The term nurse practitioners (Nps) refers to advanced practice nurses who are trained to provide holistic care, including disease prevention, health promotion in diverse populations across different age groups (Canadian Council of Registered Nurse Regulators, 2015). There currently exists a gap in policies and research examining the practice of nurses and how it relates to gay, lesbian, transgender, and bisexual patients. Interestingly, individuals who identify as LGBT may present specific health concerns that may be particular to their gender identity or orientation that are often not recognized by health practitioners resulting in more inferior healthcare services for LGBT patients.
Nurse practitioners play a critical role in the delivery of healthcare services to the Canadian people. Currently, more than 4800 registered nurse practitioners are actively engaged in providing healthcare services for millions of Canadians from various backgrounds (Canadian Institute for Health Information, 2016). One of the critical roles of NPs is to identify social inequalities and to advocate for social justice for all patients to improve the quality of healthcare services provided to all patients.
This role is particularly important when it relates to the provision of care and services to marginalized groups such as those people who identify as lesbian, bisexual, transgender, or gay (LGBT) people in the LGBT community have most healthcare needs similar to their heterosexual counterparts.
However, some conditions are particular to members of this community, and therefore specialized treatment and care may be necessary. Over the last decade, there has been a rise in the research and literature addressing the primary care need for the general LGBT populations as well as identifying the health issues and conditions that may be particular to different subgroups within the LGBT community (GLMA, 2010).
Many members of the LGBT community find it particularly challenging to find and receiving quality healthcare services that are specific to their orientation. At the core of nursing is the therapeutic nurse-patient relationship. The nurse builds up and maintains this fundamental relationship by utilizing nursing information also, skills, as well as applying caring attitudes and behaviors. Therapeutic nursing services contribute to the client’s wellbeing and health.
The relationship depends on trust, respect, compassion, and professional intimacy, and requires proper use of the force characteristic in the care provider’s job. A nurse-patient relationship is based on trust, respect, empathy, professional intimacy, and power. Regardless of the length, the context of the relationship, or whether a nurse is a secondary or primary health caregiver, these components are always available. The relationship between the nurse and a patient is venerable and needs to be taken care of. Discussions Therapeutic relationships form the foundation of all healthcare interactions is essential for effective and safe nursing care. (CNA, 2017). Positive interactions between patients and nurses can have a beneficial effect on both the outcome of healthcare interactions and the wellbeing of the patient. There is an extensive lack of information and expertise in the nursing community regarding how to interact with LGBT patients. Additionally, there lacks a safe and formal mechanism to identify a patient’s orientation .in part; this limits the quality of healthcare services provided to members of this community. Admission forms in healthcare facilities, in part, to blame for the biases in data collection since they are formulated to contain heterosexual assumptions providing only binary options regarding gender. Instituting a therapeutic nurse-patient relationship is an essential factor in nursing care.
The nurse-patient connection is established through empathy, respect, and trust. The nurse then maintains the relationship through openness, awareness, careful use of language, being nonjudgmental, and treating LGBT patients the same way as other patients. Therapeutic nursing services help to contribute to the general health of the client and improve their wellbeing. This relationship is dependent on the appropriate use of power inherent in the healthcare provider’s role. Awareness. There are several different contexts related to the concept of awareness. First, there is the question of the nurse’s knowledge of the patient’s LGBT status. Many nursing practitioner do not have an elaborate process of identifying LGBT patients in their practice. Barriers to institutional policies make it difficult to determine the patient’s status as an LGBT. Generally, intake forms formulated to capture patients’ details are structured in such a way they do not provide for the LGBT community. The binary system forms used by nurses only capture details such as married/single or male /female.
