Award Date

May 2016

Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Committee Member

Lori Candela

Second Committee Member

Alona Angosta

Third Committee Member

Michele Clark

Fourth Committee Member

Joseph Morgan

Number of Pages



Nurse practitioners provide care to an increasing number of diverse individuals who are faced with specific healthcare needs, as well as health disparities. This care encompasses those individuals who identify as lesbian, gay, bisexual, or transgender (LGBT). These individuals may have experienced delivery of healthcare by providers who lacked the necessary knowledge and/or skills needed to adequately address the needs of this specific client population. Many in the LGBT population have faced prejudice, bias, or homophobia from healthcare providers that became a barrier to accessing healthcare. In order to avoid potential barriers, nurse practitioners who function increasingly as primary care providers, must attain knowledge and skills to provide culturally competent care. Nursing programs have a responsibility to provide education within the curricula that addresses the specific healthcare needs of LGBT individuals, as well as identify health disparities faced by this population. The inclusion of LGBT nursing education, using various teaching strategies, may assist the nurse practitioner in developing cultural competence as it relates to caring for LGBT clients.

Bias and prejudice against LGBT individuals have been identified among registered nurses (RN) and nursing students. This concern relates directly to nurse practitioners, who began their careers as a nursing student and then as an RN. The small body of literature available on nurse practitioners caring for LGBT clients indicates a lack of education in their graduate programs that specifically addressed the healthcare and the health of LGBT persons. The lack of knowledge and the potential scarcity of experiences with LGBT individuals have likely contributed to healthcare providers’ inability to provide culturally competent care. Limited literature exists on the sensitive issue of nurse practitioner beliefs and behaviors with LGBT individuals. Beliefs guide and inform behaviors, which directly impact client care.

In order to assess the current beliefs and behaviors of nurse practitioners in providing culturally competent care for lesbian and gay clients, an exploratory survey was conducted. Additionally, their perceptions of the cultural competence education received in general, and specific to the care of lesbian and gay individuals was examined. The Gay Affirmative Practice (GAP) Scale was used as well as demographic information and open-ended questions in a statewide survey of currently licensed nurse practitioners. The study was informed by Josepha Campinha-Bacote’s Process of Cultural Competence in the Delivery of Healthcare Services. Descriptive and inferential statistics were used to analyze results. Data were analyzed using established statistical methods for correlational studies, primarily by Pearson product-moment correlation coefficients (Pearson’s r), and analysis of variance (ANOVA) for between-groups statistical analysis.

The findings of this study revealed that the participants’ reported level of cultural competency nursing education specific to gay and lesbian clients in both their pre-licensure and graduate nursing education programs influenced beliefs and behaviors when providing care to this population. Additionally, significant differences were found in regard to types of nurse practitioners, sexual orientation, and religious affiliation when comparing practice beliefs, practice behaviors, and total GAP scores. The insights gained from this study have the potential to inform the development of pedagogical practices that could enhance nursing education regarding cultural competence, with a focus on LGBT health.


Cultural competence; Gay; Lesbian; Nurse practitioner; Nursing education



File Format


Degree Grantor

University of Nevada, Las Vegas




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