Caring for LGBTQ People
The LGBTQ community has often been sidelined by the nursing profession. Shattell and Chinn (2014) identified that nursing organizations have often failed to speak out in support of LGBQ issues. Furthermore, the LGBTQ community has also been sidelined in nursing research as only 0.16 percent of articles published in the 10 top nursing journals within a five-year period focused on LGBTQ health. Shattell and Chinn (2014) hypothesized that the limited academic interest accorded to this community might result from the prevailing conservative and heterosexist ideologies in the society. While many healthcare professionals may opt to treat the LGBTQ community at the same level with the rest of society, the reality is that this community is faced with high levels of health issues than the rest of society. Willging, Green, and Ramon (2016) reported that the LGBTQ community is exposed to risk factors such as not feeling safe in their communities, depression, inadequate social support, and substance abuse which increase their risk for suicide. Furthermore, these risks are further enhanced in LGBTQ individuals who are also racial and ethnic minorities. Furthermore, the high levels of harassment, victimization, sexual abuse, and violence that this community experiences also puts them at increased risk of developing mental health problems (Willging et al., 2016). Presently, mental health nurses have exhibited more progressiveness in LGBTQ health issues. However, since nurses in all areas of clinical specialty encounter LGBT people, there is a need for progressives across all nursing specialties to ensure that this community is able to receive quality, culturally competent care (Shattell & Chinn, 2014). According to Willging et al. (2016), the Institute of Medicine recommended that nurses in the United States should play an integral role in redesigning healthcare within the scope of their training and education. Therefore, nurses have a crucial role to play in improving care for LGBTQ communities. In order to develop quality, culturally competent care for the LGBTQ community, nurses require to adhere to values and ethical practices that enhanced their quality of care and also work towards resolving any disconnects related to the nursing role in this context.
Nurses require to possess certain values to enable them to deliver competent care to LGBTQ individuals. Landry (2017) identified that many LGBTQ people have challenges finding health care in settings where they do not fear discrimination, are accepted, and are understood.
However, many health care professionals are unable to deliver inclusive care due to lack of knowledge and experience relating to this community. It is essential for the health care provider to understand how the experiences of LGBTQ people with other people and their identities could potentially affect their health. The National LGBT Health Education Center: Fenway Institute recommended that health care providers should keep realistic expectations with communication (Landry, 2017). Some of the strategies that can be employed to improve basic communication include using preferred names and pronouns as well as avoiding assumptions and stereotypes.
Furthermore, the provider should politely ask the patient how they prefer to be addressed if they are unsure and then communicate this information to their coworkers. Therefore, an inclusive environment will be created in the organization when all staff address the patient as per their preference. Another value that nurses should possess is being open and nonjudgement. Landry (2017) identified that this value could be achieved through best practices that include asking patients general and open-ended questions rather than questions which require specific answers that may end up excluding individuals not considered to be mainstream. It is highly important for the health care provider to form a trusting relationship with the patient that will enable them to elicit honest answers from LGBTQ individuals as this knowledge will play an integral role in promoting culturally sensitive care, improving health outcomes, and reducing health disparities.
While possessing certain values is essential to delivering competent healthcare to LGBTQ patients, there are various ethical issues which nurses face in their delivery of care to this community. Lodha and De Sousa (2018) identified that one of the ethical issues facing nurses relates to the issue of autonomy. This issue is especially prevalent in health care workers dealing with transsexual patients as the patient’s identification may differ from their self-identification. Failing to respect the patient’s self-identification may result in negative outcomes for the patient. Lodha and De Sousa (2018) identified that it is essential for providers to include LGBTQ patients while making healthcare decisions through the principle of informed consent. Another ethical issue is that of non-maleficence. Healthcare providers often have gaps in their knowledge regarding the LGBTQ community, and these gaps may lead to them causing unintended harm to the patients such as by making them feel alienated from the healthcare system through stereotyping. Lodha and De Sousa (2018) also identified another ethical issue as being the lack of justice towards the LGBTQ community. The principle of justice affirms that these individuals are entitled to failure distributed healthcare resources. However, the reality is that some LGBTQ communities such as transgender patients have limited access to health services as they are less likely to have health insurance. Finally, Lodha and De Sousa (2018) identified that LGBTQ communities are disadvantaged by the scarcity in mental health providers who have specialized in mental health care that is supportive, aware, and respectful of the life experiences of people in these communities. Access to these professionals is often seen as a gateway to accessing other professionals such as legal experts and surgeons. However, if a CARING FOR LGBTQ PEOPLE 5
patient feels that the healthcare professional does not possess this expertise, they will be highly cautious in their initial appointments, and this caution will diminish their ability to gain competent healthcare. Consequently, it is essential for these ethical issues to be resolved to enhance healthcare delivery to these communities.
