Gender as Attribute of Learner That Influences Nursing Education

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Learners Gender as a Learning Attribute In Nursing Education

Gender as Attribute of Learner That Influences Nursing Education

What Are Gender Characteristics Influences Learning,Cognitive Abilities,General Intelligence,Verbal Ability,Mathematical Ability,Spatial Ability,Problem Solving,School Achievement,Personality Traits,Aggression,Emotional Adjustment,Values and Life Goals,Achievement Orientation,Sexual Orientation and Gender Identity,Teaching Strategies According to Gender Differentiation.

 What Are Gender Characteristics Influences Learning

    Most of the information on gender variations with respect to learning is found in the educational psychology and neuroscience literature. The nursing literature, however, contains relatively little information about this subject from a teaching learning perspective. Clearly, the characteristics of gender identities do affect learning. Therefore, these findings need to be considered more closely as to how they apply to patient education in nursing practice and to teaching of nursing staff and students.

    Two well established facts exist with respect to gender. First, individual differences within a group of males or females are usually greater than differences between groups of males versus groups of females. Second, studies that compare the genders rarely can separate genetic differences from environmental influences on behavior (Crandell, Crandell, & Vander Zanden, 2012; Santrock, 2017).

    A gap in knowledge remains about what the sexes would be like if humans were not subject to behavioral conditioning. No person can survive outside a social matrix and, therefore, individuals begin to be shaped by their environment right from birth. For example, our US culture exposes girls and boys, respectively, to pink and blue blankets in the nursery, dolls and trucks in preschool, ballet and basketball in the elementary grades, and cheer leading and football in high school. 

    These social influences continue to affect the sexes throughout the life span.Of course, men and women are different. But questions remain: How different or the same are they when it comes to learning? To what can the differences and similarities be attributed? Biological and behavioral scientists have, to date, been unable to determine the exact impact that genetics and environment have on the brain. Opinions are rampant, and research findings are still inconclusive.

    However, the fact remains that there are differences as to how males and females act, react, and perform in situations affecting every aspect of life (Cahill, 2014a, 2014b; Thompson, 2010). As Cahill (2014a, 2014b) believes, the issue of sex influences is much too important to be ignored or marginalized. According to a National Academy of Sciences report. “Sex does matter. It matters in ways that we did not expect. Undoubtedly. it also matters in ways that we have not begun to imagine” (Pardue, 2001, p. x).

    For example, when it comes to human relationships, intuitively women tend to pick up subtle tones of voice and facial expressions, whereas men tend to be less sensitive to these communication cues (Thompson, 2010). In navigation, women tend to have difficulty finding their way, whereas men seem to have a better sense of direction (Thompson, 2010). In cognition, females tend to excel in languages and verbalization, yet men are likely to demonstrate stronger spatial abilities and related quantitative reasoning skills (Reilly & Neumann, 2013). 

    Scientists are beginning to believe that gender dif ferences have as much to do with the biology of the brain as with the way people are raised (Baron-Cohen, 2005; Gorman, 1992; Wilson & Auger, 2013). The debate, then, is not whether human development is influenced by nature or nurture, but how much influence heredity and environment have on shaping the abilities and personalities of men and women (Eliot, 2009; McLeod, 2007; Sincero, 2012). 

    Kimura (1999) and Larkin (2013), for example, have reported on the many different patterns of behavior and cognition between men and women that are thought to reflect varying hormonal influences on brain development. Some would argue that these examples are representative of stereotyping. Nevertheless, as generalizations, these statements seem to hold some truth. Neuro-scientists have begun to detect both structural and functional differences in the brains of males and females. 

    These early findings have led to an upsurge in neuroscience research into the mental lives of men and women (Baron Cohen, 2005; Larkin, 2013). For example, in their study on sex differences in the human brain, Ingalhalikar et al. (2014) found that male brains have less structural inter-connectedness within and across the two hemispheres than do brains of women. That is, architecturally men and women are wired differently. 

    Cahill (2014b) contends that sex influences are widespread in brain function and that “males and females appear to be two complex mosaics, similar in some respects, mildly to highly different in others” (Cahill, 2014b, p. 577). Thus, gender is a complex puzzle that requires consideration of the interplay of biological, sociological, and cultural factors.

