From “Gender-Sensitive” to SOGIESC-Transformative: Updating Nursing Theory for Gender Justice

Article Information

Cleofas, J. V. (2024). Toward diverse SOGIESC‐transformative theorizing in nursing: A revisitation and expansion of Im and Meleis' guidelines for gender‐sensitive theorizing. Nursing Inquiry, e12632. https://doi.org/10.1111/nin.12632 

What this paper is about

Over 20 years ago, nursing scholars Im and Meleis (2001) argued that much women’s health research (and the theories guiding it) was too androcentric and too biomedical—reducing women’s health to diseases and bodies, while ignoring the gendered social relations and political histories shaping health. They proposed “gender-sensitive theories” and gave guidelines for how nurses can theorize women’s health more responsibly. 

This new paper revisits that work and asks: Are those guidelines still enough for today? The author argues that the world has changed (in feminism, technology, health risks, and rights politics), and nursing needs a more contemporary, more inclusive theory-building toolkit—one that does not stop at “women vs men” but accounts for the full spectrum of sexual orientation, gender identity and expression, and sex characteristics (SOGIESC). 

So the paper does three things:

1. Summarizes Im & Meleis’ original “gender-sensitive theorizing” guidelines and shows how they were used in later nursing scholarship;
2. Evaluates those guidelines using a gender-and-development planning lens (Kabeer’s gender-responsiveness typology); and
3. Proposes an expansion: Diverse SOGIESC-Transformative Theories—a framework meant to increase nursing theory’s capacity to support gender justice today. 

Why this matters

Theory isn’t just academic. In nursing, theories shape:

• what we define as a “health problem,”
• what populations become visible or invisible,
• what kinds of data we collect,
• what interventions get designed, and
• what policies nurses advocate for.

If theories are gender-insensitive or cisheteronormative, they can accidentally normalize exclusion—especially for 2SLGBTQIA+ people, gender nonconforming clients, and marginalized women whose lives are shaped by multiple overlapping inequities. 

Step 1: What Im & Meleis (2001) offered (in plain terms)

Im & Meleis wanted nursing theories that actually fit women’s lives. Their guidelines emphasized (in summary):

• Gender should be central, not an afterthought.
• The theory should reflect women’s voices, not just the theorist’s agenda.
• It should recognize diversity among women (not all women experience health the same way).
• Theorists should practice reflexivity/positionality (who you are shapes your theory).
• The theory should include sociopolitical contexts shaping women’s health.
• It should point to nursing actions that empower women and address structural factors. 

The paper also briefly shows how later scholars used these ideas—for example, theories about refugee women’s well-being, first-time single motherhood, and gender-based violence contexts. 

Step 2: The critique—good, but not yet “transformative enough”

The author evaluates the original guidelines using Kabeer’s framework for gender responsiveness: gender-blind vs gender-aware, and within gender-aware: gender-neutral, gender-specific, and gender-transformative. 

The conclusion: Im & Meleis’ guidelines are gender-aware, but largely gender-specific to women (and girls)—and therefore not fully gender-transformative as understood in contemporary gender-and-development work. 

Three key limitations are highlighted:

1) Not enough explicit inclusion of diverse SOGIESC

The original work only lightly gestures to sexuality and “diversity,” but does not fully engage how health and care are shaped by diverse identities across SOGIESC—nor how stigma/discrimination in healthcare affects these groups. The author argues nursing theorizing must directly address these realities because they are now central to gender justice. 

2) Intersectionality needs to be more explicit and actionable

The original guidelines acknowledged differences (race, class, culture) but did not fully develop intersectionality as a core way of theorizing. Intersectionality emphasizes that health inequities emerge from overlapping structures of oppression (e.g., sexism + racism + classism + ableism), and that “women” is not a single uniform category. 

3) Men and masculinities matter—carefully

A gender-transformative approach should also analyze men and masculinities, not to recentre men, but to understand how patriarchy and cisheteronormativity shape health and healthcare for everyone, including women and gender/sexual minorities. The paper warns, though, that “including men” can be co-opted into new forms of androcentrism—so it must be handled with feminist caution and purpose. 

