The teaching of sexuality in Undergraduate Nursing courses: a systematic literature review

Abstracts

La presente revisión sistemática de la literatura busca identificar las evidencias disponibles con relación a la manera como la sexualidad humana figura en los currículos de graduación en Enfermería. La búsqueda se realizó en publicaciones con fecha de enero de 2013 a septiembre de 2022. Con abordaje cualitativo, descriptivo y exploratorio, después del análisis, considerando los elementos comunes observados, se crearon cinco categorías de contenido: formas de abordaje, contenido, construcción colectiva del currículo, cultura cis-heteronormativa y sus reflejos y propuestas de intervención. Se describieron esas categorías y por medio de ellas fue posible trazar un panorama que indica los principales resultados de investigaciones producidas con enfoque en el alcance propuesto.

Keywords
Nursing; Curriculum; Sexuality; Review; Teaching

A presente revisão sistemática da literatura procura identificar as evidências disponíveis em relação à maneira como a sexualidade humana figura nos currículos de Graduação em Enfermagem. A busca foi realizada em publicações datadas de janeiro de 2013 a setembro de 2022. Com abordagem qualitativa, descritiva e exploratória, após a análise, em face dos elementos comuns observados, foram criadas cinco categorias de conteúdo: formas de abordagem; conteúdo; construção coletiva do currículo; cultura cis-heteronormativa e seus reflexos; e propostas de intervenção. Tais categorias foram descritas e, por meio delas, se tornou possível traçar um panorama que indica os principais resultados de pesquisas produzidas com foco no escopo proposto.

Palavras-chave
Enfermagem; Currículo; Sexualidade; Revisão; Ensino

The present systematic review of the literature seeks to identify the evidence available in relation to the way in which human sexuality figures in undergraduate nursing curricula. The search was carried out in publications dated from January 2013 to September 2022. With a qualitative, descriptive and exploratory approach, after the analysis, in view of the common elements observed, five categories of content were created: forms of approach; content; collective construction of the curriculum; cis-heteronormative culture and its reflections; and intervention proposals. Such categories were described, and through them it became possible to draw an overview that indicates the main results of research produced with a focus on the proposed scope.

Palabras clave
Enfermería; Currículo; Sexualidad; Revisión; Enseñanza

Introduction

The World Health Organization (WHO) expresses human sexuality as an interaction of different aspects - which can include “sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction”¹ (p. 25) - which is present at all stages of a human being’s life. Far beyond biological elements, it also includes “psychological, social, economic, political, cultural, legal, historical, religious and spiritual” constructs¹ (p. 25).

Owing to the principles that nurses are responsible for holistic care^2-5 and that sexuality is present at all stages of human life, it can be inferred that it permeates health care. This perspective can be found in the recommendations of the WHO, which since the 1970s has emphasized the importance of nursing educators including the theme of sexuality in undergraduate curricula, especially with regard to issues of knowledge, skills, attitudes and values⁶. This vision is also included in the Sustainable Development Goals of the 2030 Global Health Agenda⁷, which covers issues related to gender and sexual health, which underscores the need for the subject to be addressed in nursing courses.

However, despite all these indications, there are gaps in the training of these professionals in sexuality care, which can lead to the omission of care, delays in treatment, difficulty in the population’s access to health services and discriminatory behavior^2,8. Although the importance of nurses’ role in promoting sexual health has been recognized for a long time, the lack of an adequate approach to this issue in nursing curricula may reflect a historical, conservative and traditionalist omission in relation to understanding sexuality, which contributes to perpetuating the training of nurses who are unprepared to provide comprehensive care to individuals, with consequences for public health².

Against this backdrop, this study aims to identify the evidence available in the literature regarding the way in which human sexuality appears in undergraduate nursing curricula. By means of a systematic literature review (SLR), the aim is to answer the following question: what evidence is available in the literature regarding the way in which human sexuality features in undergraduate nursing curricula?

Method

In order to visualize the landscape concerning the proposed objective, we opted for the systematic literature review method because we felt that this was the best way to conduct our research. According to Sampaio and Mancini⁹, the SLR, by bringing together works that have theoretical and empirical approaches, culminates in an expanded perspective that allows researchers to perceive gaps, congruences or, in some cases, discrepancies, favoring the refinement of the field of research and generating results that increasingly contribute to guiding praxis. In this way, the research is defined as qualitative, in terms of its approach, and is characterized as descriptive and exploratory.

In order for the review process to take place properly, a research protocol needs to be drawn up, which will make it possible to cadence the data that will return during its execution¹⁰. Therefore, a research protocol adapted from Paranhos, Willerding and Lapolli¹¹ was organized, which is shown in Frame 1.

Frame 1
Systematic literature review protocol.

Protocol	Description
Conceptual framework	Sexuality refers to the interaction of aspects such as sex, sexual identities and gender roles, sexual orientations, eroticism, pleasure, intimacy and reproduction, inherent to psychological, social, economic, political, cultural, legal, historical, religious and spiritual issues1.
Context	Human sexuality featuring in undergraduate nursing curricula.
Languages	English, Portuguese and Spanish.
Inclusion criteria	Studies carried out between January 2013 and September 30, 2022 (date of search). Studies within the scope of the research. Type of document: article of any kind. Studies that refer to undergraduate generalist nursing.
Exclusion criteria	Duplicate studies. Studies that do not cover the scope of the research. Studies which, in the end, only indicate the need to include human sexuality in curricula. Articles in repositories. Studies in other languages. Other types of documents.
Databases searched	Scopus, Web of Science, LILACS and PubMed.

