DiversityNursing Blog

In the ever-evolving healthcare landscape, it is crucial to prioritize inclusivity to deliver top-notch care to all patients. This is especially significant when tending to LGBTQ+ individuals, who often encounter distinct obstacles and inequalities in healthcare.

As Nurses, we play a vital role in championing patient care and establishing a warm and inclusive environment. Here are some practical suggestions to promote inclusivity for LGBTQ+ patients in healthcare settings.

Educate Yourself and Your Team

Continuous Education: Keep up to date with LGBTQ+ health issues, terminology, and cultural competence through ongoing training and professional development. This involves gaining an understanding of the unique health risks and concerns that LGBTQ+ patients may encounter.

Resource Utilization: Make use of available resources such as the Human Rights Campaign’s Healthcare Equality Index and the National LGBTQIA+ Health Education Center to stay updated on best practices.

Use Inclusive Language

Respectful Communication: Always use the patient’s preferred name and pronouns. It's perfectly okay to ask kindly, "What name and pronouns would you like me to use?"

Avoid Assumptions: Avoid assuming a person’s sexual orientation, gender identity, or relationships. Instead, use gender-neutral language like “partner” rather than “husband” or “wife,” until the patient informs you otherwise.

Create a Welcoming Environment

Visible Signs of Support: Show your support for inclusivity by prominently displaying symbols such as rainbow flags or Safe Zone stickers in common areas and on your name badge. These small gestures can greatly enhance patients' comfort levels.

Inclusive Intake Forms: Make sure intake and medical history forms are inclusive, providing choices for different gender identities and sexual orientations. Be sure to include a section for patients to specify their preferred name and pronouns.

Foster a Non-Judgmental Atmosphere

Active Listening: Listen attentively and compassionately to your patients' concerns and experiences without any hint of judgment. Validate their feelings and experiences to foster trust and rapport.

Confidentiality Assurance: Reassure patients that their confidentiality is a top priority. It's important to acknowledge that LGBTQ+ individuals may have concerns about privacy due to past experiences of discrimination.

Advocate for Inclusive Policies

Policy Development: Advocate for the implementation of non-discrimination policies within your healthcare facility that explicitly include sexual orientation and gender identity.

Inclusive Training: Encourage your institution to provide regular training on LGBTQ+ inclusivity for all staff members, including administrative and support staff.

Address Health Disparities

Screening and Preventive Care: Be mindful of the specific health risks LGBTQ+ patients may face, including higher rates of mental health issues, substance use, and certain cancers. It is important to customize screening and preventive care to address these unique risks.

Mental Health Support: Recognize the importance of mental health support for LGBTQ+ patients, who may experience higher rates of anxiety, depression, and suicidal ideation. Provide referrals to LGBTQ+-friendly mental health professionals when necessary.

Create Support Networks

Peer Support: Facilitate the creation of support groups for LGBTQ+ patients within your healthcare facility. Peer support can be a valuable resource for individuals facing similar challenges.

Community Resources: Familiarize yourself with local LGBTQ+ organizations and resources that can offer additional support and services to your patients. Provide this information to patients as part of their care plan.

Creating an inclusive environment for LGBTQ+ patients is not only a professional responsibility but also a moral imperative for Nurses. By educating ourselves, using inclusive language, fostering a welcoming atmosphere, and advocating for supportive policies, we can ensure all patients receive the compassionate and respectful care they deserve. Our dedication to inclusivity can greatly enhance the healthcare experiences and outcomes for LGBTQ+ individuals, ultimately contributing to a more fair and just healthcare system.

It is essential for healthcare to be fair and accessible to all individuals, yet LGBTQ+ individuals often face significant health disparities. These disparities arise from various factors, including societal stigma, discrimination, and a lack of culturally competent care.

As Nurses, we hold a unique position to recognize and address these health inequities, guaranteeing LGBTQ+ patients receive high-quality care they rightfully deserve. In this discussion, we delve into the specific health challenges encountered by LGBTQ+ communities and explore strategies for Nurses to alleviate these disparities.

Understanding Health Disparities in LGBTQ+ Populations

Mental Health: LGBTQ+ individuals are at a higher risk for mental health issues such as depression, anxiety, and suicidal ideation. Factors contributing to these issues include societal stigma, discrimination, and lack of social support.