    Neurobiologists are just at the dawn of understanding how the human brain works, including exactly which types of sensory input wire the brain and how that input affects it. Scientists suspect that cognitive abilities operate much like sensory ones in that they are stimulated by those activities and experiences to which a person is exposed right from birth. Circuits in different regions of the brain are thought to mature at different stages of development. 

    These circuits represent critical windows of opportunity at different ages for the learning of math, music, language, and emotion.Brain development is much more sensitive to life experiences than once believed (Begley, 1996; Hancock, 1996). A baby's brain is like “a work in progress, trillions of neurons waiting to be wired to be woven into the intricate tapes- try of the mind” (Begley, 1996, pp. 55-56). 

    Some of the neurons of the brain have been hard-wired by genes, but trillions more have almost limitless potential and are waiting to be connected by the influence of environment. The first 3 years of life, scientists have realized, are crucial in the development of the mind. The wiring of the brain-a process both of nature and of nurture, dubbed the “dual sculptors” forms the connections that determine the ability to learn and the interest for learning different types of skills (Harrigan, 2007; Nash, 1997).

    Thanks to modern technology, imaging machines are revolutionizing the field of neuroscience. Functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) are being used to observe human brains in the very acts of thinking, feeling, and remembering (Kawamura, Midorikawa, & Kezuka, 2000; Monastersky, 2001; Speck et al. , 2000; Yee et al, 2000). 

    Amazing discoveries through brain scanning have been made, such as where the emotion of love resides in the brain. Although machines can measure the brain's blood flow that supports nerve activity, no machines have been developed to date that can read or interpret a person's thoughts. The field of brain scanning still has far to go, but experts consider its potential to be incredible.

    The trend in current studies is to focus on how separate parts of the brain interact while performing different tasks rather than focusing on only isolated regions of the brain associated with certain tasks (Monastersky, 2001). Researchers have already reported that men and women use different clusters of neurons when they read than when their brains are less active. 

    For example, Kawamura et al. (2000) focused on the center in the brain of a male patient for reading and writing music, which is located in the cerebrum. They concluded that the left side of the brain is involved in this type of task, just as it is for the ability to read and write language. Also, neuro imaging studies have found that gender makes a difference in how the brain is connected (Gong.

    He, & Evans, 2011; Ingalhalikar et al., 2014). In addition, gender differences in the level of brain activity during working memory a function have been examined with fMRI. For example, in a study of verbal working memory by Speck et al. (2000), the amount of brain activity was found to increase with task difficulty. Interestingly, male subjects demonstrated more right-sided hemispheric dominance, whereas females showed more left sided hemispheric dominance. 

    Females, though, demonstrated higher accuracy and slightly slower reaction times in doing the tasks than did males. The results revealed significant gender differences in the brain's organization for working memory.In general, the brains of men and women seem to operate differently. Studies have revealed that women use more of their brains when thinking sad thoughts. When men and women subjects were asked to recall sad memories, the front of the limbic system in the brains of women glowed with activity eight times more than in men. 

    Although men and women have been able to perform equally well in math problems, tests indicate that they seem to use the them poral lobes of the brain differently to figure out problems. Also, men and women use different parts of their brains to figure out rhymes. These study results are just a few examples of early yet interesting findings from research that are beginning to show that male and female identity is a creation of both nature and nurture. 

    Along with genetics, life experiences and the choices men and women make over the course of a life-time help to mold personal characteristics and determine gender differences in the way people of all genders think, sense, and respond (Begley, Murr, & Rogers, 1995).

    In comparing how men and women feel, act, process information, and perform on cognitive and psychological tests, scientists have been able to identify differences in the actual brain chemistry and structure of humans.Most structural differences that have been discovered are relatively small, as measured statistically, but quite significant from a functional perspective (Cahill, 2014a).

    This comparison in brain structure variations seems to account better for psychological gender than simple biological sex differences (Eliot, 2009; Ruigrok et al., 2014). In fact, the gap in differences between adult women and men is larger than between girls and boys. This suggests that if differences between the sexes appear early in life, they are likely to be biological in nature, and those gender differences that appear later in adulthood development are likely shaped by the environment resulting from social learning (Eliot, 2009).

    Thus, a great deal of overlap exists in terms of how the brains of the sexes work. Otherwise, “women could never read maps and men would always be left handed. That flexibility within the sexes reveals just how complex a puzzle gender actually is, requiring pieces from biology. sociology, and culture” (Gorman, 1992, p. 44).

