Project Summary: The Human Rights Campaign just declared a national state of emergency for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) Americans in response to over 75 bills being signed into law that restrict the rights of this population, including bans to gender affirming healthcare. Denial of healthcare due to discrimination and lack of provider knowledge of transgender and gender diverse (TGD) health remain high in healthcare settings. To reduce such barriers to healthcare and known health disparities affecting TGD people, it is imperative to provide up-to-date knowledge on TGD-affirming care according to the World Professional Association of Transgender Health (WPATH) Standards of Care Version 8 (SOC-8). Nurses are uniquely suited to provide TGD-affirming care to patients as they are the largest healthcare profession. Currently, nursing programs and faculty are woefully underprepared to provide students training on TGD-affirming healthcare practices. To address these educational deficits, our aims are to 1) Create Trans*forming Care: A 7-Module Program Experience, which is a multi-pronged online learning curriculum for nursing students based on essential components of TGD healthcare utilizing the WPATH SOC-8, community partner relationships, empirical research, and subject matter experts; 2) Establish the validity of the online learning curriculum in addressing healthcare needs of TGD as identified by community partners, subject matter experts, and WPATH SOC-8; 3) Evaluate the short-term impact of the curriculum on nursing student knowledge, skills, attitudes and connections within TGD healthcare. This multi-phase study will leverage multi-method data to create and evaluate the Trans*forming Care Program. The Trans*forming Care program will be created through focus groups and expert validity, as well as utilize an innovative platform to improve nursing students’ knowledge, skills, attitudes, and connections of TGD patients. Specifically, we will establish face and content validity through qualitative methods working closely with our subject matter experts (Phase 1) – followed by a quantitative evaluation of nursing students' knowledge, skills, attitudes, and connections to TGD patients both pre and post completion of the Trans*forming Care program. The Trans*forming Care program supports the strategic plan and research lenses of the National Institute of Nursing Research (NINR). These five areas include 1) health equity, 2) social determinants of health, 3) prevention and health promotion, 4) systems and models of care, and 5) population and community health. Additionally, this project is ideally suited for this R25 as it will enhance the knowledge of health professionals on influences to health and disease that are present for TGD individuals. We anticipate this open-source continuing education program to become a model for TGD-affirming healthcare in nursing schools across the country, leading to improved health outcomes for TGD people.

Project Narrative: Over 1.6 million people in the United States identify as transgender or gender diverse (TGD), yet there is inadequate training in TGD-affirming healthcare (i.e., care provision which supports one’s identities, is relevant and competent). Of great concern, gender-based inequities are reflected in the mental and physical health disparities among TGD people compared to cisgender people - including increased rates of suicides, post- traumatic stress disorder, depression, cardiovascular disease and chronic obstructive pulmonary disease. Providing TGD affirming care reduces inequities and improves health outcomes among TGD people and prepares nurses to serve their communities with the utmost dignity and respect based on current research and knowledge.