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Muschialli L, Coduri-Fulford S, Garbett Z, Connolly DJ. Twelve tips for LGBT+-inclusive undergraduate and postgraduate medical education. MEDICAL TEACHER 2024:1-7. [PMID: 38652880 DOI: 10.1080/0142159x.2024.2344617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Sexual and gender minority (LGBT+) populations continue to experience worse health outcomes and reduced healthcare access compared to their cisgender, heterosexual counterparts, perpetuated by a lack of sufficient LGBT+-specific healthcare education within medical schools. Developing educational material that encourages self-reflective, proactive, and affirmative practice has been identified as a mechanism for increasing the quality of doctor-patient relationships and breaking down barriers in healthcare access for LGBT + communities. In this article, we provide twelve tips for those designing and delivering undergraduate and postgraduate medical curricula. We summarise evidence-based approaches to inclusive care, key overarching concepts that curricula should include and common issues to be avoided. We hope these tips provide a standard against which existing curricula and teaching practices can be appraised and form the basis of future educational material.
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Affiliation(s)
- Luke Muschialli
- University of Cambridge, Cambridge, United Kingdom
- UCL Medical School, UCL, London, United Kingdom
| | | | - Zoë Garbett
- North Central London Integrated Care Board, London, United Kingdom
| | - Dean J Connolly
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Jakobsen MD, Bromseth J, Siverskog A, Krane MS. The provision of healthcare services to older LGBT adults in the Nordic countries: a scoping review. Scand J Prim Health Care 2023; 41:359-371. [PMID: 37602941 PMCID: PMC11001363 DOI: 10.1080/02813432.2023.2242713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/26/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVES Our objectives were to examine what is known about the provision of healthcare services to older LGBT adults in the Nordic countries, identify knowledge gaps, map implications of this research for the education of healthcare professionals and delivery of healthcare, and identify key future research priorities to advance policy and practice for older LGBT adults in this region. DESIGN We conducted searches in nine databases. Peer-reviewed articles and PhD theses published in and after 2002 written in English, Norwegian, Swedish or Danish languages were included. 41 studies met our inclusion criteria. However, only eight of these studies focused specifically on older LGBT adults. Therefore, to answer all research questions, five book chapters about older groups were also included. RESULTS There were few studies from countries other than Sweden and few quantitative studies. Bisexual people represented a neglected group in research. The studies included showed that healthcare personnel lack knowledge on LGBT issues, particularly about older LGBT adults and non-binary gender identification. Older LGBT adults frequently reported being met with cis- and heteronormative expectations in healthcare encounters. For transgender people, access to medical treatment has been managed by gatekeepers influenced by a binary understanding of gender. CONCLUSIONS Relevant measures to enhance practices are increased attention on LGBT issues in education; training of healthcare professionals; measures at the institutional level; and ensuring that transgender people identifying as non-binary receive the same quality of care as individuals identifying in a binary way.
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Affiliation(s)
| | | | - Anna Siverskog
- Department of Culture and Education, Södertörn University, Huddinge, Sweden
| | - Martin Sollund Krane
- Centre for Care Research North, UiT The Arctic University of Norway, Tromsø, Norway
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Swan L, Windram J, Burchill L, Ladak LA, Reardon LC, Fernandez B, Jacobsen RM, Simpson M, Harrison D, Morton L. Sexual Health and Well-Being in Adults With Congenital Heart Disease: A International Society of Adult Congenital Heart Disease Statement. JACC. ADVANCES 2023; 2:100716. [PMID: 38938496 PMCID: PMC11198306 DOI: 10.1016/j.jacadv.2023.100716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 06/29/2024]
Abstract
As health care outcomes improve the priority for those living with adult congenital heart disease have changed to a more holistic focus on quality of life and well-being. Although health care has embraced this, there are still areas where there is a deficit in advice, allyship, and advocacy. One of these deficits is in the area of sexual health and well-being. A healthy sexual life has a myriad of physical and psychosocial benefits. However, individuals with adult congenital heart disease may have significant barriers to achieving well-being in this aspect of their lives. These barriers and their potential solutions are outlined in this paper.
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Affiliation(s)
- Lorna Swan
- Scottish Adult Congenital Cardiac Service, Golden Jubilee NHS Hospital and University of Glasgow, Glasgow, United Kingdom
| | - Jonathan Windram
- Mazankowski Heart Institute, University of Alberta, Edmonton, Canada
| | - Luke Burchill
- Mayo Clinic Adult Congenital Heart Disease Program, Rochester, Minnesota, USA
| | - Laila Akbar Ladak
- The Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan
| | - Leigh C. Reardon
- Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Children’s Heart Center, Los Angeles, California, USA
| | - Beatriz Fernandez
- Division of Cardiology, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Roni M. Jacobsen
- Division of Cardiology, Departments of Internal Medicine and Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Maggie Simpson
- Cardiology, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - David Harrison
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Liza Morton
- Glasgow Caledonian University, Glasgow, United Kingdom
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Day J, Snyder M, Dennis Flores D. Hidden No More: Addressing the Health and Wellness of LGBTQIA+ Individuals in Nursing School Curricula. J Nurs Educ 2023; 62:307-311. [PMID: 37146043 DOI: 10.3928/01484834-20230306-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual (LGBTQIA+) individuals face barriers to equitable health care access. During clinical encounters, LGBTQIA+ individuals interact with nurses and health care providers who often lack a thorough understanding of LGBTQIA+ cultures, terminology, and strategies for culturally affirming care. This article details the process undertaken to include LGBTQIA+ health elective courses. METHOD To outline LGBTQIA+ health education, a curriculum crosswalk was conducted. Course descriptions, objectives, and outcomes were crafted with faculty input. Priority LGBTQIA+ areas were analyzed, and textbook content was cross-referenced to identify topics for inclusion. RESULTS In Spring 2022, two LGBTQIA+ courses were launched. Undergraduate students at New York University Meyers (n = 27) and undergraduate and graduate students at the University of Pennsylvania (n = 18) comprised the inaugural classes. CONCLUSION LGBTQIA+ individuals experience poorer health outcomes due to longstanding health inequities. These disparities are partly fueled by the minimal exposure nursing students receive in their undergraduate education. Guidelines on the development of courses designed to highlight needs may address disparities, leading to better health outcomes. [J Nurs Educ. 2023;62(5):307-311.].
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Physiotherapists vary in their knowledge of and approach to working with patients who are LGBTQIA+: a qualitative study. J Physiother 2023; 69:114-122. [PMID: 36914520 DOI: 10.1016/j.jphys.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 03/16/2023] Open
Abstract
QUESTION What are the attitudes, beliefs and knowledge gaps of physiotherapists in Australia regarding working with patients who identify as LGBTQIA+? DESIGN Qualitative design using a custom online survey. PARTICIPANTS Physiotherapists currently practising in Australia. METHODS Data were analysed using reflexive thematic analysis. RESULTS A total of 273 participants met the eligibility criteria. Participating physiotherapists were predominantly female (73%), aged between 22 and 67 years, residing in a large Australian city (77%) and working in musculoskeletal physiotherapy (57%), in private practice (50%) and hospital (33%) settings. Almost 6% self-identified as part of the LGBTQIA+ community. Only 4% of the participants had received training related to healthcare interactions or cultural safety for working with patients who identify as LGBTQIA+ in the context of physiotherapy. Three main themes regarding approaches to physiotherapy management were identified: treating the whole person in context, treating everyone the same, and treating the body part. Gaps in knowledge were primarily related to understandings of the relevance of sexual orientation and gender identity to physiotherapy and health issues specific to LGBTQIA+ patients. CONCLUSION Physiotherapists can be considered to approach gender identity and sexual orientation in three distinct ways and suggest a range of knowledge and attitudes about working with patients who identify as LGBTQIA+. Physiotherapists who consider gender identity and sexual orientation to be relevant to physiotherapy consultations appear to have higher levels of knowledge and understanding of this topic and may also understand physiotherapy as multifactorial and not only biomedical.