    With respect to brain functioning, a mixture of the factors of heredity and environment likely accounts for gender characteristics. Nevertheless, even the largest differences in gender-related cognitive abilities are not as significant as, for example, the disparity found between male and female height. The following is a comparison of cognitive abilities between females and males in the United States based on developmental and educational psychology findings and biomedical research.

Cognitive Abilities

General Intelligence

    Various studies have yielded inconsistent findings on whether males and females differ in general intelligence. If any gender differences do exist, they seem to be attributed to patterns of ability rather than to IQ (intelligence quotient). When mean intellectual differences have been noted, they have proven minimal (Ardila, Roselli, Matute, & Inozemtseva, 2011; Kimura, 1999). Intelligence is multifaceted, but the unanimous consensus is that men and women do not differ in general intelligence (Reilly, 2012). 

    However, what is well documented is the strong correlation between IQ and heredity. That is, if parents are intelligent, their offspring also are likely to be (Santrock, 2017). On IQ tests during preschool years, girls score higher; in high school, boys score higher on these tests. These differences may be attributed to higher dropout rates in high school for low ability boys and gender identity formation in adolescence. 

    Thus, overall no dramatic differences between the sexes have been found on measures of general intelligence (Crandell et al., 2012; Snowman & McCown, 2015; Upadhayay & Guragain, 2014).Nevertheless, a very interesting trend in IQ scores has been noted. IQs (as measured by the Stanford-Binet intelligence test) are increasing rapidly worldwide. 

    In the United States, children seem to be getting smarter. As compared with IQs tested in 1932, if people took the same test today, a large percentage would score much higher. Because this increase has occurred over such a relatively short time, heredity cannot be the cause. Instead, increasing levels of education and the information age explosion likely explain the trend. This increase in IQ scores is known as the Flynn effect after the researcher who discovered it (Santrock, 2017).

Verbal Ability

    Girls learn to talk, form sentences, and use a variety of words earlier than boys. In addition, girls speak more clearly, read earlier, and do consistently better on tests of spelling and grammar. Originally, researchers believed females performed verbally at a higher level than males, but recent research has questioned this early superiority of females. 

    On tests of verbal reasoning, verbal comprehension, and vocabulary, the findings are not consistent. The conclusion is that no significant gender differences in verbal ability exist (American Psychological Association (APA), 2014).

Mathematical Ability

    During the preschool years, there appear to be no gender related differences in ability to do mathematics. By the end of elementary school, however, boys show signs of excelling in mathematical reasoning, and the differences in math abilities of boys relative to girls become even greater in high school. 

    Recent studies reveal that any male superiority may be related to the way math is traditionally taught as a competitive individual activity rather than as a cooperative group learning endeavor. Women have been shown to have a higher level of math anxiety, using up working memory resources in the brain, leading to under-performance on math tests (APA, 2014; Ganley & Vasilyeva, 2014). 

Spatial Ability

    The ability to recognize a figure when it is rotated, to detect a shape embedded in another figure, or to accurately replicate a three-dimensional object has consistently been found to be better among males than among females. Of all possible gender-related differences in cognitive activity, the spatial ability of males is consistently better than that of females and probably has a genetic origin. Many research findings have shown that men do perform better on spatial tasks than women. 

    However, the magnitude of this gender difference is still quite small (only about 5% variation) in spatial ability (Gur et al., 2000).Interestingly, women surpass men in the ability to recognize and later recall the location of objects in a complex, random pattern (Kimura, 1999). Scientists have reasoned that historically men may have developed strong spatial skills to be successful hunters, whereas women may have needed other types of visual skills to excel as gatherers of nearby sources of food (Gorman, 1992).

    Although acknowledging that spatial ability differences are the most persistent finding in the cognitive literature and that the roles of nature (heredity) and nurture (environment) remain hotly debated in the scientific world, Hoffman, Gneezy, and List (2011) argue that the gender gap in the under-representation of women in science, technology, engineering, and math (STEM) fields is a result of the indirect role of nurture. 

    Males typically are given more opportunity for relevant spatial skills training and females are persistently negatively stereotyped as having inferior spatial abilities, which leads to their increased and decreased performance respectively. 

Problem Solving

    The complex concepts of problem solving, creativity, and analysis, when examined, have led to mixed findings regarding gender differences in these skills. Men tend to try new approaches in problem solving and are more likely to be more focused on important cues and common features in certain learning tasks. Males also show more curiosity and are significantly less conservative than women in risk taking situations. In human relations, however, women perform better at problem solving than do men (Crandell et al., 2012).

