LGBTQ Patient Care?

**traumaRUs**, MSN, APRN

As our communities continue to diversify many of our patients now have the freedom to express who they are. This can impact the care we provide and in order to be sensitive to this, first we need to review some of the terminology. The acronym LGBTQA can be defined as:

Lesbian (adj., noun) - A sexual orientation that describes a woman who is emotionally and sexually attracted to other women.

Gay (adj.) - A sexual orientation that describes a person who is emotionally and sexually attracted to people of their own gender. It can be used regardless of gender identity, but is more commonly used to describe men.

Bisexual( (adj.) - A sexual orientation that describes a person who is emotionally and sexually attracted to people of their own gender and people of other genders.

Transgender (adj.) - Describes a person whose gender identity and assigned sex a birth do not correspond. Also used as an umbrella term to include gender identities outside of male and female. Sometimes abbreviated as trans.

Questioning (adj.) - Describes an individual who is unsure about or is exploring their own sexual orientation and/or gender identity.

Ally (noun) - A person who supports and stands up for the rights of LGBT people.

There are many other acronyms used in this community and here is a resource for healthcare providers.

AN had a recent opportunity to discuss this issue with Justin Milici, MSN, RN, CEN, CPEN,TCRN, CCRN, FAEN who is an Emergency Nurses Association member who provided input on ENA's Topic Brief: Care of the Gender Expansive and Transgender Patient in the Emergency Care Setting.

Some transgender people do not use their birth names and are known as a different name. What suggestions do you have for nurses who may need to know their birth names and birth genders for insurance reasons, continuity of care or for some other legitimate reason?

This is a common situation. If the patient has legally changed their name and has the supporting identification documentation, the new name can be used. If they have not legally changed their name, then their birth name must be used. In this situation, I first ask the patient how he/she would like to be addressed. I then explain to them that there will be situations that legally require their birth name, such as lab draws, radiology and other procedures and consents. I explain that this is required not only for legal purposes but for their safety.

To "out" an LGBTQI patient could risk their safety not to mention their privacy. How should nurses ensure privacy of all patients?

Nurses need to ensure privacy for all patients regardless of the situation. If a patient identifies as transgender, this needs to be clearly documented in the medical record so that the members of the healthcare team are aware and can best care for the patient safely.

If a nurse inadvertently offends or uses the wrong pronoun, what would be the best way to handle this situation?

Using the wrong pronoun is not uncommon, especially if this is a new situation for the nurse. Just simply saying, "I'm sorry" and then using the correct pronoun is often enough.

Many hospitals are adopting different visiting policies aimed at LGBTQI patients and their families? How do you think a staff nurse could influence this policy?

The nurse can influence this policy by simply being a patient advocate. Having a policy that fosters family presence while ensuring the privacy, dignity, well-being and safety of the patient is the best policy

How can we deal with medical care disparities among the LGBTQ community members?

LGBTQ patients, especially transgender, often avoid emergency department care due to: 1. Fear of discrimination due to their transgender status, and 2. Have had one or more negative experiences in the ED due to discrimination, which includes being asked intrusive questions, often having nothing to do with why they came to the ED in the first place.

So, in conclusion here are some additional tips for healthcare providers when caring for ALL patients:

Be sensitive to patients. Ensure privacy when discussing private matters.
Don't ask for more information than that needed to care for the patient.
Within your facilities' policies allow the significant other visit and provide support.
Be respectful of same sex marriage and realize that this is may be a legal relationship in your state.

How does your facility provide LGBTQ sensitive care? Do you think you have enough education to provide care in these situations?

Other Resources:

Communication Best Practices

Improving the Healthcare of Lesbian, Gay, Bisexual, and Transgender People

O pening the Door

Bumex, DNP, NP · Dec 15, 2017

Interesting article traumaRUs. I am focusing my DNP research for LGBTQ healthcare as it is something I have been very passionate about.

cac18 · Dec 15, 2017

Thanks for posting this article! As a queer trans man, it's refreshing to see discussions on how to best meet the healthcare needs of my communities. One small thing though - "transgender people" is the term preferred over "transgendered people". I realize it's pedantic, but using the correct term does make a difference to transgender folks!

