Preparedness of Practicing Nurses in the Care of Sexual and Gender Diverse People in the United States: A Scoping Review.

BACKGROUND: Sexual and gender diverse (SGD) people in the United States (US) experience health inequities due to societal stigma and marginalisation. The nursing workforce must provide evidence-based affirming, inclusive and culturally responsive care for SGD people to meet individual and community health needs and eliminate disparities. AIMS: The purpose of this scoping review was to synthesise what is known about (1) nurses' knowledge, skills and attitudes related to caring for SGD people in the US and (2) the existence, development and evaluation of SGD-related educational offerings available to practicing nurses in the US to develop the knowledge and skills needed to promote the health and wellbeing of SGD individuals, families and communities. METHODS: This review followed the scoping review methodology and PRISMA for Scoping Reviews (PRISMA-ScR). DATA SOURCES: In conjunction with a health librarian, an electronic literature search was conducted using PubMed, LGBT Health, CINAHL, ERIC and Health Source-Nursing. RESULTS: Thirty-two studies were included in this review, including quantitative and qualitative studies that sought to understand the knowledge, attitudes and clinical experiences of nurses related to the care of SGD people; studies that tested educational interventions and studies that identified educational barriers and facilitators. Major gaps in education, practice and research, as well as methodological limitations of existing studies, were noted. CONCLUSION: Nurses would benefit from expanded access to effective standardised foundational SGD-related health continuing education to help prepare them to care for diverse patient populations. Equity, inclusivity and dignity are key values of the nursing profession. It is imperative that nurses have the knowledge and skills to apply these values consistently in day-to-day professional practice across populations and settings. IMPACT: There is an urgent need to develop standardised, easily accessible evidence-based educational content to address nurses' knowledge of and attitudes towards caring for SGD people. REPORTING METHOD: This study adhered to the PRISMA-ScR reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution to this study.

Nursing pre-licensure and graduate education for LGBTQ health: A systematic review.

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer plus (LGBTQ) people experience discrimination and health disparities compared to heterosexual cisgender people. Clinicians report discomfort and insufficient preparation for providing care to LGBTQ people and nursing has been slow to integrate LGBTQ health into curricula. PURPOSE: Conduct a systematic review to examine and critically appraise peer-reviewed literature on nursing student knowledge, skills, and attitudes (KSAs) regarding LGBTQ health and the development/evaluation of LGBTQ health content in nursing curricula. METHODS: A systematic review was conducted (N = 1275 articles from PubMed, LGBT Health, CINAHL, ERIC, and Health Source-Nursing/Academic Edition). FINDINGS: Twenty articles met inclusion criteria. Twelve studies described curricular interventions; however, there were few validated tools to evaluate content coverage or KSAs. Four themes emerged specific to LGBTQ health content inclusion. DISCUSSION: While an emerging science of LGBTQ nursing education has been identified, more work is needed to build and evaluate a comprehensive curricular approach for full programmatic integration of LGBTQ health. CONCLUSION: As nursing programs build LGBTQ content into nursing curricula, care must be taken to integrate this content fully with the depth of curricular content in population health, social determinants of health, social justice, intersectionality, cultural competence, and political advocacy. TWEETABLE ABSTRACT: Greater integration of LGBTQ health content into nursing education should be a priority for nursing education.

A systematic review of U.S. nursing faculty's knowledge, awareness, inclusion, and perceived importance of sexual and gender minority-related content in nursing curricula.

