years. The results indicated that parental rejection, family member conflict, poor peer relations, and low self-esteem increased rates of psychological distress, increasing suicidality risk. Stigma leads to anti-LGBTQ+ attitudes in families, schools, and communities and is a barrier to acceptance. Family members can be ambivalent or resistant when their LGBTQ+ youth's thoughts and behaviors do not align with their preconceived expectations, leading to rejection. Rejected LGBTQ+ youth are at a greater risk of experiencing violence and homelessness (Asakura, 2019; The Trevor Project, 2021). Asakura (2019) conducted a grounded theory study. The study analyzed interviews with 16 service providers and 19 LGBTQ+ youth. The study corroborated previous research that caring adults are an asset for LGBTQ+ youth who can provide physical and emotional resources to youth who do not feel safe in places such as their homes. Access to resources may be restricted due to environmental factors such as homelessness, unsupportive school climates, and physical location (Hatchel et al., 2019). Rural areas, for example, lack physical service locations (Pachankis et al., 2020). Pachankis et al. (2020) conducted a randomized control trial with 108 participants to reach young adults living in a highstigma, low-resource setting. They concluded that online writing interventions could reach those living in these locations and positively impact the participants' mental health. McInroy (2020) also identified findings on the value of youth participation in online content, including fandom PROMOTING INCLUSIVE NURSING CARE 14 communities. Results from a mixed-method online survey of 3665 participants found that online fandom communities were a source of social support and provided opportunities for connection, guidance, and mentorship. This quality improvement project initially addressed the risk and resilience factors of the LGBTQ+ young adult and youth population but was revised to include the LGBTQ+ adult population. The risk of adverse mental and physical health outcomes and increased risky behaviors related to LGBTQ+ sexual minority stressors identified in the literature review for youth and young adults is comparable with adults. For example, Chaudoir et al. (2017) found that sexual minority stressors compromised mental and physical health and increased adult risky behaviors, contributing to more adverse physical and mental health conditions than their heterosexual peers. In addition, Chaudoir et al. identified individual self-esteem, interpersonal relationships, and community social support as protective factors that support resilience in the LGBTQ+ adult population. Discussion The literature reviewed on risks and resilience for LGBTQ+ people has common limitations of transferability of research. For example, studies such as Asakura (2016), Bridge et al. (2022), and Pachankis et al. (2020) identified studies in urban environments that may not be generalized to other locations. Similarly, Tankersley et al. (2021) identified that suicidality could vary by location, and the country of origin can influence mental health problems. Furthermore, Baams (2018) identified limitations due to data obtained from adolescents in a single state. In addition, a small sample size, such as those identified by Asakura (2016), Daly (2020), and Grant et al. (2021) can affect generalizability. PROMOTING INCLUSIVE NURSING CARE 15 The sample population size and participant attributes may affect the transferability of the research. Sampling bias is possible when participants are recruited from agencies offering various services, individuals receiving treatment, or attending school (Asakura, 2016; Baams, 2018; Tankersley, 2021). LGBTQ+ people not receiving services, not attending school, or being homeless may not have the same advantages and results as those receiving services. In addition, the sample population may not represent ethnic or racial diversity (McInroy, 2020). Study designs and the number of participants, interventions, studies, and peer-reviewed articles strengthened the validity and transferability of the research. For example, Baams (2018) had 81,885 participants in a cross-sectional survey; McInroy (2020) had 3665 participants in a mixed-method approach survey; Pachankis et al. (2020) had 108 participants in a randomized control trial; Snap et al. (2015) had 245 participants in a cross-sectional study. In addition, Chaudoir et al. (2017) identified 44 interventions from a single database; Hatchel et al. (2019) looked at 44 studies over 20 years for their meta-analysis; Tankersley et al. (2021) reviewed 44 peer-reviewed articles for their systemic review. The literature review outlined the risks and protective factors of LGBTQ+ people. However, it lacked the evidence and information to educate nursing faculty on their confidence and ability to teach LGBTQ+ patient care to nursing students. Therefore, additional articles were used to create this quality improvement project. References for these articles are shown in this paper's planning and implementation sections. Implications for Practice Nursing education should reflect the needs of the population it serves. For example, as more of the population identifies as members of the LGBTQ+ community, nursing programs should meet the needs of these community members. For example, an approach to welcoming PROMOTING INCLUSIVE NURSING CARE 16 student diversity is incorporating EDI into the nursing program application and curriculum (AACN, 2021). Nursing faculty, not members of a diverse population, may lack the experience, knowledge, skills, and attitudes necessary to teach nursing students to provide quality nursing care to the LGBTQ+ population (Collins, 2020). Therefore, educating nursing faculty on the need to increase EDI in the nursing curriculum begins with why it is essential. At WSU, EDI is part of the strategic plan, and the inclusion of EDI is an ACEN nursing program accreditation requirement (ACEN, 2022; WSU, 2022). Nursing faculty trained to explore their discomfort and bias; educated to navigate difficult conversations; and empowered to discuss gender, gender identity, and sexual orientation are better prepared to facilitate student learning (Harvard Diversity Inclusion Belonging, 2020; Table et al.,2021). Resources used for faculty education can be given to students to facilitate their learning and understanding of LGBTQ+ people and their unique healthcare needs. Nursing students learning EDI patient-centered care and standardized care practices can become prepared to provide quality care to LGBTQ+ patients in clinical practice. Framework and Project Application This quality improvement included Bandura's 1977 social learning theory. Bandura's learning theory stressed the importance of observational learning, imitation, and modeling. For example, Lavoie et al. (2018) performed a theoretical review identifying different theories used in student simulation. Bandura's social cognitive theory was one of the most frequent learning theories. Bandura identified that a motivated individual learns behavior through observation. Student observation occurs through verbal descriptions and explanations from the nursing instructor. In addition, symbolic models could allow the learner to observe a character's reactions PROMOTING INCLUSIVE NURSING CARE 17 and feelings, which teaches how to react and feel in similar situations (Ahn et al., 2020; Kurt, 2020). Framework Description Social learning theory shows that learning and behavior changes occur through observation and four essential steps. The four basic steps include attention, which influences the amount or quality of learning; retention, one must remember the behavior; reproduction, the portrayal of the behavior; and motivation, the stimulus to perform the behavior. Another influence on the learner is the behavior of the teacher. When the teacher is positive and encouraging, students believe in their ability to succeed (Kurt, 2020). Framework Application to Project Bandura's social learning theory applies to this quality improvement project since it supports competency-based education through active student learning. Students have opportunities to learn how to provide competent and equitable care for marginalized people belonging to the LGBTQ+ population. Bandura's social learning theory supports teaching nursing students how to provide inclusive nursing care and acceptance to those accessing healthcare services. This quality improvement