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Tamargo CL, Mitchell EP, Wagner L, Simon MA, Carlos RC, Giantonio BJ, Schabath MB, Quinn GP. “I need more knowledge”: Qualitative analysis of oncology providers’ experiences with sexual and gender minority patients. Front Psychol 2022; 13:763348. [PMID: 36046410 PMCID: PMC9421156 DOI: 10.3389/fpsyg.2022.763348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background While societal acceptance for sexual and gender minority (SGM) individuals is increasing, this group continues to face barriers to quality healthcare. Little is known about clinicians’ experiences with SGM patients in the oncology setting. To address this, a mixed method survey was administered to members of the ECOG-ACRIN Cancer Research Group. Materials and methods We report results from the open-ended portion of the survey. Four questions asked clinicians to describe experiences with SGM patients, reservations in caring for them, suggestions for improvement in SGM cancer care, and additional comments. Data were analyzed using content analysis and the constant comparison method. Results The majority of respondents noted they had no or little familiarity with SGM patients. A minority of respondents noted experience with gay and lesbian patients, but not transgender patients; many who reported experience with transgender patients also noted difficulty navigating the correct use of pronouns. Many respondents also highlighted positive experiences with SGM patients. Suggestions for improvement in SGM cancer care included providing widespread training, attending to unique end-of-life care issues among SGM patients, and engaging in efforts to build trust. Conclusion Clinicians have minimal experiences with SGM patients with cancer but desire training. Training the entire workforce may improve trust with, outreach efforts to, and cancer care delivery to the SGM community.
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Affiliation(s)
- Christina L. Tamargo
- Department of Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Edith P. Mitchell
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Lynne Wagner
- Department of Social Sciences and Health Policy, Wake Forest University, Winston-Salem, NC, United States
| | - Melissa A. Simon
- Department of Obstetrics and Gynecology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ruth C. Carlos
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Bruce J. Giantonio
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Matthew B. Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
- *Correspondence: Matthew B. Schabath,
| | - Gwendolyn P. Quinn
- Department of Obstetrics and Gynecology and Population Health, NYU Grossman School of Medicine, New York, NY, United States
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Callan A, Corbally M, McElvaney R. A commentary on the challenges for nurses in identifying and responding to intimate partner violence amongst gay and bisexual men. J Adv Nurs 2022; 79:e21-e29. [PMID: 35909093 DOI: 10.1111/jan.15392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/28/2022] [Accepted: 07/17/2022] [Indexed: 11/28/2022]
Abstract
AIM This commentary elucidates the challenges for nurses in effectively identifying and supporting gay and bisexual men who experience intimate partner violence and offers guidance for education, training and practice to nurses when responding to patients who may be experiencing intimate partner violence. DESIGN The commentary highlights issues raised by Callan et al.'s (2020) scoping review, translating the experiences of male sexual minorities undergoing abuse to a nursing context, in particular, issues such as homophobic remarks and heteronormative practices in health care and nursing-led environments militate against the identification of individuals who may be experiencing coerced sexual risk-taking, homophobia and sexual orientation outing. RESULTS Intimate partner violence is a widespread issue that permeates across heterosexual and LGBTQ+ communities, while impressing on the everyday realities of nurses. The potential for discrimination against sexual minority patients may be offset by improving training, education and offering recommendations for nurses in how to identify IPV and how to assess risk. CONCLUSIONS Nurses possess essential training and transferable skills such as empathy, adaptability, active listening and diplomacy and are ideally placed to facilitate disclosure of intimate partner violence. Gaps in knowledge, training and organizational support for nurses may be effectively addressed through drawing on extant research and international best practice guidelines. IMPACT Suggestions for research, education and practice to identify gay and bisexual male survivors, intervene appropriately and avoid missed disclosure opportunities are made. We conclude with a table of recommendations with a view to enhancing the essential response of nurses in addressing intimate partner violence in marginalized communities.
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Affiliation(s)
- Aisling Callan
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Melissa Corbally
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Rosaleen McElvaney
- Children's Health Ireland at Connolly 2, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
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Counselor candidates’ perception of heterosexism. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01393-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wanko Keutchafo EL, Kerr J, Jarvis MA. Evidence of nonverbal communication between nurses and older adults: a scoping review. BMC Nurs 2020; 19:53. [PMID: 32550824 PMCID: PMC7298765 DOI: 10.1186/s12912-020-00443-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/04/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Communication is an integral part of life and of nurse-patient relationships. Effective communication with patients can improve the quality of care. However, the specific communication needs of older adults can render communication between them and nurses as less effective with negative outcomes. METHODS This scoping review aims at describing the type of nonverbal communication used by nurses to communicate with older adults. It also describes the older adults' perceptions of nurses' nonverbal communication behaviors. It followed (Int J Soc Res 8: 19-32, 2005) framework. Grey literature and 11 databases were systematically searched for studies published in English and French, using search terms synonymous with nonverbal communication between nurses and older adults for the period 2000 to 2019. RESULTS The search revealed limited published research addressing nonverbal communication between older adults and nurses. The studies eligible for quality assessment were found to be of high quality. Twenty-two studies were included and highlighted haptics, kinesics, proxemics, and vocalics as most frequently used by nurses when communicating with older adults; while studies showed limited use of artefacts and chronemics. There was no mention of nurses' use of silence as a nonverbal communication strategy. Additionally, there were both older adults' positive and negative responses to nurses' nonverbal communication behaviors. CONCLUSION Nurses should be self-aware of their nonverbal communication behaviors with older adults as well as the way in which the meanings of the messages might be misinterpreted. In addition, nurses should identify their own style of nonverbal communication and understand its modification as necessary in accordance with patient's needs.
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Affiliation(s)
- Esther L. Wanko Keutchafo
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, 71 Manor Drive, Manor Gardens, Durban, 4001 South Africa
| | - Jane Kerr
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, 71 Manor Drive, Manor Gardens, Durban, 4001 South Africa
| | - Mary Ann Jarvis
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, 71 Manor Drive, Manor Gardens, Durban, 4001 South Africa
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Smith SK. Transgender and Gender Nonbinary Persons' Health and Well-Being: Reducing Minority Stress to Improve Well-Being. Creat Nurs 2020; 26:88-95. [PMID: 32321790 DOI: 10.1891/crnr-d-19-00083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article describes minority stress theory as applied to health disparities and health-care experiences of transgender and gender nonbinary (TGNB) persons. The combination of stigma, social and structural inequalities, and actual discrimination events result in mutually reinforcing dynamics that drive persistent and stubborn disparities in physical and mental health for TGNB persons (Halkitis, Kapadia, Ompad, & Perez-Figueroa, 2015). Together with distrust of the medical system and discomfort of health-care providers in caring for TGNB persons (Smith & Turell, 2017), minority stress contributes to poorer health outcomes and reduced quality of care for sexual and gender minority populations. Ways to reduce health-care-related minority stress for TGNB persons are proposed, with the goal of improving TGNB health and well-being.
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Laughey W, Sangvik Grandal N, Stockbridge C, Finn GM. Twelve tips for teaching empathy using simulated patients. MEDICAL TEACHER 2019; 41:883-887. [PMID: 29944021 DOI: 10.1080/0142159x.2018.1481283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Empathy is a key component of humane, patient-centered consulting. Physician empathy increases patient satisfaction and enablement; it may even lead to better health outcomes. Despite this, empathy in clinical encounters is often lacking and empathy in medical students decreases as they progress from the early to the senior undergraduate years. The components of empathy - like attentive listening and a mastery of non-verbal communication - are standard fare for communication training and universities and clinical postgraduate programs frequently employ simulated/standardized patients (SPs) to facilitate this training. In the field of empathy, SPs bring added value to feedback given that many are professional actors, well versed in the skills of putting themselves "in another character's shoes." Drawing from the existing evidence base and their personal training and role-play experience, the authors provide 12 practical tips for teaching empathy with simulated patients.