School Achievement

    Without exception, girls get better grades on average than boys, particularly at the elementary school level. Scholastic performance of girls is more stable and less fluctuating than that of boys (Crandell et al., 2012; Santrock, 2017; Snowman & McCown, 2015). The female advantage in school achievement in most course subjects is a common finding in educational studies, but the identification of relevant variables contributing to this gender difference must be further explored (Voyer & Voyer, 2014).

    In conclusion, research data from meta-analyses of hundreds of studies involving millions of participants indicate that perceived or actual differences in cognitive performance among the sexes are most likely caused by social and cultural factors not biological factors. That is, cognitive abilities are culturally mediated (nurture) rather than gender differences being attributed to innate abilities (nature).

     If males and females were treated as intellectual equals via gender equity measures in grade schools, colleges and universities, workplaces, and social settings in general, then individuals and society would benefit (APA, 2014; Reilly, 2012). Despite this conclusion, scientists continue to debate about how much, not whether, biology contributes to differences in the cognitive functioning of male and female brains (Nixon, 2012).

    Although no compelling evidence proves significant gender linked differences in the areas of cognitive functioning, except possibly in spatial ability, some findings do reveal gender differences when it comes to personality characteristics of males and females in the United States. Evidence reported by Crandell et al. (2012). Santrock (2017), and Snowman and McCown (2015), unless otherwise noted, substantiate the following summary findings. 

Personality Traits

    Most observed gender-related personality behaviors are thought to be largely determined by culture but are, to some extent, a result of mutual interaction between environment and heredity.


    Males of all ages and of most cultures are generally more aggressive than females (Baron-Cohen,2005). The role of the sex-specific hormone testosterone has been cited as a possible cause of the more aggressive behavior demonstrated by males (Kimura, 1999). However, anthropologists, psychologists, sociologists, and scientists in other fields continue to disagree about whether aggression is biologically based or environmentally influenced. 

    Nevertheless, male and female roles differ widely in most cultures, with males usually being more dominant, assertive, active, hostile, and destructive.Conformity and Dependence Females have been found generally to be more conforming and more influenced by suggestion. The gender biases of some studies have left these findings open to suspicion, however.

Emotional Adjustment

    The emotional stability of the genders is approximately the same in childhood, but differences do arise in how emotional reactions are displayed. Research has revealed many differences in the way males and females “detect, process, and express” emotion (Thompson, 2010, p. 1). 

    For example, a study of 55 cultures found that women tend to be more emotional, better perceive verbal and visual emotional cues, and respond with greater sadness than men. On the other hand, men are more likely to be less extroverted and conscientious, react to stress by showing an increase in blood pressure, and experience love and anger less intensely than women. 

    These differences may be a result of cultural expectations, social stereotyping, and heredity. Nevertheless, emotional reactions of women have a direct effect on their physical and mental health. Women tend to be at greater risk for depression, anxiety, and mood disorders, and men are at greater risk for hypertension, substance abuse, and antisocial behavior (Larkin, 2013).

    Evidence indicates that adolescent girls and adult females have more neurotic symptoms than males. However, this tendency may reflect how society defines mental health in ways that coincide with male roles. In addition, tests to measure mental health usually have been designed by men and, therefore, may be biased against females.

Values and Life Goals

    In the past, men have tended to show greater interest in scientific, mathematical, mechanical, and physically active occupations as well as to express stronger economic and political values. Women have tended to choose literary, social service, and clerical occupations and to express stronger aesthetic, social sense, and religious values. 

    These differences have become smaller over time, however, as women have begun to think differently about themselves, women have more freely pursued career and interest pathways, and society has begun to take a more equal opportunity viewpoint for people of all genders. 

Achievement Orientation

    Females are more likely to express achievement motivation in social skills and social relations, whereas men are more likely to try to succeed in intellectual or competitive activities. This difference is thought to reflect gender role expectations that are strongly communicated at very early ages.

    The behavioral and biological differences between males and females, known as the gender gap, are well documented. Also, well documented is gender bias, “a preconceived notion about the abilities of women and men that prevent individuals from pursuing their own interests and achieving their potentials” (Santrock, 2006, p. 66). How do these differences in gender characteristics of cognitive functioning and personality attributes relate to the healthcare needs of patients and the process of engaging them in teaching and learning?