BACKGROUND: In the US, sexual and gender minority (SGM) individuals continue to experience health inequities, and nursing curricula content and nursing faculty with SGM health expertise in the US remain limited. Addressing health disparities begins with the preparation of future nurses-US nursing faculty must be supported to meet these growing needs. PURPOSE: To describe, appraise, and synthesize research from 2000-2020 on US nursing faculty knowledge, awareness, inclusion, and perceived importance of SGM health content. METHODS: Following PRISMA 2020 guidelines, we registered a systematic review and appraisal protocol in PROSPERO, and then executed the protocol and synthesized the literature. DISCUSSION: We found an empirical evidence base surrounding US nursing faculty and SGM health much more limited than expected. Only four cross-sectional, descriptive empirical articles fit the a priori inclusion criteria. The studies were of moderate quality at best and often relied on unvalidated or older measures. In general, the studies focused on examining characteristics of nursing programs, faculty comfort with content, faculty perceptions of content importance, and hours dedicated to content. CONCLUSION: Since the close of the review, new commentaries and editorials expanding the call for change in the US were published-the time for commentary has passed. It remains unclear whether US nursing faculty are adequately prepared to educate future nurses about SGM health issues-and an unprepared healthcare workforce is yet another barrier to SGM health equity. The evidence base supporting US nursing faculty development desperately needs more studies using rigorous methodologies.

Physical and Psychological Abuse among Seropositive African American MSM 50 Aged Years and Older.

Little is known about abuse experienced among African American men who have sex with men (MSM) who are 50 years and older. A series of focus groups were conducted to examine perspectives of seropositive African American MSM age 50 years and older who reported experiencing some form of psychological or physical abuse. Thirty African American MSM were divided into four focus groups and four themes emerged: "Fear Being Gay," "No One Else to Love Me," "Nowhere to Turn," and "Sexual Risk & Control." The data suggest there is a need to develop culturally tailored interventions for this population.

Health related quality of life and depressive symptoms among seropositive African Americans.

The primary aim of this descriptive correlational study was to determine which domains of health related quality of life (HRQOL) after controlling for demographic correlates predict depressive symptoms among N=70 seropositive African American men and women on Active Antiretroviral Therapy (ART). A demographic questionnaire, the Center for Epidemiological Studies Depression Scale (CESD-D), and the SF-36 Health Related Quality of Life (HRQOL) scale were administered. The regression analyses resulted in three models. The first model indicated that emotional well-being explained 38% of the variance in depressive symptoms (P=0.000) and in model two, emotional well-being and role limitations on emotional health explained 50% of the variance (P=0.000) and in the final and best fitting model emotional well-being, role limitations on emotional health and pain explained 53% of the variance in depressive symptoms (P=0.000) respectively. The findings underscore the need to explore the impact of HRQOL on mental health, and to also screen and treat seropositive African American men and women on (ART) for depressive symptoms.

Women 50 and Older and HIV: Prevention and Implications for Health Care Providers.

The current article discusses the importance of implementing HIV and AIDS education, prevention, and intervention programs that are tailored to women 50 and older and to determine HIV risk factors for this population. A literature search was performed, resulting in 41 relevant articles. The literature underscored the significance of increasing awareness of HIV/AIDS, particularly among older women. HIV risk behaviors and the effect that these behaviors have on HIV transmission and prevention among women 50 and older are described. Prior research findings identified risk categories of older women that may contribute to the transmission of HIV among this particular population, including heterosexual relations, perceived HIV risk, ageism and HIV transmission, biological factors, transfusions, sexual enhancement aids, and health care providers and prevention messages. In addition, previous findings indicate that health care providers have not traditionally targeted women 50 and older for HIV prevention. Health care providers should incorporate discussion of HIV risk and transmission during clinic visits and implement prevention programs that target this population. [Journal of Gerontological Nursing, 43(12), 29-34.].

Qualitative Perspectives about Living with HIV from Seropositive African American MSM Aged 50 years and Older.

It has nearly been more than three decades; yet, the research on aging seropositive African American men who have sex with men (MSM) is scarce. Exploring issues for an aging population of seropositive MSM is critical given that earlier epidemiological data suggested that by 2015, half of the AIDS cases will be in adults aged 50 years and older. A qualitative approach with the aim to examine perspectives about HIV risk from a group of seropositive African American MSM 50 years of age and older was conducted. Two separate focus groups with a total N  =  30 were conducted. Four themes emerged: feeling left out, no place to call home, not a priority, and no one to grow older with.