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Affiliation(s)
- William Laughey
- Health Professions Education Unit, Hull York Medical School, University of York , York , UK
| | - Nora Sangvik Grandal
- Health Professions Education Unit, Hull York Medical School, University of York , York , UK
| | - Cal Stockbridge
- Health Professions Education Unit, Hull York Medical School, University of York , York , UK
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, University of York , York , UK
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12
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Annerstedt CF, Glasdam S. Nurses' attitudes towards support for and communication about sexual health-A qualitative study from the perspectives of oncological nurses. J Clin Nurs 2019; 28:3556-3566. [PMID: 31165516 DOI: 10.1111/jocn.14949] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 12/20/2022]
Abstract
AIM AND OBJECTIVES To explore nurses' articulations of support and communication regarding sexual health with patients. BACKGROUND Sexual health is adversely effected by cancer and various oncological treatments. Patients' often have the experience that healthcare professionals do not talk about sexual health. METHOD Semi-structured interviews were conducted with seven nurses in Southern Sweden. Content analyses were made, inspired by Foucault's concepts of power, discipline and normalisation. SRQR checklist was used. RESULTS Patients' sexual health had low priority in the oncological clinic from the perspective of nurses. The medical logic directed nurses' articulations about sexual health towards a physical view, understood as sex, and sexual problems, which could be treated pharmacologically. Further, nurses articulated a sexual norm that sex belongs to young people and younger persons in permanent, monogamous and heterosexual relationships. This norm-governed nurses' inclusion and exclusion of patients in communication about sexual health. According to nurses, most patients did not mention sex, but some patients challenged the clinic's norms. Assessing sexual health problems, nurses often engaged other professions and thereby became gatekeepers for patients' options for getting help. CONCLUSIONS From the perspective of nurses, nurses' support and communication regarding sexual health with patients with cancer diagnosis were relatively absent and had a low priority in an oncological clinic. Overall, the nurses had the power to set the agenda about patients' sexual health in the oncological clinic. The clinical gaze became a disciplinary technique that tacitly defined by whom, in what way and how sexual health could be articulated in an oncological clinic. RELEVANCE TO CLINICAL PRACTICE By illuminating nurses' preconceptions, thoughts and actions in relation to cancer patients' sexual health, the results invite practitioners to reflect upon and discuss the challenges, opportunities and limitations in providing inclusive and supportive sexual health care to cancer patients.
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Affiliation(s)
| | - Stinne Glasdam
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
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Tzur-Peled S, Sarid O, Kushnir T. Nurses' perceptions of their relationships and communication with lesbian women seeking perinatal care. J Clin Nurs 2019; 28:3271-3278. [PMID: 31066131 DOI: 10.1111/jocn.14904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVE To examine whether nurses' assessment of their relationships and communication with lesbian women seeking perinatal care is associated with their personal and professional characteristics and knowledge of homosexuality. BACKGROUND Recently, there has been a growing incidence of same-sex parenthood. Nurses administer health care to lesbian women from pregnancy planning through birth, providing consultation. Although there has been a shift in attitudes towards homosexuality, discrimination is still quite common. DESIGN This research is part of a larger cross-sectional study carried out at women's healthcare centres, concerning nurses' perceived quality of perinatal care provided to lesbian women. METHODS The study was conducted from December 2015-April 2016 at women's health centres in Israel encompassing 184 registered nurses who completed self-report questionnaires. They were assessed as to their knowledge of homosexuality and nurse-patient relationships and communication. The Squire checklist was used. RESULTS Most (73.4%) had prior acquaintance with lesbian women; only 17.9% had been educated as to lesbian women's unique health needs; of these, 66.7% thought that they had been given professional tools for working with lesbian women; 60.4% were unaware of the importance of knowing the patient's sexual orientation. The average score on a homosexuality knowledge questionnaire was 10.4 on a scale of 0-17, indicating moderate levels of factual knowledge about homosexuality. A significant positive correlation was found between nurses' knowledge of homosexuality and assessment of their relationships and communication with lesbian women seeking perinatal care. In addition, nurses' personal and professional characteristics, such as place of birth, religiosity and familiarity with lesbian women, were related to their assessment of their relationships and communication. CONCLUSION Nurses' knowledge of homosexuality and personal and professional characteristics were associated with their perceptions regarding relationships and communication with lesbian women seeking perinatal care. RELEVANCE TO CLINICAL PRACTICE Further training might broaden, refine rigid perceptions and contribute to advancing equal perinatal nursing care of lesbian women.
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Affiliation(s)
- Sharona Tzur-Peled
- Dina Academic School of Nursing, Rabin Medical Center, Petah Tikva, Israel
| | - Orly Sarid
- The Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Talma Kushnir
- Department of Psychology, Ariel University, Ariel, Israel.,Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Ross MH, Setchell J. People who identify as LGBTIQ+ can experience assumptions, discomfort, some discrimination, and a lack of knowledge while attending physiotherapy: a survey. J Physiother 2019; 65:99-105. [PMID: 30885669 DOI: 10.1016/j.jphys.2019.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/03/2018] [Accepted: 02/05/2019] [Indexed: 11/28/2022] Open
Abstract
QUESTIONS What are the experiences of people who identify as lesbian, gay, bisexual, transgender, intersex, queer or related identities (LGBTIQ+) and attend physiotherapy? How could those experiences of physiotherapy be improved? DESIGN Primarily qualitative design using a purpose-built online survey. PARTICIPANTS People aged 18 years or older, who self-identified as LGBTIQ+, and had attended physiotherapy in Australia. METHODS Open responses were analysed with thematic analysis and quantitative responses with descriptive statistics. RESULTS One hundred and fourteen participants responded to the survey, with 108 meeting all eligibility criteria. Four main themes were identified in the analysis, with almost all participants reporting experiences during physiotherapy interactions relating to at least one of the following themes: 'assumptions' about participants' sexuality or gender identity; 'proximity/exposure of bodies', including discomfort about various aspects of physical proximity and/or touch and undressing and/or observing the body; 'discrimination', including reports of overt and implicit discrimination as well as a fear of discrimination; and 'lack of knowledge about transgender-specific health issues'. Positive experiences were also evident across the first, third and fourth themes. Participants suggested or supported a number of ways to improve LGBTIQ+ experiences with physiotherapy, including: LGBTIQ+ diversity training for physiotherapists, education specific to the LGBTIQ+ population (particularly transgender health), and open options for gender provided on forms. CONCLUSION People who identify as LGBTIQ+ can experience challenges when attending physiotherapy, including: erroneous assumptions by physiotherapists, discomfort, explicit and implicit discrimination, and a lack of knowledge specific to their health needs. Positive findings and participant-suggested changes offer ways to improve physiotherapy for LGBTIQ+ people across educational and clinical settings.
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Affiliation(s)
- Megan H Ross
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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15
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Grundy-Bowers M, Read M. Developing cultural competence in caring for LGBTQI+ patients. Nurs Stand 2019; 35:29-34. [PMID: 31468809 DOI: 10.7748/ns.2019.e11390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2019] [Indexed: 01/01/2023]
Abstract
Evidence demonstrates that subconscious and intentional discrimination against lesbian, gay, bisexual, transgender, queer or questioning, and intersex (LGBTQI+) people continues to exist in the UK healthcare system. Surveys have indicated significant health inequalities in LGBTQI+ populations, including high rates of mental health issues and suboptimal healthcare experiences. This article explores these issues and encourages nurses to reflect on their unique and privileged position to champion the rights of vulnerable people, as well as their role in improving the healthcare experience of LGBTQI+ patients in the future. It also discusses safety issues and special considerations for LGBTQI+ patients, including those related to sexual health, mental health and intellectual disabilities.
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Affiliation(s)
| | - Max Read
- North East London NHS Foundation Trust, London, England
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Schweiger-Whalen L, Noe S, Lynch S, Summers L, Adams E. Converging Cultures: Partnering in Affirmative and Inclusive Health Care for Members of the Lesbian, Gay, Bisexual, and Transgender Community. J Am Psychiatr Nurses Assoc 2019; 25:453-466. [PMID: 30580674 DOI: 10.1177/1078390318820127] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Members of the lesbian, gay, bisexual, and transgender (LGBT) community suffer from disproportionate rates of physical and mental illness. This population experiences enhanced vulnerability to illness as a result of societal marginalization, known as minority stress, which is compounded by insufficient LGBT education for health care professionals and stigmatizing experiences within medical institutions. AIMS: The aims of this study were to review the literature on LGBT cultural competence interventions; evaluate the effect of a 4-hour pilot workshop, "Converging Cultures," on the development of cultural competence; and make recommendations for best practices in developing LGBT cultural competence among health care providers. METHOD: The study used a repeated-measures pre-/posttest design among a sample of 130 hospital employees and undergraduate nursing students. The GAP (Gay Affirmative Practice scale) scale, a measure of LGBT-affirmative practice beliefs, and an objective Knowledge Quiz were administered before and directly following the training. The posttest included three open-ended questions to elicit self-reflection and capture the development of cultural competence according to Campinha-Bacote's theory, the process of cultural competence in the delivery of healthcare services. RESULTS: Paired sample t tests revealed significant improvement on the GAP and Knowledge Quiz. Open-ended responses reflected the five constructs of Campinha-Bacote's theory. CONCLUSIONS: Self-reflection is an essential component of LGBT cultural competence education to uncover personal biases that affect clinical behavior. Future educational efforts for sexual and gender minorities should strive to avoid inadvertent marginalization of LGBT people through integration of concepts with existing curricula and workplace training.
