This scoping review aimed to delineate the current understanding of how nurses are trained to provide holistic care to SGM individuals. Conducting such a review helps to identify research gaps in this field (Banda, Mokgatle & Oladimeji
In scoping reviews, there is neither an expectation nor a formal requirement to assess the risk of bias or the quality of evidence (Peters et al.
The research question posed was ‘What is known’ from the current literature regarding nurse training for holistic care of individuals from SGM groups? This review aimed to outline the existing knowledge on how nurses are educated to provide holistic care to SGM groups; assess the effects of training programmes on nurses; and examine the duration, delivery methods and content of the training. A broad approach should be maintained to ensure comprehensive coverage, allowing decisions to be made on setting parameters for large volumes of references once the scope of the field is better understood (Arksey & O’Malley
Population, Concept and Context framework for determining the eligibility of the research question.
| Criteria | Determinants |
|---|---|
| Population | Nurses from any part of the world, any group, all genders, regardless of their country and ethnic groups. |
| Concept | Training or induction of nurses to holistic care for people from sexual and gender minority groups. Literature focused on nurses training will be looked at in order to map the extent of existing research on the subject, and to identify the gaps in the knowledge base. |
| Context | Any sphere of healthcare where nurses interacted with people from SGM groups (hospitals and clinics offering primary care, tertiary care and rehabilitation). |
SGM, sexual and gender minority.
This scoping review included all studies published in peer-reviewed journals that concentrated on preparing or training nurses to deliver holistic care to individuals from SGM groups. As Arksey and O’Malley (
Original research articles reporting information on the preparation of nurses in holistic care for people from SGM groups.
The articles focused on nurses or similar roles in healthcare contexts.
Articles published in peer-reviewed journals.
Articles published in English.
Articles published between 2021 and 2025.
Articles involving participants recruited from all parts of the world.
Non-English publications.
Grey literature, including conference papers, theses and dissertations.
Studies focused exclusively on all healthcare professionals other than nurses unless they provided data relevant to this scoping review.
The online software ‘Covidence’ was used for systematic screening to enhance efficiency and transparency.
This tool streamlines the screening process, aiding the review of titles and abstracts for the final review stage (
Outcome of the search strategy.
The subsequent step involves ‘charting’ essential information from the primary research reports under review (Arksey & O’Malley
Extracted studies.
| Author(s), title of the article, journal, year of publication & country | Aim of the study | Study population, sampling method and sample | Study design | Study findings |
|---|---|---|---|---|
| Brown et al. ( |
The study aimed to identify LGBTQI health content within midwifery pre-registration programme and education and education best practices. | The sample included 29 academics (survey stage) and seven formed part of the final study. | 1. Mixed methods design: (quantitative and qualitative methods). |
Academics prepared students for LGBTQ+ patients’ needs, avoiding heteronormative assumptions. Sessions covered same-sex parents and surrogacy while ensuring confidentiality for transgender patients and family safety. |
| Carmichael et al. ( |
The study examined the effect of transgender health education on nursing students’ knowledge and attitudes about caring for transgender and non-binary people (TGNB). | Senior nursing students ( |
The study used a pre-test and post-test design. A 2-h online TGNB healthcare education session served as the intervention. Participants completed TKABS-HP surveys before and after. | Participants’ TGNB care knowledge improved ( |
| Cole et al. ( |
The study aimed to assess an LGBTQIA+ inclusivity training module for nursing students. | The study involved third-semester nursing students in a US programme. Of 42 initial participants, 30 completed all study phases. | This quasi-experimental study assessed nursing students’ knowledge and attitudes pre and post LGBTQIA+ inclusivity training. The intervention used Adobe Captivate™ computer-based simulation with inpatient and outpatient scenarios from NLN (2022) ACE+. |
A moderate correlation existed between post-intervention GAP and knowledge assessment scores. The LGBTQIA+ computer-based simulation effectively improved nursing students’ attitudes and knowledge. |
| Fitze and Goodroad ( |
The aim was to develop a model for postsurgical genital affirming care using low-fidelity simulation and e-learning. | The study population included 50 surgical oncology unit nurses, with 30 nurses completing both pre-education survey, education programme, and post-education survey. | 1. Staff nurses completed the education module during shift downtime over 8 weeks in 2021. The study was a quality improvement project: Educational intervention combined low-fidelity simulation, anatomic models and an electronic module. |
Knowledge scores rose from 3 to 5 ( |
| Jordan (2024), US | The aim was to increase nursing students’ knowledge of sexual orientation and gender identity (SOGI) in caring for LGBTQIA+ patients. | The study included third-semester prelicensure baccalaureate nursing students at a US university; 94 completed pre-intervention and 52 post-intervention surveys. The article lacks sampling technique details, although participants were students in a clinical practice course, suggesting convenience sampling. | The study used a flipped classroom approach with pre-recorded videos for self-instruction and classroom activities including group discussions and role-play. Learning outcomes were evaluated using pre- and post-test design. | Pre-intervention survey: 58% – 60% felt somewhat knowledgeable about SOGI, 18% – 22% very knowledgeable; 51% lacked gender identity courses; 35% felt equipped for LGBTQIA+ care. Post-intervention survey: 47% felt very knowledgeable about SOGI, 41% somewhat knowledgeable, 9.6% had little knowledge, 1.9% claimed expertise; 75% felt equipped to address LGBTQIA+ patient needs. |
