Caring for LGBTQIA+ Identified Patients 101
December 15, 2018 Mike McLeland

Caring for LGBTQIA+ Identified Patients 101

Posted in Blog

The NE TX ARN offered scholarships for the 2018 Reach conference, and I was fortunate enough to receive one, partially covering the expenses for my trip to West Palm Beach for the 2018 ARN Reach Conference.  The session I wished to share a bit with you about:

Caring for LGBTQIA+ Identified Patients 101

By Libby Parker, MSS

PRIDE Program Manager and Outpatient Therapist
Bryn Mawr College Graduate School of Social Work and Social Research
Philadelphia, PA

I didn’t know what to expect, but was delighted to meet Mx. Libby Parker, a non-gender conforming adult, social worker, activist and speaker.  Libby prefers pronouns they, them and their.  (Webster’s new edition approves) It is difficult for me to formulate a sentence this way, and, it is even more difficult to imagine living in that particular world.  I recognize that LGBTQIA bias exists, and have seen it, even experienced it, in healthcare.  (19% of LGBQ individuals have) Merriam Webster Dictionary But for trans-identified and non-gender conforming individuals opening themselves up to the privacy smashing bulldozer that is American healthcare is another burden entirely.  I have been proud of the rehabilitation staff that I work with in their accepting and not discriminating care of LGBQ patients and their partners and families, but I also know that not everyone is aware, or accepting.  And rehab is very intimate business, we care for people’s bladder needs, and can’t very well avoid their private parts, even if they don’t match what is recorded in the electronic health record.  I know that accommodations have been made for transsexual employees in my workplace, and that the non-discrimination policy and doing the right thing is important to the staff.  I spoke to several staff nurses who stated no trans or gender non-conforming patients had to their knowledge been admitted on the unit, this seems to be true.  However the nursing manager I spoke to (from her previous experience) said she remembered two, one after several transition surgeries, the other before.    She stated “the patient made it less awkward by giving a heads up before intimate care was given.” For example, you might know that Sharon could use a condom cath and stay dry, and do this in a way to protect her privacy.

Libby spoke of the myth of “The Surgery”.  There is no one surgery, and as soon as they self-identify as a particular gender, we are required to learn the language they would prefer and what additional privacy concerns are felt from the patient’s perspective.  In Mx. Parker’s case neither male nor female will do, and thus we are challenged to adapt our nursing care to always be mindful of our patient’s need

From the course description: Participants were offered tools to improve their practice including support in examining and expanding the language they use to discuss gender and sexuality in healthcare settings.  One of the first concerns to providing seamless care is access.  Many LGBTQIA+ patients describe health disparities, but, access is not likely to be the first issue on a rehab unit.  Generally, our patients are coming from acute care, are already admitted, and we will admit them if they meet rehab criteria and are insured.  Apparently, trans people in general have a higher uninsured rate, but in Texas this is an equal opportunity problem, as we have the highest uninsured rate in the country.  Most rehab units that I have toured over the last decade have made semi-private rooms obsolete, a barrier we had for many years.  Bias is not unique to Texas, but we could be accused of wearing it more proudly, with the Texas legislature spending a good portion of the legislative session deciding where trans kids could not go to the bathroom.

Transgender Bathroom Bill Fails Again in Texas

It is incumbent upon all of us to call it out, privately, if we see it in other caregivers.

I would like to spend a few lines discussing some language.  Libby’s acronym was SIEO, sex assigned at birth, gender identity, gender expression, and sexual orientation.  As far as sex assigned at birth we have AFAB assigned female at birth, AMAB assigned male at birth and intersex (sex characteristics that do not fit binary notions of male or female).

Gender identity includes the majority of people who identify with their sex assigned at birth – Cisgender, and those whose gender identity differs from what is typically associated with sex assigned at birth – Transgender.

Sexual orientation, most caregivers are more familiar with.  An Asexual person doesn’t report attraction to anyone, Bisexual attracted to men and women, Gay is a man attracted to other men, Lesbian is a woman attracted to other women, Pansexual is attracted to all gender identities, Straight is heterosexual and Queer is someone feeling outside the norms regarding orientation or sexuality.  Questioning is someone exploring their gender, sexual identity or sexual orientation.

To wrap this up, I would like to say there were at least a couple of hundred people in the audience.  The audience was mostly middle aged women, which are the lion’s share of conference attendees.  Two stood up to ask questions and discuss health disparities and bias that their trans children had experienced.  The other attendees with questions were also open and supportive.  This made me proud to be a rehab nurse.

The CDC sites:  The US has…“a need for culturally competent medical care and prevention services that are specific to this population. Social inequality is often associated with poorer health status, and sexual orientation has been associated with multiple health threats. Members of the LGBT community are at increased risk for a number of health threats when compared to their heterosexual peers.  Differences in sexual behavior account for some of these disparities, but others are associated with social and structural inequities, such as the stigma and discrimination that LGBT populations experience.”

If you want to know how your healthcare institution ranks and what you can do to reduce health disparities between your walls check out HRC’s Health Equality Index.  In 2018 it ranked over 1600 healthcare institutions.  In one click you can download it from the Human Rights Coalition website and share it with the powerful decision makers in your institution.

Thanks for your interest,

Respectfully Submitted,

Cyndi Murphy