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
Opening the Door
canoehead, BSN, RN
6,909 Posts
We are bound to step in it and be politically incorrect as society changes. Just apologize, explain and start again.
I had to ask committed lesbian partners for pregnancy tests...that took some tap dancing. I said that things happen in a relationship that the health care team isn't privy to, so we've chosen to ask everyone for a pregnancy test since its essential for safety.
I've also been stuck awkwardly as to who was the partner, or preferred sex. Just ask. I think prefacing with "I just want to clarify...or I'm a little mixed up, so you are?"
If you have to ask about specifics, "I'd like to know...because it affects..." or "If x is part of your life, then y can happen. Do you need more information?" Honestly, I'd even go so far as saying "this feels awkward, but its important for your health, lets talk." and then jump right in. A little blushing could be forgiven, and if you can get the patient to laugh with you, its all good.
I've never come across a straight up jerk dealing with these issues, as a group they seem more forgiving, maybe because they've been ostracized for so long. Well, that's a lie; if you're dealing with a jerk, they show their jerk colors about everything, its not a sexuality issue. And we've got lots of experience with that.