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Improving healthcare for LGBTQ+ patients

How NPs can make a difference

Section Editor(s): Dorsen, Caroline PhD, FNP-BC, RN; Caceres, Billy PhD, ANP-BC, RN

doi: 10.1097/01.NPR.0000559848.29614.40
Department: Guest Editorial
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Assistant Professor, NYU Meyers College of Nursing Nursing Chair, GLMA: Health Professionals Advancing LGBT Equality

Postdoctoral Fellow, Columbia University School of Nursing and the Program for the Study of LGBT Health

Lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) “Pride” is held every year at the end of June. Pride this year marked the 50th anniversary of the Stonewall Riots, an uprising in the Greenwich Village neighborhood of New York City considered to be the start of the LGBTQ+ rights movement.

In 1969, same-sex behavior among LGBTQ+ persons in New York was illegal, and arrest could lead to loss of one's reputation, job, and family. Police regularly harassed and arrested patrons of gay bars. On June 28, during a routine raid, customers at the Stonewall Inn fought back against the police, which started 6 days of civil unrest and became the impetus for organization and activism against structural and individual oppression of LGBTQ+ persons.1

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The fight for equality continues

Despite social and legal advances, there continues to be significant struggles over the rights of LGBTQ+ persons in the US and abroad. For example, in the US, there is currently no federal law barring discrimination on the basis of sexual orientation or gender identity, meaning that states must decide for themselves if they are going to afford the same legal protections to LGBTQ+ persons as are afforded to heterosexual and cisgender persons.2

Research has consistently documented the relationship between stigma, discrimination, and poor health. In the case of LGBTQ+ persons, societal prejudice and marginalization translate to significant health inequities, including disparities in mental health, substance use, access to and utilization of preventive healthcare services, certain cancers, cardiovascular disease, diabetes mellitus, and sexually transmitted infections/HIV.3 A lack of knowledge regarding the unique culture and needs of the LGBTQ+ and explicit and implicit (subconscious) bias among healthcare providers perpetuate these health disparities.3,4

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How can NPs help?

It is time for a concerted effort in our profession to do better for LGBTQ+ health. We recommend three actions that NPs can take:

  • Learn more about the health needs and disparities of LGBTQ+ persons, with an emphasis on the intersectional nature of social, physical, and emotional health. The National LGBT Education Center at the Fenway Institute is a great place to start.5
  • Consider how we can make our practices affirming to the LGBTQ+ community by asking patients about sexual orientation and gender identity, making sure our forms, pamphlets, posters, and electronic health records reflect the range of individual identities and that our physical spaces are open and inclusive.
  • Examine our own biases to consider how implicit bias may inadvertently perpetuate health disparities in the LGBTQ+ community. Project Implicit has excellent free, confidential online quizzes for self-assessment.5,6

Since Stonewall, we have made progress toward decreasing marginalization and achieving health equity for LGBTQ+ persons, but we still have work to do to eliminate health disparities and improve healthcare for all LGBTQ+ patients.

Caroline Dorsen, PhD, FNP-BC, RN

Assistant Professor, NYU Meyers College of Nursing

Nursing Chair, GLMA: Health Professionals Advancing LGBT Equality

Billy Caceres, PhD, ANP-BC, RN

Postdoctoral Fellow, Columbia University School of Nursing and the Program for the Study of LGBT Health

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REFERENCES

1. Carter D. Stonewall: The Riots That Sparked the Gay Revolution. New York, NY: St. Martin's Press; 2004.
2. LGBTQ Americans Aren't Fully Protected from Discrimination in 30 States. http://www.freedomforallamericans.org/states/.
3. Healthy People 2020. Washington, DC: US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. http://www.healthypeople.gov/2020/topics-objectives/ topic/lesbian-gay-bisexual-and-transgender-health.
4. Dorsen C. An integrative review of nurse attitudes towards lesbian, gay, bisexual, and transgender patients. Can J Nurs Res. 2012;44(3):18–43.
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