DiversityNursing Blog

Culturally Competent Care For LGBTQ Patients

Posted by Erica Bettencourt

Fri, Apr 20, 2018 @ 02:25 PM

sc-fam-lgbtq-health-care-0220Healthcare organizations strive to provide culturally competent care for individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). Recent changes in society, including the legalization of gay marriage have raised public awareness of LGBTQ issues. Yet many healthcare professionals lack knowledge in some areas when caring for LGBTQ patients.

As a gay man who is raising a young son with his husband, Michael Johnson, PhD, RN, understands the barriers faced by LGBTQ patients and the assumption often made by nurses and other healthcare professionals that all patients are heterosexual.

“Some members of the LGBTQ community avoid seeking healthcare services because of previous negative experiences in which they faced discrimination,” said Johnson, an assistant professor at the University of Nevada, Las Vegas, School of Nursing. “Studies have shown most LGBTQ patients want to be able to share their sexual orientation or gender identity with their healthcare provider, but are often reluctant to open up because they fear they may be treated badly or even refused care."

LGBTQ individuals have a long history of discrimination at the individual and institutional levels, including the healthcare system. They may check to see if the environment is a safe place to reveal personal information, especially about sexuality. Some things an individual may take note of during their time in your waiting room area include:

  • Your organization’s nondiscrimination policy: Is it in a visible location?
  • A rainbow flag, pink triangle, or other symbol of inclusiveness
  • Availability of unisex restrooms
  • Health education literature with diverse images and inclusive language, including information about LGBTQ health
  • Posters announcing days of observance such as World AIDS Day, Pride, and National Transgender Day of Remembrance

To understand LGBTQ populations and their health needs, it is important to first define the distinct core concepts of sexual orientation and gender identity. You can read about key LGBTQ terms here.

LGBTQ health requires specific attention from health care and public health professionals to address a number of disparities, including:

  • LGBT youth are 2 to 3 times more likely to attempt suicide.
  • LGBT youth are more likely to be homeless.
  • Lesbians are less likely to get preventive services for cancer.
  • Gay men are at higher risk of HIV and other STDs, especially among communities of color.
  • Lesbians and bisexual females are more likely to be overweight or obese.
  • Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGB individuals.
  • Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.
  • LGBT populations have the highest rates of tobacco, alcohol, and other drug use.
 
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Nurses should avoid asking any unnecessary questions. People are sometimes curious about LGBTQ people and their lives, which can lead them to want to learn more by asking the patient questions. However, like everyone else, LGBTQ people want to keep their medical and personal lives private. Before asking any personal questions, first ask yourself: “Is my question necessary for the patient’s care, or am I asking it for my own curiosity?" If for your own curiosity, it is not appropriate to ask. Think instead about: “What do I know? What do I need to know? How can I ask for the information I need to know in a sensitive way?"

Effectively serving LGBTQ patients requires you to understand the cultural context of their lives, and to modify your procedures, behavior, and language to be inclusive, non-judgmental, and helpful at all times. By doing this, healthcare staff can help ensure that LGBTQ patients receive the level of care that everyone deserves. What helpful information can you add regarding this topic?

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Topics: LGBTQ, LGBTQ Healthcare, cultural competency, LGBTQ health disparities, culturally competent care

New Study to Define Health Issues in LGBTQ Community

Posted by Erica Bettencourt

Fri, Aug 25, 2017 @ 10:08 AM

LGBTQ_Symbols.jpg

The PRIDE study is the first of its kind. It aims to follow the same large group of LGBTQ people over the span of the next few decades. Enrollement is open to anyone who resides within the United States, identifies as a gender or sexual minority, and is over 18, its enrollment has surpassed 6,000 since launching in May.

We still lack a comprehensive understanding of the ways that being an LGBTQ person can influence one’s overall health, or of health disparities within the LGTBQ community itself. Researchers, Juno Obedin-Maliver and Mitchell Lunn, at the University of California–San Francisco are hoping to close that gap.

“Sexual and gender minorities make up between 2 and 6 percent of the population, however sexual orientation and gender identity are rarely asked about in health studies and they’re not included in fundamental metrics like the Census,” said Juno Obedin-Maliver, one of the principal investigators with the landmark effort, which is aptly titled the Population Research in Identity and Disparities for Equality Study — more simply referred to as the PRIDE Study. “It’s critical we have visibility into the health and health care experiences of these populations so we know where to direct our efforts. Without data, we’re flying blind.”

