No consideration for gay patients

[eric2123]

I go to nursing school in Indianapolis, IN and my school never discusses special considerations for homosexual patients. Many problems do have special considerations that would have to be taken into mind if the patient were a gay. I am gay and I think it is slightly offensive. I feel like the education that my school is providing will churn out the type of "professionals" that will perpetuate the discrimination against gay patients in the healthcare market in America. Does anyone have any thoughts?

[czyja, MSN, RN]

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I too am curious what these "special considerations" would be. What would we, as a nursing population, possibly offer to gays that we don't offer to straight people?

I don't think it is a matter of offering something different or "special" but rather offering the same thing (nursing care) in a culturally competent and sensitive way.

Part of cultural competence when dealing with LGBTGQ community looks like common sense to many of us. For example LGBTGQ people tend to have non-traditional families - so you might have two mommies and no daddy. The problem is that what seems like common sense to some is not obvious to all. Discussing these issues in nursing school should be useful to students that have not been exposed to the LGBTGQ community. I don't think it needs a semester long course, but addressing these issues within the broader context of cultural competence strikes me as useful.

Another issue is language. For example, most folks in the LGBTGQ community out here on the West Coast do not use the word "homosexual" to describe themselves. Many (including me) find it offensive as it is the preferred word of those opposed to legislation mandating the equal treatment of LGBTGQ. (It is sort of the equivalent of "negro" to my ears.) If an HCP used the word "homosexual" around me I would find another HCP. The problem is, when one is really sick and in need of nursing care one is usually not in a position to find another provider.

Pronouns can often be an issue for TG or otherwise Q people. Some nurses are understandably confused about which pronoun to use when dealing with TGQ clients. ("Well, is he a he or is he a she. Hmm, he has a member so he must be a he..."). But a person with a member may in fact self-identify as a female and prefer "she." This may sound like nit-picking but I assure it is not. When a nurse uses "she" (or "he") as preferred by the client, the nurse is in fact saying "I am working on your level. I do not judge you but respect you for who you are. You can trust me."

These are cultural issues. I think they are important issues.

[justme1972]

I don't think it is a matter of offering something different or "special" but rather offering the same thing (nursing care) in a culturally competent and sensitive way.

Part of cultural competence when dealing with LGBTGQ community looks like common sense to many of us. For example LGBTGQ people tend to have non-traditional families - so you might have two mommies and no daddy. The problem is that what seems like common sense to some is not obvious to all. Discussing these issues in nursing school should be useful to students that have not been exposed to the LGBTGQ community. I don't think it needs a semester long course, but addressing these issues within the broader context of cultural competence strikes me as useful.

Another issue is language. For example, most folks in the LGBTGQ community out here on the West Coast do not use the word "homosexual" to describe themselves. Many (including me) find it offensive as it is the preferred word of those opposed to legislation mandating the equal treatment of LGBTGQ. (It is sort of the equivalent of "negro" to my ears.) If an HCP used the word "homosexual" around me I would find another HCP. The problem is, when one is really sick and in need of nursing care one is usually not in a position to find another provider.

Pronouns can often be an issue for TG or otherwise Q people. Some nurses are understandably confused about which pronoun to use when dealing with TGQ clients. ("Well, is he a he or is he a she. Hmm, he has a member so he must be a he..."). But a person with a member may in fact self-identify as a female and prefer "she." This may sound like nit-picking but I assure it is not. When a nurse uses "she" (or "he") as preferred by the client, the nurse is in fact saying "I am working on your level. I do not judge you but respect you for who you are. You can trust me."

These are cultural issues. I think they are important issues.

I'll be honest, I think that if a gay person is offended at the term homosexual, they are being too sensitive.

To me, there is absolutely NO difference between calling someone straight versus a heterosexual. I would probably laugh if someone called me a heterosexual...it's a technical term, but grammatically correct.