• Source: Adapted from Paranhos, Willerding e Lapolli¹¹.

It was decided to carry out the search in four different databases: Scopus, Web of Science (WoS), Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed, taking into account their specific characteristics. The Scopus^(e) database is considered to be the world’s largest scientific repository and is multidisciplinary. Web of Science^(f) also has this characteristic linked to interdisciplinarity, providing comprehensive data that is collected from various academic disciplines and fields of knowledge. LILACS^(g), on the other hand, is a scientific repository in Latin America and the Caribbean in the area of health. Provided by the US National Library of Medicine, PubMed^(h) is a free searchable database with access to citations and abstracts of scientific research articles in health.

The time frame was defined due to the amount of research, which only in 2013 reached a number equal to or greater than one publication in each of the repositories chosen, as can be seen in Figure 1. From 1971 to 2012, at least one of the four databases did not identify any type of published article, but in the last five years there has been a significant increase in publications on the subject in all of them, showing the growing interest in the subject.

Figure 1
Publications between 1971 and 2022.

The main terms chosen for the search process were: “graduation”, “nursing”, “curriculum” and “sexuality”, which underwent idiomatic translation. In addition, with the help of a librarian, we tried to vary the terms and adapt them according to the database being researched, with a view to expanding the data.

Frame 2 below shows the search strategies and the results found in each database.

Frame 2
Database search results

Databases	Keywords	Results
Scopus	(nurse OR nursing) AND (“pre licensure” OR student* OR bachelor OR baccalaureate OR pupil) AND (curricula OR curriculum OR curricular) AND (“sex education” OR sexuality OR sexual OR sex OR “sexual health” OR “reproductive health”)	181
Web of Science	(nurse OR nursing) AND (“pre licensure” OR student* OR bachelor OR baccalaureate OR pupil) AND (curricula OR curriculum OR curricular) AND (“sex education” OR sexuality OR sexual OR sex OR “sexual health” OR “reproductive health”)	166
LILACS	(estudante* OR universit*) AND (graduaç*) AND curricul* AND (enferm* OR nursing OR nurses) AND (ti:sex* OR sexualidade OR “educação sexual”)	10
PubMed	(“nursing”[MeSH Terms] OR “nursing”[All Fields] OR “nursings”[All Fields] OR “nursing”[MeSH Subheading] OR “nursings”[All Fields] OR “nurse*”[All Fields]) AND (“pre licensure”[Text Word] OR “student*”[All Fields] OR “graduat*”[All Fields] OR “undergraduat*”[All Fields] OR (“bachelor”[All Fields] OR “bachelor s”[All Fields] OR “bachelors”[All Fields]) OR (“pupil”[MeSH Terms] OR “pupil”[All Fields] OR “pupils”[All Fields] OR “pupil s”[All Fields]) OR (“baccalaureate”[All Fields] OR “baccalaureates”[All Fields])) AND (“reproductive health”[Text Word] OR “sex education”[MeSH Terms] OR “sex”[Title] OR “sexual*”[Title] OR (“sexuality”[MeSH Terms] OR “sexual behavior”[MeSH Terms]) OR “sexuality”[Title] OR “sexual health”[MeSH Terms] OR “sexual and gender minorities”[MeSH Terms]) AND (“curriculum”[MeSH Terms] OR ““curriculum”[”[Title] OR ““curricula”[”[Title] OR ““program education”[Title] OR “program educational”[Title] OR ““degree education”[Title])	78
Total	435

• Source: Data from research (2023).

Following this information, the Scopus database obtained 181 records; the Web of Science database, 166 records; LILACS, ten records; and PubMed, 78 studies. The articles were included in the Rayyan^® software, which helped conduct the systematic review.

Of the 435 publications selected, 135 were duplicates, resulting in 300 records that had their titles, abstracts and keywords read in order to understand their relationship with the scope of the research, totaling 72 articles that were read in their entirety, seeking to identify the evidence available in the literature in relation to how human sexuality appears in undergraduate nursing curricula. It is important to note that this study focused on generalist nursing training, and articles from specialties - such as obstetric nursing, family nursing, advanced nursing and others - were excluded from the sample. Finally, 37 records were chosen, 17 from Scopus, nine from Web of Science, five from LILACS and six from PubMed.

To construct the analysis, we opted for the content analysis method, which according to Willerding¹² enables a global reading of the data, allowing for an effective comparative analysis. In the end, the similar data was brought together and five categories of content were constructed, based on the research by Paranhos and Costa¹³, namely: forms of approach; content related to the topic; collective construction of the curriculum; cis-heteronormative culture and its reflexes; and proposals for intervention.

Presentation and analysis of the studies’ contributions

After applying the research protocol, it became possible to analyze the data based on the 37 articles presented in Frame 3, arranged in alphabetical order by author.

