Queer Phenomenology, Sexual Orientation, and Health Care Spaces: Learning From the Narratives of Queer Women and Nurses in Primary Health Care

Lesbian, gay, bisexual, transgender and or queer patient experiences in Canadian primary care and emergency departments: a literature review

This literature review synthesises existing evidence and offers a thematic analysis of primary care and emergency department experiences of lesbian, gay, bisexual, transgender, queer and/or any other sexual or gender minority (LGBTQ+) individuals in Canada. Articles detailing first-person primary or emergency care experiences of LGBTQ + patients were included from EMBASE, MEDLINE, PsycINFO and CINHAL. Studies published before 2011, focused on the COVID-19 pandemic, unavailable in English, non-Canadian, specific to other healthcare settings, and/or only discussing healthcare provider experiences were excluded. Critical appraisal was performed following title/abstract screening and full-text review by three reviewers. Of sixteen articles, half were classified as general LGBTQ + experiences and half as trans-specific experiences. Three overarching themes were identified: discomfort/disclosure concerns, lack of positive space signalling, and lack of healthcare provider knowledge. Heteronormative assumptions were a key theme among general LGBTQ + experiences. Trans-specific themes included barriers to accessing care, the need for self-advocacy, care avoidance, and disrespectful communication. Only one study reported positive interactions. LGBTQ + patients continue to have negative experiences within Canadian primary and emergency care - at the provider level and due to system constraints. Increasing culturally competent care, healthcare provider knowledge, positive space signals, and decreasing barriers to care can improve LGBTQ + experiences.

Manifestations and Reinforcement of Heteronormativity in the Workplace: A Systematic Scoping Review

This scoping review systematizes the evidence available to date on the manifestations of heteronormativity in the workplace. The reviewed literature shows that, at an organizational level, heteronormativity is reproduced in the configuration of space, organizational policies, and the monitoring of their accomplishment by leaders. At an interpersonal level, employees interact with others based on heterosexual presumptions, they reward what is aligned with heteronormativity, and censor what is not. Finally, individuals acting of their own volition may perform their gender in ways that strengthen the presumption of heterosexuality and communicate heteronormativity alignment. This review offers suggestions for future research in the field of heteronormativity in the workplace and includes theoretical and practical implications for the creation of inclusive organizations.

When primary healthcare meets queerstory: community-based system dynamics influencing regional/rural LGBTQ + people's access to quality primary healthcare in Australia

BACKGROUND

Lesbian, gay, bisexual, transgender, Queer, and people of any other minority sexuality or gender identity (LGBTQ + or "Queer") are often marginalised from accessing quality primary healthcare (PHC) in their local community. This is largely due to Queerphobic, cis-heteronormative/sexist systems pathologising Queer life and identities. The study aims were to: (1) identify key priorities for increasing Queer people's access to quality PHC as told by Queer people themselves, (2) identify the feedback loops that reduce or support Queer people's access to quality PHC in non-metropolitan, regional/rural communities, and (3) identify potential action areas to improve system structures to increase Queer people's access to quality PHC.

METHODS

Group Model Building (GMB) workshops were held with a small group (n = 8) of LGBTQ + people in regional Victoria with lived experience of using PHC services. This participatory approach permits exploration and visual mapping of local structures causing behaviour patterns of community concern over time - in this case, Queer people's ability to access quality PHC in the Geelong-Barwon region. This is the first study that specially applies GMB in Queer PHC in the non-metropolitan regional/rural context.

RESULTS

Key community identified PHC priorities were: (a) providers' level of Queer Literacy, (b) the responsibility of Queer Advocacy (at individual, systemic, and collective levels), (c) support from safe Queer Spaces, (d) strength from a Queer Presence, and (e) power from Intersectional Queer Life. These priorities interconnected, creating system-level feedback loops reinforcing barriers and enablers to Queer people's access to quality PHC in the Geelong-Barwon region; with potential action areas identified.

CONCLUSIONS

Improving Queer people's access to quality PHC in the Geelong-Barwon region requires embedding principles of Queer Literacy, Queer Advocacy, Queer Space, Queer Presence, and Intersectional Queer Life within practices and service systems. The study findings were distilled into a novel, preliminary set of Queer Equity Principles. These need to be taken back to regional Queer communities for further co-design and planning for translation across PHC practices and systems, with potential applicability in other areas of the healthcare spectrum.