One of the big barriers we often found trying to encourage people to teach medical students, doctors or other health care providers about LGBTQ+ people was they said, “Well, there wasn’t enough evidence about the health care needs of the community.” And we kept giving lectures and complaining that the studies weren’t being done. We knew that health disparities were there, but we didn’t know how bad, how deep, how broad the problems were, or how comprehensive, because there wasn’t inclusion often in national studies. So Mitch and I said, “We’re both researchers, we’re both clinicians. Let’s stop complaining and do something about it.”

The goal is to eventually enroll about 100,000 people and follow them over the next 30 years, collecting data through an annual questionnaire. Questions will cover a range of health and social topics, such as physical activity, sleep, mental health, quality of life, insurance status, emergency care use, access to care, income, educational attainment, and family and social connections. 

“People are excited — it feels like they’re hungry to be heard and represented,” Obedin-Maliver said. “The PRIDE Study is by and for the community. Yes, it’s academically rigorous, but it’s also a labor of love and a commitment to giving back.”

For more information or to enroll in the PRIDE Study, which is based at the University of California-San Francisco, visit https://pridestudy.org.

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Topics: LGBTQ, LGBTQ Healthcare, LGBTQ community, LGBTQ health disparities, Pride study

10 Tips On Providing Culturally Competent Care To LGBTQ Patients

Posted by Pat Magrath

Fri, Mar 10, 2017 @ 12:17 PM

LGBTQ Banner.jpgHow knowledgeable are you about the LGBTQ community and their healthcare issues? Do you know enough about the terms used in this community, such as the word queer? It doesn’t mean what it used to mean. As the LGBTQ community becomes more comfortable coming out and expressing themselves, hopefully they are more comfortable seeking medical care.
 
This means they should be in an environment free of judgment where they can honestly talk about their medical concerns and receive the help and treatment they need. We hope you find this article helpful and enlightening.

Many healthcare organizations are striving to ensure sensitive and equitable care for individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). Recent societal changes, including the legalization of gay marriage and Caitlyn Jenner’s very public journey to transgender female, have raised public awareness of LGBTQ issues. Yet many nurses find gaps in knowledge when caring for LGBTQ patients. 

Healthcare curricula in colleges and universities are still sadly lacking content regarding the unique needs of, and health risks for, individuals who fall outside the “traditional” heterosexual orientation of society. However, you can prepare for meeting the needs of these individuals by informing yourself, listening, and making some simple and practical adjustments in your nursing practice.

LGBTQ persons experience a number of healthcare disparities for many reasons: discrimination and social pressures, personal sexual behaviors, limited access to health insurance, higher rates of smoking and alcohol/substance misuse, higher rates of anxiety and depression, greater risk of sexually transmitted infections (including HIV), and increased incidence of some cancers. And when nurses encounter LGBTQ individuals in the clinical setting, they may create or contribute to these barriers to quality care due to lack of understanding and personal bias.

1. Expand your knowledge about sexual orientation and gender identity

To understand the needs of LGBTQ patients, nurses must expand their own knowledge on the subjects of sexual orientation (SO) or attraction, and gender identity (GI), or how one identifies with and experiences the world. Sexuality has long been defined as heterosexual by the dominant society, yet in reality, it encompasses a spectrum of needs, desires, and behaviors that can be fluid and changing over time.

2. Know key LGBTQ definitions

You can read about the meanings of asexual, gay, lesbian, bisexual, pansexual, and “queer,” descriptors that fall under the SO umbrella, as pointed out in More than Pink: LGBTQ Breast Health, a report published by Susan G. Komen, Puget Sound. Note that “queer,” formerly considered a derogatory term, is now considered by some to be a more fluid and inclusive descriptor than other words related to sexual orientation. Also, learn the meaning of terms such as agender, cisgender, transgender, gender fluid, and others that typically describe an individual’s gender identity.

3. Deepen your LGBTQ knowledge

Deepening your knowledge base will enrich your understanding of sexuality in general, and increase your nimbleness in identifying potential health risks for patients seeking your care.

Keep your knowledge up-to-date with ongoing training, reading, and learning from others who are skilled in communicating with and caring for these patients. Some good websites that can help you further your understanding include the Centers for Disease Control and Prevention, the GLBT Health Access Project (Community Standards of Practice Section), Trans-Health.com (online magazine), Women’sHealth.gov, and many others, including sources for this article.