project includes the creation and utilization of inclusive assessment tools. These tools add to simulation experiences designed to teach nursing students how to provide inclusive quality care to LGBTQ+ patients, encouraging their comfort and ease in accessing health care. Nursing faculty teach and guide students in understanding inclusive assessment techniques and completing medical forms. In addition, trained nursing faculty assess student learning by evaluating student responses to pre-simulation and postsimulation student assignments. Furthermore, nursing faculty facilitate and observe simulation PROMOTING INCLUSIVE NURSING CARE 18 scenarios where students demonstrate their skills and behaviors in providing patient care, including inclusion for LGBTQ+ patients (Ahn et al., 2020; Kurt, 2020). Project Plan This project included increasing awareness and addressing healthcare disparities within the LGBTQ+ community by educating nursing faculty in the WSU ADN program on EDI. The Nursing EDI Guidelines for the LGBTQ Population were presented to the ADN faculty to increase their confidence in teaching EDI. The presentation described EDI definitions and reasons to incorporate EDI. In addition, the presentation identified the LGBTQ+ community population and their healthcare risks. Faculty resources in these guidelines included standardized terminology, educational videos, college campus resources, and additional resources. Moreover, nursing faculty could share these resources with students. Furthermore, the plan involved working with simulation course chairs to implement clinical simulations that provided an adequate nurse-to-patient interaction reflecting EDI. Finally, the plan included ensuring the student application for the ADN program reflected EDI guidelines by reviewing the application and working with the ADN director. Nursing EDI Guidelines for the LGBTQ+ Population aligned with the mission and values of WSU and the accreditation standards of the nursing program. WSU’s mission statement affirmed the value of every individual through embracing all identities, promoting belonging, and personalizing opportunities to transform students' lives. The university promoted equity and inclusion through various educational experiences, degree pathways, and community relationships (WSU, 2022). Additionally, nursing faculty education on EDI principles and incorporating them into the nursing curriculum met the ADN program recommendations of PROMOTING INCLUSIVE NURSING CARE 19 ACEN (2022). Besides project outcomes, other plans included needs assessments, cost analysis, consent procedures, and survey instruments. Project Design This multifaceted quality improvement project aimed to fill an EDI gap in nursing education by addressing the healthcare needs and disparities of LGBTQ+ people. This project's three quality improvement areas were nursing faculty education, nursing curriculum, and ADN program student application. Each quality improvement area utilized the Nursing EDI Guidelines for the LGBTQ+ Population. The Nursing EDI Guidelines for the LGBTQ+ Population handout (see Appendix A) and PowerPoint presentation (see Appendix B) were used to educate the nursing faculty. Simulation course chairs used the Nursing EDI Guidelines for the LGBTQ+ Population to modify a clinical simulation. In addition, reviewing the ADN program student application ensured it reflected the Nursing EDI Guidelines for the LGBTQ+ Population. Qualtrics pre-and post-surveys were offered to nursing faculty before and after the presentation. After students participated in revised simulations, qualitative verbal survey questions were asked of the three simulation course chairs to assess the alignment of simulations with the Nursing EDI Guidelines for the LGBTQ+ Population. In addition, the ADN director was asked a qualitative verbal survey question to assess the use of the Nursing EDI Guidelines for the LGBTQ+ Population in the ADN program student application (see Appendix C). Needs Assessment/Gap Analysis of Project Site and Population A need for nursing faculty to receive EDI education is because they do not represent members of a diverse population and possibly lack the experience, knowledge, skills, and attitudes necessary to teach nursing students to provide quality nursing care to LGBTQ+ patients. PROMOTING INCLUSIVE NURSING CARE 20 This ADN program lacked faculty education to build faculty confidence and knowledge in caring for LGBTQ+ patients (Collins, 2020). Key stakeholders who supported this project included the WSU SON Department Chair and the WSU SON ADN Director. For example, the ADN director approved changes to the ADN program student application, permitted the presentation of the Nursing EDI Guidelines for the LGBTQ+ Population in an ADN faculty meeting, and approved curriculum changes. In addition, key stakeholders supported this quality improvement project since it aligned with WSU's mission and values and meets nursing program accreditation recommendations (AACN, 2021; WSU, 2022). Cost Analysis and Sustainability of Project Budgetary requirements for implementing this project regarding initial faculty training were discussed with the ADN program director, who approved the content and time of the presentation (see Appendix D). The initial faculty training on the Nursing EDI Guidelines for the LGBTQ+ Population occurred immediately after a mandatory ADN faculty meeting. In addition, faculty training with simulation course chairs took place with each course chair individually through email and face-to-face meetings. The sustainability plan incorporated the Nursing EDI Guidelines for the LGBTQ+ Population PowerPoint and handout resources, introduced at the initial faculty training, into the Nursing Faculty Development Canvas course. The Canvas course containing these guidelines was available to all nursing faculty through self-guided access. In addition, sustainability involved maintaining updated links and replacing information as needed to reflect changes in clinical practice, nursing program accreditation, and WSU's mission and values. The PROMOTING INCLUSIVE NURSING CARE 21 responsibility for updating these faculty resources was a member of the Dumke College of Health Professions EDI Committee representing the college of nursing Project Outcomes The main goal was to incorporate EDI into the nursing curriculum to address healthcare disparities and the healthcare needs of LGBTQ+ people, preparing student nurses for the nursing workforce. The first project goal was to educate the ADN faculty and increase their comfort and confidence in teaching EDI by introducing them to the Nursing EDI Guidelines for the LGBTQ+ Population and their recommended use. The second project goal was to incorporate EDI into the nursing curriculum by modifying a current clinical simulation in the first, second, and third semesters of nursing courses to incorporate the Nursing EDI Guidelines for the LGBTQ+ Population. Finally, the third goal was to ensure that the ADN program application encouraged qualified students from unrepresented and underrepresented groups to apply. Consent Procedures and Ethical Considerations This quality improvement project received WSU Institutional Review Board approval. Their recommendations were to include language in the survey consent regarding the risk of potential discomfort with some of the questions in the survey (see Appendix C). Furthermore, the ADN director and ADN faculty simulation course chairs received an electronic or printed copy of the disclaimer when they answered the qualitative verbal survey question(s). Instruments to Measure Intervention Effectiveness Surveys measured ADN faculty confidence in LGBTQ+ patient care and its department importance. The survey questions were adapted and developed from The University of Texas at Austin Office for Inclusion and Equity (2022). Permission to use this instrument was not required. PROMOTING INCLUSIVE NURSING CARE 22 Project Implementation The Nursing EDI Guidelines for the LGBTQ+ Population quality improvement project were implemented into the ADN program after the content expert and the faculty advisor approved the PowerPoint, handout, and surveys. Next, the ADN faculty received education on the guidelines. Finally, following the ADN faculty presentation, simulation course chairs utilized these guidelines to revise clinical simulations. Furthermore, the ADN program student application was evaluated for guidelines alignment. Subsequently, the Nursing EDI Guidelines