Transforming Care: A Gender-Affirming Care Simulation Study

Transgender and gender non-conforming (TGNC) individuals experience significant health disparities, often stemming from bias, stigma, and a lack of provider education regarding gender-affirming care. Despite growing societal awareness, nursing curricula continue to under-prepare students to provide culturally congruent, gender-affirming care. This dissertation, presented in manuscript format, explores a pilot study integrating simulation-based education including TGNC standardized patients to improve nursing student attitudes and beliefs toward TGNC individuals.

Chapter 1 introduces the problem, highlighting the specific gap in nursing education, which is the lack of TGNC-focused content, and the urgent need to address disparities in care for TGNC individuals. Chapter 2 presents an integrative review of the literature, revealing both the lack of TGNC-focused content in baccalaureate nursing programs and the effectiveness of simulation as an educational intervention. Chapter 3 provides an analysis of Rivera’s Gender-Affirming Nursing Care (GANC) model, a prescriptive middle-range theory grounded in cultural humility, therapeutic relationships, and inclusive engagement. This framework guided the development and implementation of the simulation.

Chapter 4 describes the findings of a mixed-methods study involving thirteen nursing students who participated in a gender-affirming simulation. Quantitative data were collected using the Transgender Attitudes and Beliefs Scale (TABS) before and after the simulation. Results indicated statistically significant improvements in interpersonal comfort and sex/gender beliefs. Qualitative analysis of focus group debriefings revealed four key themes: increased comfort and confidence, power of authentic representation, enhanced empathy through lived experience, and commitment to inclusive and respectful practice. Students consistently emphasized how working with TGNC-standardized patients enhanced realism, empathy, and their commitment to inclusive care.

Chapter 5 concludes by synthesizing the study’s contributions to nursing education, theory, and practice. The findings support including TGNC standardized patients in simulation to promote affirming care, deepen students’ reflections, and prepare future nurses to meet the needs of diverse populations. This work advances equitable, patient-centered nursing education and calls for broader implementation of inclusive simulation experiences grounded in relational and reflective frameworks.