LGBTQ+ Inclusivity Training and Education: A Toolkit for Skilled Nursing Facilities.

OBJECTIVES: The objective of this study was to develop the LGBTQ+ Inclusivity Training and Education (LITE) toolkit and to examine the usability and acceptability of the LITE toolkit to health care workers and staff who work within skilled nursing facilities (SNFs). DESIGN: A community-engaged approach using human-centered design to develop the LITE toolkit. To test the usability and acceptability of the LITE toolkit, we provided a posttest survey to users after a 9-week period. SETTING AND PARTICIPANTS: The LITE toolkit was distributed to 25 SNFs throughout a 7-county area in North Carolina. METHODS: Development processes included an LGBTQ+ community advisory board, development of resource topics and a list of best practices, and development of a website. The LITE toolkit comprised a website of LGBTQ+ resources, poster of 6 Best Practices to LGBTQ+ Care, rainbow lapel pins, and writing pens with the LITE logo. Online surveys were distributed to SNF administrators to share with health care workers and staff to collect data on the usability and acceptability of the LITE toolkit. Descriptive statistics were used for data analysis. RESULTS: Fifteen participants completed the survey. Answering all survey questions was not a requirement. Seventy-nine percent (n = 14) of SNF health care workers indicated that the LITE toolkit was "easy to understand" and that they were satisfied with the contents. Fifty-three percent (n = 15) responded that the LITE toolkit would improve the way they care for patients. Sixty-six percent (n = 15) of health care workers and staff strongly agreed the LITE toolkit was applicable to their job role. CONCLUSIONS AND IMPLICATIONS: Providing useful and acceptable LGBTQ+-focused training and education for members of the SNF community addresses the need for health care worker and staff training to foster equitable care and inclusive environments for the LGBTQ+ older adult community. Additional work focused on understanding the facilitators and barriers to using the LITE toolkit in the SNF setting is needed.

A pilot resiliency course for Doctor of Nursing Practice (DNP) students: Lessons learned.

Graduate nursing students can face varied and significant stressors during their programs of study. The need for interventions to promote nursing student resiliency has been reported in the literature, by accrediting bodies, and in previous research conducted with students at the same university. Thus, the purpose of this project was to pilot a resilience course for Doctor of Nursing Practice (DNP) students. The theoretical frameworks guiding the design and implementation of the resiliency pilot program were andragogy (the science of adult learning) and rapid cycle quality improvement. The course included eleven monthly modules addressing resiliency content with written material, original videos, and online discussions and meetings. The first module overviewed the resiliency skills (Belief, Persistence, Trust, Strength, and Adaptability), five modules were dedicated to a specific resiliency skill, two modules addressed recent and anticipated challenges, two modules concentrated on the application (clinical and academic) of the resiliency skills, and the last module focused on reflection. Results of this pilot program indicate that DNP students can benefit from receiving resiliency content during their studies, especially from faculty involvement and increased peer support; however, future resiliency content may be more accepted and effective if embedded into nursing program curriculum and activities.

A call to action to improve the completeness of older adult sexual and gender minority data in electronic health records.

Sexual and gender minority (SGM) older adults experience greater health disparities compared to non-SGM older adults. The SGM older adult population is growing rapidly. To address this disparity and gain a better understanding of their unique challenges in healthcare relies on accurate data collection. We conducted a secondary data analysis of 2018-2022 electronic health record data for older adults aged ≥50 years, in 1 large academic health system to determine the source, magnitude, and correlates of missing sexual orientation and gender identity (SOGI) data among hospitalized older adults. Among 153 827 older adults discharged from the hospital, SOGI data missingness was 67.6% for sexual orientation and 63.0% for gender identity. SOGI data are underreported, leading to bias findings when studying health disparities. Without complete SOGI data, healthcare systems will not fully understand the unique needs of SGM individuals and develop tailored interventions and programs to reduce health disparities among these populations.

Health Experiences of Sexual and Gender Minority People Living With Dementia and Their Care Partners: Protocol for a Scoping Review.

