Student and faculty perspectives of gender inclusive and affirming practices in undergraduate nursing education
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Background: Transgender and gender diverse people have unique healthcare needs, which can be addressed through the provision of gender affirming care. Nurses, the largest healthcare workforce, can help meet this need. Further, nursing schools produce thousands of nurses annually, and thus are critical sites to address gender affirming care meaningfully. Yet how gender affirming care is being taught in undergraduate nursing education is unclear. Three levels of curriculum (formal, informal, and hidden) influence students’ learning about equitable care for transgender and gender diverse patients, as well as nursing students and educators. Currently, there is no nursing research on the state of transgender and gender diverse education across the three levels of curriculum (called gender inclusive and affirming practices). Purpose: This thesis aimed to explore gender inclusive and affirming practices across undergraduate nursing education in Canada. Three objectives guided the paper-based thesis: 1) to map evidence of gender inclusive and affirming practices in undergraduate nursing education literature; 2) to explore gender inclusive and affirming practices within schools of nursing in Canada; and 3) to (re)vision gender inclusive and affirming practices for nursing education. Methods: To commence this work, a scoping review, which included scholarly articles (n=47) and a search of schools of nursing websites (n=22), was conducted to map the literature on gender inclusive and affirming practices in undergraduate nursing education. As informed by the scoping review and drawing queer theory and Hafferty’s three levels of curriculum, an interpretive description study explored the perspectives of undergraduate nursing students and educators in Canada. Data collection included initial and follow-up semi-structured focus groups with students (n=18) and interviews with educators (n=7). Findings: Results from this thesis indicate that nursing education is cisnormative across all levels of curriculum. Cisnormativity – the normalization of cisgender/non-transgender people and othering of transgender and gender diverse people – is perpetuated in nursing education when gender affirming care is set to the fringes (formal); when language remains highly gendered, or pronouns are not used (informal); or when there is no transvisibility or limited access to gender inclusive washrooms (hidden). Some consequences of cisnormativity include nursing students not feeling prepared to care for transgender and gender diverse people, nurse educators not being prepared to teach this content, and transgender and gender diverse students being othered. Conclusions: Multi-level action to disrupt cisnormativity is needed within and beyond nursing education. Schools of nursing can support faculty development in gender inclusive and affirming practices and create safer, more representative and inclusive environments. Nursing governing bodies can create explicit requirements for gender inclusive and affirming practices in accreditation and licensing processes.