for the LGBTQ+ Population were added to the Nursing Faculty Development Canvas course. Project Intervention to ADN Faculty Project interventions included educating ADN faculty on the need for EDI in the nursing curriculum following a mandatory faculty meeting. To begin, ADN faculty answered quantitative survey questions about their comfort and confidence in teaching EDI regarding the LGBTQ+ patient population. Nursing faculty voluntarily accessed the pre-survey (see Appendix C) via Qualtrics by scanning the QR code with their cellphones or going to the web address on a computer. Following the pre-survey, a handout on the Nursing EDI Guidelines for the LGBTQ+ Population (see Appendix A) and a PowerPoint presentation (see Appendix B) were used to educate nursing faculty on the guidelines and their recommended use. I answered all questions asked by the nursing faculty during the presentation. After the presentation, the ADN faculty voluntarily accessed and answered a post-survey in Qualtrics using the same process used to access the pre-survey but with a different QR code and web address. Questions 1-14 on the pre- and post-surveys were the same. In addition, the post-survey included question 15, which was an open-response question. PROMOTING INCLUSIVE NURSING CARE 23 Product Intervention into Curriculum The Nursing EDI Guidelines for the LGBTQ+ Population guided simulation course chairs in modifying a clinical simulation. At the end of the semester, ADN simulation course chairs were interviewed following the implementation of revised simulations. Then, simulation course chairs answered qualitative survey questions to assess the alignment of first, second, and third-semester simulations with the Nursing EDI Guidelines for the LGBTQ+ Population (see Appendix C). The ADN program student application was reviewed in collaboration with the ADN director. Then, the ADN director was interviewed and answered a qualitative survey question assessing the alignment of the ADN program student application with the Nursing EDI Guidelines for the LGBTQ+ Population. Consequently, the ADN program student application reflected these guidelines (see Appendix C for deliverables). Interventions Align With Short-Term and Long-Term Outcomes Addressing EDI bridged a gap in nursing education. The Nursing EDI Guidelines for the LGBTQ+ Population were an accessible resource in the Nursing Faculty Development Canvas course for new and existing faculty. These guidelines met nursing accreditation criteria by increasing faculty and student EDI awareness and inclusion and educating nursing students on providing equitable care. In addition, these guidelines aligned with WSUs mission and values. Project Timeline The project timeline (see Appendix E) described the project proposal's initiation through the project evaluation. The timeline began with identifying a need for this quality improvement project, the literature review, and the project proposal. Next, planning included identifying a gap and bridging it. Finally, implementation included presenting the project plan to the ADN faculty PROMOTING INCLUSIVE NURSING CARE 24 and other stakeholders. In conclusion, the evaluation of the project was the final step and determined the effectiveness of this quality improvement project. Project Evaluation Educating nursing faculty on the Nursing EDI Guidelines for the LGBTQ+ Population and implementing these guidelines into the nursing curriculum met the project outcome of preparing nursing faculty on training student nurses to support protective factors for LGBTQ+ people seeking health care. In addition, the presentation increased the participants' knowledge of why EDI must be incorporated into the nursing curriculum, provided an accessible faculty resource, and increased faculty confidence in teaching EDI. Outlined below are the project data analysis and findings of nursing faculty's perception of their familiarity with the department and nursing curriculum inclusion of LGBTQ+ patient care and its importance to student education. In addition, the data analysis and findings indicated nursing faculty's comfort with LGBTQ+ students, faculty, and staff and comfort with engaging in discussions about LGBTQ+ patient care. Data Maintenance/Security Data obtained from the pre- and post-survey responses remained anonymous. Study participants accessed the pre- and post-survey questions by scanning QR codes with a personal cellphone or accessing links on a computer. In addition, the web-based survey tool, Qualtrics, was used to create the surveys and record and analyze participant responses. A passwordprotected Qualtrics account stored survey results. Data Collection and Analysis Two surveys were administered to ADN faculty participants. Study participants were invited to take the pre-survey before the Nursing EDI Guidelines for the LGBTQ+ Population PROMOTING INCLUSIVE NURSING CARE 25 presentation and the post-survey immediately following the presentation. Participants responded to 14 pre-survey questions and 15 post-survey questions. The post-survey questions included responses to the same questions in the pre-survey, with the addition of an open-response question (see Appendix C). Nine questions assessed ADN faculty confidence in teaching nursing students how to support the healthcare needs of LGBTQ+ patients and the importance of this education in the nursing department. Four questions were demographic. Quantitative data was obtained using a Likert-style questionnaire. Survey result percentages were obtained using Qualtrics evaluation data. Findings The project outcome of identifying faculty confidence in LGBTQ+ patient care and its department importance was met by analyzing the survey data from the ADN faculty pre- and post-survey responses (see Appendix F). The results from the pre-survey indicated that 77.78% of participants felt very familiar or somewhat familiar with the efforts, activities, and projects related to LGBTQ+ patient care in the department and 88.89% in the post-survey. Additionally, the faculty level of not familiar with the efforts, projects, and activities related to LGBTQ+ patients decreased from 22.22% in the pre-survey to 11.11% post-survey. Furthermore, 55.55% of respondents strongly agree or agree with feeling comfortable engaging in discussions about LGBTQ+ patient care in the classroom or workplace in the pre-survey and 88.54% in the postsurvey. Survey results indicated that 50.01% of participants are very involved, involved, or occasionally involved in department activities related to LGBTQ+ patient care in the pre-survey and 76.47% post-survey. In addition, pre- and post-survey results indicated that all participants strongly agree or agree that LGBTQ+ patient care skills are necessary for nursing graduates' PROMOTING INCLUSIVE NURSING CARE 26 professional success. Moreover, 33.33% of pre-survey and 72.23% of post-survey responses indicated that participants strongly agree or agree that the department curriculum prepares students to recognize the needs of LGBTQ+ patients. Pre-survey results indicated that 33.33% and post-survey results indicated that 41.18% of participants strongly agree or agree that LGBTQ+ patient care is well integrated into the department curriculum. In contrast, the pre-survey results indicated that 44.45% and the postsurvey results indicated that 29.41% disagree or strongly disagree that LGBTQ+ patient care is well integrated into the department curriculum. In addition, 94.45% of pre-survey and 100.00% of post-survey results indicated that department efforts, activities, and projects related to LGBTQ+ patient care were very important and important. Finally, pre- and post-survey results of three questions showed a slight decrease in perception of the student, faculty, and staff generally interacting positively with the following: differences of gender (89.47%, 88.24%), gender identity and expression (94.44%, 94.11%), and sexual orientation (94.45%, 93.75%). The demographic data of the study participants indicated an average of 91.51% identify as female and 8.50% as male (see Table 1). In addition, participant results indicated completing an MSN degree or higher. Regarding years of employment, participant results indicated being in the nursing department between 1 and 15 years. Reported results indicated participants' ages between 30 and 60 or greater, with 85.29% reporting between the ages of 30 and 49. Due to connectivity issues, the number of study participants varied between 16 and 19 participants