BACKGROUND: People living with dementia and their care partners who identify as a sexual and gender minority (SGM) often experience specific health inequities and disparities due to discrimination related to age, cognitive impairment, and being SGM. OBJECTIVE: The purpose of this scoping review is to identify, explore, and synthesize the state of the science regarding the health and health care experiences of SGM people living with dementia and their care partners. This review also aims to identify gaps in research and set forth key recommendations to improve the health and health care experiences of SGM people living with dementia and their care partners by advancing health equity through research, policy, and practice. METHODS: The protocol follows the guidelines set forth by Joanna Briggs Institute protocol for scoping reviews. Steps of this framework that will be followed include (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) consultation. This scoping review will explore several electronic databases, including MEDLINE, Embase, CINAHL, AgeLine, PsychINFO, and Scopus. Health librarians will conduct the initial search for articles that are in English, include people living with dementia who identify as SGM, SGM people living with dementia and their care partners, or SGM care partners caring for people with dementia. Studies must be peer reviewed and focus on the phenomenon of interest, which is the health and health care experiences of participants. Covidence will be used to review abstracts and full-text articles and to screen articles. After the search has been completed, 2 independent reviewers will screen article titles and abstracts to identify eligibility. Discrepancies will be discussed and decided upon by the 2 reviewers. Relevant studies will be collected, and data will be extracted and charted to summarize key findings. Key findings will be presented to a community stakeholder group of SGM care partners and people living with dementia, and a listening session will be convened. RESULTS: This scoping review will identify the state of the science of health and health care experiences of people living with dementia and their care partners who identify as SGM. We will identify gaps and provide recommendations to inform future research, policy, and practice to improve health and health care experiences of SGM people living with dementia and their care partners. CONCLUSIONS: Little is known about people living with dementia and their care partners who identify as SGM. This scoping review will be one of the first to identify the health and health care experiences of people living with dementia and their care partners who identify as SGM. The results of this review will be used to guide future interventions and to inform future policy and practice to improve health care and reduce health disparities in this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/44918.

Healthcare Worker Perceptions of LGBTQ+ Older Adults: Integrative Review.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults (OAs) may require care in long-term care (LTC), assisted living, and home health settings. Healthcare workers' (HCWs, e.g., registered nurses, social workers, certified nursing assistants, home health aides) perceptions and attitudes could influence care, health disparities, and outcomes. The aim of this integrative review was to discover what is known about HCWs' perceptions toward LGBTQ+ OAs. Searched databases included PsycINFO, PubMed, CINAHL, and Web of Science. Quality review assessment was conducted separately by two reviewers; Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. A total of 370 studies were identified; 10 studies were included in the review. Five studies were quantitative, four were qualitative, and one was a mixed methods study. Major themes included preparedness/training, responsibility of disclosure, and clinical practice. HCW's perceptions may be associated with discriminatory care and health disparities in the LGBTQ+ OA population.

A Qualitative Description of Direct Care Workers of Lesbian, Gay, Bisexual, Transgender Older Adults.

Purpose: The aim of the study was to examine direct care worker (DCW) perceptions of lesbian, gay, bisexual, transgender (LGBT) older adults living in long-term care, assisted living, and home health settings. DCWs provide the closest interaction with LGBT older adults in these settings. The perceptions DCWs have toward LGBT older adults is important because the quality of care can be influenced by negative attitudes. Methodology: Qualitative description was used to synthesize what is known about DCWs' perceptions toward LGBT older adults. Results: The overarching theme, "Care is Different, but Not my Care," was supported by the categories Cues of Stereotyping, Cues of Prejudice, and DCWs' Social System and Reported Care. Application: Specific implications for practice (i.e., training, recruitment, retention strategies) and policy (i.e., mandated staffing ratios, pay) are explicated to guide future interventions to ensure equitable, quality care in health care.

The Power of a Story: Enhancing Students' Empathy for Transgender Pregnant Men.