The second context is nurses developing an understanding of what it means to the patient to be in the LGBT community. The nurses try and understand how a patient’s status affects their interpersonal and health relationships and therefore gauge how the that is going to change their relationship with the patient.it is essential to understand what it means to a patient to come out to their friend and families on their orientation. Another aspect of awareness for nurses is to understand their personal views, feelings, and attitudes towards the gender and sexuality identity of their patients and how those feelings could potentially affect the therapeutic relationship. This self-awareness requires the nurses to utilize self-reflection by trying to identify their personal beliefs or biases they may subscribe to and determine their limitations and strengths in providing care for LGBT patients. For some of the nurses, this awareness and reflection of their personal experiences may have a strong influence in the nurse-patient relationship making it necessary for the nurses themselves to undertake extraordinary efforts or to mitigate their potential individual discomfort to ensure the comfort of the patient.
Some nurses, however, feel that the knowledge of a patient’s LGBT status may not be essential unless in matters relating to mental and sexual health. However, effective communication is critical in the course of a therapeutic nurse-patient relationship. This includes the knowledge of effective verbal and none verbal communication techniques that demonstrate respect and sensitivity in the patient, which helps to establish and maintain a relationship that contributes to a patient’s wellbeing (CNO, 2006). Using the appropriate terminologies is essential in the process of establishing a viable therapeutic relationship with an LGBT patient. Nurses need to be careful with what they say and how they say it since something incorrect may be perceived as insulting and therefore becomes a barrier to effective communication. This is particularly true, for example, when addressing a transgender patient. The use of the wrong pronoun may be perceived as an inadvertently offensive hence the need to have the information beforehand.
Additional strategies should be utilized to address the continuing education requirements regarding LGBT specific healthcare needs. Openness. The terms open-mindedness or openness, in general, are used by nurses to the general attitude or characteristic that they feel they possess. The word open is used to describe being approachable, accessible, and willing to accept new ideas or things. Openness is a fundamental characteristic of nursing society. Nurses also define transparency in part of the patient as a willingness to disclose their gender identity or sexual orientation with the healthcare provider, including the psycho-social concerns they may have. Careful use of language. Many nurses identify the lack of expertise and education relating to LGBT health. Nurses should understand the kind of language to use when caring for patients from the LGBT community. First, nurses should understand and use language that is considered to their LGBT patients. The deliberate avoidance of traditional terms that signify bias towards the LGBT communities, such as the use of standard terms as boyfriend/girlfriend or husband/wife.
Instead, nurses should strive to use neutral language that is less stigmatizing and neutral by, for example, substituting with words such as significant other or partner. These terms should be used when caring for members of the LGBT community in addition to polite language so that what is said or how it is said is not perceived as a barrier to therapeutic communication. Nurses need to be mindful of their language and delivery so as not to distract a meaningful process of communication. Having a nonjudgmental attitude In nursing, having a nonjudgmental attitude encompass characteristics of inclusion, respect, and involves being open and aware.
Showing no biases or judgment is an essential quality when it comes to the establishment and fostering of mutual respect and trust when addressing LGBT patients. Developing a nonjudgmental attitude involves the careful use of language, neutral facial expressions, and the demonstration of reassurance and empathy. Not treating LGBT patients differently. Members of the LGBT community are patients just as much as their heterosexual counterparts are. When attending to the LGBT community, nurses should ensure that they do not treat LGBT patients any differently since the patients have the same healthcare needs as any other patient.
Manzer, D., O’Sullivan, L., & Doucet, S. (2018). Myths, misunderstandings, and missing information: Experiences of nurse practitioners providing primary care to lesbian, gay, bisexual, and transgender patients Canadian Journal Of Human Sexuality, 27(2), 157-170. https://doi.org/10.3138/cjhs.2018-0017
Cno.org. (2020). Retrieved from https://www.cno.org/globalassets/docs/prac/41033_therapeutic.pdf.
Aisner, A., Zappas, M., & Marks, A. (2020). Primary Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) Patients. The Journal For Nurse Practitioners. https://doi.org/10.1016/j.nurpra.2019.12.011
Bolderston, A., & Ralph, S. (2016). Improving the health care experiences of lesbian, gay, bisexual, and transgender patients. Radiography, 22(3), e207-e211. https://doi.org/10.1016/j.radi.2016.04.011
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