Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2021


Doctor of Nursing Practice (DNP)

Primary Advisor

Mercedes Echevarria, DNP, APN; Kimberly Carter, PhD, RN, NEA-BC


Nurses Caring; Cultural Competency; LGBT; Mindfulness; Implicit Bias


Background: Equitable care remains a goal of the United States healthcare system, with cultural competency training used as one intervention to mitigate disparities. Cultural competency education is primarily based on racial and ethnic differences, often omitting other marginalized groups. Implicit bias consequences are not addressed in such training programs despite the association with health outcome disparities. Research related to implicit bias has demonstrated the ability to promote malleability in implicit associations.

Objectives: This project assessed a mindfulness meditation exercise intervention on nursing awareness in interacting with lesbian, gay, bisexual, and transgender (LGBT) patients. Additionally, an LGBT health education module that integrates affirmative practice and implicit bias concepts was introduced. This project served to improve awareness of implicit bias against LGBT individuals in order to begin mitigating the associations with poorer health outcomes.

Methods: Using a pre-post intervention design, participant acceptance and comfort in working with LGBT individuals was measured using the Sexuality Implicit Association Test (IAT). Participants were instructed on the use of a mindfulness meditation exercise and completed a self-paced LGBT health education module. Content included LGBT terminology, health disparities, effective communication, and an overview of implicit bias awareness.

Results: Participants were comprised of registered nurses and licensed practical nurses working at a non-profit healthcare organization. A total of 81 participants completed the pre-intervention IAT, and 51 completed the post-intervention IAT. In comparing pre- and post-intervention IAT scores, there was an overall increase in neutrality of bias between heterosexual and homosexual individuals.

Conclusions: Mindfulness provides a promising opportunity to decrease bias in healthcare workers interacting with marginalized groups. This project provides a basis for organizational change using implicit bias awareness education. The research contributes to the paucity of available literature related to LGBT-specific healthcare, implicit bias, and cultural competence.

Open Access


Included in

Nursing Commons



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