Frame 3
Presentation of selected publications

Authors	Títle	Year	Journal
Aaberg V2	The state of sexuality education in baccalaureate nursing programs	2016	Nurse Education Today
Agramonte del Sol A14	Enfoque interdisciplinario de la salud reproductiva y sexual en la formación de enfermeros universitarios en Cuba	2013	Revista Cubana de Enfermería
Aguiar FAR et al.15	Vocational training and sexual assault against women: challenges for graduation in nursing	2020	Escola Anna Nery
Aslan F et al.16	Turkish nurse educators knowledge regarding LGBT health and their level of homophobia: a descriptive–cross sectional study	2019	Nurse Education Today
Bell LM et al.17	Learning about culturally humble care of sexual and gender minority patients	2019	Teaching and Learning in Nursing
Bosse JD et al.4	Integrating sexual minority health issues into a health assessment class	2015	Journal of Professional Nursing
Braun HM et al.18	The LGBTQI health forum: an innovative interprofessional initiative to support curriculum reform	2017	Medical Education Online
Burkey DF et al.19	Infusing LGBTQ cultural competency into nursing curriculum	2021	Nurse Education Today
Burton CW et al.5	Queering nursing curricula: understanding and increasing attention to LGBTQIA+ health needs	2021	Journal of Professional Nursing
Cappiello J et al.8	Systematic review of sexual and reproductive health care content in nursing curricula	2017	Journal of Obstetric, Gynecologic, and Neonatal Nursing
Clever K et al.20	Current approaches to the integration of sex- and gender-specific medicine in teaching: a qualitative expert survey	2020	Journal of Medical Education
Cornelius JB et al.21	Examination of lesbian, gay, bisexual, and transgender health care content in North Carolina schools of nursing	2017	Journal of Nursing Education
Hickerson K et al.3	Sexual orientation/gender identity cultural competence: a simulation pilot study	2018	Clinical Simulation in Nursing
Souza FTP et al.22	Interface between women’s health and violence in the training of nurses in Brazil	2021	Investigación y Educación en Enfermería
Kim M et al.23	Development and evaluation of simulation-problem-based learning for sex education	2016	Computers, Informatics, Nursing
Lim FA et al.24	Lesbian, gay, bisexual, and transgender health: fundamentals for nursing education	2013	Journal of Nursing Education
Lima ACS et al.25	Gênero e sexualidade na formação de enfermeiros no ensino superior público brasileiro: estudo documental	2021	Revista de Enfermagem do Centro-Oeste Mineiro
Magalhães BC et al.26	How is violence themed in nursing education? Curricular components in Northeastern Brazil	2022	Journal of Interpersonal Violence
Maley B et al.27	A writing assignment to address gaps in the nursing curriculum regarding health issues of LGBT+ populations	2019	Nursing Forum
Maruca AT et al.28	Using simulation with nursing students to promote affirmative practice toward the lesbian, gay, bisexual, and transgender population: a multisite study	2018	Nursing Education Perspectives
McCann E, Brown M29	The needs of LGBTI+ people within student nurse education programmes: a new conceptualisation	2020	Nurse Education in Practice
McDowell A, Bower KM30	Transgender health care for nurses: an innovative approach to diversifying nursing curricula to address health inequities	2016	Journal of Nursing Education
McEwing E31	Delivering culturally competent care to the lesbian, gay, bisexual, and transgender (LGBT) population: education for nursing students	2020	Nurse Education Today
McNiel PL et al.32	Advocacy and awareness: integrating LGBTQ health education into the prelicensure curriculum	2018	Journal of Nursing Education
Morris M et al.33	Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: a systematic review	2019	BMC Medical Education
Nietsche EA et al.34	Nursing training for care to the homosexual and bisexual population: students’ perception	2018	Revista Baiana de Enfermagem
Paiva EM et al.35	Sexualidade e infecções sexualmente transmissíveis: análise da formação de alunos da área da saúde	2021	Revista de Pesquisa Cuidado é Fundamental Online
Petry S et al.36	The said and the unsaid in the teaching of sexually transmitted infections	2021	Acta Paulista de Enfermagem
Petry S et al.37	Approaching sexually transmitted infections in a nursing undergraduate curriculum	2021	Revista da Escola de Enfermagem da USP
Pratt-Chapman ML38	Implementation of sexual and gender minority health curricula in health care professional schools: a qualitative study	2020	BMC Medical Education
Rosser BRS et al.39	Tailoring a sexual health curriculum to the sexual health challenges seen by midwifery, nursing and medical providers and students in Tanzania	2022	African Journal of Primary Health Care & Family Medicine
Saus-Ortega C et al.40	Contents of the sexual and reproductive health subject in the undergraduate nursing curricula of Spanish universities: a cross-sectional study	2021	International Journal of Environmental Research and Public Health
Sheinfeld L et al.41	Assessing abortion coverage in nurse practitioner programs in Canada: a national survey of program directors	2016	Contraception
Sherman ADF et al.42	Transgender and gender diverse health education for future nurses: students’ knowledge and atitudes	2020	Nurse Education Today
Tsai LY et al.43	Assessing student nurses’ learning needs for addressing patients’ sexual health concerns in Taiwan	2013	Nurse Education Today
Tsai LY et al.44	Undergraduate nursing education to address patients’ concerns about sexual health: the perceived learning needs of senior traditional four-year and two-year recurrent education (RN-BSN) undergraduate nursing students in Taiwan	2014	Nagoya Journal of Medical Science
Yang H-C45	What should be taught and what is taught: integrating gender into medical and health professions education for medical and nursing students	2020	Research and Public Health

• Source: Data from research (2023).

