Culturally Competent Care of LGBT Patients: The NP Experience

Abstract

Nurse practitioners (NPs) who are culturally competent can enrich patient care, reduce health disparities, and improve health outcomes. Research that examines NP practice as it relates to the culturally competent care of lesbian, gay, bisexual, and transgender (LGBT) patients has been lacking in the literature. To address this gap, an exploratory qualitative descriptive design was used to explore NP experiences with LGBT patients. Data were collected via semi-structured interviews with 22 NPs. Inductive analysis was used to identify, analyze, and report themes within the data. Key findings were that LGBT patients were generally not seen as a distinct cultural group with specific health needs and that NP participants were unclear about the definition or principles of cultural competence as it relates to LGBT persons. Most NPs were not using a model of cultural competence to guide their practice. Instead, they utilized strategies that primarily revolved around the development and maintenance of the therapeutic nurse -patient relationship. These findings have implications for patient outcomes, as well as education, practice, and research. Culturally Competent Care of LGBT Patients: The NP Experience 54 Dana Manzer, Lucia O'Sullivan and Shelley Doucet and injury; health assessment and diagnosis; therapeutic management; and professional role, responsibility and accountability [2].NPs are employed in a variety of practice settings, including community health centers and collaborative family practice; urgent care and emergency departments; mental health and addiction services; correctional services; long-term care; and non-government agencies [3]. An individual's first point of contact or primary provider of health care may be an NP. The hallmark of NP practice is holistic, patient-centered care that assists persons of diverse cultures, races, religions, genders and ethnicities in achieving, maintaining, and enhancing their health and wellbeing [2]. Holism in nursing is grounded in caring. It is foundational to the development of the nurse-patient relationship, and a fundamental component of the Canadian Code of Ethics for Registered Nurses which outlines standards for the safe, competent, and ethical care of patients. Originally adopted in 1984, the code was revised in 2017 to reflect, among other things, the increasing diversity among Canadians accessing the health care system, and the impact of social inequities on health inequities [4].NPs have a long history of providing care to diverse populations who live within vastly different social contexts, and the impact of determinants of health are routinely incorporated into NP practice. Patients experience a variety of acute and chronic health needs over their lifespan, and possess varying levels of health management and coping abilities. However, all patients should expect to receive ethical, competent, and compassionate care from their health care provider, that acknowledges and recognizes the circumstances which influence a person's health and well-being. A key com...

Health Inequities in LGBT People and Nursing Interventions to Reduce Them: A Systematic Review

“…According to the available literature [2,[10][11][12][13], the LGBT population presents poorer results, both in terms of physical and mental health, compared to the cis-heterosexual population. In relation to health issues, the LGBT community has higher rates of mental health (MH) problems such as depression and anxiety; substance abuse (including the use of tobacco, alcohol, and other drugs); and suicide [2,[10][11][12]. The prevalence of osteoporosis and colon, liver, breast, ovarian, or cervical cancers is higher in lesbian and bisexual women and a higher proportion of this population are overweight or obese [10,11].…”

“…The prevalence of osteoporosis and colon, liver, breast, ovarian, or cervical cancers is higher in lesbian and bisexual women and a higher proportion of this population are overweight or obese [10,11]. In gay and bisexual men, higher rates of transmission of the human immunodeficiency virus (HIV), viral hepatitis, and other sexually transmitted infections (STIs); anal, prostate, testicle, and colon cancers; and body image and eating disorders have been described [10][11][12]. In trans people, in addition to their specific needs related to the trans-specific body modification process, high rates of self-harm and suicide have also been reported [10][11][12].…”

“…In relation to social issues, trans people experience greater discrimination and high rates of interpersonal violence, while at the same time, fewer people in this population have medical insurance [10][11][12]. Specifically, trans men and NB people with the capacity for pregnancy are often excluded from breast cancer screenings or gynaecological/obstetric care, often because medical staff make the wrong assumptions about the person's biology [13].…”

“…LGBT people are less likely to have children, and so during old age they are more likely to live alone and to face other health barriers resulting from social isolation and the lack of culturally competent health or social services [10,11]. Moreover, many LGBT people describe feeling uncomfortable and unsafe because of discriminatory attitudes and practices in healthcare systems; they more often report culturally inappropriate care and describe avoiding visiting health centres for the fear of receiving poor care [12,14,15]. Thus, the standardisation of cis-heterosexuality, stereotypes, and prejudices towards the LGBT community impose difficulties in individualised care for this population [12,14,15].…”

“…Moreover, many LGBT people describe feeling uncomfortable and unsafe because of discriminatory attitudes and practices in healthcare systems; they more often report culturally inappropriate care and describe avoiding visiting health centres for the fear of receiving poor care [12,14,15]. Thus, the standardisation of cis-heterosexuality, stereotypes, and prejudices towards the LGBT community impose difficulties in individualised care for this population [12,14,15].…”