Transgender veterans have specific health care needs and often experience profound health disparities, barriers to accessing care, and varying degrees of stigma and discrimination. Yet, there is a lag in research regarding transgender persons in terms of the extent and impact of diversity and inclusion within healthcare. There is a need to further define inclusion and examine how this concept is operationalized in the healthcare settings. This study addressed the gap in knowledge gained from transgender healthcare research by establishing a consensus definition of transgender inclusion as well as identified contributing factors. The study also compared the end user perspectives of both transgender veterans and direct care nursing staff for congruence and inconsistency. Included in the dissertation portfolio are three manuscripts that expound upon this issue. The first manuscript outlines the current state of science regarding transgender veteran healthcare. The second is an analysis of the concept of cultural inclusion. The final manuscript includes the results of a two round Delphi study where a combined expert panel of transgender veterans and direct care nurses (N = 10) reached consensus regarding defining factors, contributors, and barriers of transgender inclusion. The results yielded 10 factors that contribute to the consensus definition of transgender inclusion, and identified that knowledge, communication, training, policy, and advocacy were contributing factors to achieving transgender inclusion.

Date of publication

Spring 5-4-2021

Document Type




Persistent identifier


Committee members

Beth Mastel-Smith, Danita Alfred, Michelle Dietert


Doctor of Philosophy in Nursing