4. Create a welcoming environment for LGBTQ patients

LGBTQ individuals have a long history of discrimination at the individual and institutional levels, including the healthcare system. They may “scan” an environment to determine if it is a safe place to reveal personal information, especially about sexuality. Some things an individual may watch for and take note of during their time in your reception or waiting room area:

  • Your organization’s nondiscrimination policy: Is it in a visible location?
  • A rainbow flag, pink triangle, or other symbol of inclusiveness
  • Availability of unisex restrooms
  • Health education literature with diverse images and inclusive language, including information about LGBTQ health
  • Posters announcing days of observance such as World AIDS Day, Pride, and National Transgender Day of Remembrance

5. Use inclusive language

It may take a little practice, but you can shift your vocabulary towards inclusiveness, opening the door for more open healthcare discussions. This can begin right in the waiting room as patients complete required forms. Rather than asking marital status, for example, the form might read, “relationship status: married, partnered, or other.” 

When asking patients to provide their names, include an additional space indicating “Preferred Name,” as a transgender individual may not wish to be called by a name that reflects their gender identity. Including “preferred pronoun” on a form shows understanding that someone may not identify as they appear.

6. Use gender-neutral language

Approach each interaction with open-mindedness, and a nonjudgmental attitude. Remember, your job as a healthcare professional is to assist the person in solving a health concern, or reducing the risk of future health problems. If your patient doesn’t feel comfortable sharing behaviors with you that are relevant, what good is the interaction? Conveying that the information shared in the provider-patient interaction is confidential may alleviate fears your patient has. 

When asking questions about sexual history and behaviors, preface questions with a statement such as, “So that I can best advise you about your health, I’d like to ask some questions related to sexual behaviors that I ask all my patients. ” Or, “It is our standard practice here to take a sexual history for every patient we serve.”

7. Ask open-ended questions

For example, asking, “Is there anything else that would help me ensure you get the most out of this visit?” can help patients share relevant health information.

Do not overwhelm patients with questions unrelated to the reason for their visit, or to enhance your own knowledge about transgender health. Focus on the behaviors impacting health rather than on SO/GI per se, so the conversation can positively influence health and foster acceptance. 

Prevent any “awkward pause” immediately after a patient shares SO/GI information. Practice your response in advance, such as “Thank you for being open with me; this will help me provide better care for you.” Role-playing your response can increase your own comfort with these situations.

8. Reflect the patient’s language

Avoid applying labels such as “gay.” Some people do not self-identify with any particular descriptive label, yet may have sex with partners of more than one sex or gender. Do not presume. For example, lesbian or gay men may have had or have sexual experiences with individuals of the opposite sex, and bisexual individuals may have long periods of monogamy; keep in mind that sexuality can evolve over time.

9. Investigate mental and physical health risks for LGBTQ patients

Be aware of the unique social pressures and health risks of LBGTQ patients. Societal phobias, violence, and hate crimes – and the fear of them -- are all too real for these individuals. Along with the potential for being ostracized from family and other social groups, this can contribute to chronic anxiety and depression.

LGBTQ individuals who are members of minority populations often face a double whammy of discrimination. Those with non-conforming sexual orientation or gender identity may also experience higher risk of suicide, as well as increased likelihood of tobacco use and drug/alcohol misuse.

It’s also important to build your awareness of the specific physical health problems LGBTQ individuals face. Lesbian women are more at risk for certain cancers due to the prevalence of obesity, nulliparity, or later pregnancy. Lesbian women are susceptible to many of the same sexually transmitted infections as heterosexual people and gay men. Thinking that this population isn’t at risk for these STIs can result in lack of appropriate screening and treatment. In addition to HIV infection, gay men may be at higher risk for anal cancer and can be particularly susceptible to body image issues in the desire to be attractive to other men. They may also experience a variety of cancers resulting from increased obesity and use of tobacco and alcohol.

10. Convey respect

Always remember that the LGBTQ patient in front of you has taken a courageous step to be in your office and disclose some of the most personal information about their lives. Having as positive and affirming an experience as possible will make it more likely the individual will seek future care in a timely manner. 

Becoming aware of resources specifically designed for LGBTQ individuals and making referrals as appropriate (e.g., support groups, smoking cessation groups or AA meetings, etc) will convey that you care enough to become informed about their particular needs. The quality of your interaction can truly make a difference in someone’s health -- and life.

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Topics: LGBTQ, LGBTQ Healthcare

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