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Welcome to this episode of NLN podcast Nursing EDge Unscripted the Scholarship track. I'm your host, Dr. Steven Palazzo, a member of the editorial board for Nursing Education Perspective. Our speaker today is Dr. Alex Kemery who is an associate professor of nursing at the University of Indianapolis School of Nursing. We will discuss the author's article today, "Factors Influencing Faculty Decisions to Teach LGBTQ Content in the Undergraduate Nursing Programs."
The discussion will focus on the unique findings of the author who published a manuscript in the July-August issue, volume 43 number 4 of Nursing Education Perspectives. I want to start by welcoming you, Dr. Kemery and thank you for joining us on this podcast. Thank you for having me Dr. Palazzo. I appreciate the opportunity.
intriguing and definitely needed and I'm glad that someone's doing this work so I will ask you to please summarize the purpose of this study and just briefly your choice of the theory of planned behaviors as a theoretical framework. What we wanted to do with this study was to find out why baccalaureate nursing faculty are generally not teaching LGBTQ content in the
undergraduate pre-licensure programs. There have been a few studies over the years that have documented that there's a lack of content, but not a lot that's told us why that is. With this study we were hoping to identify perhaps the best places we could aim our efforts to improve kind of the uptake of this type of curriculum in undergraduate programs. We specifically chose the theory of planned
behavior for a number of reasons. It's widely used in behavioral research so it's got a good research base both inside health care and outside and it provides a good detailed method to develop instruments to measure certain behaviors and the factors that influence those behaviors. What we did like about the theory of planned behavior was that it went beyond just measuring attitudes.
So sometimes when we look at what influences behavior we look at whether or not somebody feels positively about the behavior or negatively. And while certainly that is impactful in somebody's decision to, for instance, incorporate this content into the curriculum we know it's not the only thing. The theory of planned behavior has a number of variables incorporated in it, one of them being attitudes toward the
behavior. So how does somebody feel? Do they feel like it's a good thing to teach LGBTQ content, do they feel like the outcomes in students are worth the effort? Those types of things are certainly important but we also know that other outside things are going to influence that decision and one of the things that theory of planned behavior incorporates is the idea of subjective norms. What do other people think that you should do?
We know from looking at this theory that certainly is going to play a big part and whether or not somebody's going to decide to put forth the effort to incorporate this into their curriculum so we wanted to make sure that we included that. Another kind of sub-variable on to that is that whether or not somebody is motivated
to comply with those norms. Just because other people think you should or should do something, are you motivated to go along kind of with that or not and the theory of planned behavior also tries to account for that. The last thing that we were really interested in was somebody's perceived
behavioral control. Just because somebody thinks that a behavior is good to do and thinks that it will be accepted whether or not they feel that they have control over that behavior is going to also influence whether that behavior is
ultimately carried out. So what we liked about this theory is that it allowed us to pull in more than just attitudes to look at what the norms were whether or not people were feeling pressure one way or the other to incorporate this content and what kind of control they felt they had. We were hopeful that looking at multiple variables would help us target where our efforts might be
best placed in intervening. I feel like historically we focused a lot on changing people's attitudes towards the LGBTQ community, you know the whole winning hearts and minds those types of things, but certainly we know that even though attitudes in some ways have changed the curriculum has has not and so what else might be influencing that decision, where can we aim our efforts so that we can make the most impact.
To clarify with the theory of planned behavior, the more positive you are in those different variables such as attitudes, subjective norms, and control, then in theory your increased individual intentions to do that particular thing that you're looking at and bringing attention is a surrogate for actual behavior.
It's very difficult to measure the actual behavior so you have to sit and watch all these people all the time so you measure their behavioral intension and that's their surrogate for that so that was a great explanation of what they were trying to do Your study found generally positive attitudes and support for including LGBTQ content but there were concerns with access to experts and other resources kind of the perceived control
variable. Can we explain this and what specifically is the takeaway that we as nurse educators could do tomorrow in our classrooms based on your research? We were a little surprised honestly that attitudes scored as highly as it did.
I wonder if we redid this study in the current climate and where data collection for this was a year or two ago how that might have changed since then, particularly broke out different segments of the LGBTQ community because we're seeing increased attacks especially in the trans community. But we did find higher attitudes than we expected, which was somewhat encouraging. What we did find though
were there were a number of barriers. One of the primary barriers that we saw was of course time and I think any nurse educator would point to the fact that there's more to teach every year and not any more time to teach it and certainly that was a concern that people may be more apt to teach this content if they had
more time to get it in. But other things that seem to serve as barriers would be tended to be things like not having not feeling like you have the expertise and so it's kind of natural human behavior to not want to wade into something if we don't go prepared to do it and what we saw was that some of our nurse educator respondents just didn't feel competent to teach the content. So one item on our study survey was asking whether or not somebody would be more likely to teach this
content if they felt competent to do it. 75%of our respondents agree with that statement that if they felt more competent they would be more likely to incorporate it.
