Transcript Caring for the LGBTQ client and family


The goal of this module is to help
prepare future nurse leaders to
sensitively assess and care for persons of
the LGBTQ community.
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It is essential for nurses
to provide safe,
compassionate, and
unequivocal
holistic care to all.
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L= Lesbian--As an adjective, used to refer to female
same-sex attraction and sexual behavior; as a noun,
used as a sexual orientation identity label by women
whose sexual attractions and behaviors are
exclusively or mainly directed to other women. (Joint
Commission, p.88)
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G= Gay-- An attraction and/or behavior focused
exclusively or mainly on members of the same sex or
gender identity; a personal or social identity based
on one’s same-sex attractions and membership in a
sexual-minority community (Joint Commission, p.88)
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B= Bisexual--One whose sexual or romantic
attractions and behaviors are directed at both sexes
to a significant degree (Joint Commission, p.87)
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T= Transgender--People whose gender identity or
gender expression differ from their birth sex or
prevailing ideas of masculinity and femininity (Joint
Commission, p.91)
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T=Transsexual—people who live as a sex not
associated with their birth sex, after a process known
as transitioning (Joint Commission, p.91)
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Q= Questioning—A person, often an adolescent, who
has questions about his or her sexual orientation or
gender identity. (Joint Commission, p. 90)
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Q= Queer --In contemporary usage, queer refers to an
inclusive unifying sociopolitical, self-affirming umbrella
term for people who are gay, lesbian, bisexual,
pansexual, transgender, transsexual, intersexual,
gender queer, or any other nonheterosexual sexuality,
sexual anatomy, gender identity. (Joint Commission, p. 90)
Definitions (cont’d)
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Heterosexual= individuals who identify as
“heterosexual” or “straight” or whose sexual or
romantic attractions and behaviors focus
exclusively or mainly on members of the other sex
or gender identity. (Joint Commission, p.89
)
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Homosexual= As an adjective, used to refer to samesex attraction, sexual behavior, or sexual orientation
identity. This term is considered outdated and
derogatory by many in the LGBT community (Joint
Commission, p.89).
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GNC= Gender-nonconforming refers to individuals
whose external manifestation of their gender identity
does not conform to society’s expectations of
gender roles (Lambda Legal’s Health Care Fairness Survey, 2014)
It is a mandate to conduct culturally
sensitive research to better learn the
needs and perspectives of LGBT
individuals who enter the health care
arena.
 This Report recognized the difficulty in
fairly and confidentially getting results
that need to be obtained to better meet
the health needs of these populations.
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Looking at this graphic, you see how the LGBT community falls under each
category on the left, with priority research topics in the center leading to
better outcomes and culturally competent care on the right.
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“To treat me you have to know who I am”
› http://www.youtube.com/watch?v=NUhvJgx
gAac
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This is from the Trevor Project. It is a crisis
hotline for persons who have not come out to their
family members or are struggling with the
acceptance of their sexuality.
› http://www.youtube.com/watch?v=0RsTNzRVf
do
“Leaving aside issues related to HIV/AIDs, which are
many, some of the more striking findings are that LGB
youth (and likely ‘‘T’’ youth as well) commonly
experience suicidal ideation, suicide attempts, and
depression; their rates of cigarette smoking, alcohol
consumption and substance use are elevated; and
they are over-represented among the homeless.”

This statement on the increased morbidity and
mortality for young persons dealing with LGBT issues
further supports the need for nurses to be proactive in fostering preventative health interventions
for improved mental health and well-being in these
populations.
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Respect for the individual and his/her family. Fear
of implications with disclosure may interfere with a
patient’s willingness to share, e.g.:
› Transgender patients, therefore, have to
carefully consider two disparate scenarios: on
the one hand, failure to disclose transgender
status to a health care provider may potentially
lead to inappropriate or unsatisfactory care; on
the other hand, disclosure of this information
makes transgender people potentially more
susceptible to prejudice and, in some instances,
refusal of health care (Redfern & Sinclair, 2014, p. 28)
› Elders of the LGBT community have their own
struggles and health issues that need to be
tended to in a respectful way. Their numbers are
increasing and their vulnerability is evident in the
literature. (Lim & Bernstein, 2012)
› Families of LGBT parents are another community
in which respect for both parents is essential.