Substance Use: Higher rates of substance use and abuse are observed among LGBTQ+ populations. An estimated 20 to 30% of the LGBTQ+ community abuses substances, compared to about 9% of the general population. This is often a coping mechanism for dealing with discrimination, trauma, and social rejection.

Sexual and Reproductive Health: LGBTQ+ individuals may face challenges in accessing appropriate sexual and reproductive health services. This includes higher rates of sexually transmitted infections (STIs), including HIV, particularly among gay and bisexual men and transgender women.

Chronic Diseases: There is a higher prevalence of certain chronic diseases in LGBTQ+ populations, such as cardiovascular disease, obesity, and certain cancers. These are often linked to stress, smoking, and other lifestyle factors influenced by minority stress.

Access to Healthcare: LGBTQ+ individuals often experience barriers to healthcare access, including lack of insurance, discrimination by healthcare providers, and fear of disclosing their sexual orientation or gender identity.

Strategies for Nurses to Address and Reduce Health Disparities

Provide Culturally Competent Care

Education and Training: Participate in ongoing education and training focused on LGBTQ+ health disparities and cultural competence. This involves gaining insight into the specific healthcare requirements of LGBTQ+ individuals and honing effective and respectful communication skills.

Inclusive Environment: Establish a warm and inviting atmosphere within your healthcare facility. Showcase symbols of inclusivity, incorporate inclusive language in documentation, and guarantee all team members are well-versed in LGBTQ+ cultural competence.

Enhance Mental Health Support

Screening and Referral: Conduct regular screenings for mental health concerns such as depression, anxiety, and thoughts of self-harm. Connect LGBTQ+ individuals to mental health providers and support services that affirm their identities and experiences.

Peer Support: Foster peer support groups within your healthcare facility or local community. These groups offer a safe and understanding environment for LGBTQ+ individuals to exchange experiences and effective coping mechanisms.

Address Substance Use

Non-Judgmental Approach: Approach discussions surrounding substance use with empathy and understanding. Take into account the underlying factors contributing to substance use and offer compassionate support and access to appropriate treatment resources.

Tailored Interventions: Create and execute substance use interventions that cater to the unique requirements of LGBTQ+ individuals. This entails offering culturally sensitive counseling and support programs tailored to their specific needs.

Improve Sexual and Reproductive Health Services

Comprehensive Care: Provide comprehensive and accessible sexual and reproductive health services to meet the needs of LGBTQ+ individuals. This encompasses offering STI screening, HIV prevention and treatment, as well as inclusive family planning services.

Education and Outreach: Offer education on safe sex practices and sexual health catered to the unique needs of LGBTQ+ patients. Engage in outreach efforts to link individuals with pertinent services and resources, promoting a holistic approach to sexual and reproductive health care.

Promote Chronic Disease Prevention and Management

Regular Screening: Conduct regular screenings for chronic illnesses among LGBTQ+ individuals, focusing on conditions that are commonly seen within this community.

Lifestyle Support: Provide assistance for promoting healthy lifestyle choices, including programs to quit smoking, guidance on nutrition, and techniques for managing stress.

Advocate for Policy Changes

Inclusive Policies: Advocate for the establishment of inclusive policies in healthcare environments, ensuring these policies explicitly encompass and protect individuals based on their sexual orientation and gender identity.

Access to Care: Push for enhanced healthcare access for LGBTQ+ individuals by advocating for inclusive insurance coverage, expanding healthcare services, and dismantling barriers to care. 

Addressing health disparities in LGBTQ+ populations requires a multifaceted approach that includes education, compassionate care, and advocacy. By understanding the unique challenges faced by LGBTQ+ individuals and implementing targeted strategies, Nurses can play a crucial role in reducing these disparities and improving health outcomes. Our commitment to equity and inclusivity in healthcare can make a profound difference in the lives of LGBTQ+ patients, fostering a system where everyone receives the care and respect they deserve.

As Nurses, we have the responsibility and the opportunity to lead the way in creating a more equitable healthcare system. By embracing these strategies, we can ensure our care is inclusive, compassionate, and effective for all patients, regardless of their sexual orientation or gender identity.

