LGBT articles
For this assignment, you will review and reflect on the LGBT articles. These articles can be applied to healthcare providers in the multiple care settings. Discussion of the article is based on the course objectives and weekly content, which emphasize the core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, discussions are used to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.
Discuss any take-away thoughts from the articles.
How do you plan to make a positive impact on the care of LGBT patients when you become a NP?
What attitudes/behaviors/communication/understanding is important for the NP to have?
What specific screenings / interventions will you incorporate into practice when providing care to a LGBT patient?
Do 1 page for each article
Provide references in APA format.
Delivering Culturally Sensitive Care to
LGBTQI Patients
Jessica Landry, DNP, FNP-BC
American Assoc
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aanp.inreachce.c
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ABSTRACT
Many health care providers are uncomfortable having conversations with patients
about their sexual identity or sexual behaviors. Avoiding this discomfort is causing a
serious threat to the mental and physical health of Americans, particularly those in the
lesbian, gay, bisexual, transgender, questioning, or intersex (LGBTQI) community.
The health-related disparities among LGBTQI patients range from bullying and
physical assault to refusal of health care and housing. Many individuals choose not to
seek health care due of fear of being judged, marginalized, or abused. This article
focuses on the many disparities faced by the LGBTQI community and describes how
simple changes in the practices of health care providers can potentially improve their
health outcomes.
Keywords: care of LGBTQI patient, cultural sensitivity, gender fluidity, gender
identity, LGBTQI health disparities
2016 Elsevier Inc. All rights reserved.
THE STAGGERING STATISTICS
ealth care professionals strive to provide
culturally sensitive and high-quality mental
Hand physical health care to children and
adult patients, regardless of their age, race, religion,
sexual practices, or personal belief system. Conveying
a sense of understanding of a patients culture and a
nonjudgmental attitude toward their behaviors may
be a means to meet patients where they are, and lay
a foundation for a trusting relationship that can lead
to improved health outcomes. According to the Gay
Lesbian Straight Educational Network, 74.1% of
lesbian, gay, bisexual, transgender, questioning, or
intersex (LGBTQI) students are harassed or threat-
ened in American schools.1 Of the 7,898 LGBTQI
students involved in the study, 5,852 were subjected
to derogatory remarks referencing their sexuality.
Ninety percent of these students indicated feelings of
distress during their time on campus, and 30.3%
missed at least 1 day of school due to harassment or
bullying.1
iation of Nurse Practitioners (AANP) members may
inuing education contact hours, approved by AANP, by
le and completing the online posttest and evaluation at
om.
urnal for Nurse Practitioners – JNP
Grant and colleagues2 studied 6,400 transgender
and gender nonconforming people in kindergarten
through grade 12 and found that 78% experienced
harassment, 35% suffered physical assault, 12%
were victimized by sexual violence, and 15%
discerned a sense of threat severe enough to quit
school completely. The discrimination of
transgender persons continued into the workplace,
with 90% of those surveyed reporting incidents of
harassment and mistreatment. Nineteen percent of
the economically disadvantaged and less educated
individuals in this group reported being refused
home rental or apartment leasing contracts, found
themselves homeless at some point during their life,
or experienced outright refusal of health care due to
their sexual orientation.2 Of this disadvantaged
population, 55% of those who sought asylum in
homeless shelters reported being harassed by shelter
employees, 29% were outright refused entry, and
22% were sexually assaulted by either shelter
residents or staff.
The United States Centers for Disease Control
and Prevention (CDC) named suicide as the second
leading cause of death among people between age
10-24 years in the United States between 1994 and
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VIGNETTE
A family nurse practitioner (FNP) in a busy emergency
department read the triage note of a 12-year-old boy
that stated he had tried to tie a belt around his neck to
hang himself. The medical history exhibited no sig-
nificant findings, as he had no physical or mental ill-
nesses. The FNP introduced herself and began small
talk for a few minutes, but noted only silence from the
young patient. She began asking him questions about
why he had tried to hurt himself, and he refused to
answer. She asked him questions about his school,
grades, did he have girl trouble, was his teacher
unkind or unfair? He just shook his head no, with his
eyes turned down. She continued gently questioning
him to determine if he was experiencing physical,
sexual abuse, verbal abuse, parental neglect, or
bullying from others. Again, he just shook his head and
avoided eye contact with her consistently.
