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Improving Communication With LGBTQ2S Patients.

Nurse Jessica enters Mr. Smith's room to complete his assessment. She notices that Mr. Smith is holding hands with his male visitor, who he introduces as his husband, Jake. Nurse Jessica starts to feel a little anxious. She does not have much experience with gay people, and isn't sure what to say. What if she says the wrong thing and offends them? She didn't even know that it was legal for two men to get married.

The scenario described above is one nurses might find themselves in. The feeling of uncertainty when speaking to a patient from the LGBTQ2S population can feel unsettling due to a lack of experience and knowledge. Basic knowledge can begin by understanding what LGBTQ2S means. LGBTQ2S is an acronym that stands for lesbian, gay, bisexual, transgender, queer and two-spirit. The LGB all relate to sexual orientation, or who an individual is physically, emotionally, or sexually attracted to. The term lesbian refers to women who are attracted to other women, whereas gay refers to persons who are attracted to the same sex, a term typically used with men. Bisexual relates to individuals who feel emotional and/or physical attraction to both women and men (Registered Nurses Association of Ontario [RNAO], 2007). The T stands for transgender. An individual's gender identity is the perception of being male, female, or another gender. Individuals who are transgender have a gender identity or gender expression that differs from their assigned gender at birth (World Professional Association for Transgender Health [WPATH], 2012). Queer is used inclusively to describe a wide range of non-heterosexual persons. Two-spirit or 2S is a term used within Indigenous communities to describe individuals who have both feminine and masculine spirits related to sexual orientation or gender identity (RNAO, 2007).

The need for continued equality in care for individuals across Canada is becoming increasingly recognized, therefore emphasizing the importance of informed practitioner communication with individuals who identify as LGBTQ2S. Communication between registered nurses (RNs) and patients is the foundation for the development of the therapeutic relationship (Arnold and Boggs, 2016). RNs are often the primary point of contact for many patients identifying as LGBTQ2S. Therefore, nurses have the ability to set the tone for the patient's health care experience by being knowledgeable, caring, and non-judgmental (Wardecker & Johnston, 2018). This is important because effective communication between RNs and patients can have a significant impact on health outcomes (Elliot et al., 2015; Gahagan & Subirana-Malaret, 2018; Gonzales & Hemming-Smith, 2017).

A primary barrier to communication with patients identifying as LGBTQ2S is RNs limited knowledge about the population, such as specific terminology and key health or social issues (Gahagan & Subriana-Malaret, 2018; McNiel & Elertson, 2018; Radix & Maingi, 2018). Consider a nurse who is caring for a transgender woman but refers to her using male pronouns. This can hinder the development of a trusting nurse-patient relationship, and lead to a poor patient experience (Hagen & Galupo, 2014).

Poor communication experiences could also occur if a nurse reacts negatively towards a patient when they disclose their sexual orientation or gender identity. Patients who have had a previous negative interaction with a nurse are less likely to disclose information such as sexual practices/partners or health concerns in the future. Insensitive or misinformed communication by nurses can cause patients to miss important screenings or follow-up care. Furthermore, nurses' lack of recognition and awareness of sexual orientation or gender identity may prevent recognition of possible health issues (Gahagan & Subriana-Marlaret, 2018).

Supportive communication with LGBTQ2S patients should occur throughout the therapeutic relationship, beginning from the initial encounter between the patient and the nurse. Key components of supportive communication include active listening, empathy, and trust (Arnold & Boggs, 2016). Confidentiality is also essential. While studies have shown that patients prefer to have the opportunity to disclose their sexual orientation and/or gender identity, provided it is safe to do so, few health care providers ask patients questions about sexual orientation or gender identity (Kamen, Smith-Stoner, Heckler, Flannery and Margolies, 2015; Maragh-Bass et al., 2017).

When working with patients, it is important for RNs to avoid making assumptions, which serve to further marginalize LGBTQ2S people. For example, if a female patient states they are married, the nurse could ask "what is your partner's name?" rather than "what is your husband's name?" Nurses' are also encouraged to be direct and ask the patient how they prefer to be identified by integrating the question "how would you like to be addressed?" into the initial health history (Baldwin et al., 2018). The provider should ask patients what their preferred pronoun is (she/he/them/they) and communicate this information to other practitioners working with the patient through standardized admission forms. The use of gender neutral terms is also supported if the RN is unsure of the patient's gender identity (e.g. they/them when speaking of an individual, instead of she/he). This facilitates the formation of trusting relation ships with patients and allows for patient-centered care to be provided (Baldwin et al., 2018; Hagen & Galupo, 2014; Manzer, O'Sullivan & Doucet, 2018)

Another consideration is the implementation of indirect communication in the form of LGBTQ2S positive posters, rainbow symbols, and safe space signage within places such as waiting rooms. The use of symbols can allow patients to recognize safe spaces, but should always be supported by informed and open-minded RNs who are willing collaborate in order to overcome barriers to care (Wolowic, Heston, Saewyc, Porta, & Eisenberg, 2016). There are many resources available to help nurses become more knowledgeable and integrate these communication strategies into practice through organizations and associations such as RNAO or WPATH.