Interactions Between Health Professionals and Lesbian, Gay and Bisexual Patients in Healthcare Settings: A Systematic Review

The ways in which health professionals (HPs) interact with individuals from sexual minorities can impact their perception of the health service and influence engagement. This systematic literature review aimed to identify and synthesize the qualitative literature exploring interactions between HPs and lesbian, gay and bisexual (LGB) patients in healthcare settings. A search strategy was developed and applied to CINAHL and Medline, inclusion criteria were then applied to results by two screeners with good agreement. Thematic analysis was carried out on papers meeting the inclusion criteria in three stages, beginning with coding the text line-by-line, developing descriptive themes and finally, analytical themes. Electronic searches identified 348 papers with 20 of these meeting the inclusion criteria. Thematic analysis found five themes; HPs' lack of knowledge regarding LGB specific issues, identification of sexual orientation, discomfort in interactions, LGB patients' experience of heteronormative attitudes and perceived judgment or other negative attitudes.

Empirical Phenomenological Inquiry: Guidance in Choosing Between Different Methodologies

Empirical phenomenological inquiry and analyses are of high relevance and applicability for nursing and health care. Phenomenology has clear roots in philosophy, which needs to be brought into an empirical phenomenological inquiry. However, all study of phenomena and experience does not qualify as phenomenological inquiry. The aim of this article is to provide guidance for how to relate different empirical phenomenological methodologies that are in play in the broader field of healthcare research, and thus support healthcare researchers in navigating between these methodologies. For pedagogical purposes, we present commonalities and differences as related to descriptive and interpretive phenomenological inquiries throughout the research process. The merits and criticisms of empirical phenomenological inquiry are commented on.

Access to health services among sexual minority people in the United States

Sexual minority people in the United States are less likely to have access to health services when compared to their heterosexual counterparts. Less is known about the within-group sociodemographic memberships among sexual minority people regarding access to health services. Using data from a nationally representative sample, a series of univariate and bivariate analyses were used to determine associations between sociodemographic group membership and access to health services. Results suggest there are significant differences in access to health services within the sexual minority population. Differences in access to health services when considering sex-at-birth, sexual identity, age, race/ethnicity, urbanicity, education level and income status were found. These findings offer insight into the role sociodemographic group membership has on the equity of access to health services. Specifically, results indicated that disproportionate access to health services among sexual minority people were more pronounced among those with group membership who experience social marginalisation. This was particularly true for sexual minority people who were bisexual, younger, Black and Latinx, lower-income earners and sexual minority people with less education attainment. Results from this study may be used to inform policies and practices aimed at improving access to health services including, but not limited to, the expansion of the Affordable Care Act and continued development of Federally Qualified Health Centers, while acknowledging the role of within-group differences among sexual minority people.

Tasmanian healthcare professionals' & students' capacity for LGBTI + inclusive care: A qualitative inquiry

The health disparities and care needs of lesbian, gay, bisexual, transgender and intersex (LGBTI+) patients are becoming well known. However, healthcare practitioners (HCPs) and medical students across the Global North report limited understanding of this population and express concern about their capacity to meet the needs of LGBTI + patients. To address these gaps in literature and practice, this study draws on qualitative interviews with 12 clinicians and five health professional students exploring their understandings and approaches to LGBTI + inclusive practice in Tasmania, Australia. Through a reflexive thematic analysis, we identified that both practicing clinicians and students did not believe that their training adequately prepared them to treat LGBTI + patients. Other key barriers included reduced awareness of LGBTI + community needs due to the lack of exposure to LGBTI + patients and unfamiliarity with appropriate referral pathways in the regional Tasmanian context. Conversely, factors enabling provision of LGBTI + inclusive care included prior experience working with LGBTI + patients and establishing a network of supportive colleagues and local services. Participants who identified as LGBTI + themselves saw their personal experiences as a strength in supporting LGBTI + patients. While awareness of LGBTI + inclusive health practice is increasing, Tasmanian practitioners report insufficient training and practical difficulties with referral as key challenges.

Is Smoking Queer? Implications of California Tobacco Denormalization Strategies for Queer Current and Former Smokers

This article is concerned with normative conceptions of health structuring tobacco control strategies designed to "denormalize" tobacco use. Analysis of 201 interviews with non-heterosexual and/or non-cisgender adults in California revealed that participants implicated tobacco use in exacerbating health inequities and perpetuating harmful narratives of queer suffering, but also regarded smoking as a critical tool for self-care and symbol of resistance. Participant narratives suggest that using stigma in health promotion efforts which reinforce normative conceptions of health may be harmful to queer people whose social identities exist within ongoing legacies of pathology, health stigma, and deviance from hegemonic structural norms.