BACKGROUND: Transgender individuals continue to face stigma and discrimination within the health care system. Sharing the lived experience of transgender pregnant men can increase awareness, understanding, and empathy for this underrepresented population. METHOD: A transgender man (and advocate) shared his pregnancy experiences with students enrolled in a maternity course. Students completed pre- and postpresentation surveys on their perceptions of working with transgender patients and the importance of providing transgender-affirming care. RESULTS: Students reported the speaker's presentation increased their awareness of the experience of transgender patients. Many students reported increased interest and desire to provide trans-affirming care. CONCLUSION: Nursing faculty can provide opportunities for students to meet and speak with transgender patients as a strategy to increase empathy and reduce discrimination toward transgender patients in health care. [J Nurs Educ. 2022;61(8):489-492.].

Graphic Novela: Mexican American Families' Use of Community Services for Older Adults.

Knowledge gaps exist about how to help Mexican American (MA) families seek assistance when their capacity to assist older family members is challenged. MA families may resist confronting unpleasant but real situations with the older adult, for example, the need to access long term support services (LTSS), because of cultural and structural barriers. The purpose was to describe stakeholders' reactions to a culturally focused graphic novela created in partnership with a community advisory council. Qualitative description with content analysis of a focus group's reactions to the graphic novela was used. Results included positive reactions as well as suggestions for improvement and dissemination. Graphic novelas can be an effective medium for modeling conversations about older adults' needing additional care, and demonstrating how to identify and access available LTSS or other services. Included is a description of the researchers' process of partnering with diverse stakeholders, which is essential for creating new solutions.

Experiences of dual PHD-DNP nursing students during doctoral education.

BACKGROUND: Nursing doctoral education now includes an option with a growing national interest: the PhD-DNP dual degree. Although programs have existed for 10 years, little is known about experiences of dual PhD-DNP degree nursing students (DDNS) during doctoral education, including their perceptions of mentorship during coursework, comprehensive exams, and dissertation readiness. OBJECTIVE: To explore and describe the experiences of DDNS during hybrid dual doctoral education at one Southwestern university. METHOD: Using a qualitative descriptive design, DDNS (n = 4) at a Southwestern university were interviewed about their experiences during coursework and comprehensive examinations. RESULTS: Three categories fundamental to DDNS were identified through an inductive and deductive iterative process: coursework experiences, including the key findings of in-betweenness and isolation; mentorship; and comprehensive examination experience. Categories of dissertation readiness and DDNS recommendations were inductively derived. CONCLUSION: Current interest in the PhD-DNP dual degree underscores the importance of knowing more about the experiences of DDNS. The key findings of in-betweenness and isolation have previously not been described in the nursing literature and need to be considered for the DDNS. Facilitators and inhibitors, mentorship experiences, and mentor attributes affect progression of DDNS through coursework. Strategies for success for DDNS, faculty and program success are provided.

"Tipping point" concept analysis in the family caregiving context.

AIM: Analyze the concept "tipping point" in the older adult family caregiving context to further knowledge about caregiving families, enhancing transdisciplinary theory, research, and practice. BACKGROUND: While used commonly in some disciplines, how "tipping point" has been used in health care, generally, and in relation to caregiving families, specifically, is less clear. This project was conducted to offer conceptual clarity to tipping point. DESIGN: Walker and Avant's framework. DATA SOURCE: Searches of scholarly literature in PsycINFO, CINAHL, and PubMed using the search term "tipping point" in either title or abstract. REVIEW METHODS: Definitions used were extracted; instances when the concept was implied but the actual term "tipping point" was not used and contexts where the term was used or implied were identified. RESULTS: The composite definition of a caregiving tipping point is a seemingly abrupt, severe, and absolute change event involving either the older adult or caregiver(s), or both that indicates a breakdown in the status quo of the caregiving system. CONCLUSIONS: Transdisciplinary research, care, and policy should treat caregiving families as complex systems, use longitudinal assessments, and include colloquial communication. Early detection of impending tipping points will provide family-centered decisional support and enhance families' quality of life and safety.