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Affiliation(s)
| | - Shelly Noe
- Shelly Noe, DNP, PMHNP-BC, RN, New Mexico State University, Las Cruces, NM, USA
| | - Stephanie Lynch
- Stephanie Lynch, PhD, PMHNP-BC, FNP-BC, RN, New Mexico State University, Las Cruces, NM, USA
| | - Linda Summers
- Linda Summers, PhD, FNP-BC, PFNP-BC, RN, New Mexico State University, Las Cruces, NM, USA
| | - Eve Adams
- Eve Adams, PhD, New Mexico State University, Las Cruces, NM, USA
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Provider Perspectives on the Application of Patient Sexual Orientation and Gender Identity in Clinical Care: A Qualitative Study. J Gen Intern Med 2018; 33:1359-1365. [PMID: 29855864 PMCID: PMC6082205 DOI: 10.1007/s11606-018-4489-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/26/2018] [Accepted: 05/01/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND The federal government and other organizations have recommended that healthcare institutions collect and document patient sexual orientation and gender identity (SO/GI) information in order to advance the understanding of the health of sexual and gender minority populations and to combat existing health disparities. Little is known, however, about provider perception of the clinical relevance of, or how they might use, patient SO/GI information in individual care. OBJECTIVE To explore providers' perspectives on and experiences with collection of patient SO/GI information and how the knowledge of this information may impact clinical care. DESIGN Qualitative study using in-depth individual interviews of healthcare providers. PARTICIPANTS Twenty-five healthcare providers, including physicians, physician assistants, and nurse practitioners, from the fields of family medicine, internal medicine, gynecology, and urology within a single healthcare system in an east coast city. APPROACH Interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed using principles of grounded theory and thematic analysis to identify themes emerging from the data. KEY RESULTS Providers recognized the importance of collecting patient SO/GI information for understanding population-level public health concerns and disparities, as well as understanding and respecting the context of patients' lives. However, providers also emphasized the importance of knowing patients' sexual behaviors and physical anatomy for addressing health risk and preventive care needs-and noted the distinction between these characteristics and patient SO/GI. Providers cautioned that assumptions based on knowledge of patient SO/GI may unintentionally obscure accurate profiles of patient behavior and anatomy. CONCLUSIONS Along with the potential benefits of routine collection of patient SO/GI, it is important that providers continue to inquire about patient behaviors and anatomy to inform individual risk and needs assessments. Findings from this study can inform the development of guidelines, trainings, and practices for incorporation of patient SO/GI along with existing assessment practices to improve individual and population health.
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Laughey W, Sangvik Grandal N, M Finn G. Medical communication: the views of simulated patients. MEDICAL EDUCATION 2018; 52:664-676. [PMID: 29600570 DOI: 10.1111/medu.13547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/21/2017] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Simulated patients (SPs) are extensively used in the teaching of medical communication, both for students and doctors. They occupy a unique middle ground between patients and physicians: although free from the prejudices that medical training brings, they work closely with clinical tutors to promote the principles of patient-centred consulting. Despite this, there is relatively little research around their views on what makes for good communication practice. This study aims to address this gap in the literature through a qualitative analysis of SPs' opinions, especially in the context of medical student communication. METHODS Eighteen SPs from two medical schools, Hull York Medical School and Durham, were interviewed, using an in-depth, one-to-one, semi-structured approach. Data, transcribed verbatim, were thematically analysed. RESULTS Three global themes were identified: (i) listening and empathy and showing it, (ii) continual human connection and (iii) information flow from the patient. These three themes, termed the communication triad, form a type of virtuous circle, each facilitating the other. Listening and empathy were facilitated through attributes, including attentive non-verbal communication, and through responding to cues, including making effective empathetic statements. Continual human connection was facilitated through successful beginnings, including preferring open questions to 'robotic' tick-list questions and allowing patients time to have their say. Mirroring, professional appearance, appropriate physical contact and a human approach were amongst other factors facilitating connection with patients. Information flow was encouraged by factors including showing an interest in the patient and use of silence; flow was curtailed by undesirable attributes, including interrupting, dismissive communication and making assumptions about aspects such as sexuality. CONCLUSION This first in-depth study of SPs' views on medical consulting identifies a communication triad that both affirms and builds on the current literature base. Five novel teaching points emerge, with clear relevance for best practice communication teaching and curricula design.
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Andersen AE, Moberg C, Bengtsson Tops A, Garmy P. Lesbian, gay and bisexual parents’ experiences of nurses’ attitudes in child health care-A qualitative study. J Clin Nurs 2017; 26:5065-5071. [DOI: 10.1111/jocn.14006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Anna-Eva Andersen
- Department of Health Science; Kristianstad University; Kristianstad Sweden
| | - Catherine Moberg
- Department of Health Science; Kristianstad University; Kristianstad Sweden
| | | | - Pernilla Garmy
- Department of Health Science; Kristianstad University; Kristianstad Sweden
- Department of Health Science; Clinical Health Promotion Center; Lund University; Lund Sweden
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20
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Kelly D, Sakellariou D, Fry S, Vougioukalou S. Heteronormativity and prostate cancer: A discursive paper. J Clin Nurs 2017; 27:461-467. [PMID: 28382781 DOI: 10.1111/jocn.13844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To discuss the risks that heteronormative assumptions play in prostate cancer care and how these may be addressed. BACKGROUND There is international evidence to support the case that LGBT patients with cancer are less likely to report poor health or self-disclose sexual orientation. Gender-specific cancers, such as prostate cancer, require particular interventions in terms of supportive care. These may include advice about side-effect management (such as incontinence or erectile dysfunction), treatment choices and social and emotional issues. In this paper, we discuss and analyse the heteronormative assumptions and culture that exist around this cancer. We argue that this situation may act as a barrier to effective supportive care for all Lesbian women, Gay, Transgender and Bisexual patients, in this case men who have sex with men. [Correction added on 21 September 2017, after first online publication: The first sentence of the Background section has been revised for clarity in this current version.] DESIGN: Theoretical exploration of heteronormativity considered against the clinical context of prostate cancer. METHODS Identification and inclusion of relevant international evidence combined with clinical discussion. RESULTS This paper posits a number of questions around heteronormativity in relation to prostate cancer information provision, supportive care and male sexuality. While assumptions regarding sexual orientation should be avoided in clinical encounters, this may be difficult when heteronormative assumptions dominate. Existing research supports the assertion that patient experience, including the needs of LGBT patients, should be central to service developments. CONCLUSION Assumptions about sexual orientation should be avoided and recorded accurately and sensitively, and relational models of care should be promoted at the start of cancer treatment in an appropriate manner. These may assist in reducing the risks of embarrassment or offence to nonheterosexual patients, or to professionals who may adopt heteronormative assumptions. RELEVANCE TO CLINICAL PRACTICE Having an awareness of the risks of making heteronormative assumptions in clinical practice will be useful for all health professionals engaged in prostate cancer care. This awareness can prevent embarrassment or upset for patients and ensure a more equitable provision of service, including men with prostate cancer who do not identify as heterosexual.
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Affiliation(s)
- Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Sarah Fry
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Stewart K, O'Reilly P. Exploring the attitudes, knowledge and beliefs of nurses and midwives of the healthcare needs of the LGBTQ population: An integrative review. NURSE EDUCATION TODAY 2017; 53:67-77. [PMID: 28448883 DOI: 10.1016/j.nedt.2017.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 02/27/2017] [Accepted: 04/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To explore current literature surrounding the knowledge, beliefs and attitudes of nurses and midwives of the healthcare needs of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) patients and their influence on equal and non-discriminatory care for LGBTQ individuals. DESIGN Systematic integrative review. DATA SOURCES CINAHL, MEDLINE, PubMed, InterNurse. REVIEW METHODS This integrative review used Wakefield's (2014) framework to establish the knowledge, beliefs and attitudes of nurses and midwives of the healthcare needs of LGBTQ patients. Qualitative, quantitative and mixed methods primary studies carried out between 2006 and 2015 from 7 countries were included. Four databases were searched and 98 studies were screened for eligibility by two researchers. Level of evidence was assessed by the Scottish Intercollegiate Guidelines Network (SIGN, 2010) criteria and quality was assessed by a screening tool adapted from Noyes and Popay (2007) for qualitative papers and Quality Assessment Tool for Quantitative Studies adapted from the Effective Public Health Practice Project (EPHPP, 2010). Following PRISMA guidelines, this integrative review analysed and synthesised evidence using thematic analysis to generate themes. RESULTS 24 papers were included in the final synthesis which revealed four primary themes: Heteronormativity across Healthcare; Queerphobia; Rainbow of Attitudes; Learning Diversity. CONCLUSIONS Nurses and midwives possess a wide spectrum of attitudes, knowledge and beliefs which impact the care received by LGBTQ patients. Many issues of inadequate care appear to be due to a culture of heteronormativity and a lack of education on LGBTQ health. Further research is needed on interventions which could facilitate disclosure of sexual orientation and interrupt heteronormative assumptions by staff. It is recommended that LGBTQ issues be included within undergraduate nursing and midwifery education or as part of continued professional development.
