Healthy People 2020 reports that LGBT individuals experience greater healthcare disparities during their lifetime than heterosexual individuals, including:
- higher rate of tobacco use (30% compared with 20% of the general population)
- increased alcohol and drug use
- greater risk of sexually transmitted infections (STIs) and HIV among gay and bisexual men and transgender women, especially among communities of color
- decreased utilization of preventive cancer services by lesbian individuals
- very high rates of both victimization and suicide attempts for transgender individuals
- additional barriers to healthcare for older LGBT adults due to isolation, less family support, and a deficiency in both social and support services.3
Healthy People 2020 also reports that healthcare disparities among LGBT youth include:
- higher rate of suicide attempts (two to three times greater)
- increased homelessness (20% to 40% greater)
- greater risk of STIs and HIV.3
According to the U.S. Health Resources and Services Administration (HRSA):
- 77% of HIV diagnoses in 2012 were a result of men having sex with men
- lesbian and bisexual women are at increased risk for obesity, poor mental health, substance abuse, and violence
- LGBT individuals encounter barriers to receiving optimal healthcare services.4
A deep dive into resources
A delay in or avoidance of seeking healthcare services can have detrimental effects on one's health. Therefore, it's essential that healthcare facilities provide LGBT individuals with accepting, supportive environments to treat and prevent illness. Healthcare institutions need to be ready to meet all patients' requirements, with processes in place to serve the unique needs of LGBT patients. Hospitals must respect, protect, and promote patient rights, and prohibit discrimination based on sexual orientation and gender identity or expression.
To help reduce disparities, The Joint Commission offers a field guide titled “Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community” to help U.S. hospitals “create a more welcoming, safe, and inclusive environment that contributes to improved healthcare quality for LGBT patients and their families.”5
The Institute of Medicine published The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, with insight into the various factors that impact LGBT healthcare needs.6
The Fenway Institute also has resources for healthcare providers, such as Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health.7 In addition, its National LGBT Health Education Center provides the 10 best practices for LGBT-affirming healthcare environments and hosts webinars, video training, and online learning modules.1 (See Table 2.)
Other online resources include the Safe Zone Project, which houses free training workshops on how to provide a safe environment for the LGBT community.8 At the end of the 2-hour curriculum, participants receive a “Safe Zone” sticker to place in a visible space at their organization. The sticker tells LGBT individuals, “You're welcome here.”
As a result of our young patient's visit to the hospital, the need for education about gender reassignment surgery, LGBT healthcare disparities, and the importance of providing services sensitive to this patient population's needs was discussed with hospital administration. The 10 best practices for LGBT-affirming healthcare environments were shared with administrators to build a supportive environment for LGBT patients. As a result, administrators supported a LGBT sensitivity training program for the staff.
The goal used for the training program was the same as that of Healthy People 2020: “Eliminating LGBT health disparities and enhancing efforts to improve LGBT health are necessary to ensure that LGBT individuals can lead long, healthy lives.”3 The objectives for the training program were those provided by Healthy People 2020:
- reduce disease transmission and progression
- strengthen mental and physical well-being
- decrease healthcare costs
- increase longevity.3
To achieve our goal, The National LGBT Health Education Center's training and interactive learning modules were mandated for all staff members to complete, regardless of their role in the hospital.1 In addition, the hospital's nursing education team partnered with a local LGBT support organization to develop a short presentation for all hospital staff on LGBT awareness and the principles of inclusive care.
The presentation included:
- an introductory message from the hospital's CEO affirming his commitment to the provision of inclusive care as part of the hospital's mission
- definitions of current terminology and identification of terminology that's antiquated or inappropriate
- discussion of the healthcare experiences of LGBT patients and the impact on their willingness to access healthcare services
- fundamental communication techniques to provide patient-centered care
- a video segment featuring patients describing the prejudice they've experienced from healthcare providers.
The presentation was assigned to all hospital staff members using the hospital's electronic learning management system; several in-person sessions were scheduled with speakers from the local LGBT support organization. The sessions were well attended and staff evaluations were very positive.
The hospital has committed to continue training so that not only are the physical needs of LGBT patients addressed, but also the psychological issues that this patient population faces.
Care for all
As healthcare workers, we must implement best practices for delivering care to our LGBT patients. We need to offer effective, appropriate, and optimal care to prevent the healthcare disparities that exist among LGBT individuals. A goal of Healthy People 2020 is to provide quality care for all. Like Healthy People 2020, the aim of our healthcare institution is the same. The mandatory education for all hospital employees was only the first step in ensuring that LGBT patients receive competent healthcare services. Ongoing training and education are necessary to meet the healthcare needs of all individuals, regardless of their sexual orientation or gender identity/expression.
INSTRUCTIONS Dimensions of inclusive care
- Read the article. The test for this CE activity is to be taken online at ceconnection.com/NM.
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- There's only one correct answer for each question. A passing score for this test is 13 correct answers. If you pass, you can print your certificate of earned contact hours and access the answer key. If you fail, you have the option of taking the test again at no additional cost.
- For questions, contact Lippincott Williams & Wilkins: 1-800-787-8985.
- Registration deadline is January 31, 2019.
Lippincott Williams & Wilkins, publisher of Nursing Management, will award 1.0 contact hour for this continuing nursing education activity.
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This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.0 contact hour, the District of Columbia, Georgia, and Florida CE Broker #50-1223. Your certificate is valid in all states.
Payment: The registration fee for this test is $12.95.
2. CDC. Lesbian, gay, bisexual, and transgender health. http://www.cdc.gov
3. HealthyPeople.gov. Lesbian, gay, bisexual, and transgender health. http://www.healthypeople.gov
4. Health Resources and Services Administration. Lesbian, gay, bisexual and transgender (LGBT). http://www.hrsa.gov
5. The Joint Commission. Advancing effective communication, cultural competence, and patient-and family-centered care for the lesbian, gay, bisexual, and transgender (LGBT) community. http://www.jointcommission.org
6. Institute of Medicine. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding
. Washington, DC: National Academies Press; 2011.
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
7. The Fenway Institute. Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health
. 2nd ed. American College of Physicians; 2015.