Nurses must always be prepared to care for patients from all backgrounds, including the LGBTQ+ community. Caring for the LGBTQ+ community requires an educated, compassionate, and inclusive approach. As Nurses, we ensure every patient receives the most personalized and competent care possible. Here are some tips to help you provide better care to the LGBTQ+ community.

Create a Welcoming, Warm, and Inclusive Environment

A crucial aspect of caring for the LGBTQ+ population is creating a warm, welcoming, and inclusive environment. When people feel like they are being cared for without bias or judgment, they are more likely to seek preventative and immediate care. Healthcare professionals should educate themselves on LGBTQ+ terminology so that each patient can feel understood and respected.

Expand your Knowledge of the LGBTQ+ Community

Nurses must keep updated with training, reading, and learning from others on any healthcare topic. To provide better care to the LGBTQ+ community, educate yourself on current LGBTQ+ subjects such as sexual orientation and gender identity. Consider seeking a continuing education credit from a reputable source like lgbtqiahealtheducation.org/.

Use Inclusive Language

Not all people identify with their biological sex. Using inclusive language within the LGBTQ+ community is one of the most essential aspects of providing competent, patient-centered care. When caring for the LGBTQ+ community, use language like “currently nursing’ instead of ‘nursing mother’ or ‘menstruating person’ instead of ‘menstruating mother.’ These slight variations in how we speak to and about patients who identify in the LGBTQ+ spectrum can make all the difference in how we provide care. It is essential to address and approach each patient interaction with a nonjudgmental attitude and an open mind so that each patient can feel welcome and understood.

Use Correct Pronouns

Pronouns are incredibly important when addressing patients within the LGBTQ+ community. Feel free to ask your patient what their preferred pronouns are to ensure you are addressing them in a way they want to be addressed. Asking patients about their preferred pronouns and abiding by their requests shows respect. It signifies you are aware that not every person identifies with pronouns associated with their biological sex.

Familiarize Yourself with LGBTQ+ Health Disparities

It is important to build awareness around the specific health problems that affect the LGBTQ+ community so we can do our part in bridging healthcare gaps. Unfortunately, LGBTQ+ people experience higher rates of sexually transmitted infections, drug and alcohol abuse, anxiety, depression, suicide, cancer, violence, or bullying. Nurses should continually strive to further their educational knowledge of health disparities and interventions to make healthcare more accessible to the LGBTQ+ population.

Show Respect and Establish Trust

LGBTQ+ patients deserve the same respect as any other patient. For some LGBTQ+ patients, it can take a lot to seek care and disclose personal information about their lives. Many patients may feel judged if they reveal intimate details about their lives, so we must create a warm, judgment-free environment to collect all the information we need to provide the most competent care possible. Building a trusting nurse-patient relationship can help reduce health disparities and improve patient outcomes.

Conclusion

As Nurses, we are responsible for modifying how we provide healthcare and creating individualized care plans so every patient can feel comfortable in the healthcare setting regardless of their sexual orientation or gender identity. All any patient wants is to feel heard, validated, and respected when seeking medical care, and it is our job to do our part and remain educated on the specific needs of the LGBTQ+ community.

Health disparities are the health differences experienced between different groups based on race, ethnicity, disability, sex/gender, socioeconomic status, educational level, and more. Unfortunately, the LGBTQ+ community is no exception to health disparities.

Health differences in the LGBTQ+ community can include how many people contract a specific disease, how severe the condition becomes, the complications associated with the disease, how many people die from an illness, access to healthcare, and how many people can access preventative health screenings.

Health disparities within the LGBTQ+ community can affect every aspect of a person's life, including physical and mental health. As healthcare providers, we are responsible for identifying health disparities and continually working toward bridging these gaps so every person can receive quality healthcare and routine health screenings.

