"But what do you really think?" Nurses' contrasting explicit and implicit attitudes towards people with disabilities using the implicit association test.

AIMS: To investigate how nurses' implicit and explicit attitudes towards people with disabilities (PWD) compare to (1) other healthcare providers and (2) non-healthcare providers. METHOD: We present an analysis of secondary data from the publicly available disability Implicit Association Test (IAT). We compare the explicit and implicit attitudes towards PWD for (1) nurses (n = 24,545), (2) other healthcare providers (n = 57,818) and (3) non-healthcare providers (n = 547,966) for a total of 630,238 respondents, between 2006 and 2021. DATA SOURCES: We use publicly available data for the Disability IAT from Open Science Framework repository of Project Implicit available at https://osf.io/tx5fi/. REPORTING: STROBE checklist. RESULTS: There is a distinct contrast between nurses' explicit and implicit attitudes. While nurses have more positive explicit attitudes towards PWD compared to other groups, they also have more negative implicit attitudes towards PWD. As such there is a contrast between nurses' stated (explicit) attitudes and their unconscious (implicit) attitudes towards PWD. Further, we find that implicit bias towards PWD-among all groups-has not improved over the 15 year period of our sample. CONCLUSIONS: We present a contrast between nurses' explicit and implicit attitude towards PWD compared to non-healthcare providers. We posit that implicit bias is driven by a combination of workload and stress which drives nurses to unconscious modes of thinking more frequently. IMPLICATIONS: We discuss three potential tools for improved educational praxis regarding treatment of PWD; (1) more PWD service user involvement, (2) the use of mindfulness techniques to reduce stress and (3) the use of patient contact simulation to promote education and understanding. PATIENT OR PUBLIC CONTRIBUTION: There is no patient or public contribution.

Nurses' implicit and explicit attitudes towards transgender people and the need for trans-affirming care.

Background: The primary objective of this study is to investigate the implicit and explicit attitudes of healthcare professionals - in particular nurses - towards transgender people. This is especially important in light of recent calls for improved trans-affirming care provision by healthcare professionals to generate quality healthcare access and outcomes for transgender people. Methods: We use publicly available data from the transgender version of the Implicit Association Test from 2020 to 2022. We focus on differences between three subsets of participant: (1) non-healthcare professionals (N = 177,810), (2) non-nursing healthcare professionals (N = 22,443) and (3) nursing healthcare professionals (N = 11,996). We present the results of parametric statistical tests (t-tests) and an ordinary least squares regression, to analyse the robustness of our results when controlling for a host of sociodemographic characteristics. Results: We find that non-healthcare professionals have significantly lower implicit bias towards transgender people compared to healthcare professionals. Further, within healthcare professionals, we find nurses have significantly higher implicit bias towards transgender people compared to non-nurses. We show how implicit bias and explicit attitudes are highly correlated. Further, we provide evidence that healthcare professionals - but in particular nurses - conflate sex and gender identity. Conclusion: Whilst nurses continue to have higher levels of implicit and explicit bias towards transgender people there remains a need to globally establish additional enhanced trans-affirming care training provision for nursing and medical students.