Children may be biological from previous
marriage, artificial insemination, or step or
adopted. Awareness of the parents’ orientation
will foster better communication and
individualization of care. (J.Burkholder & Burbank, 2012)
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Active Listening to learn important aspects of their
life. Strive to be inclusive in all assessments:
› "What name do you prefer to be called?"
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especially important for the transgender client
"Tell me about your support system."
"Do you have a partner?"
"Do you feel safe from everyone in your support
system or family?"
“Does anyone verbally or physically abuse
you?"
"Who are you comfortable with sharing
information about your health in your support
system?"
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Presence as an intervention is important in
establishing trust. Nurses need to take time to
be present with the LGBT patient and family,
and not avoid them.
Understand and identify your biases so
that you can change your attitudes if
needed.
 Understand your own attitudes toward
LGBT issues.
 Try to learn about the laws in the state or
country in which you practice regarding
same sex marriage, adoption/foster
care, and partner adoption.
 If you don’t know, ask!
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Gather as much information as
necessary to understand as clearly as
possible the family composition and
specific requests by the family.
 Work with the hospitals, doctor’s offices,
and other health care staff to make the
setting friendly to all types of parents.
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What does the health reform mean for the
LGBT community?
› The ACA (Obamacare) means affordable
new coverage options, limits on discrimination
based on sexual orientation and gender
identity and coverage even if a person has a
preexisting condition. And those are only
some of the benefits. (http://www.glma.org/ )
The American Association of Colleges of
Nursing, and the Quality and Safety Education
for Nurses (QSEN) project
advocate for nurses to gain cultural
competence and to provide culturally
sensitive care to all people of various
spiritual/religious, cultural, and lifestyle
orientation.
“As the largest group of health providers in
the United States, and by virtue of their scope
of practice,
nurses are in a position to bridge health
disparities and provide culturally sensitive
care across the lifespan.” (Lim & Bernstein, 2012, p. 174)
This is our challenge and our goal
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The Fenway Institute—The National LGBT Health
Education Center
The Gay and Lesbian Medical Association–
health professionals advancing LGBT equality
› Guidelines for Caring for LGBT patients
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The Joint Commission:
› Advancing Effective Communication, Cultural
Competence, and Patient and Family Centered
Care for the Lesbian, Gay, Bisexual, and
Transgender (LGBT) Community: A Field Guide.
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Healthy People 2020—LGBT Health
Caring for LGBT Patients—a resource from Univ
of Michigan. Great “how to” on questions that
need to be asked.
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American Association of Colleges of Nursing (2008). Tool kit of resources
for cultural competent education for baccalaureate nurses. Retrieved
from http://www.aacn.nche.edu/education-resources/toolkit.pdf
Anastas, J.W. (2013). Policy, practice and people: current issues
affecting clinical practice. Clinical Social Work Journal. 41. pp. 302–307
DOI 10.1007/s10615-013-0454-1
J. Burkholder, G., & Burbank, P. (2012). Caring for lesbian, gay, bisexual,
and transsexual parents and their children. International Journal Of
Childbirth Education, 27(4), 12-18.
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and
transgender people: Building a foundation for better understanding.
Washington, DC: The National Academies Press.
Lim, F. A., & Bernstein, I. (2012). Promoting awareness of LGBT Issues in
aging in a Baccalaureate nursing program. Nursing Education
Perspectives, 33(3), 170-175. doi:10.5480/1536-5026-33.3.170
Redfern, J.S. & Sinclair, B. (2014). Improving health care encounters and
communication with transgender patients. Journal of Communication
in Healthcare, 7(1), 25-40. doi:10.1179/1753807614Y.0000000045
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Rounds, K. E., Burns McGrath, B. , & Walsh, E. (2013).
Perspectives on provider behaviors: A qualitative study of
sexual and gender minorities regarding quality of care.
Contemporary Nurse, 44 (1). Pp. 99-110.
The Joint Commission. (2011). Advancing effective
communication, cultural competence, and patient and
family centered care for the lesbian, gay, bisexual, and
transgender (LGBT) community: A field guide. Retrieved from
http://www.jointcommission.org/lgbt/
When Health Care Isn’t Caring: Transgender and Gendernonconforming People: Results from Lambda Legal’s Health
Care Fairness Survey. Retrieved from:
http://www.lambdalegal.org/sites/default/files/publications/
downloads/whcic-insert_transgender-and-gendernonconforming-people.pdf