75% additionally identified not just not having that knowledge as a base kind of a base level of knowledge to be able to get this stuff into their into their teaching, we also saw that a lot of our respondents, about 75% again said that if they had some training they would be more likely to teach these types of things.
And so being able to see that some of these barriers we suspected that these were barriers but having that kind of confirmed with some data has been very helpful and it's letting us know that maybe if we can get these resources out to people that maybe we won't have such a hard time getting uptake of it.
So the things I believe that we could kind of take from this is that as researchers, as academics, that if we can get this content into the right hands then there may not be as much pushback as we maybe fear, but we have to get those resources developed. Unfortunately there are a few resources out there that are available and that are free.
I don't necessarily think that any currently available resource is the ideal resource but I think there are things out there that nurse educators can go online today and find and at least have some base knowledge, some baseline competency that they can develop in order to start putting this into their
curriculum now. Certainly we would advocate for hiring LGBTQ people to help inform your particular curriculum and I think that's a great goal and one that I would really encourage nurse educators to seek out those experts and help them co-create content so while we would like everyone to partner with an LGBTQ health expert somebody who is part of the community because things rapidly change in this community .
We know that it can also be a barrier if the project seems too big and so if it seems like a goal you can't reach you're not going to, you're not going to get started. We would encourage people to go to some of these already available toolkits that we've discussed in the article and to start pulling some activities, case studies, just some basic knowledge to start incorporating into things. It doesn't need to be a class on LGBTQ health.
In fact, while I love specific standalone classes on LGBTQ health and I teach one as an elective, the students who and the nurses who need that content are not the ones who are most likely to enroll and so we know that there's anytime we do a training we're not necessarily getting the people who need it the most for a number of reasons, so there are some things out there that show you how you know you can incorporate some LGBTQ topics into
the curriculum already doing and sometimes it's as easy as making it part of your case study. Maybe not the focus of the case study, but for instance here at the university where I teach we have a postpartum hemorrhage simulation and that has been revamped so that the individual hemorrhaging is non-binary and that was a pretty easy way to start normalizing LGBTQ identities without revamping the entire simulation. Right, that was a good suggestion, a good example.
Yeah I thought it was and I can't take credit for that. It was a colleague of mine, Dr. Karen McPherson who pulled that one off, but it was a very small change in in her simulation that brought up a point for discussion so when they're debriefing they can talk through those things too. How did you feel when you thought
this was your patient's gender identity? Did you have trouble with pronouns and some basic things that start normalizing things for students and so it doesn't have to be an entire curriculum overhaul. I like the idea, good examples of the resources in the article. You mentioned a good example there. And we do only have so much time for this content. We're kind of content-saturated as it is. So instead of doing what we tend to do in curriculum and I think from experience
is tokenizing situations - dropping them in. Here's a situation, a case study and then that's the only exposure students get to a particular cultural context of strength or ethnicity or in this case nobody can concern the issue is how do we better thread these things through our curriculum so they're just integrated with the curriculum in a way that's more natural.
They're not, tomorrow's class is an example on LGBTQ health care and that's it for the whole program right and we can check the box off and move on from it. We did it, we're moving on to the next thing about how to be more intentional. Right, absolutely and what we run the risk of is if we kind of take this one and done approach where we've checked the box and said that we've done it I don't think that we're doing a great
job capturing the diversity of the community. We've given one example and we've run the risk of presenting the LGBTQ community as a monolith and having students walk away with that thinking that if they can't...if the person that they're encountering doesn't meet that box that they have learned about they don't know what to do and so I really advocate for incorporating these things in the content you're already
teaching through a number of ways. There's a good toolkit available online created for actually health care providers in Canada in cooperation with, in partnership with the LGBTQ community there. What I like about it is that it was freely available online so anybody can go access these
their case studies and things available. I was not involved in the creation of it though I wish I had been because it's a pretty amazing resource and I think that's a good starting place for people who really don't know much of anything at all about the community to start learning things and to find some activities that can be plugged in without a whole lot of effort on the nurse educators part and hopefully people start accessing toolkits like this,
finding out where their own gaps are because I believe that's another big barrier is that we don't know what we don't know. We see that in our students and we see that in educators so once educators start looking into this information and acknowledging that they do have gaps in their own information start seeking out other resources and filling in those gaps. Well I want to thank you so much
for joining us in this podcast. I really appreciate your time and expertise in sharing this work and broadening our understanding of this work and how we can actually begin with some of these techniques to talk about into our own circle and do that sooner rather than later. For our listeners, if you have not had the opportunity to read about Dr. Kemery's work, you will find the manuscript published in the Nursing Education Perspectives, "Factors Influencing Faculty Decisions
to Teach LGBTQ Content in Undergraduate Nursing Programs." It's published in the July-August issue. And again, thank you for our listeners for joining us and I want to thank our guest speaker Dr. Kemery again. Dr. Kemery, any final words for our audience?
I think one of the things to keep in mind is that you're not going to be perfect at this and that being respectful is going to go a long way people can tell when you are being intentionally respectful versus disrespectful and so going into things with a good attitude will help you overcome a lot of your barriers. Good point and thank you. [Music]