Lesbian, Gay, Bisexual, Transgender and Queer biases in Obstetric Nursing curricula

classicdame, MSN, EdD · Apr 28, 2011

I think the study is feasible. I also think people who make judgments like you mentioned are stupid. Basically, anyone who is "different" is a small threat to my ego because I might say or do the wrong thing then be embarrassed. But I am old enough now to realize that we are all different and embrace that wonderful quality in all God's creatures!

chiandre · May 1, 2011

Thank you classicdame. I hope to contribute to the care of this population. It is shocking that in the year 2011, people are still negative about diversity. I know that this issue is not very popular among many people, but it has to be addressed. To be able to provide evidenced based, culturally congrugent care, nurses have to start talking about this issue. Thanks again for your input.

JaneyW · May 2, 2011

I agree that this needs to be addressed and encourage you in your research. I have to say, though, that I don't agree that it is always a matter of education. A nurse's religion may make it impossible for them to see this population in any other terms than those you quoted in your original post. Where the education needs to be is in reminding nurses to leave their personal biases at the door when providing caring and competent patient care. I don't have those biases and am appalled by that nurse, but I don't think it is unusual depending on the culture/religious persuasion of the region where you practice. I teach both fundamentals and maternal child and I start them thinking about this sort of thing in fundamentals and revisit it in maternal child when speaking about providing care to those you may not agree with/feel comfortable with. Everyone deserves our best regardless of how we feel about their religion, sexual orientation, skin color, drug habit, whatever.

What I would like is more resources on how to provide sensitive care to this population, about what sort of special needs they may have and also about how I can educate my students toward that. I'm glad you are going to contribute to the body of knowledge!

SheaTab · May 2, 2011

This is excellent! I'll never forget one particular lecture during my first nursing program (2003). My instructor was a middle-aged ex-military woman who was teaching psych. We were going through various chapters in the book and when we reached the small section on the GLBT community she said, "we all know how we feel about this so let's move on." and, that was the end of that. I was particularly insulted and made my concerns known to all involved. I hope they have since chosen to include some education since many nurses don't seem to work well with that population. THe fact is, it really doesn't matter how we "feel" about it. It isn't just nurses as I've seen it from physicians in the emergency room as well. I've worked in L&D and I've heard nurses call lesbian patients dykes and have seen more than my fair share of eye-rolling. I have seen a lesbian OB run (essentially) out of an OB unit because the nurses created a hostile environment for her. I can't count the times that I heard, "I wouldn't want a lesbian delivering my baby!" Why? But you wouldn't mind a male OB? It's as if many just can't see past the sexuality and see the person.

Since then, I have completed master's and have had the great pleasure of teaching ADN nurses myself. It never ceases to amaze me when I hear students make comments about patients based on weight, race, gender-identity, etc. I always ALWAYS include a heartfelt message to them about this. We are here to provide you with the very best possible care ... Whatever package you come in and whatever your needs may be. All of us would hate to think that our medical providers were making jokes about our habitus or lifestyle.

How were you thinking of designing your study?

jmqphd · May 4, 2011

I agree that this needs to be addressed and encourage you in your research. I have to say, though, that I don't agree that it is always a matter of education. A nurse's religion may make it impossible for them to see this population in any other terms than those you quoted in your original post. Where the education needs to be is in reminding nurses to leave their personal biases at the door when providing caring and competent patient care.

I am slightly perturbed by these comments. Upon what data are you basing your assumption that "religious" nurses might not be able to care for any class of patient? Do you have evidence for this? Or is this a bias of yours? Which religion is hazardous to nurses' thought processes? Is it all religions?

Based upon what I read, I have to wonder if it is possible for Janey to give compassionate care to conservative Christian (or Muslim, or Orthodox Jewish) patients? Would she try to be open minded about interacting with them, tolerating their perspectives, understanding a bit about their doctrines, listening to them when they preface their health behaviors on some scripture passage and on and on and on. And if I were Janey's colleague, could I be sure that she would tolerate me if I were "out of the closet" with my religious beliefs (assuming I am performing on a professional level)? Does Janey have a repertoire of therapeutic responses to patients who view the world as sinful and in need of redemption? How many nurses think deeply about patients' spiritual needs. Do they have a good working relationship with their hospital chaplains or even know how to contact them when needed?

And... I wonder when a doctoral student will research and write a dissertation on non-constructive biases toward conservative/Orthodox religious nursing students and practicing nurses?