Predictors of Depression among Seropositive Batswana Men and Women: A Descriptive Correlational Study.

The purpose of this descriptive correlational study was to describe predictors of depressive symptoms among N=70 seropositive Botswana men and women residing in Gaborne, Botswana. A demographic questionnaire, the Center for Epidemiologic Studies Depression Scale, (CESD-D), and the SF-36 [Quality of life] were administered. The questionnaires were translated and back translated in Setswana and administered by Batswana men and women. The results of the regression analyses resulted in two calculated models. In the first Model energy/fatigue explained 46% of the variance in depressive symptoms (P=.000), and in the second Model energy/fatigue and role limitations on emotional well-being explained 50% of the variance in depressive symptoms respectively. The study findings underscore the need for mental health services for seropositive Batswana men and women.

Correlates of Condom Use Among Substance Using Older Seropositive MSM: Implications for Mental Health Practice.

The purpose of this study was to describe the correlates of condom use among a sample of N = 60 substance using seropositive men who have sex with (MSM). The mean age of the study participants was 52 ranging 50-75 years of age. Seventy-percent of study participants reporting smoking marijuana, 62% using cocaine, 25% heroin, 37% alcohol, and 30% amphetamines. Among those reporting substance use, 75% reported it was a hassle to use condoms, 42% indicated pleasure decreased with condom use, 72% indicated safer sex is boring, 72% reported the idea of using condoms is unappealing, 78% reported condoms ruined sex, and 71% said condoms interfered with romance. A multiple logistic regression analysis revealed low self-esteem, relationship status, attitudes towards condom use, and depression predicted condom use χ2 = 20.79, df = 6, ρ =.002. The study findings have implications for mental health nursing practice with seropositive African American MSM.

The Nonsilent Assault on Democracy.

Ending voter disenfranchisement.

Why Voting and Voter Disenfranchisement Matter to Health.

Nurses can play a crucial role as trusted advocates.

Age-related effects on symptom status and health-related quality of life in persons with HIV/AIDS.

Health-related quality of life (HRQOL) is linked to symptom status and may be related to age in HIV-positive persons. Data were collected in a multisite HIV-positive sample (N = 1,217) using an HIV-specific HRQOL and three symptom status instruments according to the Wilson and Cleary HRQOL model. Multiple stepwise linear regression analysis found that younger age predicted higher sexual function (ΔR(2) = .12, p < .01) and older age predicted greater provider trust (ΔR(2) = .04, p < .01). No significant differences were found in symptom status or the other seven HRQOL dimensions. Although older HIV-positive persons reported more comorbidities, they did not report more symptoms.

Sexual diversity and HIV risk among older heterosexual African American males who are seropositive.

The purpose of this study is to describe the occurrence of non-condom use during vaginal or anal intercourse, controlling for HIV symptoms, AIDS knowledge, relationship status, and safe-sex discussion, in 73 self-identified heterosexual African American males who are seropositive. The participants were analyzed as a subset from a larger sample of 130 African American men who are HIV seropositive. HIV-related symptoms were reported by all of the study participants. Twenty-seven percent of the participants reported engaging in same-sex behavior, 37% reported not using condoms during vaginal sex, and 75% reported not using condoms during anal sex during the past 3 months. Twenty-four percent did not decrease sexual risk behaviors, despite being seropositive. The logistic regression analysis indicated that the odds for participants not using condoms who did not engage in safe-sex discussions were 77.4 times for vaginal sex and 14.2 times during anal sex. These findings are compelling given that African Americans comprise 50% of new HIV infections each year.

Predictors of self-efficacy to use condoms among seropositive middle-aged African American men.

Condom use during sexual encounters continues to be a challenge for seropositive individuals. Hence, the influence of personal characteristics, AIDS knowledge, and religious well-being on perceived self-efficacy to use condoms has been examined in a convenience nonprobabilistic sample of 130 middle-aged seropositive African American men from the Mid-Atlantic region. AIDS knowledge and religious well-being are strongly related to self-efficacy to use condoms. These findings indicate that it is critical to explore further the relationship of AIDS knowledge and religious well-being with self-efficacy to use condoms.

