Caring for LGBTQ+ Patients in Critical and Progressive Care

Our goal in nursing is to provide equitable and efficient care for patients and families. Often, patients in the LGBTQ+ community feel misunderstood or even erased. Field practice experiences have revealed that misconceptions, bias and knowledge gaps can contribute to denying equitable healthcare. This situation emphasizes the importance of more specific education to address and prevent incidents that range from insensitivity and alienation to mistreatment of LGBTQ+ patients. It is our professional obligation and moral imperative to respond to these challenges and foster a safe environment that supports LGBTQ+ patients and their loved ones.

Understanding the Challenges

LGBTQ+ patients often face significant healthcare barriers due to a lack of culturally competent care. Many healthcare providers are not adequately educated to address the specific needs of LGBTQ+ patients and their families, leading to unintentional yet often harmful missteps in care. According to the Center for American Progress's (CAP's) nationally representative survey, 33% of transgender individuals have reported needing to educate their healthcare providers about transgender care. A Lambda Legal report titled "When Health Care Isn't Caring" reveals that 56% of lesbian, gay or bisexual individuals and 70% of transgender and gender-nonconforming individuals have experienced discrimination in healthcare settings. This discrimination often includes being refused care, encountering insensitive or harsh language or facing biased attitudes, highlighting the pervasive nature of these issues.

These challenges are compounded by fears of discrimination, misgendering and privacy violations, which deter many LGBTQ+ patients from seeking necessary care. According to CAP's "Discrimination and Experiences Among LGBTQ People in the US: 2020 Survey Results," 29% of LGBTQ+ individuals reported avoiding medical treatment due to anticipated discrimination, with this figure rising to 48% among transgender individuals. A 2022 survey by the Trevor Project emphasizes the mental health impact, with 45% of LGBTQ+ youth surveyed reporting seriously considering suicide in the past year. An article published by Jake A. Muller and team notes that transgender patients are less likely to use emergency department services compared with their cisgender peers, a trend that could be attributed to previous adverse healthcare experiences. This hesitation to seek care can lead to worse health outcomes, underscoring the essential role of healthcare providers in fostering an inclusive and supportive care environment. By prioritizing culturally safe care, clinicians can help ensure equitable health outcomes for all patients, including LGBTQ+ patients.

Cultural Humility and Sensitivity

Cultural humility is essential in healthcare, particularly when caring for LGBTQ+ patients. Unlike cultural competence, which implies a finite mastery of understanding, cultural humility is an ongoing process of self-reflection and personal growth. This approach encourages healthcare providers to continually evaluate their own biases and engage with patients as equal partners in care. Knowledge of cultural humility fosters a mindset that respects and values the unique experiences of LGBTQ+ individuals, promoting empathy, open communication and mutual respect. By embracing cultural humility, healthcare providers can create a more inclusive and supportive environment, ensuring that all patients receive respectful, individualized care.

Explore the following programs and resources for care of LGBTQ+ patients:

GLMA: Health Professionals Advancing LGBTQ+ Equity

• GLMA provides education and services for professional healthcare organizations to promote LGBTQ+ healthcare awareness and skills for their members through webinars, workshops and standard operating procedures for affirmative care of LGBTQ patients across different care specialties.

The Fenway Institute

• The Fenway Institute provides comprehensive educational initiatives and services, including webinars and on-site clinician training. Their courses include inclusive clinical skills, health disparities and health policy.

Human Rights Campaign (HRC) Healthcare Equality Index

• The HRC's Healthcare Equality Index includes a section on training and tools for healthcare organizations seeking to increase inclusiveness. The participating facilities can avail themselves of individualized training modules and self-evaluation of compliance with nondiscrimination policies and staff training.