responding to the pre- and post-surveys. PROMOTING INCLUSIVE NURSING CARE 27 Table 1 Pre- and Post-Survey Demographic Results Survey Question Percentage of Participants BSN Highest degree completed MSN 76.47 DNP 11.76 EDD 0 PhD 11.76 0 1-2 20.59 3-5 26.47 6-10 47.06 11-15 5.88 F 91.51 M 8.50 T/NB PNTA 0 0 < 30 30 – 39 32.35 40 – 49 52.94 50 – 59 8.83 0 <1 Years in department I identify as ____ Age 0 16 or > 0 60 or > 5.88 Note. n = 17. Participant numbers are averaged. A variety of scales were used. See abbreviations for scales. Bachelor of Science in Nursing (BSN), Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), Doctor of Education (EDD), Doctor of Philosophy (PhD) Female (F), Male (M), Transgender/Non-Binary (T/NB), Prefer not to answer (PNTA) The final question in the post-survey was an open-response question asking participants to share comments or thoughts regarding LGBTQ+ patients or LGBTQ+ patient care that was not addressed elsewhere in the presentation (see Table 2). Six participants responded with seven responses that reflected three emergent themes. Specifically, the emergent themes were positive perception of presentation, risk factors associated with gender, and comparison of nursing student diversity to WSU student diversity. PROMOTING INCLUSIVE NURSING CARE 28 Table 2 Post-Survey Faculty Responses About EDI Emergent Theme Positive perception of presentation Example “I appreciate that we are including this in our courses.” “We should have a discussion about where in the curriculum to include topics related to this and encourage inclusive language in all courses.” “Great content and something very needed.” “Well done and needed in our school of nursing.” Risk factors associated with gender “One concern I have as a nurse is taking birth gender completely out of health questioning and only gender-neutral terms. There are risk factors associated with gender and we need to be aware of these on treating our patient population.” “I have a student that questioned if we could put period products in men’s bathrooms.” Comparing nursing student diversity “How does our spread of nursing students compare to the spread of the university's diverse population.” to the WSU student diversity ADN nursing clinical simulation course chairs attended the faculty education on the Nursing EDI Guidelines for the LGBTQ+ population. After the presentation, the three simulation course chairs expressed an interest in increasing EDI regarding the LGBTQ+ population in a clinical simulation. The first- and third-semester clinical simulation courses have implemented aspects of EDI into clinical simulations. For example, the first-semester clinical simulation course revised the patient assessment form, and the third-semester clinical simulation course included a clinical simulation scenario with an LGBTQ+ patient and family. One-on-one education and advisement were offered to each chair to assist them in revising a clinical simulation in their course. PROMOTING INCLUSIVE NURSING CARE 29 In response to the qualitative survey questions regarding clinical simulations, the thirdsemester clinical simulation course chair responded that one clinical simulation in the course reflected the use of the Nursing EDI Guidelines for the LGBTQ+ Population. The simulation effectively provided an adequate nurse-to-patient interaction. In addition, the simulation reflected a real patient experience since it identified and addressed health disparities, barriers to quality healthcare, and patient-centered care, with the outcome of providing a welcoming and safe environment. Finally, the simulation course chair reported that faculty were comfortable teaching students EDI using an LGBTQ+ patient care scenario. The ADN director reports that the ADN program student application reflected the Nursing EDI Guidelines for the LGBTQ+ Population. The application was revised in 2022 and reviewed, with no recommendations for adjustment identified. The results of the application review were reported to the ADN director. Strengths The project's strengths included volunteer participants from the nursing faculty and a valid instrument from the University of Texas at Austin Office for Inclusion and Equity (n.d.) that aided in the creation of survey questions. In addition, participant comments were generally positive, with an understanding that EDI needs to be included in the nursing curriculum. Therefore, the Nursing EDI Guidelines for the LGBTQ Population could be adapted to various nursing courses. Weaknesses Participants were ADN faculty members who agreed to participate in person and via Zoom. Computer connectivity reduced the number of participants who could participate remotely. The small sample size consisted of 16 to 19 participants. Eighteen participants PROMOTING INCLUSIVE NURSING CARE 30 responded to most of the pre-survey questions, with 17 responding to demographic questions. Seventeen to 18 participants responded to the post-survey questions. Qualitative survey questions regarding clinical simulations reflecting the use of the Nursing EDI Guidelines for the LGBTQ+ Population could not be asked of first- and secondsemester clinical course chairs since these guidelines had not yet been implemented. Both first and second-semester clinical course chairs expressed an interest in including an LGBTQ+ patient clinical scenario in a clinical simulation in their respective clinical courses. However, changes to their courses would not take place during the current semester. Instead, clinical simulation course chairs must be asked survey questions at the end of the semester when a revised clinical simulation is taught to nursing students. Quality Improvement Discussion The Nursing EDI Guidelines for the LGBTQ+ Population is a quality improvement project that provides information and education to nursing faculty to increase their comfort and understanding of LGBTQ+ patient care. In addition, it provides guidance and support in implementing EDI into an ADN clinical simulation curriculum. The faculty learn the definition of EDI and its importance in the nursing program through an educational presentation. In addition, faculty learn about the LGBTQ+ population’s healthcare needs, standardized terminology, and additional information and resources. Current information and resources are available in Canvas, an online learning management system. Survey responses before and after the educational presentation indicate that nursing faculty understand the need for increasing EDI in the nursing curriculum and want to know how to implement it in their courses. This project can provide a foundation for future practice. PROMOTING INCLUSIVE NURSING CARE 31 Translation of Evidence Into Practice The evidence indicates that the LGBTQ+ population is more likely to experience health disparities and healthcare barriers than their heterosexual peers (Chaudoir et al., 2017; Daly, 2020). Furthermore, barriers to health care are risk factors that increase delaying and refusing treatments or undertreatment (Grant et al., 2021). With the LGBTQ+ increased population over the past few years and the expected continued increase, nurses need training to effectively address the healthcare needs of this population (Murez, 2021). Educating nursing faculty about EDI and implementing it into the nursing curriculum is essential to reducing healthcare barriers and addressing community healthcare needs (Daly, 2020). The Nursing EDI Guidelines for the LGBTQ Population were useful in educating nursing faculty on EDI and guiding the implementation of it into various nursing courses in the nursing curriculum. By facilitating nursing faculty education on EDI and increasing their comfort in teaching it, nursing students can learn to provide care for LGBTQ+ patients, address health disparities, and remove healthcare barriers. Implications for Practice and Future Scholarship Increasing EDI in the nursing curriculum is essential to meet accreditation requirements and align with WSU's mission and values expectations (ACEN, 2022; WSU, 2022). To meet these goals, nursing faculty require education to achieve the knowledge, skills, and values required to understand and implement EDI into the nursing curriculum. Faculty are then prepared to effectively teach and train nursing students to provide quality nursing care and address the healthcare needs of the LGBTQ+ population. Faculty teaching EDI in the nursing curriculum prepares nursing students to apply their knowledge in clinical situations