Beyond 'invisibility': queer intelligibility and symbolic annihilation in healthcare

Sexual minority health is increasingly receiving attention by health sciences education and healthcare, with the core argument being that health can be improved by challenging sexual minority invisibility. Invisibility as a concept, however, does not allow for a deeper theoretical engagement with the reasons and consequences of the lack of representation of queerness in healthcare. Drawing on empirical research with queer healthcare users in South Africa, I argue that 'invisibility' actually encompasses two distinct, though related, concepts: queer symbolic annihilation as the reason for the exclusion of queer identities in health professions education and, by consequence, in healthcare; and queer (un)intelligibility as the consequence of this systemic erasure. By simply attributing discriminatory healthcare experiences of queer people to 'invisibility' we are missing opportunities to address underlying issues of queer symbolic annihilation and unintelligibility.

Rendering LGBTQ+ Visible in Nursing: Embodying the Philosophy of Caring Science

Although health care institutions continue to address the importance of diversity initiatives, the standard(s) for treatment remain historically and institutionally grounded in a sociocultural privileging of heterosexuality. As a result, lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities in health care remain largely invisible. This marked invisibility serves as a call to action, a renaissance of thinking within redefined boundaries and limitations. We must therefore refocus our habits of attention on the wholeness of persons and the diversity of their storied experiences as embodied through contemporary society. By rethinking current understandings of LGBTQ+ identities through innovative representation(s) of the media, music industry, and pop culture within a caring science philosophy, nurses have a transformative opportunity to render LGBTQ+ visible and in turn render a transformative opportunity for themselves.

Accessing new understandings of trauma-informed care with queer birthing women in a rural context

AIMS AND OBJECTIVES

Participant narratives from a feminist and queer phenomenological study aim to broaden current understandings of trauma. Examining structural marginalisation within perinatal care relationships provides insights into the impact of dominant models of care on queer birthing women. More specifically, validation of queer experience as a key finding from the study offers trauma-informed strategies that reconstruct formerly disempowering perinatal relationships.

BACKGROUND

Heteronormativity governs birthing spaces and presents considerable challenges for queer birthing women who may also have an increased risk of trauma due to structurally marginalising processes that create and maintain socially constructed differences.

DESIGN

Analysis of the qualitative data was guided by feminist and queer phenomenology. This was well suited to understanding queer women's storied narratives of trauma, including disempowering processes of structural marginalisation.

METHODS

Semistructured and conversational interviews were conducted with a purposeful sample of thirteen queer-identified women who had experiences of birthing in rural Nova Scotia, Canada.

RESULTS

Validation was identified as meaningful for queer women in the context of perinatal care in rural Nova Scotia. Offering new perspectives on traditional models of assessment provide strategies to create a context of care that reconstructs the birthing space insofar as women at risk do not have to come out as queer in opposition to the expectation of heterosexuality.

CONCLUSIONS

Normative practices were found to further the effects of structural marginalisation suggesting that perinatal care providers, including nurses, can challenge dominant models of care and reconstruct the relationality between queer women and formerly disempowering expectations of heteronormativity that govern birthing spaces.

RELEVANCE TO CLINICAL PRACTICE

New trauma-informed assessment strategies reconstruct the relationality within historically disempowering perinatal relationships through potentiating difference which avoids retraumatising women with re-experiencing the process of coming out as queer in opposition to the expectation of heterosexuality.

Mastering wellness: LGBT people’s understanding of wellbeing through interest sharing

The wellbeing of lesbian, gay, bisexual and transgender (LGBT) people has generated considerable research interest over 30 years. An alternative perspective to the consensus of increased LGBT mental health risk is put forward in light of research with general populations on social wellbeing through community involvement. This qualitative research is aligned with emergent research trends problematising the dominant ‘at risk’ representation. Through 10 in-depth interviews with 11 LGBT people living in Ireland involved in physical, creative and social activities, within and outside LGBT communities, this study explored the relationship between LGBT wellbeing and interest sharing. The theme of ‘mastering wellness’ emerged from the personal narratives, emphasising participants’ agency regarding their wellbeing. Participants’ openness in discussing mental health contrasts with the Irish population. Respondents generally understood that anyone may experience periods of mental ill-health and equally experience times of wellbeing. This suggests potentially stigmatised communities simultaneously challenge the stigmatising representation of LGBT identities and mental health and binary constructs of normal/abnormal. The implications of this study underscore the need for nursing policy and practice initiatives promoting wellbeing within and beyond LGBT communities.