| Kaiafas and Kennedy ( |
This project aimed to improve care for LGBTQ patients in a military emergency department. | Through purposive convenience sampling, 42 nurses (63%) attended the first session and 39 (59%) the second session, with 72 total participants (36 pre/post-intervention unmatched). | The study evaluated nurses in a military emergency department through pre- and post-assessments. The intervention provided evidence-based education in two 30-min sessions. The AIM tool assessed participants’ knowledge, skills, openness, support and oppression awareness before and after. | 1. Knowledge and Skills subscale scores increased post-intervention ( |
| Koch et al. ( |
The study aimed to improve nursing students’ ability to provide culturally sensitive care to transgender patients and address poor cultural intelligence among colleagues. | The study population comprised prelicensure nursing students in a second-degree Accelerated BSN programme’s foundations course in the Southeast US. Using convenience sampling, 29 of 72 participating students completed the post-test evaluation survey for final analysis. | The study used a descriptive post-test; mixed methods design in a foundations course for first semester nursing students. The survey included quantitative and qualitative questions to assess students’ learning and perceptions. | 92.31% ( |
| Maihle, Anderson and Von Sadovszky ( |
The aim of the study was to improve nurses’ knowledge and attitudes regarding LGBTQ patients and their families at a large, Midwestern paediatric hospital. | The study examined nurse clinical leaders in paediatric hospital clinics. Sixteen nurses were invited; 14 completed the pre-test and intervention, and 13 finished all stages. The final analysis included these 13 participants. | Participants were recruited via email and meetings to complete a pre-test in Redcap, followed by an educational module and post-test. The intervention consisted of a 30-min self-paced PowerPoint presentation adapted from the National LGBTQIA+ Health Education Centre’s module. | Knowledge: Overall, there was a significant increase in correct knowledge scores from pre-test ( |
| Mitchell and Potetz ( |
This study evaluated the effectiveness of a brief educational intervention on NP students’ competency in LGBTQ patient care. | Participants were nurses in family/adult-gerontology nurse practitioner programmes at a Midwestern university. Most (70%) were aged 25–34 and 90% female. From 30 initial participants, 13 completed both pre- and post-intervention surveys. | Participants completed a baseline survey on LGBTQ care knowledge, attended a health session with role-playing and completed follow-up after 6 weeks. Researchers compared pre- and post-intervention scores using mixed effect modelling. | Total competency scores increased to 5.78 ( |
| Muwanguzi et al. ( |
This study explored nurses’ attitudes towards caring for sexual and gender minorities (SGMs), specifically MSM and transgender persons, before and after training. | All participants had heard about MSM, but few had experience providing healthcare to MSM or transgender individuals. Initially, 25 nurses were approached, six declined, resulting in a final sample of 19 nurses. | This qualitative study used pre-post interviews to assess nurses’ attitudes towards sexual and gender minority patients before and after stigma reduction training. Analysis followed the ‘data analysis spiral’ of organising data, coding themes, interpreting and presenting findings. | Post-training reflections showed nurses gained better understanding of sexual orientation versus gender identity. Some suggested periodic training. While cultural beliefs persisted, nurses recognised their duty to provide professional care. |
| Priddle et al. ( |
This study explored LGBTIQ+ health content in Australian undergraduate nurse education among students, graduates and educators. | The study included nursing students (final year or graduated within 5 years), early career nurses (graduated within 5 years) and nursing educators teaching at Australian universities. The sample included two students, three nurses and four educators from five universities across three Australian states. | Using Cultural Safety theory for LGBTIQ+ communities, semi-structured interviews were conducted with students/graduates and educators via Zoom for 25–60 min. Reflexive thematic analysis used six steps to analyse experiences. | Students noted content gaps, while educators saw potential. Education used binary sex concepts, ignoring gender continuums. Educators differed on LGBTIQ+ teaching. LGBTIQ+ students self-protected in learning. Educators reflected on LGBTIQ+ content integration. Graduates noted poor LGBTIQ+ care preparation. |
| Rohde and Goode ( |
The study examined if simulation teaches nursing students gender-affirming care to improve knowledge and attitudes toward LGBTQIA+ patients. | One hundred seventy-one prelicensure nursing students enrolled in Introduction to Health Assessment participated in the simulation experience in the fall of 2022. |
This study used simulation in nursing to teach care of transgender and gender non-conforming patients through pre-briefing, video viewing and debriefing. Surveys assessed LGBTQIA+ care knowledge using Likert and free-text questions, with statistical analysis of themes. | After simulation, students reported understanding transgender healthcare (70% strong, 30% some). All respondents felt confident providing gender-affirming care. 70% indicated strong confidence in therapeutic communication with transgender patients. |