resulting in culturally competent care (Gianelis & Butler, 2022). PROMOTING INCLUSIVE NURSING CARE 32 Positive patient interactions occur when the nurse is knowledgeable about a patient’s healthcare needs. In addition, effective communication and normalized conversations increase the patient's comfort and acceptance. Culturally competent care addresses health disparities and decreases healthcare barriers. Sustainability The Nursing EDI Guidelines for the LGBTQ+ Population is a sustainable quality improvement tool. These guidelines and companion PowerPoint are located in the Nursing Faculty Development course. This course is available to all nursing faculty in Canvas, the online learning management system used by WSU. Canvas is accessible through a desktop computer or mobile device. In addition, nursing faculty can print the guidelines for minimal printing costs if a printed copy is wanted. Dissemination I continue to share the Nursing EDI Guidelines for the LGBTQ+ Population information with nurses and nursing faculty inside and outside WSU. The guidelines were presented to the ADN nursing faculty at WSU, and I continue to work with them. For example, I work with the three clinical simulation course chairs to aid in implementing EDI into a clinical simulation for each clinical course. Moreover, I help other nursing faculty at WSU to implement EDI into various nursing courses, including didactic hybrid, online, and face-to-face. In addition, I have the opportunity to present the Nursing EDI Guidelines for the LGBTQ+ Population to the nursing program faculty of the three technical colleges that train practical nurses who continue their nursing education at WSU in the Practical to Registered Nursing Program. Presenting to these educational partners allows them to learn the education provided to first- and secondsemester nursing students at WSU. In addition, it educates them on preparing their students to PROMOTING INCLUSIVE NURSING CARE 33 continue with their third- and fourth-semester nursing courses at WSU. Finally, the Nursing EDI Guidelines for the LGBTQ+ Population were presented as a poster presentation at the 2023 Western Institute of Nursing Conference. Conclusion Our communities need nurses who provide quality and equitable health care to all community members. The LGBTQ+ population is a stigmatized minority group with unique mental and physical health challenges. Unfortunately, they are more likely to face greater discrimination and healthcare barriers than their heterosexual peers resulting in treatment delays, inadequate care, or a lack of care. Therefore, nursing faculty must have the knowledge, skills, and attitudes to educate nursing students to provide compassionate and inclusive care to all patients to eliminate health disparities and achieve the best possible outcomes. In addition, nursing faculty must have confidence in teaching LGBTQ+ patient care and be knowledgeable in EDI to teach nursing students evidence-based interventions and practices to address health disparities. Including EDI in nursing education meets accreditation and university expectations, prepares nursing students to create positive healthcare experiences, and builds LGBTQ+ patient resilience. Moreover, having EDI in the nursing curriculum also encourages qualified students to apply to nursing programs. Faculty and student populations should represent the diversity in the community. While representing community members, nurses can provide nursing care that meets the community's physical and mental healthcare needs. PROMOTING INCLUSIVE NURSING CARE 34 References Accreditation Commission for Education in Nursing. (2022, July). ACEN 2023 accreditation manual: Section III ACEN standards and criteria. https://www.acenursing.org/Resources-for-Nursing-Programs/sc2023-July2022.pdf Ahn, J. N., Hu, D., & Vega, M. (2020). "Do as I do, not as I say": Using social learning theory to unpack the impact of role models on students' outcomes in education. Social and Personality Psychology Compass, 14(2), n/a. https://doi.org/10.1111/spc3.12517 American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf Asakura, K. (2016). Paving pathways through the pain: A grounded theory of resilience among lesbian, gay, bisexual, trans, and queer youth. Journal of Research on Adolescence, 27(3), 521-536. https://doi.org/10.1111/jora.12291 Asakura, K. (2019). Extraordinary acts to "show up": Conceptualizing resilience of LGBTQ youth. Youth & Society, 51(2), 268-285. https://doi.org/10.1177/0044118X16671430 Baams, L. (2018). Disparities for LGBTQ and gender nonconforming adolescents. Pediatrics, 141(5), 1-12. https://doi.org/10.1542/peds.2017-3004 Bridge, L., Smith, P., & Rimes, K. (2022). Sexual minority young adults' perspectives on how minority stress and other factors negatively affect self-esteem: A qualitative interview study. International Review of Psychiatry, 34(3-4), 383-391. https://doi.org/10.1080/09540261.2022.2051444 PROMOTING INCLUSIVE NURSING CARE 35 Chaudoir, S. R., Wang, K., & Pachankis, J. E. (2017). What reduces sexual minority stress? A review of the intervention "toolkit". Journal of Social Issues, 73(3), 586-617. https://doi.org/10.1111/josi.12233 Collins, R. (2020). Achieving diversity and inclusion in nursing requires a closer look at the profession's structure. Oncology Nursing Society. https://voice.ons.org/stories/achievingdiversity-and-inclusion-in-nursing-requires-a-closer-look-at-the-professions Daly, A., & Champion, J. D. (2020). Creating inclusive health care environments: Health care stories from the trans population. Journal of the American Association of Nurse Practitioners, 33(6), 451-458. https://doi.org/10.1097/JXX.0000000000000383 Gianelis, K. A., & Butler, J. M. (2022). Improving equitable access to inclusive sexual healthcare in a small urban college health setting. Nursing Forum, 57(4), 686-693 https://doi.org/10.1111/nuf.12708 Grant, R., Smith, A., K. J., Newett, L., Nash, M., Turner, R., & Owen, L. (2021). Tasmanian healthcare professionals' & students' capacity for LGBTI + inclusive care: A qualitative inquiry. Health & Social Care in the Community, 29(4), 957-966. https://doi.org/10.1111/hsc.13130 Hatchel, T., Polanin, J. R., & Espelage, D. L. (2019). Suicidal thoughts and behaviors among LGBTQ youth: Meta-analyses and a systematic review. Archives of Suicide Research, 25(1), 1-37. https://doi.org/10.1080/13811118.2019.1663329 Harvard Diversity Inclusion Belonging. (2020, October 6). Diversity, equity, access, inclusion & belonging: Foundational concepts & affirming language. https://edib.harvard.edu/files/dib/files/foundational_concepts_and_affirming_language.pd f?m=1605601285 PROMOTING INCLUSIVE NURSING CARE 36 HealthyPeople 2020. (2022a). Access to health services. https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services HealthyPeople 2020. (2022b). Lesbian, gay, bisexual, and transgender health. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-andtransgender-health Hendricks, A. (2022). WSU opens renovated simulation center. Weber State University Dumke College of Health Professions. https://www.weber.edu/CHP/DeeSimulationCenter.html Jones, J. M. (2022, February 17). LGBT identification in the US ticks up to 7.1%. Gallup. https://news.gallup.com/poll/389792/lgbt-identification-ticks-up.aspx Kurt, S. (2020, January 6). Social learning theory: Albert Bandura. Educational Technology. https://educationaltechnology.net/social-learning-theory-albert-bandura/ Lavoie, P., Michaud, C., Bélisle, M., Boyer, L., Gosselin, É., Grondin, M., Larue, C., Lavoie, S., & Pepin, J. (2018). Learning theories and tools for the assessment of core nursing competencies in simulation: A theoretical review. Journal of Advanced Nursing, 74(2), 239-250. https://doi.org/10.1111/jan.13416 McInroy, L. (2020) Building connections and slaying basilisks: Fostering support, resilience, and positive adjustment for sexual and gender minority youth in online fandom communities, Information, Communication & Society, 23(13), 1874-1891, https://doi.org/10.1080/1369118X.2019.1623902 Murez, C. (2021, June 15). Big rise in U. S. teens identifying as gay, bisexual. U.S. News & World Report. https://www.usnews.com/news/health-news/articles/2021-06-15/big-risein-us-teens-identifying-as-gay-bisexual PROMOTING INCLUSIVE NURSING CARE 37 Pachankis, J. E., Williams, S. L., Behari, K., Job, S., McConocha, E. M., & Chaudoir, S. R. (2020). Brief online interventions for LGBTQ young adult mental and behavioral health: A randomized controlled