I have done alot of volunteer work with the AIDS projects in my area for many years before I had children. I know I have been exposed to this population more than alot of people. However, the media in the last 10 years, even if someone was homophobic, would have to know something about the culture because there is simply no escaping it.

However, to me, common sense and manners should prevail.

Men and women who are going through a transgendered process (and yes, I know everyone doesn't elect to have the surgery), I have met those that were "in between" that I actually couldn't tell which direction they were going, and I have asked, "Please forgive me because I want to be able to address you properly....would you prefer to be called Mr. or Miss?"

I have NEVER had a single transgendered person to be offended by this question...in fact, they even thank me for being considerate enough to ask. Again, this falls under if they are going to get mad because 100% of others don't understand this subculture, then that falls into the catagory of being too sensitive.

Anyone that is gay or transgendered at minimum, knows that they are in the minority population....which is around 10% of the general population...and FOR this reason, special time is not taken out in nursing schools to address these issues.

Latin Americans are now the largest minority group....however, I didn't get anything special regarding this population in my studies and we have an extremely low LA population in my area.

I could write a book on the care and concerns of the gay population, but probably couldn't write you two paragraphs on Latin Americans.

To me, it's the same thing.

[Fiona59]

The more I read this, the more I see the OP having an agenda. Different terms over the years have been used to describe the homosexual community with gay only coming into the mainstream in the last 30 odd years. To many people the word "gay" will always mean happy, joyful, celebratory and not be a term regarding sexual orientation.

I honestly think the nursing community is being judged. My facility does perform a certain amount of gender re-assignment surgery so it's not a total unknown in my area. I've worked with prostitutes of all sexual persuasions.

I think as nurses we should focus on caring for the patient in front of us and respecting whatever they chose to tell us about their private life. Personally, I don't care who does what to whom in the privacy of their own homes. PDA's are often overdone regardless of the couple involved. I don't need to see a set of teenagers swallowing each others faces, couples walking along with their hands down the back of each others clothing. I don't find pecks on the cheeks and hugs offensive regardles of who is doing it. There are societal boundaries that are crossed on a daily basis.

One of the nicest couples on my street growing up were two grey haired gentleman who had lived together for years. Everyone knew they were a couple, nobody kept their kids away from them. They were just the old guys on the block who gave out the best candy at halloween.

[czyja, MSN, RN]

I'll be honest, I think that if a gay person is offended at the term homosexual, they are being too sensitive.

I think people should be called what they wish to be called. "Homosexual" is not a term chosen by the LGBTGQ community to describe itself. Rather it was chosen by a well meaning German sociologist to describe the community. Unfortunately it has been used the medical community to pathologize LGBTGQ people. It has been used as a means to legally discriminate against LGBTGQ people. Gay, Lesbian, Q- are terms chosen by the community to describe itself. Thus they are preferred. Why not call a group a group what they wish to be called?

To me, there is absolutely NO difference between calling someone straight versus a heterosexual. I would probably laugh if someone called me a heterosexual...it's a technical term, but grammatically correct.

The argument that "heterosexuals" are not offended by the term "heterosexual" therefore "homosexuals" should not be offended by the word "homosexual" fails to consider that the word "homosexual" has been used to pathologize, denigrate, and otherwise discriminate against LGBTGQ people.

I disagree with your assertion that that "hetersexual" and "homosexual" are "grammatically correct." Gore Vidal, a master of the English language, once elegantly pointed out that they are adjectives, not nouns. One could have a "heterosexual community" but and individual is best called a "heterosexualist."

and I have asked, "Please forgive me because I want to be able to address you properly....would you prefer to be called Mr. or Miss?"

Right on! Sadly many people are not savvy enough to ask this question. That is why I advocate for discussion of LGBTGQ issues in nursing school.

Latin Americans are now the largest minority group....however, I didn't get anything special regarding this population in my studies and we have an extremely low LA population in my area.

I think this is very important. I think Latinos might even constitute a majority in California - either that or they soon will. Nurses would be well served by a discussion of Latino culture and healthcare concerns in nursing school.

