Date of Completion


Embargo Period



gay affirmative practice, advanced practice nurses, lesbian, gay, cultural competence, sexual orientation

Major Advisor

E. Carol Polifroni

Associate Advisor

Thomas Long

Associate Advisor

Art Engler

Field of Study



Doctor of Philosophy

Open Access

Open Access


APRNs are increasingly providing more of the primary care services to diverse populations in the United States. The population includes persons of non-heterosexual identities who often encounter barriers when seeking health care. Given the minuscule focus in nursing education about these patient populations, a clearer understanding of APRNs’ beliefs, behaviors, and experiences caring for lesbian and gay patients was essential.

The purpose of this mixed methods study was to explore and identify the beliefs, behaviors, and experiences of APRNs with lesbian and gay and patients. Social constructionism was the theoretical perspective that guided this study, and the philosophical perspective of pragmatism informed the methodology. The study followed a convergent parallel design informed by Creswell and Plano Clark (2011). A sample of 678 APRNs from a northeastern state completed an on-line survey comprised of the 30-item, Gay Affirmative Practice (GAP) (Crisp, 2002) Likert-type scale, 13 demographic items and an open-ended statement requesting a description of experiences of having cared for lesbian and gay patients. Quantitative data were analyzed using descriptive statistics and ANOVA. Qualitative data were analyzed using Krippendorff’s (2013) content analytic technique of clustering units to form themes. ANOVA indicated statistically significant differences in GAP scale scores based on personal identity, having a lesbian or gay family member, political party, practice place, practice focus, and the number of lesbian and gay patients. Eight thematic categories emerged from APRN experiences: affirming, more education needed, witnessed discrimination, limited experience with lesbian/gay patients, sexual orientation only asked if relevant, treat all the same, non-affirming, and sexual orientation not focus of practice. The thematic categories of affirming, have witnessed discrimination, and more education needed consistently had the highest GAP scale scores compared to the other themes.