The following are the content categories created during the data analysis process, which bring together the main evidence found based on the studies from the RSL.

Ways to approach

WHO guidelines establish the need for sexuality to be covered in nursing training⁴⁰. In this way, we realized that the studies that came back from our review process focus primarily on three approaches: transversal, extracurricular/optional/elective and one-off.

The transversal approach is one that has an interdisciplinary perspective^15,20,22,26, made up of themes that cut across the most different areas of knowledge, which contributes to the formation of a professional who is contextualized in terms of reality, with qualified scientific and technical knowledge^15,26. This approach poses a risk insofar as stating that sexuality is a cross-cutting theme in the curriculum can encourage other people to take responsibility, i.e. teachers and subjects expect the theme to appear at other times in the course and, as a result, end up not addressing it³⁷.

The reflection about a curriculum that considers sexuality in an extracurricular way can have numerous results, both positive and negative. When they appear as elective or optional^18,20,21,24, research or extension projects^8,15, subjects and/or extracurricular activities on sexuality end up limiting the participation of some students, as they attract mostly those who identify with the topic^20,34,35. On the other hand, possibilities are opening up for greater dialog with other areas¹⁵ besides health, providing increasingly broad instruments for students to acquire varied knowledge around those that are not part of the curriculum^18,34.

Finally, there is the one-off approach to the subject of sexuality, which becomes peripheral even when it is included in subjects considered traditional in the field of Nursing, such as Health Assessment, Ethics, Women’s Health, Diversity in Health, Fundamentals of Nursing, Medical-Surgical Nursing, Pharmacology, Anatomy and Physiology, Adult Health, Child and Adolescent Health, Sexual and Reproductive Health, Mental Health and Public Health^{3,8,21,23,28,30,31}. In this approach, in some institutions, discussions on the subject are no more than superficial reflections³⁴ in the face of such a complex and important issue for nurses’ training, pointing to a possible weakness^15,20,22,26. The motivations for this occurrence are varied, with the prominence of “moral behaviors [...] that end up influencing teaching and the approach to the student-teacher relationship”³⁴ (p. 4), an aspect that leads to the next content category.

Cis-heteronormative culture and its reflexes

The reflection about a curriculum that perceives, on a global level, the cis-heteronormative social context and that discusses unconscious biases is a way of uncovering the hidden curriculum³³. The curriculum, as a living instance, directly interferes in everyday academic life, either through what is expressed or what is not expressed, creating gaps for biases to become established³⁹. If there are such spaces, moral judgments become part of the academic environment³⁷, given the existence of teaching autonomy which, at the same time as being a positive aspect, can also be negative.

Although there is a consensus that the absence of sexuality in the nursing curriculum can lead to problems for public health, it is the attitudinal and unconscious barriers that culminate in its exclusion from the curriculum guidelines, sometimes expressed in the form of justifications such as lack of time, lack of priority, lack of qualified teachers, lack of comfort in tackling the subject and the discourse that sexuality is too specific to be part of the nursing curriculum^3,8,15,27.

This culture is also related to the pedagogy of the closet, in which all the people who make up the educational context end up, for fear of reprisals, hiding their conceptions of sexuality, affecting the potential that exists in intergroup contact³³. Furthermore, it should be noted that there are teachers who speak in favor of including sexuality in the curriculum, but who adopt completely adverse attitudes in practice¹⁶. In addition, because they are aware that the subject is taboo, many teachers justify not dealing with sexuality in their classes because they are afraid of reactive movements on the part of students and management^8,36.

Within this scope, possible solutions include teacher training on the subject of sexuality³⁴, enabling the inclusion of this subject as a curricular component⁴⁵, and the development of work focused on the autonomy and uniqueness of the student³⁴, which can be achieved through didactic practices and resources such as: simulation^3,19,33, problem-based learning^20,23, discussion forums¹⁸, case studies^19,24,27, discussions on cultural competence and/or humility that include skills training and language suitable for the LGBTIAP+ and queer⁽ⁱ⁾population^{3,5,17,19,28,31}, extracurricular strategies aimed at raising awareness and reducing biases³² and reflection “on the interdisciplinarity and multidisciplinarity of a curriculum that meets all the health needs of the population”³⁶ (p. 8).

Even if some teachers are uncomfortable with the approach, it is possible to embrace emotion and use it as a means of learning. As with any other subject, teachers are not expected to have complete knowledge, but they should be able to teach the main concepts, be creative in their teaching strategies, be available and flexible to learn from their students and know at least what resources are viable for questions they are unable to answer⁴.

Content related to the topic

Content is an extremely important curricular component in the technical training of future nurses, as it provides guidance for discussions on a wide variety of topics. The studies from this RSL offer numerous indications of what could be defined as content in undergraduate nursing courses, as well as in other health courses. These contents are shown in Frame 4.