Step 3: The proposal—Diverse SOGIESC-Transformative Theories

The heart of the paper is a proposed upgraded category of nursing theories: Diverse SOGIESC-Transformative Theories.

What makes them distinct?

• They expand the lens from “women’s health” to gender justice across SOGIESC, including women, 2SLGBTQIA+ communities, and (where relevant) men/masculinities. 
• They are grounded in intersectional feminism and queer theory (alongside social critical theory and postmodernism), to directly interrogate patriarchy and cisheteronormativity. 
• They define “transformative” as not just empowering individuals, but also committing to dismantling structures(social, institutional, ideological) that reproduce inequities. 
• They insist on action: nursing theories should guide practice that addresses both practical SOGIESC needs(immediate safety, care access, wellbeing) and strategic SOGIESC needs (rights, empowerment, institutional accountability). 

The paper also introduces a typology based on SOGIESC-responsiveness:

• SOGIESC-insensitive (treats health as universal; ignores SOGIESC or uses it as a mere “control”),
• SOGIESC-aware (includes SOGIESC but may not be intersectional or institution-transforming), and
• SOGIESC-transformative (intersectional, structurally critical, and action-oriented). 

Bottom line

The paper is essentially a call to nursing scholars: our theory toolkits must evolve with the world. If nursing wants to be a profession committed to equity, our theories must become more explicit about SOGIESC diversity, intersectionality, and the structural work needed to achieve gender justice—not only for women, but across the gender spectrum. 

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Policy/practice recommendations (actionable takeaways)

1. For nursing educators

• Teach students to evaluate theories for SOGIESC-responsiveness (insensitive vs aware vs transformative) using clear criteria (e.g., Does it address cisheteronormativity? Does it include intersectionality? Does it propose strategic action?). 

2. For researchers/theorists

• Build theories with communities, not just about them: include voices across SOGIESC—and across class, race/ethnicity, age, disability, and other axes—so “diversity” becomes real representation, not a line in the limitations section. 

3. For clinical leaders and policy stakeholders

• Use theory-guided practice to address both:
  • Practical needs (affirming services, safe access, respectful documentation and care pathways), and
  • Strategic needs (institutional accountability, anti-discrimination protocols, gender-affirming care access, workforce training). 

4. For journals and peer reviewers

• Encourage authors to include a short reflexive statement on SOGIESC and intersectionality when gender is central to the argument, and assess whether “gender” is being treated as a simple binary assumption. 

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Glossary of key terms

• SOGIESC — Sexual Orientation, Gender Identity and Expression, and Sex Characteristics; a framework that captures diverse gender/sexual identities and intersex variations. 
• Cisheteronormativity — The ideology that assumes cisgender identity and heterosexuality are “normal,” granting privilege to some and marginalizing others. 
• Gender-sensitive theorizing — Theory-building that centers gender (originally focused on women’s health), values women’s voices, recognizes diversity among women, situates experiences socially/politically, and proposes nursing actions. 
• Gender-transformative — Approaches that aim to change structures and institutions that produce gender inequality, not just respond to symptoms. 
• Intersectionality — A framework showing how multiple social identities and power structures overlap to shape unique experiences of oppression/privilege and health outcomes. 
• Queer theory — A critical lens that challenges essentialist notions of gender/sexuality and critiques cisheteronormative social organization. 
• SOGIESC-responsiveness — A proposed “property” of theories: whether and how a theory accounts for SOGIESC-related inequities (insensitive/aware/transformative). 
• Practical SOGIESC needs — Immediate needs tied to survival, wellbeing, and access to care. 
• Strategic SOGIESC needs — Longer-term needs tied to empowerment, rights, institutional change, and accountability for equitable care. 
• Masculinities — Social constructions of manhood that shape health behaviors, care access, and power relations; important to analyze without recentring patriarchy.