She proceeded to the examination portion of the visit
and the only abnormal finding was redness around his
neck from the belt. She ordered a soft tissue X-ray of his
neck and left the room to question his parents. They re-
ported that he had many friends, achieved honor roll
several times, and his teacher had positive reports of
behavior and academic performance; yet, in spite of all
the positive aspects of his life, he had begun to express
more sadness overthe last year andthis concerned them.
The FNP decided she would approach him once
more, this time without his parents, nurse, or social
worker present. She sat on the side of his bed and
touched his arm, she asked him to please make eye
contact with her. He appeared defeated and worn, much
too young to wear such an expression. She asked him
directly again, Why did you try to hurt yourself? You
have much goodness in your life; you are handsome,
smart, and your friends, teacher, and parents love you
and are concerned about you. I want to understand why
you want to die. He looked the FNP squarely and stated,
Because I am a girl and no one understands that.
When she tried to respond she realized she was afraid
she would use the wrong words and possibly make him
feel worse. She had been preparing to have him
committed to a psychiatric facility, and she was con-
cerned he would assume he was being committed for
his gender identity and not his suicide attempt. The FNP
attempted to explain this, she felt she was unclear. He
was discharged to a psychiatric facility from which he
was shortly discharged. Four months later he attempted
suicide again, this time he was successful.
2012, with 5,178 of these deaths in 2012 alone.3 The
CDC also reported that, among students attending
American schools and enrolled in grades 9-12, 14.8%
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of heterosexual students attempted suicide compared
with 42.8% of gay, lesbian, or bisexual students
within the 12-month period prior to being sur-
veyed.4 The survey further reported that, compared
with heterosexual students, nearly twice as many gay,
lesbian, and bisexual students were threatened or
injured with a weapon, such as a gun, knife, or club,
on school grounds at least once.
HEALTH DISPARITIES IN THE LGBTQI COMMUNITY
The CDC reported that gay, lesbian, bisexual, and
students are 30.5% more likely to feel sad or hope-
less, 13.6% are more likely to be victims of sexual
violence, 23% are more likely to attempt suicide,
15.4% are more likely to use marijuana, and twice as
likely to experiment with hallucinogenic drugs as
their heterosexual peers at the same age.5 The survey
also revealed that students who questioned their
sexual identity were 14.9% more likely to suffer
from physical violence during dating and 9.5% more
likely to use or abuse cocaine than their
heterosexual peers.
The responsibility for the health of sexual mi-
nority students has largely been placed on schools,
which often play very limited role in educating stu-
dents on sexual and mental health. The School
Health Policies and Practice Study showed that about
half of American high schools discuss sexual identity
or orientation as part of the curriculum at any grade
level.5 The study further noted that only 34.6% of
these high schools provide health care specifically to
LGBTQI students. Many psychological textbooks
and current literature still refer to those questioning
their gender or displaying gender-nonconforming
traits as have a gender-identity disorder (International
Classification for Disease-10th revision, F-64.9), which
causes more confusion for teachers, nurses, and
physicians who are trying to advocate in the best
interests of their students or patients.
Often, health care providers lack the education,
terminology, and basic understanding of LGBTQI
culture, and this does not go unnoticed by pediatric or
adult patients. The National LGBT Health Education
Center: Fenway Institute researched why many people
in this group do not seek basic health care. Over-
whelmingly, the collective answer was that they felt
invisible to their provider.6 The Dont ask/dont
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tell model that has been unintentionally applied in
general practice is ineffective and is contributing to the
staggering number of health disparities seen in this
population. The National LBGT Cancer Network
reported that patients often fear the responses from
providers. This may, in part, explain some of the cause
for health disparities among this group.7
UNDERSTANDING GENDER FLUIDITY
Health care professionals cannot change societal
norms nor force the majority population to accept
any race, religion, culture, or sexual orientation, but
we are responsible for their health care collectively.
National LGBT Health Education Center: Fenway
Institute expressed the importance of understanding
gender fluidity, in contrast to traditional binary
viewpoints of sexual identity, as a means to grasp
the basic understanding of this culture.8 This
understanding will allow for the health care provider
to appreciate a more comprehensive assessment of the
patients current and future health needs.
