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Nurse Documentation of Sexual Orientation and Gender Identity in Home Healthcare

A Text Mining Study

Bjarnadottir, Ragnhildur I., PhD, MPH, RN; Bockting, Walter, PhD; Yoon, Sunmoo, PhD, RN; Dowding, Dawn W., PhD, RN

CIN: Computers, Informatics, Nursing: April 2019 - Volume 37 - Issue 4 - p 213–221
doi: 10.1097/CIN.0000000000000492

Health disparities have been documented in the lesbian, gay, bisexual, and transgender population, but more research is needed to better understand how to address them. To that end, this observational study examined what is documented about sexual orientation and gender identity in narrative home care nurses' notes in an electronic health record. Lexical text mining approaches were used to examine a total of 862 715 clinical notes from 20 447 unique patients who received services from a large home care agency in Manhattan, New York, and extracted notes were qualitatively reviewed to build a lexicon of terms for use in future research. Forty-two notes, representing 35 unique patients, were identified as containing documentation of the patient's sexual orientation or gender identity. Documentation of sexual orientation or gender identity was relatively infrequent, compared to the estimated frequency of lesbian, gay, bisexual, and transgender people in the US population. Issues related to fragmentary language emerged, and variety in phrasing and word frequency was identified between different types of notes and between providers. This study provides insight into what nurses in home healthcare document about sexual orientation and gender identity and their clinical priorities related to such documentation, and provides a lexicon for use in further research in the home care setting.

Author Affiliations: Columbia University School of Nursing, New York, NY (Drs Bjarnadottir, Bockting, Yoon, and Dowding); University of Florida, College of Nursing, Gainesville (Dr Bjarnadottir); Program for the Study of LGBT Health, New York Psychiatric Institute/Columbia Psychiatry (Dr Bockting); Medicine Department, Division of General Medicine, Columbia University (Dr Yoon); Center for Home Care Policy & Research (Dr Dowding); and Visiting Nurse Service of New York (Dr Dowding), New York, NY; and Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, United Kingdom (Dr Dowding).

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Corresponding author: Ragnhildur I. Bjarnadottir, PhD, MPH, RN, University of Florida College of Nursing, 1225 Center Drive, PO Box 100197, Gainesville, FL 32608 (

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