trial in a high-stigma, low resource context. Journal of Consulting and Clinical Psychology, 88(5), 429–444. https://doi.org/10.1037/ccp0000497 Snapp, S. D., Watson, R. J., Russell, S. T., Diaz, R. M. & Ryan, C. (2015). Social support networks for LGBT young adults: Low cost strategies for positive adjustment. Family Relations, 64(3), 420-430. https://doi.org/10.1111/fare.12124 Tankersley, A. P., Grafsky, E. L., Dike, J., & Jones, R. T. (2021). Risk and resilience factors for mental health among transgender and gender nonconforming (TGNC) youth: A systematic review. Clinical Child and Family Psychology Review, 24, 183-206. https://doi.org/10.1007/s10567-021-00344-6 The Trevor Project. (2021, December 15). Facts about LGBTQ youth suicide. https://www.thetrevorproject.org/resources/article/facts-about-lgbtq-youth-suicide/ The University of Texas at Austin Office for Inclusion and Equity. (n.d.). Climate assessment. https://equity.utexas.edu/wp-content/uploads/2016/10/Climate-Assessment.pdf The University of Texas at Austin Office for Inclusion and Equity. (2022). Diversity planning tools for diversity and inclusion committees. https://equity.utexas.edu/diversity-planningtools/ UCLA Williams Institute School of Law. (2020, September). LGBTQ youth population in the United States. https://williamsinstitute.law.ucla.edu/publications/lgbt-youth-pop-us/ University of Alberta Faculty of Nursing. (n.d.). 2020 Strategic plan for equity, diversity, and inclusivity. https://www.ualberta.ca/nursing/media-library/fon-2020-edi-strategicplan.pdf PROMOTING INCLUSIVE NURSING CARE 38 Utah Suicide Prevention Coalition. (n.d.). Utah LBGTQ+ suicide prevention plan 2020-2023. https://liveonutah.org/wp-content/uploads/2020/10/LGBTQ_Strategic_Plan-6.pdf Weber State University. (2022). Strategic plan. https://www.weber.edu/strategic-plan Weber State University Dumke College of Health Professions. (2022). Annie Taylor Dee school of nursing. https://www.weber.edu/nursing PROMOTING INCLUSIVE NURSING CARE 39 Appendix A DNP Project, Nancy Weston, MSN, RN, CNE Defining Equity, Diversity, and Inclusivity in Nursing Education (EDI) • • • Equity: "The guarantee of fair treatment, access, opportunity, and advancement for all students, faculty, and staff, while at the same time striving to identify and eliminate barriers." Diversity: "All of the ways in which people differ, including primary characteristics, such as age, race, gender, ethnicity, mental and physical abilities, and sexual orientation…diversity refers to all of the characteristics that make individuals different from each other." Inclusion: "The notion that an organization or system is welcoming to new populations and/or identities. This new presence is not merely tolerated but expected to contribute meaningfully into the system in a positive, mutually beneficial way. Inclusive processes and practices are ones that strive to bring groups together to make decisions in collaborative, mutual, equitable ways." (Harvard Diversity Inclusion Belonging, 2020) Why Incorporate EDI for the LGBTQ+ Population • • Weber State University's Mission, Vision, & Values support EDI Accreditation Commission for Education in Nursing (ACEN) requirements: o Standard 2 – Faculty and Staff & Standard 4 - Curriculum Nursing Programs Train Student Nurses to Provide Care for Their Community Population • • • 24,000 LGBTQ+ youth live in Utah (2017) (Murez, 2021) 80,000 LGBT adults live in Utah (2019), 3.7% of the adult population (The Williams Institute, UCLA School of Law, 2019) Nursing programs need to enhance diversity to address changing demographics (AACN, 2021) LGBTQ+ Community Health Care Risks • • • Health disparities: Risk for HIV, STD, unintended pregnancy, forced sexual intercourse, discrimination, violence, prejudice, & bullying Adverse health outcomes: suicide risk, depression, substance use, poor academic performance More likely to experience barriers to quality healthcare & face discrimination by healthcare providers Nursing Faculty Confidence Teaching LGBTQ+ Patient Care Do faculty have the experience, knowledge, skills, & attitudes necessary to teach nursing students? (Collins, 2020). Essential faculty training • • Nursing faculty: explore discomfort & bias & increase comfort in discussing gender, gender identity & expression, & sexual orientation Integrate & evaluate EDI content in the curriculum o Standardized terminology: Harvard Diversity Inclusion Belonging (2020), Human Rights Campaign (n.d.) PROMOTING INCLUSIVE NURSING CARE • 40 Utilize resources: WSU: LGBT Resource Center, EDI WSU Faculty Committee, The Dumke College of Health Professions EDI Committee; CDC: Lesbian, Gay, Bisexual, & Transgender Health Navigate Difficult Conversations & Standardize Care Practices • • • • • • • • • • • Patient-centered care: Get to know the patient, & ask focused & relevant questions such as: o What is your quality of life? What are your home, work, & friend situations? What is your biggest concern or concerns I should know? Normalize conversations within ourselves-conversations are already taking place among students Do not be afraid of the patient's answers, be open, avoid defensive words, & avoid blame Identity affirming patient care–address the patient with the preferred name and pronoun Include LGBTQ+ patient examples in nursing courses Teach how to provide patient-centered identity-affirming care Be present as students work to understand each patient Role play to prepare for patient interactions Identity-affirming patient-centered care Introduce yourself: I'm ____, & I will be your nurse today. My pronouns are ____. I can see that you identify as ____. What is your preferred name? What are your pronouns? Ask questions if unsure or do not understand: Patients want to be heard & not feel invisible. o Involve them in healthcare decisions o Assumptions affect health care (NYC Health and Hospitals, 2011; National LGBTQIA+ Health Education Center, 2017) Commit to Inclusion • • • Feeling welcomed helps patients to follow a plan of care: o Receive routine screenings, prevent missed testing, receive follow-up care, & promote medication compliance/adherence Feeling unsafe, negative experiences, or discrimination results in a lack of treatment, delayed treatment, or undertreatment (Daly, 2020). Communicate using terms that identify the patient: o Use gender-neutral terms married, widowed, husband, wife, partner, father, mother, male, female, non-binary, transgender, & parent (National LGBTQIA+ Health Education Center, 2017; Table et al.,2021) Standardized Terminology Asexual: Complete or partial lack of sexual attraction or lack of interest in sexual activity with others. Cisgender: A person whose gender identity & assigned sex at birth align (e.g., man & male). LGBTQ+: An acronym that collectively refers to individuals who are lesbian, gay, bisexual, transgender, or queer. The addition of the Q for queer is a more recently preferred version of the acronym as cultural opinions of the term focus increasingly on its positive definition, which recognizes more fluid identities; & as a move towards greater inclusivity for gender-expansive people…The Q can also stand for questioning, referring to those still exploring their sexuality &/or gender. Finally, the '+' represents those who are part of the community but for whom LGBTQ does not accurately capture or reflect their identity. PROMOTING INCLUSIVE NURSING CARE 41 Gender: "A set of…traits…that classify an individual along a spectrum of man, woman, both, or neither." Gender Binary: This term implies that gender is biologically determined. A "disproven concept that there are only two genders, man & woman." Gender Expression/Presentation: "Outward manifestations of one's gender identity as presented by one's vocal tenor, body shape, hairstyle, clothing selection, behavior, etc." Gender Identity: One's internal sense of being male, female, neither, both, or another gender. One's gender identity can be the same or different from the sex assigned at birth. Gender Spectrum: "Concept that gender exists beyond a simple man/woman binary model, but instead exists on a continuum...more masculine or more feminine aspects…move fluidly along the spectrum, & some identify off the spectrum entirely." Heterosexual: A person who is emotionally, romantically, &/or physically attracted to someone of the opposite gender. This term is often referred to as straight. Non-Binary: "Individuals who identify as neither man nor woman, both man & woman, or a combination of man or