Frame 4
Content related to sexuality

Contents
Anatomy, physiology and biological aspects2,8,20	Chronic diseases and sexuality2,3,8,17,19,20,28,44
Sexual and reproductive health2,8,14,22,25,40,44	Drugs and sexual behavior40
Sexual violence against women15,22,26	Heteronormativity5,34,45
Sexuality at different stages of life40,44	Basic concepts about genders5,18,20,45
Components of sexuality40	Advanced concepts about genders5,29,45
Human sexual response and sexual function2,8,44	Concepts about affective-sexual diversities/orientations5,44
Mental health and sexual health38,44	LGBTIAP+ and queer health care2-5,16-19,21,24,26,28-30,32,38,44,45
Sexual disorders and dysfunctions2,40,44	Cultural competence and humility in LGBTIAP+ and queer healthcare3-5,17-19,27-29,31
Expression of love and attraction44	Gender equality45
Body image related to intimacy44

• Source: data from research (2023).

Bearing this in mind, curricula should be built in a way that is closer to the academic community’s experience, enabling singularities to be perceived and establishing respect for differences. In addition, a dialogue must be created with specialists so that they can contribute their different levels of knowledge on the subject^43,44.

Collective construction of the curriculum

Building a curriculum is a process that involves overcoming a lack of interest²⁰, in which collective work indicates the possibility of unique powers that are achieved through an exercise that includes the different players in the school context, as well as contact with other fields of knowledge. Thus, thinking about a nursing curriculum that addresses the issue of sexuality in its complexity and understands it as a health need is a difficult task that can be better carried out collectively.

This is a need that even comes from the students themselves^29,35, opening up space for the emergence of a leader to motivate the whole team, which could be the students, as well as an LGBTIAP+ and queer member of the teaching staff with experience outside teaching. Attention should be paid to the fact that centralizing responsibility in a single teacher can discourage others from being co-responsible for building a curriculum that understands and works with differences^4,36,37.

As well as being a space that protects plurality, collective construction enables the creation of bonds that protect students, teachers and the institution, reinforces its sustainability and reduces the biases between the formal and hidden curriculum³⁸. It is worth highlighting the fact that joint construction, which involves interaction between different academic-scientific contexts, makes it possible for topics such as sexuality to form part of a common curriculum, which will have a positive impact on the training and professional performance of future nurses³⁹.

Intervention proposals

Thinking about interventions, in their most varied formats, means creating bridges between the curriculum and the changes taking place in society, which is a “challenge for traditional higher education in educational institutions with fixed curricula”³⁴ (p. 7). In these linking processes, the macro and micro come together, as well as the external and internal contexts of the institutions, and political-organizational effects cannot be disregarded, whether through the federation, states or municipalities, which also make up the socio-political conjuncture³⁸.

Building a dialogue between faculty, students and external experiences, with the participation of specialists, patients and organizations such as LGBTIAP+ and queer organizations - through panels, lectures, seminars and conversation circles - can act as a great catalyst, transforming the educational environment based on knowledge and practical experiences^3,19,38,45.

Institutional support in dissolving the so-called hidden curriculum is also extremely important, as it is based on an action to reconfigure the academic culture. This exercise involves the continuous development of strategic planning, in which the related variables can be observed and controlled together. Financial resources are also needed to develop specific projects related to sexuality, such as research in the area^20,38.

Curriculum revision appears to be the most prominent indication in the findings of this study, in order to evaluate the mandatory and necessary content for the training of undergraduate students^{8,24,35,37,38,40,45}, creating an inclusive and welcoming curriculum, a movement that must be continuous and renewed periodically, as the dynamics of classes and academic semesters change, making it necessary for educational teams to be constantly trained in sexuality and its consequences^18,20,40.

Final considerations

Despite being a structural aspect of human life and, for this reason, being recommended for inclusion in undergraduate nursing curricula, sexuality is still a topic surrounded by taboos, which have a direct impact on the way it is approached in the academic context. The aim of this study was to show ways in which the subject can be effectively included in the training of nurses.

The one-off approach to the subject of sexuality was most evident, pointing to a difficulty in thinking about it in an interdisciplinary way due to unconscious biases, even though its presence is guaranteed by the curricula. The contents, in turn, indicate the multiple possibilities for including the subject in the curriculum. The collective construction of the curriculum would be an alternative to this issue, since it allows teachers, students and managers to participate in the process of preparation and constant revision, committing themselves to the theme.

It is essential that the nursing course environment is a space to address topics related to social stigma, sexual health, prejudice, structural violence, health disparities and minority stress, since neglecting to include the theme of sexuality in the curriculum has repercussions on the professional performance of nurses in global health care; even if professionals show positive attitudes, unprepared nurses end up omitting issues related to sexuality and, due to their lack of knowledge, instead of acting as facilitators, they adopt discriminatory attitudes, leading to iatrogenic behavior in healthcare environments.

• (e)
  Available at: https://www.elsevier.com/pt-br/solutions/scopus (Accessed: 4 Apr. 2023).
• (f)
  Available at: https://clarivate.com/products/scientific-and-academic-research/research-discovery-and-workflow-solutions/webofscience-platform/ (Accessed: 4 Apr. 2023).
• (g)
  Available at: https://lilacs.bvsalud.org/ (Accessed: 4 Apr. 2023).
• (h)
  Available at: https://pubmed.ncbi.nlm.nih.gov/ (Accessed: 4 Apr. 2023).
• (i)
  For the construction of this text, we decided to use the acronym LGBTIAP+ and queer, in reference to lesbian, gay, bisexual, transsexual, transvestite, transgender, intersex, asexual, pansexual and queer people - as a social and political position/recognition -, as indicated by Manzoni de Almeida and Paranhos⁴⁶.