Tips for Respectful and Inclusive Communication

Skilled communication is critically important in nursing care, especially when providing care for LGBTQ+ patients and their families. Following are some tips to help ensure respectful and inclusive interactions:

• Use Affirming Language: Validating a patient's gender identity shows respect and helps foster an inclusive care environment. Consider asking patients: "What name and pronouns do you use?" This question establishes trust and safety for the patient and their loved ones.
  • Example: "Hi, my name is Luis, and my pronouns are he/him/él. What are your name and pronouns?"
• Avoid Assumptions: Sexual orientation, gender identity, health status, marital status and family relationships should not be assumed based on a person's appearance or their paperwork. Every patient is a unique person. Enter patients' interactions with curiosity, and ask questions to determine their personal details.
  • Examples of questions to ask after your initial introduction:
    • "Who is here with you today?"
    • "How are the people here related to you?"
    • "Would you like me to include the people here with you in my assessment and your care?"
• Educate Yourself: Do not wait to be told or find out common terms and concepts concerning the LGBTQ+ communities. By staying informed, you can avoid misunderstandings and unintentional use of incorrect terms.
  • Book recommendation: "The ABC's of LGBT+" by Ash Hardell
• Be Patient Centered: Explore any recent problems and patient complaints. Although there may be some aspects of a patient's sexual orientation or gender identity that may be relevant to their care, avoid unnecessary invasive questions that may infringe on their privacy. Consider using broad, exploratory questions to give patients the opportunity to discuss items that might not have been shared before.
  • Example: "Is there anything else we haven't discussed that you would like us to know to help ensure your care addresses what is important to you?"
• Normalize the Conversation: Make questions about gender identity and sexual orientation part of patients' first visit and registration questions. This process takes the pressure off the patient and may make it easier for them to discuss important information.

Importance of Confidentiality and Privacy

Maintaining confidentiality and privacy is essential to the care of all patients but especially LGBTQ+ patients, who may fear stigma and discrimination:

• Ensure Privacy of Information: Carefully consider who has access to the patient's personal and medical details, even family members. Sensitive information should be discussed in private, and extra precautions should be taken to protect the data. For example, a young LGBTQ+ patient may not have disclosed their sexual orientation or gender identity to their family. Similarly, adult patients may wish to keep certain aspects of their care private, even with loved ones present.
• Understand Legal and Ethical Obligations: Ensure you understand the legal aspects of privacy and nondiscrimination that apply to LGBTQ+ patients. All staff should respect these requirements in order to safeguard patients' rights.
• Create Safe Spaces: Work to ensure that your unit is a safe environment for all patients. This includes making nondiscrimination policies visible in the unit, waiting room and hospital website to patients and using items such as pride flags, pronoun badge buddies or safe space stickers to inform patients that their identities are respected and protected.
• Handle Mistakes Gracefully: If you accidentally use the wrong name or pronoun, say you are sorry and correct yourself immediately without making it a major issue. This approach helps preserve the patient's self-esteem and demonstrates caring and respect.

By adapting these communication and privacy measures, healthcare providers can enhance the quality of care and rapport with LGBTQ+ patients, so they are protected and respected throughout their healthcare encounters.

A Call to Action

I encourage all clinicians to consider the points noted above and assess their practices for any shortcomings. What steps can you take to further your knowledge of the requirements of LGBTQ+ patients and their families? You could attend classes to improve your awareness and knowledge. Add these measures to your practice to help ensure all patients receive quality and humane care.

Also, ask yourself: "How can I effect these changes in my work environment? What steps can I take to advocate for policy and care improvements in my organization?" Each small step helps build a healthcare environment that values dignity and health equity for all.

Additional Resources

• National LGBTQIA+ Health Education Center
• CDC "Health Disparities Among LGBTQ Youth" Statistics and Resources
• Healthy People 2030 Health Disparities Among LGBTQ Youth Objectives
• Emergency Nurses Association Diversity, Equity and Inclusion Resources
• "ANA Position Statement: Nursing Advocacy for LGBTQ+ Populations"
• "Giving Safe, Sensitive Care to LGBTQ Patients and Families"
• "Fast Facts about LGBTQ+ Care for Nurses"
• "Leveraging Diversity Toward a Healthy Work Environment"
• "Medical Management of Gender Diverse Populations"

How can you enhance your clinical practice to be more inclusive of LGBTQ+ patients?