woman." Pansexual: Someone with the potential for an emotional, romantic, or sexual attraction to people of any gender-not necessarily simultaneously, in the same way, or to the same degree. Pansexual can sometimes be interchanged with bisexual. Pronouns: Words used to refer to a person after initially using their name. Gendered pronouns include she & he, her & him, hers & his, & herself & himself. "Personal/Preferred gender pronouns (or PGPs) are the words someone asks others to use when referencing them. Pronouns may be plural gender-neutral pronouns such as they, them, or their(s). Alternatively, they may be ze (rather than she or he) or hir (rather than her(s) & him/his). Transgender: An umbrella term used to describe people who are not cisgender & have a gender identity different than their sex assigned at birth. Sexual Orientation: "Emotional, romantic, or sexual feelings toward other people." (Harvard Diversity Inclusion Belonging, 2020; Human Rights Campaign, n.d.) Faculty & Student Informational Resources Video Resources • LGBT Healthcare Training Video: "To Treat Me, You Have to Know Who I Am" by NYC Health & Hospitals • LGBT Voices: "Perspectives on Healthcare by National LGBTQIA+ Health Education Center • Understanding Gender Identity in Healthcare by Roswell Park Comprehensive Cancer Center • We Are Here: A Transgender Training Video for Healthcare Professionals by Mandala Center for Change Standardized Terminology Resources • Diversity, Equity, Access, Inclusion & Belonging Foundation Concepts & Affirming Language by Harvard Office of Diversity, Inclusion, and Belonging • Human Rights Campaign Glossary of Terms by Human Rights Campaign WSU Resources • LGBT Resource Center by Weber State University LGBT Resource Center • Equity, Diversity, and Inclusion (EDI) WSU Faculty Committee by Weber State University Faculty Senate PROMOTING INCLUSIVE NURSING CARE 42 • The Dumke College of Health Professions EDI Committee by Weber State University Dumke College of Health Professions • WSU Name and Gender Change Process by Weber State University Records Office CDC Resource • LGBT Youth Resources by the Centers for Disease Control and Prevention Lesbian, Gay, Bisexual, and Transgender Health References American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf Essentials-2021.pdf Centers for Disease Control and Prevention. (2020). LGBT youth resources. https://www.cdc.gov/lgbthealth/youth-resources.htm Conron., K. J., & Goldberg, S. K. (2020, April). LGBT people in the US not protected by state non-discrimination statuses. The Williams Institute, UCLA School of Law. https://williamsinstitute.law.ucla.edu/wp-content/uploads/LGBT-ND-Protections-UpdateApr-2020.pdf Daly, A., & Champion, J. D. (2020). Creating inclusive health care environments: Health care stories from the trans population. Journal of the American Association of Nurse Practitioners, 33(6), 451-458. https://doi.org/10.1097/JXX.0000000000000383 Harvard Diversity Inclusion Belonging. (2020, October 6). Diversity, equity, access, inclusion & belonging: Foundational concepts & affirming language. https://edib.harvard.edu/files/dib/files/foundational_concepts_and_affirming_language.pd f?m=1605601285 Human Rights Campaign. (n.d.). Glossary of terms. https://www.hrc.org/resources/glossary-ofterms Murez, C. (2021, June 15). Big rise in U. S. teens identifying as gay, bisexual. U. S. News & World Report. https://www.usnews.com/news/health-news/articles/2021-06-15/big-risein-us-teens-identifying-as-gay-bisexual NYC Health and Hospitals. (2011, May 25). LGBT healthcare training video: "To treat me, you have to know who I am" [Video]. YouTube. https://www.youtube.com/watch?v=NUhvJgxgAac National LGBTQIA+ Health Education Center. (2017, January 9). LGBT voices: Perspectives on healthcare [Video]. National LGBTQIA+ Health Education Center. https://www.lgbtqiahealtheducation.org/video/lgbt-voices-perspectives-on-healthcare/ Table, B., Tronstad, L. D., & Kearns, K. (2021). 'Anything is helpful': Examining tensions and barriers towards a more LGBT-inclusive healthcare organization in the United States. Journal of Applied Communication Research, 1-20. https://doi.org/10.1080/00909882.2021.1991582 The Williams Institute, UCLA School of Law. (2019). LGBT data and demographics. https://williamsinstitute.law.ucla.edu/visualization/lgbt-stats/?topic=LGBT#density Weber State University Dumke College of Health Professions. (2022). College committees: The Dumke college of health professions. https://www.weber.edu/CHP/Committees.html Weber State University Faculty Senate. (2022). Faculty senate committees. https://www.weber.edu/facultysenate/Committees.html Weber State University LGBT Resource Center. (2022). LGBT Resource Center. https://www.weber.edu/lgbtresourcecenter PROMOTING INCLUSIVE NURSING CARE 43 Weber State University. (2022). Name and gender changes: Name & gender change process for students. https://www.weber.edu/Records/NameChange.html#:~:text=Name%20%26%20Gender %20Change%20Process%20for%20Students&text=Students%20can%20update%20their %20legal,or%20registrar%40weber.edu. Weber State University. (2022). Strategic plan. https://www.weber.edu/strategic-plan PROMOTING INCLUSIVE NURSING CARE Appendix B Nursing EDI Guidelines for the LGBTQ+ Population PowerPoint Slide 1 Slide 2 44 PROMOTING INCLUSIVE NURSING CARE 45 Harvard iversity Inclusion elonging, Slide 3 Slide 4 PROMOTING INCLUSIVE NURSING CARE Slide 5 Slide 6 46 PROMOTING INCLUSIVE NURSING CARE Slide 7 Slide 8 47 PROMOTING INCLUSIVE NURSING CARE Slide 9 Slide 10 48 PROMOTING INCLUSIVE NURSING CARE Slide 11 Harvard iversity Inclusion elonging, Slide 12 Human ights ampaign, n.d. 49 PROMOTING INCLUSIVE NURSING CARE Slide 13 Slide 14 50 PROMOTING INCLUSIVE NURSING CARE Slide 15 Slide 16 51 PROMOTING INCLUSIVE NURSING CARE Slide 17 Slide 18 52 PROMOTING INCLUSIVE NURSING CARE Slide 19 Slide 20 53 PROMOTING INCLUSIVE NURSING CARE Slide 21 Slide 22 54 PROMOTING INCLUSIVE NURSING CARE Slide 23 55 PROMOTING INCLUSIVE NURSING CARE 56 Appendix C Surveys Survey 1 These are the qualitative verbal survey questions about clinical simulation experiences asked of simulation course chairs after curriculum changes were made and students taught the revised clinical simulations at the end of the Fall 2023 semester: 1. Does at least one simulation per semester reflect the Nursing EDI Guidelines for the LGBTQ Population? 2. How does this simulation effectively provide an adequate nurse-to-patient interaction reflecting EDI? 3. How does this clinical simulation represent a real patient experience reflecting EDI? Survey 2 This survey is the qualitative verbal question about the ADN program student application asked of the ADN Director: 1. How does the application reflect Nursing EDI Guidelines for the LGBTQ Population? Survey 3 These are the quantitative pre- and post-survey questions offered to the associate ADN faculty to measure their confidence levels in LGBTQ+ patient care and its department importance. Survey created in Qualtrics Pre-Survey ADN Faculty Confidence in LGBTQ+ Patient Care and Its Department Importance 1. The following is an online survey that takes approximately 5 minutes to complete. The survey questions will be about your confidence in teaching nursing students how to support the healthcare needs of LGBTQ+ patients. Some questions may be uncomfortable to answer. Participation in this survey is entirely voluntary, and you may withdraw from participation at any time. By participating in this survey, you are giving your consent. The results of this survey are reported using aggregated data, keeping responses anonymous and confidential. Data will be used for educational or quality improvement purposes to improve outcomes. If you have any questions, please contact Nancy Weston (nancyweston@weber.edu). ฀ I agree to participate ฀ I do not agree to participate 2. How familiar are you with the efforts, projects, and activities related to LGBTQ+ patients in your department? □ Not familiar □ Somewhat familiar PROMOTING INCLUSIVE NURSING CARE 57 □ Very familiar 3. Please indicate your level of agreement. Overall, the curriculum in my department prepares students for careers in nursing, recognizing the interests/needs of LGBTQ+ patients. □ Strongly agree □ Agree □ Neutral □ isagree □ Strongly disagree □ o not know/unable to assess 4. I believe that skills related to LGBTQ+ patient care are necessary for the professional success of nursing graduates. □ Strongly agree □ Agree □ Neutral □ isagree □ Strongly