Forgive me, I didn't mean to hijack the discussion. But if you are interested in tolerance, you need to think broadly. I endorse the OP and her research and think it could be an excellent contribution to our EBP. But be careful... you can't measure your multicultural credentials by how much you reject one (formerly dominant) culture over another.

Whispera, MSN, RN · May 4, 2011

jmq, I think you misread Janey's posting. She didn't say it wouldn't be possible for someone to give compassionate care. She said it might be impossible for someone to know another person's lifestyle/culture without feeling bias toward him or her. Feeling a bias doesn't mean one acts on it. Everyone has biases. It's good to recognize them so we don't let them lead us to do something inappropriate.

chiandre · May 4, 2011

In our society today, many people are grappling with this issue. I agree with Janey that it may not just be about education. However, we need to address this issue in nursing. Other healthcare providers are slowly integrating this issue in their curricula, but nursing is barely addressing it. I always teach my students that to be able to provide care to any group or any culture, we have to do exactly what Whispera noted above, we have to critically reflect and accept our own biases. That way, we will be able to provide care objectively.

jmqphd · May 5, 2011

jmq, I think you misread Janey's posting. She didn't say it wouldn't be possible for someone to give compassionate care. She said it might be impossible for someone to know another person's lifestyle/culture without feeling bias toward him or her. Feeling a bias doesn't mean one acts on it. Everyone has biases. It's good to recognize them so we don't let them lead us to do something inappropriate.

I reread Janey's quote and am not interpreting it quite like you do. I would appreciate her clearing up my misunderstanding. Several responders have alluded to religion as an obstacle to understanding and dealing sympathetically with LGBT patients. People here seem to be saying that those poor, ignorant religious types just can't be educated away from their biases by enlightened nursing faculty.

Maybe the take home message here is that we are all biased. The skill we are seeking to perfect in ourselves and teach to our students is exactly what Whispera mentioned. My beliefs (and those of any of my students) are valuable, and are legitimate guides for behavior. But we strive to teach students that these are our beliefs, not necessarily those of our patients. And as Whispera said, sometimes we implement nursing actions because they are the right ones... proven by evidence based research... not because they are the ones we "feel" like implementing.

Interestingly, today was a big teaching unit on the Immune system. As part of that we showed a video of Dr. Anthony Fouci of NIAID discussing poverty, racism and homophobia and the effect they have on screening and long-term, consistent treatment for HIV infected patients. We had a great discussion with several students participating. So... we try to teach to cultural issues as much as our accelerated curriculum permits. If we fail to do it as well as we would like, it's only because of the huge crush of material we have to teach. Not because we don't value the needs of a particular minority.

chiandre · May 6, 2011

My pastor preaches against this issue and other issues such as abortion, etc. however, as a born again christian, a nurse and a scholar/practitioner, I have my own beliefs. At first, I was against homosexuality because of my religious upbringing. However, as I continue to interact with the LGBTQ members at work as an obstetrics nurse and as a nursing faculty, I have changed my mind about them.

Do not get me wrong, I believe that everybody has a right to his or her own opinions and values. As for me, a person is a person notwithstanding their culture, race, sexual orientation, etc. TheLGBTQ members that I meet have the same dreams, ambitions, worries, and struggles. I have started IVs on some of them and they actually have the same red blood. I have seen them rejoice, cry, and worry. Their culture is not always about sex. They are dads, moms, daughters, sons, nurses, students, pastors, born-again christians, doctors, taxpayers, neighbors, etc

I understand that we are always cautious about people that are different from us. The onus is on us to overcome our biases so that we can provide an objective and caring care to our patients.

jmqphd · May 7, 2011

I don't see any conflict at all in an authentic, orthodox Christian giving the best possible nursing care to LGBT patients. If we shunned patients whose behavior was contrary to God's standards... we basically wouldn't take care of anyone. I believe Christians should be the most tolerant people in the world, since they have an awareness of their own position as sinners before a Holy God. If we receive mercy, should we not show it to others?

I guess that's why I am flummoxed about why there is discussion about "religion" being a source of invincible ignorance and bias against LGBT's.

THe Christian religion has some intellectually consistent doctrines about sexual sin. The church calls sexual behavior outside of marriage to be sin. So the LGBT community is a bunch of sinners. Just like the folks in my church pews. Just like I am.

Sorry... I don't see the problem for LGBT cared for by a devout Christian.

Mission · May 9, 2011

To OP:

I think this study sounds fascinating. Maybe also a preliminary study with GLBT parents about their perceptions of care they received? KUP on your findings.

Mission