How to Include LGBTQ+ Health Topics in Undergraduate Nursing Curricula

Many years ago, when I was a second-degree BSN student, a guest lecturer from the organ transplant team at the hospital affiliated with my nursing school was talking about liver disease, liver transplantation and risk factors. At one point she said, very casually, “Gay men are at higher risk of getting hepatitis B and hepatitis C,” and then went on to talk about how untreated hepatitis can lead to liver failure and the need for a transplant.

My heart started pounding. I looked around at the lecture hall. I raised my hand. “Why?” 

She stammered. She turned bright red. She giggled. And then she managed to sputter out something about how a particular sex act, when unprotected, put this population at higher risk. “So,” I said, “It’s not that being gay puts them at higher risk, it’s that this is a high-risk behavior, right?” She didn’t answer, she just continued on with her lecture. This was one of the very few mentions of lesbian, gay, bisexual, transgender or queer/questioning (LGBTQ+) health in my baccalaureate program.

I didn’t realize it at the time, but that experience, in 2004, started me on a journey to change how we approach LGBTQ+ health and social topics in pre-licensure, undergraduate nursing curricula. While there are more robust resources for incorporating LGBTQ+ health into curricula now than there were in the early 2000s, current research suggests we still have a long way to go. 

One study showed that while 70% of nursing faculty respondents indicated they were “moderately or fully” prepared to teach LGBTQ+ health topics, 23-63% stated that they never or seldom taught these topics (Lim, et al., 2015). Another showed that while 78.6% of educators said that teaching about “homosexuality” is very to extremely important, only 28.1% of faculty said they felt very or extremely well prepared to teach about homosexuality (Sirota, 2013). National surveys about the amount of time dedicated to LGBTQ+ topics in baccalaureate programs reflect the gap between faculty interest and inclusion of these topics in curricula. An average of 2.25 hours and a median of 2.12 hours are spent on these topics within BSN curricula (Lim, et al., 2015; Carabez et al, 2015; Hickerson, et al., 2018).

While there is no clear evidence about how much time is “enough,” the gap between interest in teaching these health topics and actually doing it suggests there are opportunities for better preparation of nursing educators to develop and deliver more LGBTQ+ inclusive course content.

Here are some of my recommendations for developing and delivering more LGBTQ+-inclusive course content for undergraduate nursing students:

• Be aware that LGBTQ+ populations are not monolithic in their health care needs, and that LGBTQ+ persons, like anyone else, navigate multiple intersectionalities of identity and care needs across the life span and in their encounters with health care settings. 
• Seek out available resources to increase your own awareness and knowledge as an educator. There are great materials and resources available to help educators increase their knowledge and skills around gender and sexual orientation terminology and the health needs of LGBTQ+ populations, such as the Fenway Institute National LGBTQIA+ Health Education Center and the Stanford University faculty development course  Teaching LGBTQ+ Health. 
• Interrogate norms and assumptions around gender expression and sexual orientation that may present themselves in course content and seek to include case studies and materials that mitigate against these norms (e.g., the health and social considerations of a pregnant transgender man in an obstetrics course). 
• Be willing to confront your own biases and facilitate conversations with students about theirs. Fostering cultural safety for historically minoritized patient populations starts with acknowledging implicit biases and working to mitigate against them.
• Include LGBTQ+ health and social topics into nursing curricula in ways that do not exclusively focus on sexuality, gender expression, gender-affirming therapies or even health iniquities. These considerations are important, but so are many other events and health needs across the lifespan. 

These recommendations are not necessarily a strict “how-to,” but keeping these considerations in mind as nurse educators seek to make their curricula and course offerings more inclusive of LGBTQ+ populations will ensure that future nursing graduates enter the workforce well-equipped to provide informed, compassionate and knowledgeable care for their LGBTQ+ patients.

Caitlin Nye, MSN, RN, NPD-BC, is enrolled in the PhD program at UB School of Nursing. She is also an assistant professor at SUNY Upstate University Hospital College of Nursing. Her doctoral research focuses on improving the preparation and self-efficacy of nursing faculty to include LGBTQ+ health topics in undergraduate nursing curricula.