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The role of nurses in providing competent care to the LGBTQ community can be greatly improved from its present status. Stewart and O’Reilly (2017) reported that six percent of nurses were not confident responding to the needs of LGBTQ patients while 21 percent of nurses did not feel confident in meeting specific care needs of transgendered patients. The lack of confidence was attributed to the lack of education and knowledge to address the needs of patients in these communities. In fact, Stewart and O’Reilly (2017) reported that many patients identified that they were denied screenings such as cervical smear tests or were given inaccurate information regarding their health concerns. The lack of sufficient knowledge and skills can be linked to the lack of integration of information specific to the LGBTQ population into healthcare policy of undergraduate curricula. Furthermore, this information was also rarely integrated into opportunities and training for continuous professional development. Stewart and O’Reilly (2017) identified that 11 percent of staff responsible for patient care had been educated on the health requirements of LGBTQ patients, and among these staff, only half were trained on sexual health needs. The impact of this disconnect is that LGBTQ patients find themselves spending a significant amount of time educating their health providers rather than receiving care. This situation is especially frustrating from individuals with lesser-known identities as they may end up feeling that they might not be getting value for their rime and/or money. Stewart and O’Reilly (2017) reported that this problem was also prevalent in Gender Identity Clinics where up to 10 percent of the patients identified that they had to educate their healthcare providers at some point. Consequently, in order to bridge this disconnect, there is a need to provide sufficient training opportunities to nurses to ensure that they have the knowledge and confidence that will enable them to competently care for their LGBTQ patients.
As a nurse, I expect that I should be able to offer quality, culturally competent care to all individuals. However, learning the realities of the quality of nursing care that LGBTQ patients receive is disheartening. This sentiment results from the fact that individuals in these communities are already at a heightened risk of greater negative outcomes than the general population, such as a high risk for mental health problems and suicide. Nurses, therefore, require to possess certain values when caring for LGBTQ patients especially in terms of their communication with them. There is a needs to create an environment of inclusivity in the healthcare setting to enhance the positive healthcare outcomes for this community. Furthermore, there is a need to resolve some of the ethical issues that have been contributing to the negative experiences that LGBTQ patients have while trying to access healthcare. These issues include the patient’s autonomy and the disproportionate access to care that these communities experience. Furthermore, there is a need to resolve issues stemming from the limited knowledge regarding the LGBTQ that nurses have. This limited knowledge contributed to the nurses feeling that they are not competent to provide care to these communities. Moreover, since the nurses tend to spend a significant amount of time learning from the individuals, they have less time to focus on providing adequate care.
Due to the disparities experienced by the LGBTQ community in accessing adequate healthcare, I am interested in specializing in providing care to these communities as a registered nurse in future. I will also seek to contribute to the quality of care provided to them by engaging in research that seeks to improve the provision of care to the LGBTQ community.
References
Landry, J. (2017). Delivering culturally sensitive care to LGBTQI patients. The Journal for Nurse Practitioners, 13(5), 342-347. doi: 10.1016/j.nurpra.2016.12.015
Lodha, P. & De Sousa, A. (2018). Ethical issues in the treatment of transsexual patients. Global Bioethics Inquiry, 6(1), 13-18.
Shattell, M. M. & Chinn, P. L. (2014). Nursing silent on LGBT Q health: Rebel Nurses provide hope. Archives of Psychiatric Nursing, 28, 76-77. doi: 10.1016/j.apnu.2013.11.002 Stewart, K. & O’Reilly, P. (2017). Exploring the attitudes, knowledge and beliefs of nurses and midwives of the healthcare needs of the LGBTQ population: An integrative review.
Nurse Education Today, 53, 67-77. doi: 10.1016/j.nedt.2017.04.008
Willging, C. E., Green, A. E., & Ramos, M. M. (2016). Implementing school nursing strategies to reduce LGBTQ adolescent suicide: A randomized cluster trial study protocol.
Implementation Science, 11, 1-11. doi: 10.1186/s13012-016-0507-2
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