Charlene Downing

Background: Sexual and gender diverse populations experience inequities in health and health care access, as well as gaps in health professional education. Preregistration nursing and midwifery education represents a critical formative stage for developing inclusive and affirming practice; however, the integration of sexual and gender diversity within curricula remains variable and inconsistently described. Mapping how inclusive pedagogical practices address sexual and gender diversity in preregistration nursing and midwifery education will clarify current approaches and identify gaps in the literature. Objective: This study aims to map how sexual and gender diversity is addressed through inclusive pedagogical practices in preregistration nursing and midwifery education globally. Methods: This protocol follows the Joanna Briggs Institute (JBI) guidance for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting checklist and will be reported in accordance with PRISMA-ScR guidance. We will search the CINAHL, MEDLINE, PubMed, Scopus, and Web of Science databases, as well as targeted gray literature. Two reviewers will independently screen titles and abstracts, followed by full-text screening, and extract data using a piloted form through Covidence. Prior to formal screening, reviewers will pilot-test the inclusion criteria on a sample of titles and abstracts to ensure consistency. Agreement will be discussed, and the eligibility criteria will be refined as required. Data extraction will include pedagogical practices addressing sexual and gender diversity (teaching strategies, curriculum content, simulation, and assessment), theoretical or conceptual frameworks; outcomes and indicators (knowledge, attitudes, skills, confidence, and learning environment), and any identified equity considerations (attention to gender identity and sexual orientation and intersectionality). Synthesis and presentation of findings will be completed using the Patterns, Advances, Gaps, Evidence for Practice, and Research Recommendations (PAGER) framework. Results: The scoping review was initiated in May 2026 following protocol registration with the Open Science Framework. Preliminary searches conducted in November 2025 informed the final search strategy. The final searches were conducted in May 2026 across 5 databases. At the time of manuscript submission, screening and data extraction were in progress. Data charting and synthesis are expected to be completed by October 2026, with findings anticipated for dissemination in December 2026. Conclusions: This review is expected to identify diverse but inconsistently applied inclusive pedagogical practices, which show a predominance of short-term outcome evaluations and limited theoretical underpinning. It will also highlight key gaps, particularly in the inclusion of gender diverse populations, midwifery-specific evidence, and rigorously evaluated interventions. This review will provide a comprehensive map of inclusive pedagogical practices addressing sexual and gender diversity in preregistration nursing and midwifery education, identify gaps in the evidence base, and inform curriculum development and educator training. Trial Registration: Open Science Framework 10.17605/OSF.IO/8GHVD; https://osf.io/8ghvd International Registered Report Identifier (IRRID): PRR1-10.2196/93408

Background: Nursing is grounded in caring and supported by professional and legislative frameworks that mandate equitable services. Despite this, nurses often face challenges in delivering culturally competent care to marginalized individuals. In South Africa, lesbian, gay, bisexual, transgender, queer, intersex, and other (LGBTQI+) persons continue to experience healthcare disparities when accessing primary healthcare (PHC) services. Objective: This study aimed to explore and describe the barriers that PHC nurses experience in providing culturally competent care to LGBTQI+ persons in Gauteng Province, South Africa. Methods: An exploratory qualitative design was employed. Using snowball sampling, two focus group interviews were conducted with professional nurses. Data were collected using a semi-structured interview guide and were analyzed thematically. Results: Nurses reported being inadequately prepared to provide culturally competent care to LGBTQI+ people. Personal and systemic factors constrained inclusive practice. Conclusion: The findings of this study underscore a pressing need to empower nurses through training, support, and systemic change, thereby fostering inclusive and culturally congruent care for LGBTQI+ individuals in South African primary healthcare facilities.

BACKGROUND Sexual and gender diverse (SGD) populations experience inequities in health and in health professional education. Mapping how inclusive pedagogical practices address sexual and gender diversity in pre‑registration nursing and midwifery education will clarify current approaches and gaps. OBJECTIVE To map how sexual and gender diversity is addressed through inclusive pedagogical practices in pre-registration nursing and midwifery education globally. METHODS This protocol follows the JBI guidance for scoping reviews and the PRISMA‑ScR reporting checklist. We will search CINAHL, MEDLINE, PubMed, Scopus, and Web of Science, plus targeted grey literature. Two reviewers will independently screen titles/abstracts and full texts and chart data using a piloted form. Data extraction will include pedagogical practices addressing sexual and gender diversity (teaching strategies, curriculum content, simulation, assessment), theoretical or conceptual frameworks, outcomes or indicators (knowledge, attitudes, skills, confidence, learning environment), and any identified equity considerations (attention to gender identity and sexual orientation, intersectionality). Synthesis and presentation of findings will be completed using the Patterns, Advances, Gaps, Evidence for practice, Research (PAGER) recommendations framework. The planned start for performing the scoping review is May 2026. RESULTS Results are expected to inform curriculum development and guide future systematic reviews. CONCLUSIONS This review will provide a comprehensive map of inclusive pedagogical practices addressing sexual and gender diversity in pre‑registration nursing and midwifery education, identify gaps, and inform curriculum development and educator training. CLINICALTRIAL The review will adhere to PRISMA‑ScR. The protocol has been registered on the Open Science Framework (OSF).