• Beraldi ML, Paranhos W, Garcia ORZ, Horta ALM. The teaching of sexuality in Undergraduate Nursing courses: a systematic literature review. Interface (Botucatu). 2024; 28: e240005 https://doi.org/10.1590/interface.240005

• Funding

  This work was carried out with the support of the Coordination for the Improvement of Higher Education Personnel Brazil (Capes) - Funding Code 001.

Referências

• ¹
  Organização Mundial da Saúde. Saúde sexual, direitos humanos e a lei. UFPR, IFRS, UFRGS, tradutores. Porto Alegre: UFRGS; 2020.
• ²
  Aaberg V. The state of sexuality education in baccalaureate nursing programs. Nurse Educ Today. 2016; 44:14-9. doi: 10.1016/j.nedt.2016.05.009.
  » https://doi.org/10.1016/j.nedt.2016.05.009
• ³
  Hickerson K, Hawkins LA, Hoyt-Brennan AM. Sexual orientation/gender identity cultural competence: a simulation pilot study. Clin Simul Nurs. 2018; 16:2-5. doi: 10.1016/j.ecns.2017.10.011.
  » https://doi.org/10.1016/j.ecns.2017.10.011
• ⁴
  Bosse JD, Nesteby JA, Randall CE. Integrating sexual minority health issues into a health assessment class. J Prof Nurs. 2015; 31(6):498-507. doi: 10.1016/j.profnurs.2015.04.007.
  » https://doi.org/10.1016/j.profnurs.2015.04.007
• ⁵
  Burton CW, Nolasco K, Holmes D. Queering nursing curricula: understanding and increasing attention to LGBTQIA+ health needs. J Prof Nurs. 2021; 37(1):101-7. doi: 10.1016/j.profnurs.2020.07.003.
  » https://doi.org/10.1016/j.profnurs.2020.07.003
• ⁶
  World Health Organization. Education and treatment in human sexuality: the training of health professionals, report of a WHO meeting [‎held in Geneva from 6 to 12 February 1974]. Genebra: WHO; 1975. (Technical Report Series,‎ n. 572).
• ⁷
  Organização das Nações Unidas. Transformando nosso mundo: a agenda 2030 para o desenvolvimento sustentável. Genebra: ONU; 2016.
• ⁸
  Cappiello J, Coplon L, Carpenter H. Systematic review of sexual and reproductive health care content in nursing curricula. J Obstet Gynecol Neonatal Nurs. 2017; 46(5):e157-67. doi: 10.1016/j.jogn.2017.04.132.
  » https://doi.org/10.1016/j.jogn.2017.04.132
• ⁹
  Sampaio RF, Mancini MC. Estudos de revisão sistemática: um guia para síntese criteriosa da evidência científica. Brazilian J Phys Ther. 2007; 11(1):83-9. doi: 10.1590/S1413-35552007000100013.
  » https://doi.org/10.1590/S1413-35552007000100013
• ¹⁰
  Gomes IS, Caminha IO. Guia para estudos de revisão sistemática: uma opção metodológica para as ciências do movimento humano. Movimento. 2013; 20(1):395. doi: 10.22456/1982-8918.41542.
  » https://doi.org/10.22456/1982-8918.41542
• ¹¹
  Paranhos W, Willerding I, Lapolli É. Formação dos profissionais de saúde para o atendimento de LGBTQI+. Interface (Botucatu). 2021; 25:e200684. doi: 10.1590/interface.200684.
  » https://doi.org/10.1590/interface.200684
• ¹²
  Willerding IAV. Arquétipo para o compartilhamento do conhecimento à luz da estética organizacional e da gestão empreendedora [tese]. Florianópolis (SC): Universidade Federal de Santa Catarina; 2015.
• ¹³
  Paranhos WR, Costa CMI. “Curto uma pegação no sigilo”: o Grindr como território de subjetivações dos espaços de desejo. Periódicus. 2023; 1(18):176-9. doi: 10.9771/peri.v1i18.49899.
  » https://doi.org/10.9771/peri.v1i18.49899
• ¹⁴
  Agramonte del Sol A. Enfoque interdisciplinario de la salud reproductiva y sexual en la formación de enfermeros universitarios en Cuba. Rev Cuba Enferm. 2013; 29(1):48-59.
• ¹⁵
  Aguiar FAR, Silva RM, Bezerra IC, Vieira LJES, Cavalcanti LF, Ferreira Jr AR. Vocational training and sexual assault against women: challenges for graduation in nursing. Esc Anna Nery. 2020; 24(1):e20190135. doi: 10.1590/2177-9465-EAN-2019-0135.
  » https://doi.org/10.1590/2177-9465-EAN-2019-0135
• ¹⁶
  Aslan F, Şahin NE, Emiroğlu ON. Turkish nurse educators knowledge regarding LGBT health and their level of homophobia: a descriptive-cross sectional study. Nurse Educ Today. 2019; 76:216-21. doi: 10.1016/j.nedt.2019.02.014.
  » https://doi.org/10.1016/j.nedt.2019.02.014
• ¹⁷