disagree 5. Please indicate your level of agreement. I believe that students, faculty, and staff in my department generally interact positively with each other across differences of __________. Gender □ Strongly agree □ Agree □ Neutral □ isagree □ Strongly disagree Gender identity and expression □ Strongly agree □ Agree □ Neutral □ isagree □ Strongly disagree Sexual orientation □ Strongly agree □ Agree □ Neutral □ isagree □ Strongly disagree 6. I am personally involved in activities related to LGBTQ+ patient care in my department. □ Very involved □ Involved PROMOTING INCLUSIVE NURSING CARE □ Occasionally involved □ Not involved 7. How important is it that my department has efforts, activities and projects related to LGBTQ+ patient care? □ Very important □ Important □ Not particularly important □ Unimportant 8. How satisfied are you with the inclusion of LGBTQ+ patient care in the department? □ Very satisfied □ Satisfied □ Neutral □ issatisfied □ Very dissatisfied 9. LGBTQ+ patient care is well integrated into the required core curriculum/course offerings of my department. □ Strongly agree □ Agree □ Neutral □ isagree □ Strongly disagree □ o not know/unable to assess 10. I feel comfortable engaging in or leading discussions about LGBTQ+ patient care in the classroom or workplace. □ Strongly agree □ Agree □ Neutral □ isagree □ Strongly disagree 11. What is the highest degree you have completed? □ SN □ MSN □ NP □E □ Ph 12. How many years have you been in the nursing department? □ Less than 1 year □ 1-2 years □ 3-5 years □ 6-10 years 58 PROMOTING INCLUSIVE NURSING CARE 59 □ 11-15 years □ 16 or more years 13. I identify myself as __________. □ Female □ Male □ Transgender/Non-binary □ Prefer not to answer 14. What is your age? □ less than 3 years of age □ 3 – 39 years of age □ 4 – 49 years of age □ 5 – 59 years of age □ 6 years of age or more Thank you for your participation in this survey. The questions on this survey were adapted and developed from: The University of Texas at Austin Office for Inclusion and Equity. (n.d.). Climate assessment. https://equity.utexas.edu/wpcontent/uploads/2016/10/Climate-Assessment.pdf The following substitutions have been made based on the scope of this study: 1. LGBTQ+ patient care or LGBTQ+ patients was substituted for diverse populations, diversity. 2. My department was substituted for The college/school, college/school environment/experience. 3. Nursing department was substituted for college/school. Questions that did not apply to this study were removed. Post-Survey ADN Faculty Confidence in LGBTQ+ Patient Care and Its Department Importance The post-survey was the same as the pre-survey, except that question #15 was added. 15. Please use this space to share any comments or thoughts regarding LGBTQ+ patients or LGBTQ+ patient care not addressed elsewhere in this presentation. [open response field] PROMOTING INCLUSIVE NURSING CARE 60 Appendix D Project Budget Implementation Expenses Items Faculty Training – included in a mandatory faculty meeting Faculty Training – Simulation Course Chairs Training Materials – Handout Miscellaneous Total Cost per Unit $15.09 Number 30 Total cost $452.70 $90.56 3 $271.68 $0.30 30 $9.00 $0 $105.85 0 63 $0 $733.38 Cost per Unit $0 $0 Number 0 0 Total Cost $0 $0 $45.28 1 $45.28 $0 0 $0 $45.28 0 $45.28 Ongoing Expenses Items Rent – none Faculty training Self-guided Canvas course Faculty maintenance of resources – Resource updates to Canvas Equipment – Faculty access to Canvas Course Total PROMOTING INCLUSIVE NURSING CARE 61 Appendix E Project Timeline Task Project Proposal and Literature Review Project ideas discussed with WSU SON administration and faculty advisor Identify and contact project consultant Dr. Cadman Literature Review Project Proposal Plan Project Look at current use of EDI in ADN clinical simulations and patient health history form Review ADN Program Student Application Informal conversations with faculty Look at the American Association of Colleges of Nursing (AACN) website Obtain WSU IRB Approval Create Nursing EDI Guidelines for the LGBTQ+ Population Create PowerPoint presentation Create Surveys1. Pre- and post-faculty surveys 2. Verbal survey questions for simulation course chairs 3. Verbal survey question for ADN director Implement Project ADN faculty training of Nursing EDI Guidelines for the LGBTQ+ Population Administer pre- and post-surveys to ADN Faculty Review simulations and Patient Health History Form with ADN simulation course chairs Add Nursing EDI Guidelines for the LGBTQ+ Population presentation materials to the Nursing Faculty Development Canvas course Present the Nursing EDI Guidelines for the LGBTQ+ Population to OTech, BTech & DTech Nursing Faculty Evaluate Project Assess Qualtrics Survey Results of Self-Report of Confidence of ADN faculty before and after staff meeting presentation Start End Progress 1/21/2022 5/22/2022 Complete 5/28/2022 6/15/2022 Complete 12/6/2021 6/15/2022 9/27/2022 6/21/2022 Complete Complete 5/9/2022 8/12/2022 Complete 5/9/2022 5/9/2022 5/9/2022 8/12/2022 8/12/2022 6/15/2022 Complete Complete Complete 7/7/2022 5/9/2022 7/29/2022 8/1/2022 Complete Complete 7/1/2022 7/1/2022 10/12/2022 10/12/2022 Complete Complete 11/14/2022 11/14/2022 Complete 11/14/2022 11/14/2022 Complete 11/14/2022 12/14/2022 Started 11/14/2022 3/12/2022 Complete 1/11/2023 4/28/2023 Started 11/14/2022 1/23/2023 Complete PROMOTING INCLUSIVE NURSING CARE Assess alignment of simulation with Nursing EDI Guidelines for the LGBTQ+ Population Assess alignment of ADN Program Student Application with Nursing EDI Guidelines for the LGBTQ+ Population 62 4/1/2023 4/28/2023 Started 11/14/2022 12/14/2022 Complete PROMOTING INCLUSIVE NURSING CARE 63 Appendix F Pre- and Post-Survey ADN Faculty Confidence in LGBTQ+ Patient Care and Its Department Importance Survey Question Familiar with department activities related to LGBTQ+ patients NF 22.22 (11.11) Percentage of Participants SF VF 61.11 16.67 (50.00) (38.89) SA A N D SD The department curriculum prepares students for nursing careers, recognizing the needs of LGBTQ+ patients. 11.11 (16.67) 22.22 (55.56) 22.22 (11.11) 38.89 (16.67) 5.56 (0) DNK/ UTA n/a n/a LGBTQ+ patient care skills are necessary for nursing graduate professional success. 72.22 (82.35) 27.78 (17.65) 0 (0) 0 (0) 0 (0) n/a n/a LGBTQ+ patient care is well integrated into the department curriculum 0 (17.65) 33.33 (23.53) 16.67 (29.41) 38.89 (29.41) 5.56 0 5.56 0 I feel comfortable engaging in or leading discussions about LGBTQ+ patient care in the classroom or workplace. 11.11 (41.48) 44.44 (47.06) 33.33 (11.76) 11.11 0 0 0 n/a n/a Students, faculty, and staff generally interact positively with each other across differences of gender. 68.42 (70.59) 21.05 (17.65) 5.26 (5.88) 5.26 (5.88) 0 (0) n/a n/a Students, faculty, and staff in my department generally interact positively with each other across differences of gender identity and expression. 61.11 (58.82) 33.33 (35.29) 0 (0) 5.56 (5.88) 0 (0) n/a n/a Students, faculty, and staff in my department generally interact positively with each other across differences of sexual orientation. 66.67 (62.50) 27.78 (31.25) 0 (0) 5.56 (6.25) 0 (0) n/a n/a VI 5.56 (17.65) I 16.67 (11.76) OI 27.78 (47.06) NI 50.00 (23.53) VIMP 55.56 (70.59) IMP 38.89 (29.41) NPI 5.56 (0) U 0 (0) Faculty are involved in department activities related to LGBTQ+ patient care Importance of department efforts, activities, and projects related to LGBTQ+ patient care PROMOTING INCLUSIVE NURSING CARE Satisfied with department inclusion of LGBTQ+ patient care VS 11.11 (17.65) 64 S 33.33 (35.29) N 44.44 (29.41) DS 11.11 (17.65) VD 0 (0) Note. n = 18, (n = 17), Participant numbers are averaged. This table demonstrates participant responses to the A N Faculty’s confidence in LGBTQ+ patient care and its department importance before and after the educational presentation. Pre-survey results are presented without parentheses, and post-survey results are presented in parentheses. A variety of scales were used. See abbreviations for scales. Not familiar (NF), Somewhat familiar (SF), Very familiar (VF) Strongly agree (SA), Agree (A), Neither agree nor disagree (N), Disagree (D), Strongly disagree (SD), Do not know/unable to assess (DNK/UTA), Not applicable (n/a) Very involved (VI), Involved (I), Occasionally involved (OI), Not involved (NI) Very important (VIMP), Important (IMP), not particularly important (NPI), Unimportant (U) Very satisfied (VS), Satisfied (S), Neutral (N), Dissatisfied (DS), Very dissatisfied (VD)