Traditionally, gender has been expressed in a binary
viewmale and female. Boys and men were expected
to behave in a masculine manner as leaders of the home
and family, whereas girls and women were expected to
respect the male authority and to dress with femininity
and modesty. It is not surprising that anyone who
chooses to believe or behave outside of what is
considered normal by the majority at that given time
are discriminated against to varying degrees. Societal
norms are expectations of the groups majority and
those desiring acceptance within the group should
conform, or suffer potential consequences.
The concept of gender fluidity suggests that gender
identity and sexual preference are multidimensional
and multifactorial in nature. One may be born male
and be attracted sexually to another male, a female, or
both. This male may be comfortable (cisgender) or
tormented (transgender) in his male body (see Table 1
for glossary). How one identifies their gender does not
have to be consistent with the sex to which they are
attracted, nor to the gender to which they were
assigned at birth. Some are not specifically sexually
attracted to any gender, but rather to the person
themselves, regardless of their biologic sex.
The expression of self may vary greatly among
this diverse group. Some simply want to pass as their
The Journal for Nurse Practitioners – JNP344
gender identity instead of their biologic sex. Some may
prefer to dress extravagantly as one gender or another,
whereas others are incapable of expressing the gender
they identify with, and suffer from isolation, depres-
sion, and even attempt or commit suicide.9 Potential
warning signs could be recognized and addressed by
astute health care providers and the number of suicide
successes and attempts could decrease.
PROVIDING INCLUSIVE QUALITY CARE
Many LGBTQI people have difficulty finding health
care where they feel they are accepted, understood,
and do not fear discrimination.10 LGBTQI people
are extremely diverse and can be of any race,
nationality, religion, wealthy, or impoverished, and
anything in between.11 It is the role of the health
care provider to understand how their identities and
experiences with others can potentially affect their
health. Barriers to this type of affirmative and
inclusive care may be limited access, past negative
experiences, and lack of knowledge and experience
of the health care professional who is
delivering care.10
The National LGBT Health Education Center:
Fenway Institute has developed strategies that have
been shown to foster an inclusive, safe environment
for LGBTQI people.6 The first strategy
recommended is that providers keep realistic
expectations with communication. Many times,
LGBTQI people have experienced discrimination or
lack of awareness from previous providers and may
come to expect this reaction when they are seeking
care. For example, if the health care provider uses the
wrong pronoun or makes the verbal assumption that
a pediatric patient lives with a mother and father
instead of 2 mothers or 2 fathers, the provider can
simply apologize, correct the mistake, and try to
reestablish constructive dialog while focusing on the
reason they are seeking care.
Strategies that can be employed by health care
providers include: improving basic communication;
avoiding assumptions and stereotypes; and using
preferred pronouns and names.12 When a health care
provider is unsure of how the patient wishes to be
addressed, it is acceptable to politely ask them, and
document this information for other coworkers to be
aware. Respect, concern, and an inclusive
Volume 13, Issue 5, May 2017
Table 1. Glossary of Terms
Ally A person who does not identify with the LGBTI group but shows support
and advocates for the rights of LGBT people.
Asexual or ACE Has no sexual orientation and exhibits a lack of interest in sex; not
considered in the same domain of celibacy.
Bisexual A person who is attracted to both men and women.
Bottom surgery A means of describing external genitalia reassignment surgery.
Cisgender Comfortable with the external genitalia present at birth; not transgender.
Disorders of Sexual development A congenital condition in which reproductive organs do not develop into a
definite male or female reproductive system.
Drag king/queen The theatrical performance of women dressed as men (drag king) and men
dressed as women (drag queen).
Gender fluid Describes a person whose gender identity is not static, it is a mixture of the
2 traditional genders in which the person may be attracted to males or
females. This group is a attracted to a persons authenticity and personal
compatibility regardless of the external genitalia.
Gender nonconforming A person whose gender expression does not conform to societal norms
Gender dysphoria Distress by those whose gender identity is not incongruent with birth
gender, presents clinically with signs of mental distress, and has impaired
social and occupational functioning.
Gender expression The person acts, dresses, speaks, and behaves in ways that may or may not
correspond to assigned sex at birth.
Intersex An individuals biologic anatomy (fetal development of reproductive
system) vary from the expected norm (eg, ambiguous genitalia or those
born with both a penis and vagina or a testicle and ovary).
