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How to care for the LGBTQ community’s health issues
Discrimination and difficulty accessing healthcare are big challenges
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By Linda Childers
EDITOR'S NOTE: Linda Childers is a freelance writer.
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.
And as chairman of the national Gay and Lesbian Medical Association nursing group, Johnson often helps to develop sensitivity training for nurses and other health professionals who want to learn how to better serve lesbian, gay, bisexual, transgender and queer patients. “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 be open up because they fear they may be treated badly or even refused care. “It’s important for nurses and other staff to know how to ask sensitive, respectful questions that can give them an increased knowledge of each patient’s health risks.”

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“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 be open up because they fear they may be treated badly or even refused care.” — Michael Johnson, RN

Organizations strive for inclusivity and sensitivity

The Human Rights Campaign, the nation’s largest LGBTQ civil rights organization, has found LGBTQ patients face a variety of barriers in accessing healthcare: A survey by Lambda Legal found that 56% of lesbian, gay and bisexual individuals report cases of serious discrimination, while 70% of transgender patients report serious discrimination. Rose Otero, RN-BC, nursing education manager at the Beatrice Renfield Department of Nursing Education, at Mount Sinai Hospital, said the medical center prides itself on being a non-discriminatory hospital.
Mount Sinai Hospital is one of seven hospitals that comprise Mount Sinai Health System in New York, which is regularly recognized in the annual Healthcare Equality Index report, the national LGBTQ benchmarking tool that evaluates healthcare facilities’ policies and practices related to the equity and inclusion of LGBTQ patients, visitors and their employees. The report, published by the Human Rights Campaign Foundation, rates healthcare facilities that have gone beyond offering seminars on providing inclusive care to LGBTQ patients, and have made intensive training part of their culture. She frequently speaks at orientations and has led inservices on how to address LGBTQ patients using correct terminology and proper pronouns and how to approach patients with a non-judgmental attitude and an open mind. “When I first meet a patient, I’ll introduce myself and say, “And you are? How would you like me to address you?” Otero said. “I start out by trying to learn the chosen name and pronoun the patient prefers.” Otero also refrains from making assumptions about a patient’s family members, asking “Do you have a partner?” rather than “Are you married?” or assuming a woman who accompanies another woman to the hospital is her sister or friend. With Mount Sinai’s Center for Transgender Medicine and Surgery, one of the first centers of its kind in the country, Otero said everyone, including nurses, security, admitting and food service staff, has attended the inservice. “Some patients who haven’t fully transitioned may want to be addressed by a name other than the one on their medical records,” Otero said. “We tell staff to be respectful and to keep any biases they may have to themselves.”
Johnson said he’s often asked why nurses and other healthcare staff need to undergo sensitivity training if they treat all patients equally. “Members of LGBTQ communities are more likely than heterosexual patients to experience difficulty accessing healthcare,” Johnson said, adding that they have a harder time finding LGBTQ providers, revealing their sexuality or gender identity to their provider. “In addition, there are other health indicators and diseases that can disproportionately affect the LGBTQ community.” For instance, according to the CDC, gay and bisexual African-American men are disproportionately affected by HIV/AIDS. Also, according to the American Cancer Society’s website, lesbians are at a slightly higher risk of developing breast cancer than heterosexual women. “Creating an inclusive environment allows providers to work with patients to create an appropriate and individualized care and treatment plan,” Johnson said.

Organizations strive for inclusivity and sensitivity

While some progress has been made in making care for LGBTQ patients more welcoming and accessible, Patti Zuzelo, EdD, RN, ACNS-BC, ANP-BC, CRNP, FAAN, a clinical professor of nursing in the College of Nursing and Health Professions at Drexel University in Philadelphia, said the healthcare field is still not as inclusive as it needs to be. Zuzelo, who has spoken on institutionalized heterosexism in healthcare, said nurses are in a position where they can help inspire change. “There’s still an underlying assumption in healthcare that everyone is heterosexual,” Zuzelo said. “This isn’t a topic that is typically covered in medical or nursing school, and many people who work in healthcare just aren’t aware these disparities exist.” Organizations such as HRC and its Healthcare Equality Index can help with training and best practices such as making changes to electronic medical records and hospital paperwork to incorporate sexual orientation and gender identity and criteria that hospitals can use to become equality leaders. “The most important thing for nurses to remember is not to have any preconceived notions about their patients,” Zuzelo said. “There are tons of learning modules and resources available to help nurses to become more informed about the unique healthcare issues faced by LGBTQ patients, and to ensure that all of their patients receive the same quality care.”
Michael Johnson, RN, right, is pictured with his husband Matthew Roell and their son Mason Roell-Johnson.

Learn more about LGBTQ health issues

For nurses who want to educate themselves further about LGBTQ health topics, the following resources can help: The non-profit, SAGE, advocacy and service for LGBT elders, offers cultural competency training for staff at nursing homes and others who care for seniors. They also have downloadable guides on creating an inclusive environment for LGBTQ seniors. The U.S. Department of Health and Human Services offers the free downloadable guide, “Top Health Issues for LGBT Populations Information and Resource Kit”. The National LGBT Health Center, a program of the Fenway Institute, offers a free downloadable guide, “Understanding the Health Needs of LGBT People”.
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