  Bell LM, Brennan-Cook J, Sisson J, Steigerwald M, Cook C, Cicero EC, et al. Learning about culturally humble care of sexual and gender minority patients. Teach Learn Nurs. 2019; 14(3):216-8. doi: 10.1016/j.teln.2019.04.006.
  » https://doi.org/10.1016/j.teln.2019.04.006
• ¹⁸
  Braun HM, Ramirez D, Zahner GJ, Gillis-Buck EM, Sheriff H, Ferrone M. The LGBTQI health forum: an innovative interprofessional initiative to support curriculum reform. Med Educ Online. 2017; 22(1):1306419. doi: 10.1080/10872981.2017.1306419.
• ¹⁹
  Burkey DF, Fetty A, Watson-Huffer K. Infusing LGBTQ cultural competency into nursing curriculum. Nurse Educ Today. 2021; 96:104642. doi: 10.1016/j.nedt.2020.104642.
  » https://doi.org/10.1016/j.nedt.2020.104642
• ²⁰
  Clever K, Richter C, Meyer G. Current approaches to the integration of sex- and gender-specific medicine in teaching: a qualitative expert survey. GMS J Med Educ. 2020; 37(2):Doc26. doi: 10.3205/zma001319.
  » https://doi.org/10.3205/zma001319
• ²¹
  Cornelius JB, Enweana I, Alston CK, Baldwin DM. Examination of lesbian, gay, bisexual, and transgender health care content in North Carolina schools of nursing. J Nurs Educ. 2017; 56(4):223-6. doi: 10.3928/01484834-20170323-06.
  » https://doi.org/10.3928/01484834-20170323-06
• ²²
  Souza FTP, Silva CF, Moreira FTLS, Callou RCM, Belém JM, Albuquerque GA. Interface between women’s health and violence in the training of nurses in Brazil. Invest Educ Enferm. 2021; 39(1):e06. doi: 10.17533/udea.iee.v39n1e06.
  » https://doi.org/10.17533/udea.iee.v39n1e06
• ²³
  Kim M, Shin M. Development and evaluation of simulation-problem-based learning for sex education. Comput Inform Nurs. 2016; 34(1):17-25. doi: 10.1097/CIN.0000000000000200.
  » https://doi.org/10.1097/CIN.0000000000000200
• ²⁴
  Lim FA, Brown Jr DV, Jones H. Lesbian, gay, bisexual, and transgender health: fundamentals for nursing education. J Nurs Educ. 2013; 52(4):198-203. doi: 10.3928/01484834-20130311-02.
  » https://doi.org/10.3928/01484834-20130311-02
• ²⁵
  Lima ACS, Alves MJH, Pereira EV, Pereira AP, Albuquerque GA, Belém JM. Gênero e sexualidade na formação de enfermeiros no ensino superior público brasileiro: estudo documental. Rev Enferm Centro-Oeste Min. 2021; 11:1-14. doi: 10.19175/recom.v11i0.3877.
  » https://doi.org/10.19175/recom.v11i0.3877
• ²⁶
  Magalhães BC, Silva CF, Silva Filho JA, Pinto AGA, Maia ER, Lopes MSV, et al. How is violence themed in nursing education? Curricular components in Northeastern Brazil. J Interpers Violence. 2022; 37(17-18):NP16859-84. doi: 10.1177/08862605211025845.
  » https://doi.org/10.1177/08862605211025845
• ²⁷
  Maley B, Gross R. A writing assignment to address gaps in the nursing curriculum regarding health issues of LGBT+ populations. Nurs Forum. 2019; 54(2):198-204. doi: 10.1111/nuf.12315.
  » https://doi.org/10.1111/nuf.12315
• ²⁸
  Maruca AT, Diaz DA, Stockmann C, Gonzalez L. Using simulation with nursing students to promote affirmative practice toward the lesbian, gay, bisexual, and transgender population: a multisite study. Nurs Educ Perspect. 2018; 39(4):225-9. doi: 10.1097/01.NEP.0000000000000302.
  » https://doi.org/10.1097/01.NEP.0000000000000302
• ²⁹
  McCann E, Brown M. The needs of LGBTI+ people within student nurse education programmes: a new conceptualisation. Nurse Educ Pract. 2020; 47:102828. doi: 10.1016/j.nepr.2020.102828.
  » https://doi.org/10.1016/j.nepr.2020.102828
• ³⁰
  McDowell A, Bower KM. Transgender health care for nurses: an innovative approach to diversifying nursing curricula to address health inequities. J Nurs Educ. 2016; 55(8):476-9. doi: 10.3928/01484834-20160715-11.
  » https://doi.org/10.3928/01484834-20160715-11
• ³¹
  McEwing E. Delivering culturally competent care to the lesbian, gay, bisexual, and transgender (LGBT) population: education for nursing students. Nurse Educ Today. 2020; 94:104573. doi: 10.1016/j.nedt.2020.104573.
  » https://doi.org/10.1016/j.nedt.2020.104573
• ³²
  McNiel PL, Elertson KM. Advocacy and awareness: integrating LGBTQ health education into the prelicensure curriculum. J Nurs Educ. 2018; 57(5):312-4. doi: 10.3928/01484834-20180420-12.
  » https://doi.org/10.3928/01484834-20180420-12