Background: Single young mothers raising a child with severe intellectual disability face distinct day-to-day challenges. For many, the caregiving role is both demanding and life-changing. Beyond typical parenting duties, mothers often provide intensive care and must navigate health and support systems that can be difficult to understand and access. This can create ongoing uncertainty as they manage daily care and supervision, make sense of complex diagnoses and care needs, cope with emotional and practical demands, and seek appropriate resources and services. As they work to secure suitable care and services for their children, mothers may experience ongoing uncertainty, stress and worry. Objectives: The study aimed to explore and describe the experiences of single young mothers caring for children with severe intellectual disability. Method: A qualitative, exploratory and descriptive research design was adopted to capture the nuanced experiences of eight purposefully sampled single young mothers caring for a child with severe intellectual disability. Results: Three themes emerged: (1) Knowledge gaps among single young mothers, (2) Emotional and psychological impact of the diagnosis and (3) Strength and support systems among single young mothers. Conclusion: The findings can guide professionals in developing initiatives for single young mothers that strengthen financial stability, overall well-being, and caregiver education in caring for their children. Contribution: The study provides in-depth insight into the experiences of single young mothers caring for children with severe intellectual disability in the South African context. It highlights the knowledge gap, emotional challenges and support needs. The findings inform contextually relevant recommendations to strengthen professional support, enhance maternal well-being and improve quality of life for both the mothers and their children.

Background: In South African public healthcare, continuing professional development (CPD) is essential for maintaining nursing competence; however, participation rates remain suboptimal despite regulatory mandates. Objectives: This study assessed professional nurses’ learning readiness and motivation, while reporting contextual factors influencing CPD participation in public hospitals in Gauteng province. Method: A cross-sectional design was employed with 158 professional nurses from three public hospitals, using validated instruments to measure self-directed learning readiness (17 items, α = 0.95), desire for learning (8 items, α = 0.92), and workplace learning opportunities. Descriptive statistics and exploratory factor analysis were conducted. Results: Despite 94.3% nurses having access to learning opportunities and 98.7% expressing interest, only 51.0% participated. Staff shortages emerged as the primary barrier (41.7%), followed by scheduling conflicts (16.7%). Nurses demonstrated strong learning readiness (mean 3.2–3.8/5.0), yet contextual constraints limited engagement. Technology deficits were pronounced: 84.8% lacked workplace internet access despite 82.5% preferring blended learning. Conclusion: The gap between high motivation and limited participation reveals that CPD challenges are fundamentally structural, not individual. Contribution: This study provides evidence that effective CPD in resource-constrained settings requires multilevel interventions addressing workforce adequacy, technology infrastructure, and organisational support.

Background: The Diploma in Nursing programme (Regulation R.171) in South Africa has traditionally been delivered through face‐to‐face classroom teaching combined with supervised clinical practice. However, the COVID‐19 pandemic in 2020 necessitated a rapid transition to online learning to ensure continuity of nursing education while minimising the spread of the virus. As caring is a fundamental value underpinning the nursing profession, it was essential that this value be maintained within virtual learning environments. In this study, caring presence is conceptualised as both relational and structural, encompassing lecturers’ communication, emotional support, accessibility, institutional responsiveness and digital equity. Aim: This study explored nursing students’ perceptions of lecturers’ caring presence during online learning at a public nursing college in Gauteng Province, South Africa, and developed recommendations to inform the design and implementation of future online and blended learning environments. Design and Methods: A qualitative, contextual research design guided by the Appreciative Inquiry approach was employed to explore nursing students’ experiences of lecturers’ caring presence during online learning. Data were collected through focus group interviews with third‐year nursing students and analysed using thematic analysis. Participants and Setting: Twenty‐three third‐year nursing students enrolled in the Diploma in Nursing programme participated in four focus group interviews conducted across two nursing college campuses in South Africa. Results: Four overarching themes emerged from the data, reflecting students’ perceptions of lecturers’ caring presence during online learning. Participants highlighted the importance of effective communication, emotional support, lecturer accessibility, institutional responsiveness and equitable access to digital resources in fostering a caring online learning environment. Students recommended integrating caring values into the college’s mission and philosophy, strengthening the development of professional attributes such as caring, compassion, resilience and empathy through blended learning approaches, incorporating digital literacy into the nursing curriculum, providing continuous professional development for lecturers in the use of learning management systems and ensuring accessible technical support for all nursing students. Conclusion: The findings demonstrate that caring presence remains a critical component of quality nursing education, regardless of the mode of delivery. Strengthening caring relationships, institutional support and digital preparedness can enhance students’ learning experiences in online environments. The recommendations may inform curriculum development, educational policy and future research aimed at promoting caring‐centred online nursing education.