Hopefull2009 - It strikes me that you have found the best way to give good care to you clients is to treat them all with the same level of caring and respect. I think this is a perfectly valid way to practice and I commend you for working this way.

I would, however, suggest that there are differences between people that can impact care. What is intuitive to you (eg asking a TG person how they would like to be addressed) may not be intuitive to everybody - so spending a little time on it in nursing school is not a bad idea - it will only improve care.

Another poster suggested that the OP has an "agenda." Let readers beware: accusing the LGBTGQ community of having an "agenda" is a frequently used tactic of those who wish to perpetuate discrimination against the LGBTGQ community.

I think the OP's agenda might well be a desire to ensure that LGBTGQ people receive professional, culturally competent nursing care.

[vashtee, RN]

Try not to take it personally. In the diversity unit we did, pretty much everything that was discussed about the Jewish population and their customs was referencing the Orthodox community, even though they are a minority population amongst Jews. I don't think the intent was to offend.

[AirforceRN, RN]

CZYJA...I understand your point regarding affording the same care to everyone. I guess I am naive to assume that all nurses are able to check their predjudices at the nursing school door. If only everyone understood how much easier it is to care for people if you don't have to judge them at the same time...

I'm sorry if I offended you with the use of the term homosexual. I don't agree that you are being overly sensitive, but its a difficult battle to change things like this. So many groups are labelled and eventually that label becomes derogitory and must be changed...whose fault is it? Its no longer correct to call someone "retarded", despite that fact that by strict definition, it makes sense. The same goes for the term handicapped, and I'm sure the list continues.

So what is the correct term to use? LGBTGQ is a mouthful and I am sure there are people out there that feel the same way about the terms queer or gay as you do about homosexual. My point is...we will never be able to please everyone with just one term.

[czyja, MSN, RN]

I'm sorry if I offended you with the use of the term homosexual. ...LGBTGQ is a mouthful and I am sure there are people out there that feel the same way about the terms queer or gay as you do about homosexual. My point is...we will never be able to please everyone with just one term.

Thank you for your concern. I am not in the least bit offended. My point is that that the community uses "gay," "lesbian," "qu--r" (the word I prefer, but I think it is not permitted on these forums, that is why I use LGBTGQ which is truly a hideous mouthful that is useless in spoken English but convenient in written English).

"Homosexual" is just not used by "homosexuals" with the exception of some of our seniors. For many of us it congers up images of Anita Bryant and Fred Phelps (the sort of "I call them homosexual, because their lifestyle is anything but 'gay'" rhetoric) If I hear it in general conversation I think "oh, they're straight -" But if I hear it in a healthcare setting I think "uh-oh, do these folks have a clue about my reality?" The experience is sort of like being in a foreign country.

Would that all nurses and docs treated the people they serve with dignity and respect! The sad reality is that when I pick up the newspaper I read about the Lesbian couple that were denied IVF because the doc thought it immoral to provide it. One reads with regularity about same sex partners denied access to each other in hospitals because they are not "family." Fairly recently there was an article in the NY Times about LGBTGQ seniors in LTC - there were horror stories about nurses trying to "convert" clients away from their "sin," and about a woman who was not permitted to be with her partner on her as she died (not "family") Stuff like this makes Q people nervous when the go to the hospital. While this may not happen where you work, it happens.

[czyja, MSN, RN]

CZYJA...I understand your point regarding affording the same care to everyone.

I forgot - I see that you are in Canada - it is also noteworthy that LGBTGQ people enjoy much broader protection of their civil liberties in Canada as a result of the Canadian Supreme Courts expansive reading of the Charter of Rights and Freedoms (a remarkable document in and of itself). I cannot imagine that Canadian hospitals would be permitted to do some of the stuff that happens here in the US.

