Table of Contents
Introduction
The term nurse practitioners (Nps) refers to advanced practice nurses who are trained to provide holistic care including disease prevention and 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 significant when it relates to the provision of care and services to diminished groups such as those people in the LGBT community who 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 research and literature addressing the primary care need for general LGBT populations as well as identifying the health issues and conditions that may be particular to different subgroups within the LGBT community. Many members of the LGBT community find it particularly challenging to find and receiving quality healthcare services that are specific to their orientation (Manzer et al., 2018).
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 well-being 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, 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.
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Discussions
Therapeutic relationships form the foundation of all healthcare interactions is essential for effective and safe nursing care. (CNA, 2017). Effective communications between patients and nurses can have a beneficial effect on both the outcome of the healthcare interactions and the well-being 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 the data collection, since they are formulated to contain heterosexual assumptions providing only binary options regarding gender (CNA, 2017).
Awareness
There is the question of the nurse’s knowledge of the patient’s LGBT status. Many nursing practitioners do not have an elaborate process of recognizing LGBT patients in their practice. Hindrances 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. 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 nonverbal communication techniques that demonstrate respect and sensitivity of the patient, which helps to establish and maintain a relationship that contributes to a patient’s well-being.
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 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 nurses use the term open-mindedness or openness as a general attitude or characteristic that they feel they possess. Openness is a fundamental characteristic of nursing society that describe of being approachable, accessible, and willing to accept new ideas or things. 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 and girlfriend or husband and wife. Instead, nurses should strive to use neutral language that is less stigmatizing—for example, substituting with words such as significant other or partner. Nurses need to be mindful of their language and delivery so as not to distract a meaningful process of therapeutic communication.
Conclusion
To conclude, instituting a therapeutic nurse-patient relationship is an essential factor in nursing care. The nurse-patient connection is established through empathy, respect, and trust. To promote this relationship, nurses should be open while caring for LGBT patients and their families. Having a non-judgmental attitude, an open mind, and a willingness to assist the patients, just like any other patient, goes a long way to ensure that all patients receive quality health based on their needs. While positive attitudes and attributes do not necessarily make up for the lack of knowledge, nurses have the potential to reduce the amount of stigmatization that LGBT patients face while seeking medical attention within the healthcare environment and therefore, foster a more elaborate therapeutic nurse-patient relationship which in turn helps to improve the overall well-being and health of the LGBT patients.
References
- 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
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- American Psychological Association (2012). Guidelines for psycho-logical practice with lesbian, gay, and bisexual clients. American Psychologist, 67(1), 10–42. https://doi.org/10.1037/a0024659. Medline:21875169.
- Banks, C. 2001. The co$t of homophobia: Literature review of the economic impact of homophobia on Canada. Retrieved fromhttp://lgbtqpn.ca/wpcontent/uploads/woocommerce_uploads/2014/08/Cost%20of%20Homophobia.pdf.
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