Background: Access to dignified healthcare services is regarded as a human right; however, individuals identified as LGBTQI+ persons still appear to be humiliated and uncared for when accessing primary healthcare facilities. Objectives: This study explored and described the experiences of the LGBTQI+ persons when accessing primary healthcare facilities. Method: A qualitative interpretative phenomenological analysis was employed. Unstructured individual interviews were conducted with 16 self-identified LGBTQI+ persons from five districts and analysed using inductive thematic analysis. Results: Three themes were identified: (1) social injustice, (2) professional nurses’ unpreparedness for inclusive care and (3) experiences of affirmative care. Each theme encompassed relevant sub-themes. Conclusion: The results revealed a lack of humanity and uncaring healthcare services that LGBTQI+ individuals received when accessing primary healthcare facilities in Gauteng, South Africa. Contribution: These findings advocate for inclusive, respectful, dignified and sensitive healthcare services.

Background: Culturally sensitive nursing care is vital in paediatric settings, where children’s health experiences and responses to care are influenced by their cultural beliefs, family practices and developmental needs. Objectives: This study aimed to develop, describe and evaluate a model to guide professional nurses in providing culturally sensitive care for hospitalised children. Method: A theory-generative, qualitative, exploratory, descriptive and contextual design was employed. The model was created through four systematic steps: concept analysis, formulation of relationship statements, model construction and expert evaluation. Results: The resulting model helps professional nurses to recognise and clarify their own values, incorporate institutional cultural guidelines and utilise relevant resources to facilitate culturally sensitive care. Conclusion: At the core of the model is the active involvement of mothers or primary caregivers throughout the child’s hospitalisation, ensuring holistic, culturally responsive and developmentally appropriate care. Contribution: The model provides a practical framework to improve cultural competence and enhance paediatric nursing care across diverse clinical settings.

Background: Workforce diversity reduces health care disparities and enhances patient-centred care. Holistic admission review (HAR) in student nurse selection has been proposed to increase diversity in nursing. Nursing has been slow in the uptake of HAR. Additionally, South Africa nursing programme admissions primarily emphasise academic metrics. The focus on academic measures leads to the exclusion of academically successful, diverse and competent candidates. Objectives: This study sought to analyse the concept of HAR in the context of nursing education, addressing the question of the conceptual meaning of HAR in this context. Method: Walker and Avant’s eight-step concept analysis framework was implemented to establish a clear understanding of HAR. A scoping review, using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, was conducted across 10 databases and institutional repositories. Sources were screened using Covidence, and data extraction followed the conceptual analysis framework. Results: Out of 8558 screened sources, 84 were included in the analysis. Holistic admission review requires policies to address the use of a diverse selection committee using a standardised rubric to assess both cognitive and non-cognitive attributes. Conclusion: Holistic admission review is triggered by a lack of diversity and bias in selection processes. The HAR framework consists of four phases and ultimately fosters an inclusive student body equipped to deliver high-quality patient care. Holistic admission review enhances student retention, empowers future leaders and strengthens the nursing workforce. Contribution: This concept analysis will refine the research questions for subsequent phases, including exploring HAR’s meaning and developing a nursing education model for equitable student selection in South Africa.

Background: South Africa has the world's highest HIV prevalence rate (12.7%), with university students disproportionately affected. While HIV Pre-Exposure Prophylaxis (PrEP) is an effective preventive measure for high-risk individuals, its uptake among university students remains low, which hinders progress toward national and global targets to end the AIDS epidemic by 2030. This study aimed to identify the factors influencing PrEP uptake in this vulnerable population, specifically among university students in Gauteng province, using Pender's Health Promotion Model.Methods: A quantitative, descriptive cross-sectional survey was conducted among 537 university students across six universities in Gauteng province. Data were analysed using Partial Least Squares Structural Equation Modelling to identify significant predictors of PrEP use.Results: The study revealed a low PrEP uptake rate among students at risk of contracting HIV. The analysis identified several factors that directly influenced PrEP uptake, including knowledge (β = 0.122, p = 0.001), interpersonal influence (β = 0.082, p = 0.038), situational influence (β = 0.145, p = 0.001), and perceived benefits (β = 0.121, p = 0.003). Significant interactions were also found between condom use and knowledge (β = 0.098, p = 0.004) and between condom use and perceived benefits (β = 0.127, p = 0.013).Conclusion: PrEP uptake is a complex process influenced by the dynamic interplay of factors consistent with Pender's Health Promotion Model, particularly interpersonal, cognitive, and situational factors. These results provide valuable evidence for developing multifaceted, youth-friendly interventions, such as a mobile health application, to promote PrEP use, reduce HIV incidence, and help achieve national and global HIV prevention targets.