    With respect to gender differences and aging, as suggested by current life-span mortality rates, white females have a life expectancy of approximately 80 years compared to approximately 73 years for white males. Also, men have higher mortality rates for each of the 10 leading causes of death (Kochanek, Murphy, Xu, & Tejada Vera, 2016). 

    However, more needs to be understood about women's health, because for years their health issues have been underrepresented in research studies. Fortunately, this trend has changed within the last 2 to 3 decades, and significant evidence is beginning to surface about the physical and mental health status of females (DeCola, 2012; Dignam, 2000; US Department of Health and Human Services [US-DHHS ], 2012).

    One point that is known is that women are likely to seek health care more often than men do (US Census Bureau, 2012a). It is suspected that one of the reasons women have more contact with the healthcare system is that they traditionally have tended to be the primary caretakers of their children, who need pediatric services. 

    In addition, during their childbearing years, cisgender women seek health services for care surrounding pregnancy and childbirth (Smith, 2006). However, other variables such as socio demographics and health status-come into play to account for gender differences in the use of healthcare services (Bertakis, Azari. Helms, Callahan, & Robbins, 2000; Courtenay, 2000; Kaiser Family Foundation, 2015; Regitz-Zagrosek, 2012). 

    Furthermore, Falk et al. (2016) found that females report higher levels of symptom distress (pain, fatigue, and nausea) than men likely because women receive less attention and symptom alleviation than men, which indicates serious inequality in care. 

    Perhaps the reason that men tend not to rely as much as women on care from health providers is the gender role expectation by our society that men should be stronger. They also tend to be risk takers and to think of themselves as more independent. 

    Although men are less likely to pursue routine health care for purposes of health and safety promotion and disease and accident prevention, they typically face a greater number of health hazards, such as a higher incidence of automobile accidents, use of drugs and alcohol, suicide, heart disease, and participation in dangerous occupations. Furthermore, men are less likely to notice symptoms or report them to physicians (Courtenay, 2000).

Sexual Orientation and Gender Identity

    The exact number of Bian, gay, bisexual. transgender, and queer/questioning (LGBTQ) individuals in the United States and around the world are unknown; however, this population is estimated to include more than 8 million people in this country alone (Fenway Institute, 2010). This number is based on US Census data and represents a very conservative estimate of the LGBTQ population. 

    Although the US Census does gather information on same-sex couples, it does not ask questions about sexual orientation or gender identity (Gates, 2013). There-fore, single gays and lesbians are not identified in US Census data, nor are members of the transgender community. Because of hesitancy on the part of many members of the LGBTQ population to disclose their sexual orientation and/or gender identity, underrepresentation is always an issue.

    When considering gender and the social and other factors that influence the unique learning styles and educational needs of men and women, it is important to include the LGBTQ community. The LGBTQ population represents a distinct cultural group whose needs are often overlooked by nurses and other health professionals (American Medical Student Association, 2015; Sullivan, Guzman, & Lancellotti, 2017). 

    Although members of the LGBTQ population have many of the same health problems as the general population, disparities do exist, and as a group, their health outcomes are worse than those of the heterosexual community (Centers for Disease Control and Prevention [CDC].2014; Krehely, 2009). Three main problems contribute to the health disparities experienced by the LGBTQ population:

1. The social stigma associated with being LGBTQ creates undue stress and contributes to negative health behavior patterns. For example, research has identified increased rates of tobacco, alcohol, and drug use among the LGBTQ population as well as a high incidence of depression, anxiety, suicide, and other mental health problems (Livingston et al. 2015; Woodiel & Cowdery, 2014 ).

2. Structural barriers decrease access to health care for people who are LGBTQ (Mayer et al., 2008). For example, unemployment in the LGBTQ community resulting from job discrimination and lack of insurance benefits for same-sex domestic partners have led to a higher-than-average number of people without health insurance coverage (Gonzales, 2014; Krehely, 2009).

3. Lack of culturally appropriate care for the LGBTQ community results. in limited or ineffective use of healthcare services. For example, to avoid negative interactions with healthcare providers, LGBTQ patients particularly bisexual men and women are often reluctant to disclose their sexual orientation or gender identity. Without this vital piece of information, nurses and other health professionals are unable to provide comprehensive care. 