[greygooseuria]

I think raising culturally competent nurses is important in totality. Nurses should be aware of differences in race/class/gender/sexual orientation/etc. and how it can affect care. People need to be aware of their prejudices and how it can affect their practice. I didn't realize how prejudiced I was against low-income drug users until I started being a CNA, and I quickly became aware and curbed that behavior because it is NOT right to be judgmental.

I think a class on Nursing Cultural Competency should be required in all nursing schools. Intro to Sociology/Psychology just doesn't cut it. In the US, with our multicultural society, we need to learn to appreciate ALL walks of life without judging them and realizing that one culture's beliefs do not affect our own and we do not need to be threatened by them.

There ARE special considerations to be taken for ALL patients. Sorry for the person that said that they couldn't think of special considerations for gay patients: THERE ARE. Just as there would be special considerations for a woman with ovarian cancer or a black man with COPD. They have social identities that are going to intersect (race, class, gender, sexual orientation ALL affect someone's "filter" of how they see the world) and if you don't GET that, you are going to **** all over the Nurse/Patient relationship, lose their trust, and potentially influence their health outcome in a negative way.

And SteveRN, you KNOW I admire you and want to be a peds nurse too, but any discussion about gay people inevitably involves gay marriage. It is something we are denied in the US and to many of us, it is like salt on a wound. To say that it plays no part ignores the importance it holds to the gay community and ignores the concerns of them as a whole.

[SteveNNP, MSN, NP]

And SteveRN, you KNOW I admire you and want to be a peds nurse too, but any discussion about gay people inevitably involves gay marriage. It is something we are denied in the US and to many of us, it is like salt on a wound. To say that it plays no part ignores the importance it holds to the gay community and ignores the concerns of them as a whole.

I hear you. I wasn't slamming gay marriage issues. I just wanted to keep the discussion focused on the original topic at hand, as opposed to potentially derailing a very interesting thread.

I didn't say it didn't play any part in anything.... I just feel that a nursing school does a pretty good job of creating relatively nonjudgemental and caring nurses. By the time most of us younger ones graduated, we had a pretty good look at gay/lesbian issues, including including the partner in decisionmaking. Unfortunately the legal community still does not recognize that, especially in this day and age of HIPAA.

Just think how far it's come in the last decade.

[czyja, MSN, RN]

I quickly became aware and curbed that behavior because it is NOT right to be judgmental.

I agree that it is "not right to be judgmental." And I commend you for recognizing your prejudice and acting appropriately.

It seems to me that the problem with a nurse harboring prejudiced feelings is not a moral problem - it is a clinical problem. Your post points to this rather nicely. Clients know when their provider is uncomfortable treating them or is unaware of their cultural needs. This creates a barrier to care. It is the barrier to care that concerns me the most.

[smk1, LPN]

The problem with trying to "teach" cultural competency is that it inevitably fails miserably and adds to stereotypes. Case in point. My nursing text states taht African Americans are prone to eating dirt and clay during pregnancy. (PICA) So you need to assess their dietary habits on regular intervals. I would be offended as a black lay person if my doctor thought I was eating dirt because I am black. My text also states that you can't make eye contact with asians because it is rude, you can't ask blacks about their family support on the first interview because it is rude etc... None of this is great information if you ask me. In some instances it may be true, but you can't apply it as a broader rule. Many blacks still prefer to be called "black", some are offended by it and prefer African american, so hispanics like the term "hispanic" others prefer latino/latina, and certainly they are not all "mexican" or "spanish". The debate over what to call people belonging to the gay community is another example. It is going to vary, from coast to coast and from person to person because we are all individual. The real way to create culturally competent nurses is to teach them to show respect dignity and to stop assuming things about their patients. Ask what the patient likes to be called, if they have a significant other. WHo do they consider their family. What sorts of foods do they like to eat. Are there any other things that we should know to increase their level of comfort and care. Trying to teach blanket rules about huge groups of people never works. Teach the basic principles about how EVERYONE should be treated seems like a fare better idea.