Barriers to Healthcare in the LGBTQ+ Community

Research has revealed that LGBTQ+ individuals are less likely to have access to quality healthcare for a variety of reasons, including

• A lack of inclusive and competent healthcare providers with knowledge of LGBTQ+ health and health issues affecting transgender persons.
• The concern of stigma or discrimination from healthcare providers
• Prior negative experiences from LGBTQ+ persons
• The financial burden of affording health insurance or paying out of pocket for care
• Being refused care due to sexual orientation, gender identity, or gender presentation

Regardless of the reason behind healthcare barriers within the LGBTQ+ population, there are several health disparities that healthcare workers must educate themselves upon to help better serve the community. Here are some of the most prominent health conditions affecting LGBTQ+ people and what you can do to help better serve your patients.

Sexually Transmitted Infections (STIs)

Gay, bisexual, and other men who have sex with men are more affected by certain STIs, including HIV (human immunodeficiency virus) and HPV (human papillomavirus), than other individuals. Many people in the LGBTQ+ community hesitate to seek medical care due to the potential stigma and judgment they may receive about their lifestyle, which can lead to worse medical outcomes. As medical providers, we must create a safe, inclusive, and judgment-free space for people within the LGBTQ+ population to receive medical care.

To better serve the LGBTQ+ population, Nurses must educate themselves on the increased health risks of the LGBTQ+ community and ensure that every patient receives routine health screenings and health education. It can be difficult and embarrassing for any person to seek medical care for sexual health concerns or screenings, so it is essential to create a nonjudgmental, inclusive, and caring environment for patients to feel comfortable disclosing sexual information and receiving care.

Anxiety and Depression

It is estimated that up to 60% of the LGBTQ+ population deals with anxiety and depression at some point. Unfortunately, LGBTQ+ people experience worse mental health outcomes than other communities. Factors behind anxiety and depression in LGBTQ+ people can range from discrimination, bullying, lack of acceptance from friends and family, lack of representation in school and media, lack of inclusive language, and less access to community support.

As a healthcare professional, you can better support the well-being of the LGBTQ+ community by creating and welcoming a safe environment free of judgment and stigma. We can also work to provide better mental health services. The Trevor Project is a fantastic resource for LGBTQ+ patients struggling with anxiety and depression. The Trevor Project offers trained counselors who can be reached 24/7 by phone or text. Every counselor is trained to understand the unique challenges of the LGBTQ+ community, and every conversation is 100% free and confidential.

Drug and Alcohol Abuse

Statistics show that people within the LGBTQ+ community are twice as likely to suffer from drug and alcohol abuse than other populations. This is mainly attributed to the fact that the LGBTQ+ community faces discrimination, social stigmas, and a general lack of support despite the growing acceptance from strangers, acquaintances, friends, and family. Drugs and alcohol are often used as a coping mechanism for those struggling with anxiety, depression, and other insecurities.

To better support the LGBTQ+ community struggling with drug and alcohol abuse, healthcare providers can use motivational interviewing and screening tools to better identify individuals who may be struggling so we can better provide care and support. Furthermore, healthcare professionals should approach these situations with kindness and understanding while using inclusive language to help patients navigate recovery.

There are many resources available to the LGBTQ+ community who are interested in living a sober life, including Gayandsober.org, where the LGBTQ+ community can connect with other LGBTQ+ people living a sober life, and Inspire Recovery, where the LGBTQ+ community can seek resources to achieve and maintain sobriety.  

Be an Advocate

Everyone, regardless of their age, gender, sexual orientation, or race, should receive competent, compassionate, and inclusive medical care. As Nurses, we must always advocate for our patients and strive to provide every person with the best possible care. To help reduce health disparities in the LGBTQ+ community, Nurses should educate themselves on how to care for people within the community and advocate for health screenings and competent medical care for every individual.  

To learn more about how Nurses can better serve the LGBTQ+ community, consider checking out these resources.

Center for Disease Control and Prevention: LGBTQ Health Services

Nurses(Heale)

GLMA: Health Professionals Advancing LGBTQ Equality

U.S Department of Health and Human Services

LGBTQ+ health is a growing national concern due to increasing evidence of health care disparities experienced by the LGBTQ+ community.

LGBTQ+ people face many barriers within health care, including discrimination, ignorance, and fear. So it can be difficult for these patients to confide in and trust healthcare providers. However, there are things that can be done to make patients feel more comfortable.