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Affiliation(s)
- Kate Stewart
- Department of Nursing and Midwifery, University of Limerick, Ireland.
| | - Pauline O'Reilly
- Department of Nursing and Midwifery, University of Limerick, Ireland.
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Meer T, Müller A. “They treat us like we’re not there”: Queer bodies and the social production of healthcare spaces. Health Place 2017; 45:92-98. [DOI: 10.1016/j.healthplace.2017.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/06/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
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Richardson BP, Ondracek AE, Anderson D. Do student nurses feel a lack of comfort in providing support for Lesbian, Gay, Bisexual or Questioning adolescents: what factors influence their comfort level? J Adv Nurs 2016; 73:1196-1207. [PMID: 27900788 DOI: 10.1111/jan.13213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to find out if student nurses feel comfortable in caring by providing support for Lesbian, Gay, Bisexual or Questioning adolescents and what factors influence their level of comfort. BACKGROUND Research indicates that nurses and nursing students experience varying levels of comfort when caring for adults who are Lesbian, Gay, Bisexual or Questioning: adult patients feel that nurse's attitudes change towards them once they disclose their sexuality. There has been minimal research to date on nursing attitudes to working with adolescents who are Lesbian, Gay, Bisexual or Questioning. DESIGN Both quantitative and qualitative methods were used in this descriptive study. Questionnaires were completed by 152 nursing students and nine took part in semi-structured focus groups. METHOD A two-way ANOVA was used to analyse the questionnaires. Thematic analysis was used to identify the themes arising from the focus groups. Data were collected between August 2013 - July 2014. RESULTS/FINDINGS The results and findings of the study were that student nurse's felt discomfort in providing support; due to a lack of knowledge of Lesbian, Gay or Bisexual sexuality, personal and religious beliefs and the perceptions of others. However, all students indicated they had a positive attitude towards Lesbian, Gay, Bisexual and Questioning adolescents. CONCLUSION More needs to be done to raise self-awareness and improve the level of knowledge in relation to Lesbian, Gay and Bisexual issues amongst student nurses. Educational institutions and practice areas need to recognize this fact and reflect this in their educational programmes.
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Dean MA, Victor E, Guidry-Grimes L. Inhospitable Healthcare Spaces: Why Diversity Training on LGBTQIA Issues Is Not Enough. JOURNAL OF BIOETHICAL INQUIRY 2016; 13:557-570. [PMID: 27389527 DOI: 10.1007/s11673-016-9738-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 06/26/2016] [Indexed: 05/15/2023]
Abstract
In an effort to address healthcare disparities in lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations, many hospitals and clinics institute diversity training meant to increase providers' awareness of and sensitivity to this patient population. Despite these efforts, many healthcare spaces remain inhospitable to LGBTQ patients and their loved ones. Even in the absence of overt forms of discrimination, LGBTQ patients report feeling anxious, unwelcome, ashamed, and distrustful in healthcare encounters. We argue that these negative experiences are produced by a variety of subtle, ostensibly insignificant features of healthcare spaces and interpersonal interactions called microaggressions. Healthcare spaces and providers often convey heteronormative microaggressions, which communicate to LGBTQ-and, we suggest, intersex and asexual (IA)-people that their identities, experiences, and relationships are abnormal, pathological, unexpected, unwelcome, or shameful. We identify heteronormative microaggressions common to healthcare settings and specify how they negatively impact LGBTQIA patients. We argue that standard diversity training cannot sufficiently address heteronormative microaggressions. Despite these challenges, healthcare institutions and providers must take responsibility for heteronormative microaggressions and take steps to reduce their frequency and mitigate their effects on LGBTQIA care. We conclude by offering strategies for problem-solving at the level of medical education, institutional culture and policy, and individual awareness.
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Affiliation(s)
- Megan A Dean
- 215 New North Hall, 37th and O Streets, N.W., Washington, DC, 20057, USA.
| | - Elizabeth Victor
- William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, USA
| | - Laura Guidry-Grimes
- Medstar Washington Hospital Center and Georgetown University, 110 Irving St NW, East Building, Room 3108, Washington, DC, 20010, USA
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Abstract
The issue of sex is often avoided in or excluded from occupational therapy. This opinion piece argues that the exclusion of sex contradicts the holistic and client-centred arguments of occupational therapy and can lead clients to the adoption of precarious occupations in order to pursue their sexual needs. It offers an overview of some of the reasons for the exclusion of sex discourses from occupational therapy and calls for an appreciation of clients' sexual needs. By learning more about clients' experiences, occupational therapists can establish priorities towards shared outcomes and facilitate the maintenance, development and re-establishment of meaningful occupational lives.
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26
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Guntram L, Zeiler K. ‘You have all those emotions inside that you cannot show because of what they will cause’: Disclosing the absence of one's uterus and vagina. Soc Sci Med 2016; 167:63-70. [DOI: 10.1016/j.socscimed.2016.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 01/03/2023]
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Malterud K, Bjorkman M. The Invisible Work of Closeting: A Qualitative Study About Strategies Used by Lesbian and Gay Persons to Conceal Their Sexual Orientation. JOURNAL OF HOMOSEXUALITY 2016; 63:1339-1354. [PMID: 26914706 DOI: 10.1080/00918369.2016.1157995] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The last decades have offered substantial improvement regarding human rights for lesbian and gay (LG) persons. Yet LG persons are often in the closet, concealing their sexual orientation. We present a qualitative study based on 182 histories submitted from 161 LG individuals to a Web site. The aim was to explore experiences of closeting among LG persons in Norway. A broad range of strategies was used for closeting, even among individuals who generally considered themselves to be out of the closet. Concealment was enacted by blunt denial, clever avoidance, or subtle vagueness. Other strategies included changing or eliminating the pronoun or name of the partner in ongoing conversations. Context-dependent concealment, differentiating between persons, situations, or arenas, was repeatedly applied for security or convenience. We propose a shift from "being in the closet" to "situated concealment of sexual orientation."
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Affiliation(s)
- Kirsti Malterud
- a Research Unit for General Practice , Uni Research Health , Bergen , Norway
- b Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
- c Research Unit for General Practice in Copenhagen , Copenhagen , Denmark
| | - Mari Bjorkman
- a Research Unit for General Practice , Uni Research Health , Bergen , Norway
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Carrotte ER, Vella AM, Bowring AL, Douglass C, Hellard ME, Lim MSC. "I am yet to encounter any survey that actually reflects my life": a qualitative study of inclusivity in sexual health research. BMC Med Res Methodol 2016; 16:86. [PMID: 27465507 PMCID: PMC4964098 DOI: 10.1186/s12874-016-0193-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heteronormativity describes a set of norms and assumptions pertaining to heterosexual identities and binary gender. In 2015, we conducted our annual Sex, Drugs and Rock'n'Roll study, an online health survey of over 1000 Victorians aged 15-29 years. Feedback from participants suggested that our survey contained heteronormative language. In response to this, we aimed to make inclusive changes to our survey via consultation with young gender and sexually diverse (GSD) people. METHODS We conducted two semi-structured focus groups in Melbourne with a total of 16 participants (age range: 21-28 years). Participants were mostly cisgender women, and there were two transgender participants and one non-binary participant. Participants also had a range of sexual identities including lesbian, queer, bisexual, pansexual, and asexual. Focus group discussions were transcribed verbatim and analysed thematically. RESULTS Most participants indicated heteronormativity affects their lives in multiple ways, noting its impacts on access to sexual healthcare, invalidating sexual experiences and miscommunication in forms and surveys. Overall, participants emphasised the need for sexual health research to avoid assumptions about behaviour, to be clear and eliminate question ambiguity and avoiding treating gender as binary. Participants also discussed how the Sex, Drugs and Rock'n'Roll survey could address a range of sexual behaviours and experiences, rather than focusing on penetrative sex, which many participants found invalidating. CONCLUSIONS Our findings have important implications for future health surveys aimed at general populations. We present recommendations that encourage research to be more inclusive to ensure data collection from GSD participants is respectful and rigorous.