The use of effective communication with LGBTQ2S patients requires knowledge of language and sensitivity to the barriers faced by this population. Knowing proper terminology and developing confidence in using it will lead to enhanced positive experiences and remove barriers to healthcare for individuals identifying as LGBTQ2S.

Emily Chambers is a fourth-year nursing student at the University of New Brunswick in Saint John. Emily identifies as a member of the LGBTQ2S community and has a passion for working towards a better future in healthcare for this population.

References

Arnold, E.C., & Boggs, K.U. (2016). Interpersonal relationships. Professional communication skills for nurses (7th ed.). St. Louis, Missouri: Elsevier Saunders.

Baldwin, A., Dodge, B., Schick, V. R., Light, B., Scharrs, P. W., Herbenick, D., & Fortenberry, J. D. (2018). Transgender and genderqueer individuals' experiences with health care providers: What's working, what's not, and where do we go from here? Journal of Health Care for the Poor & Underserved, 29(4), 1300-1318. https://doi.org/10.1353/hpu.2018.0097

Elliott, M. N., Kanouse, D. E., Burkhart, Q., Abel, G. A., Lyratzopoulos, G., Beckett, M. K., Roland, M. (2015). Sexual minorities in England have poorer health and worse health care experiences: A national survey. JGIM: Journal of General Internal Medicine, 30(1), 9-16. https://doi.org/10.1007/s11606-014-2905-y

Gahagan, J., & Subirana-Malaret, M. (2018). Improving pathways to primary health care among LGBTQ populations and health care providers: Key findings from Nova Scotia, Canada. International Journal for Equity in Health, 17(1). doi:10.1186/s12939-018-0786-0

Gonzales, G., & Henning-Smith, C. (2017). Health disparities by sexual orientation: Results and implications from the behavioral risk factor surveillance system. Journal of Community Health,42(6), 1163-1172. doi:10.1007/s10900-017-0366-Z

Hagen, D. B., & Galupo, M. P. (2014). Trans individuals' experiences of gendered language with health care providers: Recommendations for practitioners. International Journal of Transgenderism, 15(1), 16-34. https://doi.org/10.1080/15532739.2014.890560

Kamen, C. S., Smith-Stoner, M., Heckler, C. E., Flannery, M., & Margolies, L. (2015). Social support, self-rated health, and lesbian, gay, bisexual, and transgender identity disclosure to cancer care providers. Oncology Nursing Forum, 42(1), 44-51. https://doi.org/10.1188/15.ONF.44-51

Manzer, D., O'Sullivan, L. F., & Doucet, S. (2018). Myths, misunderstandings, and missing information: Experiences of nurse practitioners providing primary care to lesbian, gay, bisexual, and transgender patients. The Canadian Journal of Human Sexuality, 27(2), 157-170. doi:10.3138/cjhs.2018-0017

Maragh-Bass, A. C., Torain, M., Adler, R., Schneider, E., Ranjit, A., Kodadek, L. M., ... Haider. (2017). Risks, benefits, and importance of collecting sexual orientation and gender identity data in healthcare settings: A multi-method analysis of patient and provider perspectives. LGBT Health, 4(2), 141-152. doi:10.1089/lgbt.2016.0107

McNiel, P. L., & Elertson, K. M. (2018). Advocacy and awareness: Integrating LGBTQ health education into the prelicensure curriculum. Journal of Nursing Education, 57(5), 312-314. doi:10.3928/0148483420180420-12

Radix, A., & Maingi, S. (2018). LGBT cultural competence and interventions to help oncology nurses and other health care providers. Seminars in Oncology Nursing, 34(1), 80-89. doi:10.1016/j.soncn.2017.12.005

Registered Nurses Association of Ontario (RNAO). (2007). Position statement: Respecting sexual orientation and gender identity. Retrieved from https://www.rainbowhealthontario.ca/wp-content/ uploads/woocommerce_uploads/2014/08/Respecting_Sexual_ Orientation_and_Gender_Identity.pdf

Wardecker, B. M., & Johnston, T. R. (2018). Seeing and supporting LGBT older adults caregivers and families. Journal of Gerontological Nursing, 44(11), 2-4. doi:10.3928/00989134-20181010-01

Wolowic, J. M., Heston, L., Saewyc, E., Porta, C., & Eisenberg, M. (2016). Embracing the rainbow: LGBTQ youth navigating "safe" spaces and belonging in North America. Journal of Adolescent Health, 58(2), S1. https://doi.org/10.1016/j.jadohealth.2015.10.018

World Professional Association for transgender health (WPATH). (2012). Standards of care for the health of transsexual, transgender, and gender- nonconforming people. Retrieved from https://www.wpath. org/media/cms/Documents/SOC%20v7/Standards%20of%20Care_ V7%20Full%20Book_English.pdf.
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Author:Chambers, Emily A.; Pastirik, Pam; Manzer, Dana
Publication:Info Nursing
Date:Sep 22, 2019
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