According to a Johns Hopkins Nursing article by Alex Nava, small but powerful expressions of affirmation and acceptance of support like wearing a rainbow pin, tells the patient that you see them and they are welcome there.

Increasing your knowledge of LGBTQ+ health can help you provide more culturally sensitive care. There is plenty of educational content out there like the field guide published by the Joint Commission called, Advancing Effective Communication, Cultural Competency and Patient and Family-Centered Care for the LGBTQ+ Community. Healthy People 2020 is another great resource to check out.

You should be aware of using terms correctly and avoiding others that may offend someone. DiversityNursing.com offers a great glossary of terms to help you!

According to Nurse.org, a LGBTQ+ patient may “scan” an environment to determine if it is a safe place to reveal personal information. To make patients feel more at ease, they recommend your reception or waiting room area include:

• A visible nondiscrimination policy
• A rainbow flag, pink triangle, or other symbols 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

Your health organization should also use gender-inclusive medical forms.

You should ask the patient what pronouns they use. It is also important that you correct other staff members who may address the patient incorrectly, even when the patient isn't around.

Ask open-ended questions such as “Tell me about yourself? Are you involved in a relationship?” But don't assume anything, let the information they share guide the rest of your interview.

According to the Hospital for Special Surgery (HSS), you should be aware of issues particular to, or different for, the LGBTQ+ population such as:

• Coming out
• Having children—reproduction or adoption
• Parenting and creating families
• Adolescence
• Aging
• Legal rights as parents and partners

Patients often feel better talking to someone they can relate to. Hiring members of the LGBTQ+ community as part of your staff is great for patients and the organization. These team members can become mentors for others.

We as Nurses can help LGBTQ+ patients feel safe and supported by implementing these suggestions.

LGBTQ+ people of all ages, races and ethnicities, religions, and social classes have experienced health inequalities.

According to the Office of Disease Prevention and Health Promotion (ODPHP) and healthypeople.gov, research suggests that LGBTQ+ individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBTQ+ persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBTQ+ individuals, and have long-lasting effects on the individual and the community. Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBTQ+ individuals.

It is difficult to estimate the number of LGBTQ+ individuals and their health needs because most national or State surveys do not include sexual orientation and gender identity questions.

In order to document, understand, and address the environmental factors that contribute to health disparities in LGBTQ+ communities, we need to increase the number of nationally-representative health-related surveys that collect information on sexual orientation and gender identity (SOGI). This will allow researchers and policy makers to accurately characterize LGBTQ+ health and disparities.

The ODPHP and healthypeople.org research has found,

• LGBTQ+ youth are 2 to 3 times more likely to attempt suicide.
• LGBTQ+ 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.
• LGBTQ+ populations have the highest rates of tobacco, alcohol, and other drug use.

According to the Aging with Pride: National Health, Aging, and Sexuality/Gender Study, about 2.7 million U.S. adults 50 and older identify as LGBTQ+, including 1.1 million age 65 and older. Those numbers are expected to nearly double by 2060.

And among subgroups within the LGBTQ+ community, some are struggling with their health more than others:

• Both Hispanic and African-American LGBTQ+ older adults in the project are more likely to report having HIV than their white counterparts.
• Hispanic LGBTQ+ adults are more likely to report asthma, diabetes and visual impairment.
• African-American LGBTQ+ older adults are more likely to be obese and have high blood pressure.
• Native American LGBTQ+ older adults are less likely to report cancer than whites but more likely to report poor physical health, disability, obesity, asthma and cardiovascular disease.
• Asian/Pacific Islander LGBTQ+ older adults are more likely to have visual impairment.

Along with collecting SOGI information in national surveys and health records, other efforts needed to improve LGBTQ+ health disparities include,

• Better access to health insurance, employment, and housing
• More laws protecting against bullying in schools
• More social programs targeted to and/or appropriate for LGBTQ+ youth, adults, and elders
• Better access to health care providers who are knowledgeable and culturally competent in LGBTQ+ health
• Prevention of violence and homicide toward the LGBTQ+ community, and especially the transgender population

It is necessary that efforts are enhanced to improve LGBTQ+ health and eliminate disparities so LGBTQ+ individuals can lead long, healthy lives.

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.