Gender inclusive and affirming practices across undergraduate nursing curriculum: A scoping review

Objectives: There are increasing calls for gender affirming care, yet there remains uncertainty as to how nursing education is preparing students. The purpose of this scoping review was to map gender inclusive and affirming practices across the three levels of curriculum (formal, informal, and hidden) in the education of undergraduate nursing students. This novel approach allows consideration of transgender and gender diverse nurses (students and educators). Design: Scoping review as per Arksey and O'Malley and Levac et al. Data sources: Four databases (Medline, Embase, CINAHL, and Scopus) were searched for literature that addressed transgender and gender diversity, discussed at any level of curriculum. In addition, we searched key schools of nursing websites for inclusion of gender inclusive and affirming practices in documents and faculty profiles. We limited our search of peer-reviewed articles and websites to those in English, from Canada and the USA. Review methods: The article search and extraction were conducted by two independent reviewers while the school of nursing websites were searched by the lead author. Results: Forty-seven articles were included and categorized as either (a) Doing (n = 32) (formal, interventionbased) or (b) Thinking (n = 15) (discussion- or evaluation-based) gender inclusive and affirming practices. Twenty-five of the intervention-based articles were single-instance occurrences of learning, primarily by simulation (n = 17). Recommendations at each level of curriculum are offered. Of the 22 schools of nursing websites searched, less than 2 % of faculty profiles list pronouns. Conclusions: While there has been an uptake of formal interventions on gender affirming care there remains a gap in addressing gender inclusive and affirming practices at the informal and hidden curriculum levels. Gender inclusive and affirming practices across all levels of nursing education can help advance culturally safe practices for TGD patients and experiences for TGD nurses and students.