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Affiliation(s)
- Elise R Carrotte
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Alyce M Vella
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Anna L Bowring
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia
| | - Caitlin Douglass
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia
| | - Margaret E Hellard
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia
| | - Megan S C Lim
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
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29
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Munson S, Cook C. Lesbian and bisexual women's sexual healthcare experiences. J Clin Nurs 2016; 25:3497-3510. [DOI: 10.1111/jocn.13364] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Siân Munson
- Central Primary Health Organisation; Palmerston North New Zealand
| | - Catherine Cook
- Massey University School of Nursing; Auckland New Zealand
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Wada K, Smith DR, Ishimaru T. Reluctance to care for patients with HIV or hepatitis B / C in Japan. BMC Pregnancy Childbirth 2016; 16:31. [PMID: 26850002 PMCID: PMC4744415 DOI: 10.1186/s12884-016-0822-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/31/2016] [Indexed: 12/12/2022] Open
Abstract
Background Healthcare workers are faced with various professional dilemmas in the workplace, including at times, a reluctance to care for particular patients. This study investigated personal attitudes and factors influencing Japanese nurses’ reluctance to care for patients infected with HIV, Hepatitis B Virus (HBV), or Hepatitis C Virus (HCV). Methods Participants completed an anonymous online survey focusing on potential attitudes towards hypothetical patients, awareness of infection risk and their confidence in using precautions to prevent infection. Statistical associations were analyzed using Poisson regression models. Results Regarding personal attitudes, 41 % and 18 % of nurses agreed or somewhat agreed that they would be reluctant to care for a hypothetical patient infected with HIV or HBV / HCV, respectively. Reluctance to care for patients with HIV or HBV / HCV was positively associated with prejudicial attitudes and negatively associated with confidence in personal safety precautions. Hypothetical reluctance to care for patients with HBV / HCV was negatively associated with actual previous experience caring for HBV / HCV patients. Older age among nurses (≥50 years) was positively associated with an increased reluctance to care for hypothetical patients with HIV. Conclusions Overall, this study suggests that anxiety arising from perceived infection risk and having a prejudicial attitude might affect the acceptance of infected patients, while personal confidence in universal precautions probably mitigates this situation. Improving nurses’ confidence in using universal precautions therefore represents a positive measure that can help reduce prejudice and improve the quality of healthcare services in Japan, as elsewhere. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0822-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Koji Wada
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Derek R Smith
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, Australia.
| | - Tomohiro Ishimaru
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Bangkok, Thailand. .,Occupational Health Training Center, University of Occupational and Environmental Health, Kitakyushu, Japan.
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Hooper A, De Boos D, Nair RD, Moghaddam N. First-person narratives around sexuality in residential healthcare settings: a meta-ethnographic synthesis. SEXUAL AND RELATIONSHIP THERAPY 2016. [DOI: 10.1080/14681994.2015.1131256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Law M, Mathai A, Veinot P, Webster F, Mylopoulos M. Exploring lesbian, gay, bisexual, and queer (LGBQ) people's experiences with disclosure of sexual identity to primary care physicians: a qualitative study. BMC FAMILY PRACTICE 2015; 16:175. [PMID: 26651342 PMCID: PMC4675062 DOI: 10.1186/s12875-015-0389-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 12/01/2015] [Indexed: 11/10/2022]
Abstract
Background It has been demonstrated that health disparities between lesbian, gay, bisexual and queer (LGBQ) populations and the general population can be improved by disclosure of sexual identity to a health care provider (HCP). However, heteronormative assumptions (that is, assumptions based on a heterosexual identity and experience) may negatively affect communication between patients and HCPs more than has been recognized. The aim of this study was to understand LGBQ patients’ perceptions of their experiences related to disclosure of sexual identity to their primary care provider (PCP). Methods One-on-one semi-structured telephone interviews were conducted, audio-recorded, and transcribed. Participants were self-identified LGBQ adults with experiences of health care by PCPs within the previous five years recruited in Toronto, Canada. A qualitative descriptive analysis was performed using iterative coding and comparing and grouping data into themes. Results Findings revealed that disclosure of sexual identity to PCPs was related to three main themes: 1) disclosure of sexual identity by LGBQ patients to a PCP was seen to be as challenging as coming out to others; 2) a solid therapeutic relationship can mitigate the difficulty in disclosure of sexual identity; and, 3) purposeful recognition by PCPs of their personal heteronormative value system is key to establishing a strong therapeutic relationship. Conclusion Improving physicians’ recognition of their own heteronormative value system and addressing structural heterosexual hegemony will help to make health care settings more inclusive. This will allow LGBQ patients to feel better understood, willing to disclose, subsequently improving their care and health outcomes.
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Affiliation(s)
- Marcus Law
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 3157, Toronto, ON, M5S 1A8, Canada. .,Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | - Anila Mathai
- Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | | | - Fiona Webster
- Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | - Maria Mylopoulos
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 3157, Toronto, ON, M5S 1A8, Canada. .,The Wilson Centre, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada.
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Heyes C, Dean M, Goldberg L. Queer Phenomenology, Sexual Orientation, and Health Care Spaces: Learning From the Narratives of Queer Women and Nurses in Primary Health Care. JOURNAL OF HOMOSEXUALITY 2015; 63:141-155. [PMID: 26295596 DOI: 10.1080/00918369.2015.1083775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Queer phenomenology as an interpretive framework can advance health research by illuminating why primary health care providers (HCPs) must move beyond definitions of sexuality as a set of reified identity formations indexed to normative gender, gender of partner, and sexual and reproductive practices. Our interviews with queer women participants and primary care nurses offer an implicit critique of heteronormative health care space, temporality, and power relations, as they form the lived experiences of our participants. We conclude by pointing to the limits of our methodology in exposing the larger relations of power that dictate experiences of heteronormative health care.
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Affiliation(s)
- Cressida Heyes
- a Department of Philosophy , University of Alberta , Edmonton , Alberta , Canada
| | - Megan Dean
- b Department of Philosophy , Georgetown University , Washington , DC , USA
| | - Lisa Goldberg
- c Faculty of Health Professions , School of Nursing, Dalhousie University , Halifax , Nova Scotia , Canada
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Curmi C, Peters K, Salamonson Y. Barriers to cervical cancer screening experienced by lesbian women: a qualitative study. J Clin Nurs 2015; 25:3643-3651. [DOI: 10.1111/jocn.12947] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Claire Curmi
- School of Nursing & Midwifery; University of Western Sydney; Penrith NSW Australia
| | - Kath Peters
- School of Nursing & Midwifery; University of Western Sydney; Penrith NSW Australia
| | - Yenna Salamonson
- School of Nursing & Midwifery; University of Western Sydney; Penrith NSW Australia
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Heyes CJ, Thachuk A. Queering know-how: clinical skill acquisition as ethical practice. JOURNAL OF BIOETHICAL INQUIRY 2015; 12:331-41. [PMID: 25037245 DOI: 10.1007/s11673-014-9566-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/28/2014] [Indexed: 05/13/2023]
Abstract
Our study of queer women patients and their primary health care providers (HCPs) in Halifax, Nova Scotia, reveals a gap between providers' theoretical knowledge of "cultural competency" and patients' experience. Drawing on Patricia Benner's Dreyfusian model of skill acquisition in nursing, we suggest that the dissonance between the anti-heteronormative principles expressed in interviews and the relative absence of skilled anti-heteronormative clinical practice can be understood as a failure to grasp the field of practice as a whole. Moving from "knowing-that" to "knowing-how" in terms of anti-heteronormative clinical skills is not only a desirable epistemological trajectory, we argue, but also a way of understanding better and worse ethical practice.
