Imagine being rushed to an emergency room; you are in pain, distressed, and uncertain of what’s happening. You see people all around you, but you do not recognize any of the faces; you are searching for something familiar and comfortable, but you cannot find it. You are told you need surgery. After the operation, you wake up and want to see your significant other, who you were with when the injurious incident happened. The hospital denies you and your partner proper visitation rights because you are a member of the LGBTQ+ community. You are left alone and afraid in your hospital room.
While you may not have faced this situation yourself, this happens often. LGBTQ+ patients face many struggles, such as being denied care. When they are given medical assistance, they may feel unsafe or be mistreated in an environment that should feel open and comfortable. Patients should trust hospitals and feel accepted in one; if not, is that genuinely medical care? Forming a therapeutic bond with a patient is vital for a nurse. The direct interactions between a nurse and a patient can be just as impactful as the medical care. Nurses should know how to consider LGBTQ+ patients properly; displaying discomfort or bias on the job is unacceptable. As a nurse, it is our responsibility to make our hospitals feel as safe as possible. Here are eight things that we can do to ensure that LGBTQ+ patients receive the treatment, both medical and personal, that they deserve.
1. Make sure that your hospital’s space is inclusive and comfortable
Hospital nondiscrimination policies or the patient bill of rights should be displayed in the waiting room or main public entrance. This policy should express that equitable care will be provided regardless of a patient’s sexual orientation, gender identity, or expression, which may put patients at ease. Additionally, visual media in common areas, pamphlets, and brochures should be inclusive and cover topics relevant to LGBTQ+ patients. Relevant magazines, posters, and information about local resources for the LGBTQ+ community should be readily available. Décor and images depicting couples and families should include same-sex partners, same-sex parents, and diverse families.
Moreover, unisex or single-stall restrooms should be available for patients whose appearance might not conform to gender stereotypes. Hospital/clinic intake forms should include more than just “male” and “female” for gender options. Visitation policies should be fair and nondiscriminatory so that no patient is denied equal visitation rights. By doing this, LGBTQ+ patients may feel more welcome and comfortable when receiving care in your institution.
2. Be open-minded
Even if the workspace appears to accept all people, the mentality of the people who work there matters more, and this starts at the individual level. Nurses have a professional responsibility to be open-minded. Nurses care for patients based on their needs, as the 2014 ANA Code of Ethicsstates, “setting aside any bias or prejudice.” A patient who looks different should never be judged based on their appearance.
3. Don’t assume and don’t be pushy
Beyond being nonjudgmental, nurses should avoid making assumptions about patients based on how they present themselves. A patient who presents themselves in a gender-neutral or non-conforming way should not be assumed to be a member of the LGBTQ+ community simply because it fits the nurse’s available stereotype or paradigm. The nurse should not behave in a way that assumes personal knowledge about a patient until that knowledge is shared or confirmed directly by the patient. According to the ANA Code of Ethics, everybody should be treated equally, as “the need for and right to health care is universal, transcending all individual differences.” Questions should be asked in an open-ended and unbiased format using terms like partner or spouse instead of husband or girlfriend. If a patient is uncomfortable sharing information regarding their gender or sexual orientation, the nurse should respect the patient’s boundaries unless the information is critical to the care being given. The nurse should always inform the patient why certain information is being solicited and how it directly relates to the safe delivery of their care.
4. Utilize the appropriate LGBTQ+ vocabulary
Cultural competency and knowledge are crucial; a comprehensive education regarding the LGBTQ+ community can help nurses better care for and understand all patients. Knowing the basic terminology, such as what the letters in the acronym of LGBTQ+ stand for, is a good start (i.e., lesbian, gay, bisexual, transgender, or queer/questioning). You can check out our blog post on Nurses, Patients, and 21st-Century Gender Expression for a crash course. We suggest the glossary of gender expression terms compiled by the Human Rights Campaign for those interested in a comprehensive understanding. Knowledge is the foundation for empathy, breaking stereotypes, and making patients feel understood when they need it most.
5. Understand the physical, mental, and legal risks that are unique to LGBTQ+ patients
Many health conditions specifically affect members of the LGBTQ+ community. Such conditions include higher rates of substance abuse, smoking, and alcoholism; higher rates of anxiety and depression; higher rates of some sexually transmitted diseases, including HIV; and increased incidence of some cancers (Western Journal of Medicine, 2000). Members of the LGBTQ+ community also have less access to health insurance and health care services, such as preventative care (e.g., cancer screenings), resulting in delays or denial of care at times. An in-depth understanding of these risks can assist nurses in providing more personalized and efficient care for LGBTQ+ patients. Once again, the ANA Code reminds us that “factors such as culture, value systems, religious or spiritual beliefs, lifestyle, social support system, sexual orientation or gender expression, and primary language are to be considered when planning individual, family, and population-centered care.”
6. Engage in cultural competency workshops
Often, when nurses feel uncomfortable with a patient, it’s because they have not had exposure to similar patients. The nurse’s discomfort can make the patient feel unsafe and other medical professionals in the situation uncomfortable. While this is not the nurse’s intention, it can be remedied by increased exposure. Cultural competency workshops train healthcare professionals to interact effectively with patients of all different backgrounds through hypothetical situations. Such exercises can also be incorporated during meetings occasionally to increase the normalcy of such interactions. These opportunities allow nurses to apply the knowledge they’ve gained from books and other resources and reinforce that a patient is a patient no matter what. All patients deserve kindness and respect when receiving care.
7. Be aware and reflect on the experience of an LGBTQ+ patient in your hospital’s setting
To ensure that you and your facility are offering the care that LGBTQ+ patients need, assessing how to optimize the environment or what is missing should occur on an ongoing basis. This continuous process requires all the previous steps and an active and objective awareness regarding potential areas for growth. As an LGBTQ+ patient in your institution, would you feel comfortable in the reception area? Are the pamphlets and patient education materials inclusive? Are same-sex couples afforded the same visitation and proxy decision-making rights as heterosexual couples? Have all staff members completed diversity training? If the answer to any of these questions is “no,” then changes must be implemented. Such awareness helps you and your hospital be as welcoming as possible. An open dialogue with your community through anonymous patient and family surveys, comment cards, and suggestion boxes may also solicit valuable and honest feedback regarding details that may have been overlooked.
8. Treat all patients with respect
Many members of the LGBTQ+ community spend their formative years hiding their identity from everyone, even the people who know them best. Many are concerned about issues of confidentiality or denial of care. It takes tremendous courage for patients to disclose their personal information to a healthcare professional.
The ANA reminds us that nurses respect “the inherent dignity, worth, unique attributes, and human rights of all individuals.” A nurse should never make a patient feel like they came to the wrong place to receive the care they need. If treatment is provided sensitively and respectfully, perhaps they will have the strength to reach out for help again in the future.
The personal interactions that you have with your patients can make a world of difference. Mistreatment resulting from biases, stereotypes, and ignorance puts lives at risk. Nurses must do as much as possible to provide the highest quality and most inclusive healthcare. As in so many other facets of healthcare, nurses can be the change we hope to see in the world.