| Sherman et al. ( |
The study evaluated the Transgender Curriculum Integration Project’s impact on nursing students’ transgender health knowledge. | The study included 160 Johns Hopkins nursing students (2014–2015), with varying sample sizes across surveys. |
Mixed methods with surveys and qualitative responses assessed students’ knowledge before and after TGD curriculum integration. Analysis identified themes and statistical differences. | TGD-specific content improved students’ gender sensitivity and care skills, although sensitivity remained low. Knowledge of TGD resources increased significantly. Students emphasised the importance of patient gender identity and requested more TGD content. |
| Tartavoulle and Laundry ( |
This study evaluated a programme to help nursing students provide culturally competent care for LGBQI+ patients. | The study included nursing students from six prelicensure schools in southeastern US. The sample of 1398 students was split between rural (71%) and urban (29%) areas, with no prior LGBTQI+ interventions. | A pre-test-post-test quasi-experimental design measured student attitudes and knowledge of LGBTQI+ individuals before and after the Advocacy Programme. Researchers assessed effects of a 2-h programme on nursing students without random assignment. | Attitudes improved on Genderism and Transphobia Scale and Homonegativity Scale ( |
| Tsusaki et al. (2023),US | The study assessed e-Learning feasibility for SGM healthcare, student recruitment’s impact, and LGBT-DOCSS effectiveness in measuring clinical preparedness for SGM populations. | The study population included family nurse practitioner (FNP) students. From 122 FNP students, 28 completed pre- and post-scale measures through voluntary sampling. | A pre-post-test study implemented an educational intervention on sexual and gender minority healthcare for nursing students. The LGBT Development of Clinical Skills Scale assessed preparedness. Content was delivered via e-Learning in nurse practitioner courses during August–December 2022. | The LGBT-DOCSS showed good internal consistency (alpha ≥ 0.80) pre- and post-intervention. Faculty found the content effective. Time constraints affected optional content completion. Post-test scores showed no change in bias awareness. The study proved feasible while identifying needed amendments. |
| Wang et al. ( |
This study aimed to develop and evaluate an online training programme for enhancing cultural competence in LGBT patient care among Taiwanese nurses and nursing students. | The study sampled nurses and student nurses aged 20+ from 42 nursing schools, 25 associations, and 97 long-term care facilities in Taiwan. Of 301 completed questionnaires, 201 were nurses (66.8%) and 100 student nurses (33.2%). | A pre-/post-test study was conducted, measuring outcomes before and after implementing an online training programme across nursing schools, associations and long-term care facilities. | Participants’ LGBT health knowledge increased post-test. |
| Webb and Zablocki ( |
This study explored nurse educators’ perceptions of teaching gender-affirming care to nursing students, focusing on LGBTQ+ patient care. | The study included nurse educators with 1 year of teaching experience in undergraduate nursing programmes. Purposive and snowball sampling was employed. | The study used a qualitative design to explore gender-affirming care teaching in nursing education and educators’ attitudes through open-ended questions. | Participants noted LGBTQ+ patient-centred care’s importance but had limited teaching opportunities. Most lacked LGBTQ+ terminology and transgender health knowledge. Barriers included time constraints, content overload, poor textbook coverage and discomfort from knowledge gaps or religious beliefs. |
| Ziegler et al. ( |
This study created an online toolkit focused on cultural humility for healthcare interactions with LGBTQI and Two-Spirit individuals. | Simulation experts and LGBTQI2S content experts designed games, with community members acting in virtual simulations. | The project used design thinking with LGBTQI2S community members and providers to develop a toolkit through team building and website creation. Testing incorporated user feedback from nursing students and faculty. | The team created a bilingual LGBTQI2S Cultural Humility Toolkit with simulations and resources for healthcare providers. LGBTQI2S community members acted in simulations, while testing with nursing students improved website diversity. |
Note: Please see the full reference list of Ndlovu, S. & Van Wyk N.C., 2026, ‘Enhancing holistic nursing care for sexual and gender minorities: A scoping review of global training initiatives’,
ACE+, Advancing Care Excellence; AIM, Ally Identity measuring tool; BSN, Bachelor of Science in Nursing; GAP, Gay Affirmative Practice scale; GNC, Gender non-conforming; LGBT, Lesbian, Gay, Bisexual and Transgender; LGBT-DOCSS, Lesbian, gay, bisexual, transgender Development of Clinical skills scale; LGBTQI, Lesbian, Gay, Bisexual, Transgender and Queer; LGBTQI, Lesbian, Gay, Bisexual, Transgender, Queer/questioning and Intersex; LGBTQ, Lesbian, Gay, Bisexual, Transgender and Queer; LGBTQIA, Lesbian, Gay, Bisexual, Transgender, Queer/questioning, Intersex and Asexual; LGBTQIA+, Lesbian, Gay, Bisexual, Transgender, Queer/questioning, Intersex and Asexual (+) representing other identities; MSM, Men having sex with men; NP, Nurse Practitioner; RN, Registered Nurse; TGD, Transgender and gender diverse; TKABS-HP, transgender knowledge, attitudes and beliefs scale for health care professionals; US, United States.
Ethical clearance to conduct this study was obtained from the Faculty of Health Sciences Research Ethics Committee of the University of Pretoria (No. 338/2025).