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Affiliation(s)
- Cressida J Heyes
- Departments of Political Science and Philosophy, University of Alberta, HM Tory Building 11-27, Edmonton, Alberta, Canada, T6G 2H4,
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Grigorovich A. The meaning of quality of care in home care settings: older lesbian and bisexual women's perspectives. Scand J Caring Sci 2015; 30:108-16. [PMID: 25919504 DOI: 10.1111/scs.12228] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/20/2015] [Indexed: 11/29/2022]
Abstract
Research suggests that the experience of being a lesbian or bisexual woman influences women's interactions with health care providers, and their perception of the quality of care. Limited research to date, however, has examined how ageing and sexuality mediates women's experiences of quality, when accessing health care in the community. To fill a gap in the literature, this study investigated older lesbian and bisexual women's perspectives on the meaning of quality of care in the context of receiving home care services. This was a qualitative single case study. Sixteen participants, aged 55-72 from Ontario, Canada, participated in semi-structured interviews between 2011 and 2012. The interviews were recorded and transcribed. The interview data were analysed using iterative thematic analysis and guided by a feminist ethic of care perspective. Participants described quality of care in ways that were in line with a feminist ethic of care; that is, they wanted care providers to be responsive and attentive to their needs, to involve them in the caring process and to demonstrate respect and caring. Participants also indicated that providers' comfort with, and knowledge of, sexual diversity was important for enabling quality of care. These findings deepen our understanding of how to support quality of care for this population through changes to provider education and training, and health policy.
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Affiliation(s)
- Alisa Grigorovich
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Eliason MJ, Fogel SC. An ecological framework for sexual minority women's health: factors associated with greater body mass. JOURNAL OF HOMOSEXUALITY 2015; 62:845-882. [PMID: 25569747 DOI: 10.1080/00918369.2014.1003007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In recent years, many studies have focused on the body of sexual minority women, particularly emphasizing their larger size. These studies rarely offer theoretically based explanations for the increased weight, nor study the potential consequences (or lack thereof) of being heavier. This article provides a brief overview of the multitude of factors that might cause or contribute to larger size of sexual minority women, using an ecological framework that elucidates upstream social determinants of health as well as individual risk factors. This model is infused with a minority stress model, which hypothesizes excess strain resulting from the stigma associated with oppressed minority identities such as woman, lesbian, bisexual, woman of color, and others. We argue that lack of attention to the upstream social determinants of health may result in individual-level victim blaming and interventions that do not address the root causes of minority stress or increased weight.
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Affiliation(s)
- Michele J Eliason
- a Department of Health Education , San Francisco State University , San Francisco , California , USA
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Arthur DP. Social Work Practice with LGBT Elders at End of Life: Developing Practice Evaluation and Clinical Skills Through a Cultural Perspective. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2015; 11:178-201. [PMID: 26380926 DOI: 10.1080/15524256.2015.1074141] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article focuses on culturally sensitive clinical issues related to best practices with lesbian, gay, bisexual, transgender (LGBT) elder patients at end-of-life (EOL) at key points in the therapeutic relationship. Vital concepts, including practice evaluation and clinical skills, are presented through a cultural and oncology lens. There is a paucity of LGBT research and literature as well as a shortfall of MSW graduate school education specific to social work palliative and end-of-life care (PELC) practice with LGBT elders. The content of this article is designed to be adapted and used as an educational tool for institutions, agencies, graduate programs, medical professions, social work, and students. Learning the unique elements of LGBT cultural history and their implications on EOL care can improve social work practice. This article provides an examination from assessment and engagement basics to advance care planning incorporating specific LGBT EOL issues.
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Affiliation(s)
- Darren P Arthur
- a Beth Israel Comprehensive Cancer Center-East Campus , Mount Sinai Beth Israel Hospital , New York , New York , USA
- b New York University Silver School of Social Work , New York , New York , USA
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Abstract
This article reviews research on stigma and discrimination—at both the interpersonal and societal levels—faced by disadvantaged groups. Research on interpersonal discrimination primarily concerns discrimination that is perceived and directly experienced (e.g., discrimination in employment and health care), whereas research on societal discrimination focuses on broad societal factors (e.g., institutional policies, social attitudes). We review evidence across numerous fields of study that rely on several types of research designs, which indicate that both forms of stigma and discrimination demonstrably contribute to health inequalities for disadvantaged groups such as racial and ethnic minorities and lesbian, gay, and bisexual populations. These adverse health outcomes range from maladaptive physiological stress responses in a laboratory setting to premature mortality at a population level. The science on stigma and discrimination applies to policy issues in education, same-sex marriage, and health care delivery. Some current policies increase the experience of stigma. We argue that more holistic social policies can recognize the psychosocial factors that contribute to well-being, thereby reducing social inequalities in health.
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Dibley L, Norton C, Schaub J, Bassett P. Experiences of gay and lesbian patients with inflammatory bowel disease: a mixed methods study. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/gasn.2014.12.6.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lesley Dibley
- Research Associate, Florence Nightingale School of Nursing and Midwifery, King's College, London, England
| | - Christine Norton
- Professor of Clinical Nursing Research, Florence Nightingale School of Nursing and Midwifery, King's College, and Imperial College, London, England
| | - Jason Schaub
- Senior Lecturer in Social Work, Buckinghamshire New University, High Wycombe, England
| | - Paul Bassett
- Independent Statistician, Stats Consultancy, Amersham, England
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Marques AM, Oliveira JMD, Nogueira C. [The lesbian population in health studies: contributions for a critical reflection]. CIENCIA & SAUDE COLETIVA 2014; 18:2037-47. [PMID: 23827908 DOI: 10.1590/s1413-81232013000700019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 05/11/2012] [Indexed: 11/22/2022] Open
Abstract
For decades, lesbian sexuality was associated with pathology in the attitudes to and practices of health sciences and psychology. During the twentieth century that position changed gradually. This article analyzes these changes in a theoretical reflection on the domain of lesbian health, dominated by heteronormative and heterosexist concepts and practices both in research and in health care. By means of a critical contextualization of the literature, specific health needs of lesbians were identified and the interventions of health care professionals and services were questioned. Specific concrete actions are proposed in the fields of health promotion and in the eradication of discrimination and inequality in health care.
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Affiliation(s)
- António Manuel Marques
- Escola Superior de Saúde, Instituto Politécnico de Setúbal, Estefanilha, Setúbal, Portugal.
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Lindner P, Martell C, Bergström J, Andersson G, Carlbring P. Clinical validation of a non-heteronormative version of the Social Interaction Anxiety Scale (SIAS). Health Qual Life Outcomes 2013; 11:209. [PMID: 24354964 PMCID: PMC3878259 DOI: 10.1186/1477-7525-11-209] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 12/12/2013] [Indexed: 02/07/2023] Open
Abstract
Introduction Despite welcomed changes in societal attitudes and practices towards sexual minorities, instances of heteronormativity can still be found within healthcare and research. The Social Interaction Anxiety Scale (SIAS) is a valid and reliable self-rating scale of social anxiety, which includes one item (number 14) with an explicit heteronormative assumption about the respondent´s sexual orientation. This heteronormative phrasing may confuse, insult or alienate sexual minority respondents. A clinically validated version of the SIAS featuring a non-heteronormative phrasing of item 14 is thus needed. Methods 129 participants with diagnosed social anxiety disorder, enrolled in an Internet-based intervention trial, were randomly assigned to responding to the SIAS featuring either the original or a novel non-heteronormative phrasing of item 14, and then answered the other item version. Within-subject, correlation between item versions was calculated and the two scores were statistically compared. The two items’ correlations with the other SIAS items and other psychiatric rating scales were also statistically compared. Results Item versions were highly correlated and scores did not differ statistically. The two items’ correlations with other measures did not differ statistically either. Conclusions The SIAS can be revised with a non-heteronormative formulation of item 14 with psychometric equivalence on item and scale level. Implications for other psychiatric instruments with heteronormative phrasings are discussed.
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Affiliation(s)
- Philip Lindner
- Department of Clinical Neuroscience, Karolinska Institutet, Karolinska, Sweden.
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Fenge LA. Developing understanding of same-sex partner bereavement for older lesbian and gay people: implications for social work practice. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2013; 57:288-304. [PMID: 24006957 DOI: 10.1080/01634372.2013.825360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/11/2013] [Indexed: 06/02/2023]
Abstract
There is little research and literature exploring same-sex partner bereavement in later life or end-of-life experiences of lesbian and gay elders in the United Kingdom. This article considers this often overlooked area of social work practice and explores a range of factors emerging from a small explorative study that considers the experience of loss and bereavement for lesbian and gay elders. Discussion of issues emerging include consideration of the wider psycho-social nature of bereavement and end-of-life experiences for lesbian and gay elders, and the implications this has for social work education and practice.
