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Pride Month Q&A with Professor Tonda Hughes

In honor of Pride Month, we caught up with Professor Tonda Hughes, PhD, the executive director of the Center for Sexual and Gender Minority Health Research (CSGMHR), to discuss progress toward integrating LGBTQ health into nursing education, research, and practice. 

Q: Have you seen improvements in how the nursing profession addresses SGM health since the first National Nursing LGBTQ Health Summit held at Columbia Nursing in 2019?  

A: Yes, and it is very heartening. Increasing nursing’s awareness, advocacy, and action in regard to SGM-related health concerns has been a career goal of mine for at least a decade, and the summit was a major milestone in the journey toward that goal.  

Q: What steps has Columbia Nursing taken to incorporate SGM health into research, education, and practice? 

The CSGMHR, launched in June 2021, was a major outcome of the summit, and is believed to be the first such center of its kind in nursing. The center aims to be a leader in training for established and emerging researchers committed to improving the health and lives of SGM people. We also seek to advance Columbia Nursing’s social justice and health equity mission by helping to close gaps in knowledge, reduce health disparities, and improve quality of life for current and future generations of SGM people.  

A major effort in this regard is the submission of an application to the National Institute on Aging for an Institutional Training grant (F32) to train predoctoral and postdoctoral fellows to conduct high quality research on SGM aging and health. Walter Bockting (co-director of the CSGMHR) and I led this initiative; the first submission received an excellent score but was not funded. We resubmitted the application in May this year and are hopeful that it will be funded.  

Regarding teaching and practice, Columbia Nursing is launching a certificate program in transgender and non-binary (trans/nb) health care for nurse practitioners (NPs) in September this year, led by Associate Professor Laura Kelly, PhD. Because the goal of the program is to improve trans/nb care and increase access to care in settings where NPs practice, participants will complete the practicum in their current practice setting.  

Also at Columbia Nursing, Assistant Professor Billy Caceres, PhD, and April Ancheta, PhD ’22, are spearheading a novel national SGM health mentoring program for prelicensure nursing students. Five students from five nursing schools are currently enrolled in the year-long program, which will culminate in individual poster presentations by the mentees on a topic related to SGM health and a summary presentation describing the program at the 2022 National Student Nurses’ Association’s annual convention.  

We also launched an SGM pilot funding project in which we require researchers outside of Columbia Nursing to partner with a nursing faculty member. We hope that this program will encourage more nurse researchers to consider including a focus on SGM health in their research portfolios. 

The nursing school’s commitment to advancing SGM health, and its reputation as a leader in this arena, is also evidenced by the successful recruitment of several outstanding SGM researchers and scholars: 

Ronica Mukerjee is a nurse leader in caring for a severely marginalized health disparity population—refugees and asylum-seekers, particularly LGBTQ people and substance users. Her clinical work in various contexts, from New York to Tijuana and elsewhere, aims to alleviate structural barriers to health and advance health equity, social justice, and asylum health with a focus on harm reduction for substance users and gender-affirming care for transgender patients. She has documented lessons learned in The Clinician’s Guide to LGBTQIA+ Care: Cultural Safety and Social Justice in Primary, Reproductive and Sexual Healthcare (2021), which she co-wrote and edited.  

Corina Lelutiu-Weinberger is a social psychologist who has worked for more than a decade at the intersection of social science and public health, primarily aiming to document and ameliorate the impact of stigma on mental and physical health among youth, people of color, and SGM people globally. Her programs of research, funded by the National of Institute of Mental Health, Fogarty International Center, and the National Institute on Drug Abuse, range from individual-level mobile interventions for mental health (depression, anxiety, suicidality), alcohol/substance use, and HIV-related outcomes to systems-level interventions to modify clinical systems and provider attitudinal and practice biases for more equitable health care.  

Phoenix Matthews, a clinical psychologist, is nationally and internationally known for their health disparities research with under-represented and under-served populations, including Black and SGM people. Their work has a strong community focus and has had major policy impacts. For example, their research findings played a major role in Chicago being the first U.S. city to ban menthol cigarettes—the most nicotine-heavy cigarettes, which companies have targeted to Black citizens for decades.   

These new faculty members join the CSGMHR’s six other faculty, four postdoctoral research scientists or fellows, and six predoctoral fellows. 

Q: What are the most encouraging signs of progress you’ve noticed? 

A: COVID-19 slowed progress in addressing recommendations from the summit, but we still have managed to make a good deal of progress. The workgroups formed after the summit, on education, research, and practice, have produced several publications, including an historical overview and critique of National Institute of Nursing Research (NINR) funding for SGM health research (Bosse et al., 2020, Nursing Outlook); a description of an innovative approach to improving nursing curricula (Sherman et al., 2021, Nurse Education Today); and results of an evidence-based Transgender Curriculum Integration Project (Sherman et al., 2021, Nurse Education Today). The education workgroup has also conducted three systematic reviews, one of which is currently under review for publication.  

More nursing students—both graduate and undergraduate—are expressing interest in SGM health. At least a third of our incoming PhD nursing students over the past five years have reported interest in research on SGM-related health disparities.  

Another encouraging indicator is the inclusion of SGM health in the American Academy of Nursing’s 2021 Institute for Nursing Leadership Signature Event, “Moving Conversation to Action: Championing Health Equity,” where I was invited to present “Health Equity in Action: Nursing’s Role in Reducing LGBTQ Health Disparities.” Academy organizers received overwhelming positive feedback from the attendees both during the live session and after the conference. 

Q: When and where will the next summit take place?  

A: The second summit was postponed twice due to COVID-19. We hope to hold it in a location more central to the U.S., and not on the East or West Coast.  

There was resounding support to hold the summit annually or biannually, perhaps with regional events that would then feed into larger in-person meetings. Participants suggested expanding future summits to include licensed practical nurses in addition to those prepared at the associate degree, baccalaureate, master’s, and doctoral levels. Participants also encouraged the inclusion of clinical leaders, as well as legal and other health professional colleagues. There was consensus that representatives from SGM communities be included as active participants in future summits. Consideration was given to expanding the geographic diversity of participants by including virtual attendees with video conferencing and webcasts. 

The first National Nursing LGBTQ Health Summit succeeded in serving as a collective call to action for the profession to become active in the reduction of health inequities among this historically underserved population. As the largest health professional workforce globally, nurses are uniquely positioned to have a profound impact in reducing SGM health disparities 

Q: Is there anything else you’d like to share about the summit (and future summits), nursing, and SGM populations? 

A: Despite some great progress, there is so much more that needs to be done. The nursing profession lacks guidelines for the care of LGBTQ people, partly because it lacks the evidence upon which to base such recommendations. This makes it difficult for nursing faculty to know what to teach nursing students and for practicing nurses to deliver high quality, culturally appropriate care. Too many students are graduating from nursing programs without having learned anything about SGM health or having learned only from the “hidden curriculum”—the unspoken or implicit perspectives, values, behaviors, and norms that exist in the educational setting, such as social expectations of gender and sexuality.  

The 2019 summit was an important first step in addressing major gaps in nursing education, research, and practice. It was attended by nursing deans and leaders of major nursing organizations, including the American Association of Colleges of Nursing and the American Academy of Nursing. However, to address the recommendations and achieve the vision that came out of the summit, and that is documented in the report, major changes are needed in education, research, and practice. As the largest health care profession and the profession viewed by the U.S. public as the most honest and ethical for 20 consecutive years, according to Gallup, nursing should not only be participating in efforts needed to redress structural factors undergirding homophobia and prejudice toward SGM people, we should be leading these efforts. To quote former U.S. President Barack Obama, “Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek.”