Commentary: Competence, attitudes, and educational needs in LGBTQ+ nursing care

Commentary to: Assessing nursing students’ clinical competence in caring for LGBT+ clients: a cross-sectional study in Hong Kong (Ma et al., 2025).

Summary of the paper

This study by Ma et al. (2025) which assesses nursing students’ clinical competence in caring for LGBTQ+ clients through a cross-sectional study in Hong Kong, investigated nursing students’ attitudes and competence in LGBTQ+ care. Using an online survey across seven institutions (June–September 2024), the study employed four validated scales with Cronbach alpha scores ranging from 0.80 to 0.96, ensuring strong reliability. Findings showed that although attitudes towards LGBTQ+ populations were generally positive, clinical competence was only moderate, indicating a gap between knowledge and practice. More favourable attitudes and higher competence were associated with younger age, female gender, LGBTQ+ identity, lack of religious affiliation, and prior exposure to LGBTQ+ clients. Participation in targeted training and direct encounters further enhanced competence, underscoring the importance of experiential learning. These results emphasise the need to integrate reliable, LGBTQ+-focused content and experiences into nursing curricula to reduce stigma and improve care.

Connection to nursing theory, practice and research

This research aligns closely with Madeleine Leininger’s Culture Care Diversity and Universality Theory, which emphasises culturally congruent care tailored to the unique values, beliefs, and needs of diverse populations (Leininger and McFarland, 2002). LGBTQ+ individuals represent a distinct cultural group with specific health vulnerabilities; making understanding these factors is essential for competent, affirming care. This study adds to the growing body of evidence on health disparities and gaps in nursing education, particularly in non-Western contexts (Alibudbud, 2024). It underscores that positive attitudes alone are insufficient; deliberate training, direct exposure, and reflective practice are critical for enhancing clinical competence and reducing bias (Yu and Bauermeister, 2023).

Comparison with other research

When compared with our international study exploring nursing students’ knowledge and attitudes towards LGBTQ+ healthcare across the United States, South Africa, the Philippines, Greece, and Indonesia (Cornelius et al., under review), both studies highlight persistent gaps in nursing preparedness despite generally positive attitudes. Additionally, both studies demonstrate that personal identity and exposure to LGBTQ+ individuals strongly influence readiness, with younger age, female gender, and LGBTQ+ identity associated with higher competence or willingness to provide care (Yu and Bauermeister, 2023). The Hong Kong study focuses on clinical competence within a single region, while the cross-country study emphasises knowledge and attitudes across diverse cultural settings, highlighting cross-cultural variability and the influence of national context on preparedness (Alibudbud, 2024). Together, these findings reinforce the need for targeted, culturally responsive, and experiential educational interventions to ensure both knowledge and competence in LGBTQ+ care (Damery et al., 2025).

One surprising finding was that, in our study, Roman Catholic students demonstrated greater clinical competence and preparedness compared to their Buddhist peers (Cornelius et al., under review). The study contributes to existing knowledge by providing evidence from Hong Kong, where research on LGBTQ+ health is limited, and challenges current educational practices by emphasising that positive attitudes alone are insufficient; deliberate, structured training is essential to close competence gaps and foster an inclusive healthcare environment.

Practice implications and beneficiaries

The study’s findings have direct implications for nursing education, clinical practice and policy development:

• Nursing education: The research reinforces the need to incorporate structured LGBTQ+-focused modules, simulations and clinical encounters into nursing curricula to enhance clinical competence and reduce stigma (Yu and Bauermeister, 2023).

• Clinical practice: Healthcare organisations can implement policies and continuing education initiatives that promote inclusive practices and culturally competent care (Damery et al., 2025). Additionally, adopting a two-step gender identity protocol – first asking sex assigned at birth, followed by current gender identity – can improve accuracy and patient comfort in clinical documentation (Toroff et al., 2019).

• Researchers and policymakers: Hospital administrators, the World Health Organization, and policymakers can leverage these findings to guide curriculum development, evaluate educational interventions, and establish standards for LGBTQ+ health content across diverse contexts. Overall, the study underscores the importance of fostering a healthcare environment that is both inclusive and equitable, where nurses are prepared to provide culturally responsive and affirming care, benefiting both patients and providers (Wong et al., 2025).

Areas for further research

Although this study examined nursing students’ clinical competence and attitudes at a single point in time, there is a need to explore how these competencies and attitudes evolve throughout their nursing education, from programme entry to graduation. Additionally, future research should investigate whether improvements in student competence and attitudes translate into measurable enhancements in patient experiences, satisfaction, and health outcomes for LGBTQ+ populations.

Conclusion

The study’s findings are particularly relevant for patient groups that have historically experienced stigma or discrimination, such as LGBTQ+ individuals seeking routine, preventive, or specialised care. Healthcare settings – including primary care clinics, sexual health services, mental health facilities, and hospital units – can benefit from staff trained to recognise and address barriers to care. This study underscores the need for targeted, culturally responsive, and experiential educational interventions in nursing curricula to bridge gaps in both knowledge and clinical competence, ensuring inclusive and competent care for LGBTQ+ patients globally.

Biography

Judith Cornelius is a Professor of Nursing and a nationally recognised or recognized? scholar in LGBTQ+ health and nursing education. She is a fellow in the American Academy of Nursing and the National League for Nursing Academy of Nursing Education.