    Other members of the LGBTQ community simply avoid seeking health care unless it is of absolute necessity. As a result, they may not take advantage of preventive services or receive early treatment for serious health problems (Durso & Meyer, 2012; McRae, Ochsner, Mauss, Gabrieli, & Gross, 2008).

Teaching Strategies According to Gender Differentiation 

    Davidson, Trudeau, van Roosmalen, Stewart, and Kirkland (2006) describe gender as a “multifaceted construct” (p. 731) that includes modifiable attributes that influence health outcomes: and health education. These attributes include personality, social supports, coping skills, values, and health-related behaviors. When planning teaching strategies, nurses must be aware of the extent to which attributes such as these, as well as heredity related characteristics, affect health seeking behaviors and influence individual health needs. 

    As stated previously, in some areas males and females display different orientations and learning styles (Severiens & Ten Dam, 1994, 1997; Wehrwein, Lujan, & DiCarlo, 2007). The precise differences seem to depend on interests and past experiences in the biological and social roles of men and women in American society. 

    Women and men are part of different social cultures, too. They use different symbols, belief systems, and ways to express themselves, much in the same manner that different ethnic groups exhibit distinct cultures. In the future, these gender differences may become less pronounced as the gender roles become more blended.

    Language and symbols are also very important to the LGBTQ community. The most commonly employed symbols of the LGBTQ community are the pink triangle and the rainbow pride flag. These symbols, which are used by this community as a show of pride and unity, are often displayed in healthcare settings as a sign of welcome to LGBTQ patients (Woodiel & Cowdery, 2014).

    It is also important that nurses become familiar with the labels, terms, and phrases preferred by the LGBTQ community and use them appropriately in conversation and in preparing teaching materials. Language and culture continually change, so the nurse must work toward remaining current. For example, although the word queer was once considered derogatory, in recent years, many within the LGBTQ community have embraced the term and use it proudly.

    When serving in the role of educator, nurses must create an environment that is welcoming to all men and women regardless of gender identity or sexual orientation. Members of the LGBTQ community look for subtle clues to determine whether the nurse will accept them without judgment (Woodiel & Cowdery, 2014). 

    For example, a women's or children's health clinic that displays photos of only traditional families may give the message that nontraditional families are not welcome. Brochures on LGBTQ health issues and unisex bathrooms are all strategies that give a welcoming message to a diverse patient base.

    When working with men and women, it is important that the nurse avoid making assumptions about family structure, sexual orientation. or lifestyle. Many families are structured differently in the 21st century from families in years past. For example, more men are assuming primary responsibility for child care. The nurse should never assume that a patient is heterosexual, even if that person is or has been married to a member of the opposite gender, as almost half of self identified lesbians have been or are currently married to men (Fenway Institute, 2010). 

    Likewise, the nurse should not assume that when a person refers to a spouse that he or she is talking about a member of the opposite gender. As more and more states are legalizing same-sex marriage, married members of the LGBTQ community are frequently using the term husband or wife rather than partner.

    To complete an accurate assessment of every individual, the nurse should take the opportunity to gather accurate information from the patient. Admission or intake forms are often designed for the traditional family. Patients are often not given an opportunity to identify a same-sex domestic partner. Transgender patients are usually forced to select either male or female with no room for elaboration. 

    By adjusting the forms to be more inclusive, the nurse not only creates a welcoming environment but also offers an opportunity for the patient to share important information. Nurses also must be knowledgeable about gender related health disparities and are encouraged to include this information when educating patients. They are also encouraged to use versatile teaching style strategies so as not to perpetuate stereotypical approaches to teaching and learning with people of all genders. 

    In 2011, the Institute of Medicine (IOM) recommended educating healthcare providers about LGBTQ issues, which has resulted in more attention being paid by educational and clinical practice settings to the knowledge, attitudes, and skills of health professionals in caring for members of the LGBTQ community (IOM, 2011). 

    However, to date the nursing profession lacks research, theoretical frameworks, and practical guidelines to deliver culturally appropriate care to meet the diverse healthcare needs of the LGBTQ population (Carabez, Pellegrini, Mankovitz, Eliason, & Dariotis, 2015). 

    Also, Carabez, Eliason, and Martinson (2016) discovered a lack of understanding by staff nurses of the needs of transgender patients and challenged nursing education to better prepare the nurse workforce to provide high-quality care to patients with different gender identities.

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