Perceived and real barriers for men entering nursing: implications for gender diversity.

UNLABELLED: The objective of this literature review is to describe the perceived or real barriers to men seeking a career in nursing, and to suggest strategies for ameliorating barriers. A literature search exploring barriers existing for men pursuing nursing was conducted. Although the literature underscored the structure of nursing has changed substantially over the last fifty years, these changes have not always provoked a change in the public's perception of nursing. Barriers for men entering nursing still exist. Implications for gender diversity in nursing are discussed. PRECIS: Strategies for decreasing barriers experienced by males entering nursing are warranted.

Understanding the HIV risk reduction needs of heterosexual African American substance-abusing men.

With the increasing prevalence of HIV/AIDS, nurses find themselves caring for diverse populations at risk for HIV. One subpopulation at risk is African American men with a history of substance use. To better understand the risk reduction needs of these men, a focus group was conducted with 16 African American men attending an outpatient drug treatment program in Philadelphia. The purpose was to identify perceptions of HIV risk, engagement in HIV risk behaviors, and barriers to condom use in order to generate recommendations for risk reduction programs tailored to the needs of this population. Results revealed that African American substance-abusing men perceive themselves to be at risk for HIV infection and other adverse health outcomes yet lacked adequate information related to HIV prevention. The need for culture- and gender-specific interventions to reduce HIV-related risk behaviors among African American substance-using men is discussed.

Gender differences in use of prayer as a self-care strategy for managing symptoms in African Americans living with HIV/AIDS.

The objective of this study was to explore the association of gender to use of prayer as a self-care strategy for managing the HIV-related symptoms of fatigue, nausea, depression, and anxiety among African American men and women who are HIV-seropositive. To accomplish this, data were determined using convenience sampling from a sample of 448 African American men and women from the United States who were participants in a national study on self-care symptom management of HIV/AIDS. Chi-square analyses were used to examine the potential relationships between gender and the use of prayer for managing the four symptoms. The mean age of the sample was 42.69 +/- 7.93 years (range, 20-66). Results showed the following gender differences in the use of prayer as a self-care strategy: fatigue-men 46% (n = 62), women 54% (n = 74); nausea-men 52% (n = 33), women 48% (n = 30); depression-men 55% (n = 90), women 45% (n = 73); and anxiety-men 77% (n = 83), women 87% (n = 73). Chi-square analyses determined that significant differences exist between African American men and women in the frequency of the use of prayer for managing HIV-related fatigue (chi(2) = 14.81, 1 df, p = .000), nausea (chi(2) = 4.10, 1 df, p =.043), and depression (chi(2) = 5.21, 1 df, p = .022). There was no gender difference in the use of prayer to manage anxiety. Prayer was reported as a self-care strategy by over 50% of the respondents for three of the four symptoms and was rated highly efficacious. The authors conclude that the African American men and women differed in their selection of prayer as a self-care strategy for managing HIV-related depression, fatigue, and nausea. A higher proportion of women than men used prayer to manage fatigue, and more men than women reported using prayer to manage nausea and depression.

Determinants of HIV and AIDS among young African-American men who have sex with men: a public health perspective.

This study was an examination of community, age, race and ethnicity. Individual behavior and health promotion was critically examined within the context of (HIV) Human Immunodeficiency Virus and AIDS (Acquired Immuno Deficiency Syndrome) among young African-American men who have sex with men. Examples from the literature provided empirical illustrations of how these concepts have been defined conceptually and measured with respect to HIV/AIDS; particularly among this population from a public health perspective. Additionally, a conceptual model depicting the interplay of these concepts was reviewed and is provided and discussed to shed further light on the conceptual link between these concepts and healthy behaviors among sexually active African-American young men who have sex with men. The concepts are discussed in an integrative format throughout the paper within the backdrop of the proposed model for understanding the wave of HIV/AIDS within this subculture from a public health nursing perspective.