LGBTQ Cultural Competence Training approved for Washington, DC (as per a public health priorities education for nurses)

CONTACT HOURS: 2

BY: 

Marcy Caplin, PhD, MSN, RN, CNE; Sheryl M. Ness, MA, BSN, ADN, RN

LEARNING OUTCOME AND OBJECTIVES:  Upon successful completion of this continuing education course, you will be prepared to provide effective and respectful care for patients identifying as LGBTQ+. Specific learning objectives to address potential learning gaps include:

  • Describe terminology that is inclusive and respectful of the LGBTQ+ community.
  • Summarize health disparities, health risk factors, and clinical implications specific to members of the LGBTQ+ community.
  • Discuss legal issues associated with quality care for LGBTQ+ patients.
  • Identify best practices regarding collecting and protecting patient information for LGBTQ+ patients.
  • Discuss elements of culturally competent care for LGBTQ+ patients, including physical space, informational materials, patient communication, and staff training.
  • Examine the intersection of oppression, discrimination, and cultural biases in order to provide nondiscriminatory care.

TABLE OF CONTENTS

  • Introduction
  • Terminology
  • Health Disparities and Health Risk Factors
  • Laws Related to LGBTQ+ Healthcare
  • Best Practices Regarding Patient Information
  • Best Practices for Culturally Competent Care
  • Oppression, Discrimination, and Cultural Bias in Healthcare
  • Conclusion
  • Resources
  • References

INTRODUCTION


It is not uncommon for a person who identifies as lesbian, gay, bisexual, transgender, or questioning/queer (LGBTQ) to have had negative experiences in the healthcare environment due to discrimination and/or stigmatization based on their sexual orientation and/or gender identity. Such encounters may occur due to cultural bias or a lack of awareness and understanding by the provider of the healthcare needs and goals of such individuals.

For example:

  • A gay man might be screened for HIV before being assessed for actual risk.
  • A transgender man may be denied a mammogram because they transitioned from female to male.
  • A lesbian visiting a new primary care provider might be asked if they would like a mental health referral to explore “abnormal” sexual feelings.
  • A gender fluid person may not know how to respond to a healthcare form that only provides the options of male or female gender identity.

These sorts of negative encounters immediately affect the patient’s trust of the healthcare system and marginalize their needs. Continuing stigma makes many patients reluctant to reveal their sexual orientation or gender identity to healthcare providers even though this information can be important to receiving individualized care.

From a historical perspective, it was not until 1973 that the American Psychological Association declared that homosexuality (now considered a marginalizing term) was not a mental illness (McHenry, 2022). This was a major milestone in the movement toward cultural awareness and in the fight for equal rights for people who identify as lesbian, gay, or bisexual. Similarly, being transgender was listed as “gender identity disorder” until 2013, when the DSM-5 changed it to “gender dysphoria,” a more patient-centric term (Byne et al., 2020).

Over the past 20 years, the healthcare community has started to recognize and research the unique needs of these groups. One of the most significant reports includes the 2011 Institute of Medicine report titled “The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.” This document outlined a research agenda for the future. The report also placed a focus on the needs of LGBT patients and described the uniqueness for each of the LGBT groups (IOM, 2011). Similarly, Healthy People 2030 includes a goal to improve the well-being, safety, and health of the LGBT patient population (ODPHP, n.d.).

Even though social acceptance has been increasing since that time and laws and policies are changing, LGBTQ+ individuals continue to face barriers, stigma, bias, and discrimination. Access to healthcare that is unbiased and culturally affirming remains a challenge in most parts of the United States.

People within the LGBTQ+ population are extraordinarily diverse, representing every social class and ethnicity in every geographical area and every profession (HRC, 2020). Healthcare professionals who practice cultural sensitivity in working with LGBTQ+ patients can have a positive impact and increase trust as they continue to understand the individual needs of their patients.