• ³³
  Morris M, Cooper RL, Ramesh A, Tabatabai M, Arcury TA, Shinn M, et al. Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: a systematic review. BMC Med Educ. 2019; 19(1):325. doi: 10.1186/s12909-019-1727-3.
  » https://doi.org/10.1186/s12909-019-1727-3
• ³⁴
  Nietsche EA, Tassinari TT, Ramos TK, Beltrame G, Salbego C, Cassenote LG. Formação do enfermeiro para o cuidado à população homossexual e bissexual: percepção do discente. Rev Baiana Enferm. 2018; 32:e25174.
• ³⁵
  Paiva EMC, Ramos SCS, Martins NS, Nascimento MC, Calheiros AP, Calheiros CAP. Sexualidade e infecções sexualmente transmissíveis: análise da formação de alunos da área da saúde. Rev Pesq Cuid Fundam. 2021; 13:809-14. doi: 10.9789/2175-5361.rpcfo.v13.9190.
  » https://doi.org/10.9789/2175-5361.rpcfo.v13.9190
• ³⁶
  Petry S, Padilha MI, Bellaguarda MLR, Vieira AN, Neves VR. The said and the unsaid in the teaching of sexually transmitted infections. Acta Paul Enferm. 2021; 34: eAPE001855. doi: 10.37689/acta-ape/2021AO001855.
  » https://doi.org/10.37689/acta-ape/2021AO001855
• ³⁷
  Petry S, Padilha MI. Approaching sexually transmitted infections in a nursing undergraduate curriculum. Rev Esc Enferm USP. 2021; 55:e20210019. doi: 10.1590/1980-220X-REEUSP-2021-0019.
  » https://doi.org/10.1590/1980-220X-REEUSP-2021-0019
• ³⁸
  Pratt-Chapman ML. Implementation of sexual and gender minority health curricula in health care professional schools: a qualitative study. BMC Med Educ. 2020; 20(1):138. doi: 10.1186/s12909-020-02045-0.
  » https://doi.org/10.1186/s12909-020-02045-0
• ³⁹
  Rosser BRS, Mkoka DA, Rohloff CT, Mgopa LR, Ross MW, Lukumay GG, et al. Tailoring a sexual health curriculum to the sexual health challenges seen by midwifery, nursing and medical providers and students in Tanzania. Afr J Prim Health Care Fam Med. 2022; 14(1):e1-e9. doi: 10.4102/phcfm.v14i1.3434.
  » https://doi.org/10.4102/phcfm.v14i1.3434
• ⁴⁰
  Saus-Ortega C, Ballestar-Tarín ML, Chover-Sierra E, Martínez-Sabater A. Contents of the sexual and reproductive health subject in the undergraduate nursing curricula of Spanish universities: a cross-sectional study. Int J Environ Res Public Health. 2021; 18(21):11472. doi: 10.3390/ijerph182111472.
  » https://doi.org/10.3390/ijerph182111472
• ⁴¹
  Sheinfeld L, Arnott G, El-Haddad J, Foster AM. Assessing abortion coverage in nurse practitioner programs in Canada: a national survey of program directors. Contraception. 2016; 94(5):483-8. doi: 10.1016/j.contraception.2016.06.020.
  » https://doi.org/10.1016/j.contraception.2016.06.020
• ⁴²
  Sherman ADF, McDowell A, Clark KD, Balthazar M, Klepper M, Bower K. Transgender and gender diverse health education for future nurses: students’ knowledge and attitudes. Nurse Educ Today. 2021; 97:104690. doi: 10.1016/j.nedt.2020.104690.
  » https://doi.org/10.1016/j.nedt.2020.104690
• ⁴³
  Tsai LY, Huang CY, Liao WC, Tseng TH, Lai TJ. Assessing student nurses’ learning needs for addressing patients’ sexual health concerns in Taiwan. Nurse Educ Today. 2013; 33(2):152-9. doi: 10.1016/j.nedt.2012.05.014.
• ⁴⁴
  Tsai LY, Huang CY, Shih FF, Li CR, Lai TJ. Undergraduate nursing education to address patients’ concerns about sexual health: the perceived learning needs of senior traditional four-year and two-year recurrent education (RN-BSN) undergraduate nursing students in Taiwan. Nagoya J Med Sci. 2014; 76(3-4):273-84.
• ⁴⁵
  Yang HC. What should be taught and what is taught: integrating gender into medical and health professions education for medical and nursing students. Int J Environ Res Public Health. 2020; 17(18):6555. doi: 10.3390/ijerph17186555.
  » https://doi.org/10.3390/ijerph17186555
• ⁴⁶
  Manzoni de Almeida D, Paranhos W. Erased bodies in the university space: autoethnography as a form of visibility. J Critical Educ Policy Studies. 2023; 20(3):311-44.

Edited by

Editor

Roseli Esquerdo Lopes

Associated editor

Josefina Leonor Brown

Publication Dates

• Publication in this collection
  13 May 2024
• Date of issue
  2024

History

• Received
  30 June 2023
• Accepted
  01 Dec 2023