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Affiliation(s)
- Lee-Ann Fenge
- a National Centre for Post-Qualifying Social Work , Bournemouth University , Bournemouth , UK
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Spinner-Gelfars AH. Using simulation to promote effective communication with a diverse student population. TEACHING AND LEARNING IN NURSING 2013. [DOI: 10.1016/j.teln.2013.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McCabe J, Holmes D. Nursing, sexual health and youth with disabilities: a critical ethnography. J Adv Nurs 2013; 70:77-86. [PMID: 23627581 DOI: 10.1111/jan.12167] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2013] [Indexed: 11/26/2022]
Abstract
AIM To explore the experiences of nurses providing sexual health care to adolescents with physical and/or developmental disabilities, with attention to the institutional and social discourses that shape these interactions. BACKGROUND Previous research has shown that nurses demonstrate a lack of attention to the impact of illness or disability on sexual health. However, in their therapeutic relationship with patients and families, nurses are in an ideal position to promote sexual health. DESIGN A critical ethnography study was conducted in an urban paediatric rehabilitative facility. METHOD Field work occurred over 4 months (2008-2009) and data collection included interviews (n = 9), key informant discussions, collection of documentary evidence and observation of the institutional setting. FINDINGS Four themes were identified (institutional space, professional interactions, engaging with sexuality, nursing experience), which revealed that nurse-patient interactions about sexual health were affected by a complex network of discourses. These encounters were shaped by practical discourses, such as time and space and by more complex discourses, such as professional relationships, normalization and asexuality. CONCLUSION Nurses occupy and strive to maintain, the role of a caring agent. However, aspects of the clinical, institutional and broader social environments may undermine their ability to promote sexual health. In nurses' efforts to maintain therapeutic relationships with clients, sexual health is often medicalised to legitimize it as an appropriate topic of discussion with patients and families. Facilities serving youth with disabilities should take steps to address barriers to the delivery of sexual health promotion and several solutions are proposed.
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Affiliation(s)
- Janet McCabe
- College of Nursing, University of Saskatchewan, Prince Albert, Saskatchewan, Canada
| | - Dave Holmes
- School of Nursing, Univerity of Ottawa, Ontario, Canada
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Cherguit J, Burns J, Pettle S, Tasker F. Lesbian co-mothers' experiences of maternity healthcare services. J Adv Nurs 2012; 69:1269-78. [DOI: 10.1111/j.1365-2648.2012.06115.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jan Burns
- Department of Applied Psychology; Canterbury Christ Church Univeristy; Kent; UK
| | | | - Fiona Tasker
- Department of Psychological Sciences; Birkbeck University of London; UK
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Abstract
BACKGROUND The concept of heterosexism is used in a variety of ways in healthcare literature. The lack of consensus of the term makes identifying when and how it impacts the health care of lesbian, gay, and bisexual people difficult. A lack of clarity of the concept could also hinder effectiveness of education, awareness, and research tool development efforts. PURPOSE The purpose of this concept analysis is to offer a synthesized definition of the term heterosexism, including its relation to and distinction from related concepts like homophobia and heteronormativity. METHODS The authors use Walker and Avant's eight-step concept analysis method: select a concept, determine the aim of analysis, identify all uses of the concept, determine defining attributes, construct a model case, construct additional cases, identify antecedents and consequences, and define empirical referents. CONCLUSION The results of the analysis reveal focus areas for future research, tool development, and suggestions for improvements in nursing clinical practice.
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Affiliation(s)
- Sarah Morrison
- School of Nursing, Washburn University, Topeka, KS, USA.
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Xu Y, Staples S, Shen JJ. Nonverbal Communication Behaviors of Internationally Educated Nurses and Patient Care. Res Theory Nurs Pract 2012; 26:290-308. [DOI: 10.1891/1541-6577.26.4.290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Because of language barriers and cultural differences, internationally educated nurses (IENs) face documented communication challenges in health care delivery. Yet, it is unknown how and to what extent nonverbal behaviors affect patient care because of research gap in the existing nursing literature. Methods: This is an exploratory study evaluating nonverbal communication behaviors of IENs interacting with standardized patients (SPs) in a controlled clinical setting through videotape analysis. Participants included 52 IENs from two community hospitals in the same hospital system in a southwestern metropolitan area in the United States. Twelve nonverbal behaviors were rated using a 4-point Likert scale with 4 indicating the best performance by the research team after watching videos of SP–IEN interactions. The global communication performance was also ranked in four areas: genuineness, spontaneity, appropriateness, and effectiveness. The relationships between these four areas and the nonverbal behaviors were explored. Finally, a qualitative analysis of two extreme cases was conducted and supplemented the quantitative findings. Results: The IENs received average scores under 2 in 5 out of the 12 nonverbal behaviors. They were “hugging” (1.06), “lowering body position to patient’s level” (1.07), “leaning forward” (1.26), “shaking hands” (1.64), and “therapeutic touch” (1.66). The top three scores were for “no distractive movement,” “eye contact,” and “smile” (3.80, 3.73, and 3.57, respectively). The average overall global impression score was 2.98. The average score for spontaneity was 2.80, which was significantly lower than the scores for genuineness (3.15), appropriateness (3.11), but comparable to the average score for effectiveness (2.85). Finally, therapeutic touch, interpersonal space, eye contact, smiling, and hugging were all significantly correlated with one or more of the global impression scores, with therapeutic touch showing moderate correlations with all of the scores as well as the overall global impression score. Implications: The IENs’ nonverbal behaviors in areas such as hugging, lowering body position to patient’s level, leaning forward, shaking hands, and therapeutic touch have room for improvement. Targeted interventions focusing on norms and expectations of nonverbal behaviors in the U.S. health care setting are called for to improve quality of care.
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Randall CE, Eliason M. Out lesbians in nursing: what would Florence say? JOURNAL OF LESBIAN STUDIES 2012; 16:65-75. [PMID: 22239453 DOI: 10.1080/10894160.2011.557644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Research and education on lesbian health has increased substantially in quantity and quality in the past 40 years, but little of this work has been produced by nursing scholars. We began our academic nursing careers as out lesbian faculty at the same college of nursing in the late 1980s, where we collaborated on the earliest studies of attitudes about lesbians in the nursing profession. Our paths diverged in the early 1990s, but we shared similar experiences in nursing education that highlight the structural and attitudinal barriers within nursing that have inhibited lesbian health studies. The deeply imbedded lesbian phobia within nursing has historic roots that plague contemporary research, education, and practice. In this article, we discuss the inclusion of lesbian health in nursing, share some of our personal stories about the obstacles we encountered, and end with suggestions for changing this stifling climate for future generations of lesbian health scholars.
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Affiliation(s)
- Carla E Randall
- School of Nursing at the University of Southern Maine, Lewiston, Maine 04240, USA.
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Eliason MJ, Dejoseph J, Dibble S, Deevey S, Chinn P. Lesbian, gay, bisexual, transgender, and queer/questioning nurses' experiences in the workplace. J Prof Nurs 2011; 27:237-44. [PMID: 21767821 DOI: 10.1016/j.profnurs.2011.03.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Indexed: 11/30/2022]
Abstract
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) nurses constitute one of the largest subgroups within the profession of nursing, yet there is very little empirical research in the nursing literature and virtually no attention to issues of discrimination and exclusion in the workplace by nursing education or professional nursing organizations. This study reports the findings of an online survey of 261 LGBTQ nurses from a database of an LGBTQ health advocacy organization. The survey contained both quantitative and qualitative items and revealed that many workplaces lacked policies and procedures that would make LGBTQ nurses feel safer and more included and that many coworkers, supervisors, and patients had exhibited discriminatory behavior or verbal harassment, sometimes leading to significant consequences for the LGBTQ worker. LGBTQ nurses expressed a need for a professional organization that would educate the nursing profession and the general population about LGBTQ issues and address their advocacy and health care policy needs. Efforts to correct the current workplace climate for LGBTQ employees would involve (a) changes in workplace policies, (b) education of the health care workforce, and (c) advocacy from nursing professional organizations.
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Affiliation(s)
- Michele J Eliason
- Department of Health Education, San Francisco State University, CA 94132, USA.
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