Rocknurse, MSN, APRN, NP · Dec 15, 2017

Thanks for the article. Lesbian nurse here...great to see our issues being addressed.

**SafetyNurse1968, ADN, BSN, MSN, PhD** · Dec 15, 2017

I love this article! I recently have been trained to teach Our Whole Lives (OWL) a human sexuality curriculum that goes from kindergarten to older adults. I have been teaching the adult OWL at my church, and the folks are really loving the chapter on sexual and gender identity. One thing I learned in my training that surprised me was the concept of Aesexuality. I hadn't realized there is a group of people out there who have no sexual feelings and they too need our support. I started imagining being a teenager, surrounded by all these hormonal peers, while you are feeling nothing and wondering "what is wrong with me?"NOTHING! I am so glad there is a growing wave of education out there - as nurses we are uniquely positioned to support patients/human beings; children through adults in our search for sexual and gender identity. THANK YOU!

audreysmagic, RN · Dec 15, 2017

Great article! Like msufan3710, I'm really passionate about this, and I'm lucky to work at a facility that really supports LGBTQ health - we have an entire program devoted to it. We're freestanding psych, but we're also involved with medical facilities in the area. As an out lesbian, I'm really proud (no pun intended) to be able to reach out to others in my community who need help in this way. (As an aside, if anyone here has burning questions about the LGBTQ community you're uncertain about asking publicly, feel free to DM me - as long as they're respectful, of course! I know at work, I've had several employees ask me about appropriate questions/terminology and I'd always rather they ask me first to be sure rather than risk alienating a patient!)

**traumaRUs, MSN, APRN** · Dec 15, 2017

Thanks for posting this article! As a queer trans man, it's refreshing to see discussions on how to best meet the healthcare needs of my communities. One small thing though - "transgender people" is the term preferred over "transgendered people". I realize it's pedantic, but using the correct term does make a difference to transgender folks!

Thanks for pointing this out. I have edited this

sunny time · Dec 16, 2017

the above information should be used whether patients are different or straight. treat everyone with respect, kindness and nonjudgemental. in Ca we have people from all walks in life, different religions, thoughts and beliefs. I have been here for so long I forget the conservative ways I grew up with in the Midwest. that doesn't mean I agree with the lifestyles, religions,etc. but I give people the leeway they need to live their life as they see fit.

BedsideNurse · Dec 16, 2017

I get that things are getting confusing, especially now that we've went from "you're born that way" to "you are whatever you say you are, and it's fluid." regarding orientation and gender, but I honestly doubt anyone--including grade schoolers--needs to have words like gay and bisexual defined. My kids are in high school and they've been inundated with gay and trans EDU near daily since about 4th grade. But even for the older nurses, unless they live under a rock, (and maybe even then), I think we all have that down. Just sayin.'

idkmybffjill · Dec 16, 2017

I'm not sure if it's just me, but all the links send me to gmail with a pop up that says, "The conversation that you requested no longer exists."

Either way, I definitely think it's good that more and more places are becoming more aware of lgbt issues. While there's a lot more people who know the basic terms and such, they don't always know how the best, most sensitive approach.

Here.I.Stand, BSN, RN · Dec 17, 2017

Maybe I live in a sufficiently diverse area, but since 2003 I've never observed a need for adjusted visiting policies... the pt's family/support system is is who the pt says they are.

In one case though, I got the feeling this woman had had trouble in the past. It was a lesbian couple in their 60s; the pt was going to the OR and her partner was on the cot in the pt's room. The partner asked me how to get to the OR waiting room from the unit. I hesitated -- because I'm severely directionally challenged and was trying to picture the route in my head, so that she didn't get lost. Not even 2 sec had elapsed, and she said "I'm her partner of 30 years, we are each other's POA..." like she thought I was hesitating based on their relationship.

Jedrnurse, BSN, RN · Dec 17, 2017

Same sex marriage is legal in ALL states. ("this may be a legal relationship in your state...?")

LGBTQ Patient Care?

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