Academic journal article Nursing Education Perspectives

Nursing Students' Attitudes toward Lesbian, Gay, Bisexual, and Transgender Persons: An Integrative Review

Academic journal article Nursing Education Perspectives

Nursing Students' Attitudes toward Lesbian, Gay, Bisexual, and Transgender Persons: An Integrative Review

Article excerpt


AIM The aim of this study was to critically appraise and synthesize findings from studies on the attitudes of nursing students toward lesbian, gay, bisexual, and transgender (LGBT) persons.

BACKGROUND There is paucity of research to assess the attitudes of nursing students toward LGBT persons.

METHOD An electronic search was conducted using PubMed, Medline, Web of Science, EbscoHost, Psyclnfo, and the Cumulative Index to Nursing and Allied Health Literature using medical subject headings terminologies. Search terms used included gay, lesbian, transgender, bisexual, LGBT, nursing students, baccalaureate nursing, undergraduate nursing, homophobia, homosexuality, sexual minority, attitudes, discrimination, and prejudice.

RESULTS Less than 50 percent of the studies (5 out of 12) suggested positively leaning attitudes of nursing students toward LGBT persons; six studies reported negative attitudes, and one study reported neutral attitudes.

CONCLUSION There are some indications that student attitudes may be moving toward positively leaning. Studies published before 2000 reported a preponderance of negative attitudes.

KEY WORDS Nursing Students--Attitudes--LGBT--Homosexuality--Health Disparities


Health inequity continues to affect the lesbian, gay, bisexual, and transgender (LGBT) population. However, in the last several years, the health care needs of this population have received significant attention from policy makers. The Institute of Medicine (IOM), Healthy People 2020, and the Agency for Healthcare Research and Quality have all highlighted best practices in dealing with the unique health issues of LGBT persons.

Health inequity is closely tied to sexual and social stigma (IOM, 2011), with sexual stigma defined as the negative regard, inferior status, and relative powerlessness that society collectively accords to any nonheterosexual behavior, identity, relationship, or community (Herek, 2007). The heteronormative construct of society (Rondahl, 2009) has created social barriers resulting in legal discrimination in access to health care, lack of appropriate social programs for LGBT persons, and a shortage of culturally competent health care providers and educators who are knowledgeable in LGBT health (, 2016).

Despite the increasing social acceptance of homosexuality (Pew Research Center for People and the Press, 2011), the evidence suggests that LGBT persons have significant health disparities as compared to heterosexuals that are slowly gaining exploration from researchers (Lim, Brown, & Kim, 2014). The challenge for nursing education is to synthesize the growing evidence of LGBT health issues into meaningful curricular integration that will result in positive health outcomes for patients, for their families, and for society.


At the height of the AIDS (acquired immune deficiency syndrome) epidemic, studies demonstrated high levels of homophobia, fear of contagion, avoidance, and stigmatization of LGBT person among nurses (Forrester & Murphy, 1992; Meisenhelder, 1994). Analysis of such studies indicates that it is difficult to separate attitudes about AIDS from attitudes about LGBT populations (Eliason, Dibble, & DeJoseph, 2010). Although the last decade has seen a growing acceptance of LGBT identities and expressions, recent metasyntheses indicate that negative attitudes toward sexual minorities persist among nurses (Dorsen, 2012; Eliason et al., 2010). These findings may be an indication of the lack of meaningful inclusion of LGBT health in nursing education across all levels (Sirota, 2013) and the limited exposure to LGBT persons during clinical practice in prelicensure education (Lim, Brown, & Jones, 2013).

The call to integrate LGBT health into the nursing curriculum has been the subject of discussion among nurse experts in LGBT health (Chinn, 2013; Eliason et al. …

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