MSM Men who have sex with men.
Omnigender A person who is sexually attracted to someone regardless of the gender
identity, gender expression, or either biologic sex.
Queer A label that describes those who identify with a sexual orientation outside
the social norms. Some consider this term empowering (younger
generation), whereas others strongly dislike the term.
Transsexual Gender identity is not congruent with their biological external genitalia.
They may or may not desire hormonal or surgical means to feel more
congruency to their perception of self.
Transgender Describes a person whose biologic anatomy does not correspond with their
sexual identity and many have a desire to outwardly express the gender to
which they identify.
Questioning Describes those who are unsure and taking time to determine their gender
identity; searching for their authentic self.
Adapted from the National LGBT Health Education Center: Fenway Institute15 and the Gay Alliance.16
environment is perceived when all hospital/clinic
staff are addressing the patient as they express
themselves (Table 2).
If the name and gender on records do not
match, it is recommended to ask, Could your
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chart be under a different name? or What is
the name on your insurance card?8 It is not
recommended to refer to their birth name as their
real name, as this may imply that their wish to be
called by their preferred name is not respected.
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Table 2. Communicating Respectfully in Health Care
Best Practices Examples
Addressing a new patient: Do not assume a pronoun
like sir or maam, but rather keep your remarks
open and general.
How can I assist you? or Welcome, what brings you to
the hospital/office?
If you unsure of the pronoun a patient wants used,
simply ask politely. If you use the wrong pronoun,
apologize and document the patients preferred
name and pronoun so others are aware.
I am sorry for using the wrong pronoun and I did not
mean any disrespect, I will note this in your chart so
others hopefully will not make the same mistake or
How would you like to be addressed while you are
staying in the hospital/while you are at the clinic?
If you cannot find the patients preferred name in the
electronic health record, ask about other names they
have used in the past.
Could your record be under another name, perhaps? or
How does your name read on your insurance card?
In conversation, you should use the terms that the
person uses to describe themselves. Some identify
as queer and it is acceptable to address them this
way, if it is consistent with how they personally
identify.
If a person verbalizes that he is queer, do not call him
gay or homosexual. If a woman refers to her partner as
her wife, you should follow suit.
Adapted from the National LGBT Health Education Center: Fenway Institute.8(p21)
Sometimes their name is changed on the drivers
license or other medical documents, but, for legal
or safety reasons, their gender is not changed.
Consider the negative consequences that could
result if a transgender person (female to male) is
arrested and placed in a cell with male inmates.
Sometimes gender documentation change is not
done because specific screening services may be
excluded by insurance carriers. An example is the
female-to-male transgender patient, whose insur-
ance carrier may refuse to pay for a Pap smear if
there is a male gender on file. Knowledge of this
information can play a role in improving health
outcomes, promoting culturally sensitive care, and
reducing health disparities.
AFFIRMING CLINICAL ENCOUNTERS
Beyond having a welcoming environment for
LGTBQI patients, health care providers should be
open and nonjudgmental when taking sexual and
social history data.13 Best practices include using
open-ended and general questions and avoiding
asking questions with specific answers that can
exclude individuals who are not mainstream. When
inquiring about partner/marital status, asking Who
lives at home with you? or Who is family to you?
is more inclusive than Do you have a wife/
husband? Questions should be worded to initiate
The Journal for Nurse Practitioners – JNP346
discussion about their intimate relationship and/or
sexual behaviors that may affect their health. An
example of an open-ended question is, What does
safe sex mean to you? Eliciting honest answers
allows for the provider to have a better understanding
about what screening tests to order, currently relevant
patient education to provide, and to anticipate
guidance in preventing future possible negative out-
comes. Knowledge of this information can play a role
in improving health outcomes, promoting culturally
sensitive care, and reducing health disparities.
Once a trusting relationship has been established
between the patient and the health care provider, a
sexual risk assessment should be conducted. This
assessment is commonly known as the 5 Ps: partners;
practices; past sexually transmitted disease history;
protection from sexually transmittable diseases; and
pregnancy plans.12 These questions assist the provider
in stratifying a patients risks for poor health
outcomes or diseases. Registered nurses, advanced
practice nurses, and physicians are encouraged to
become trained in how to provide respectful, quality
care to LGTBQI patients.14
CONCLUSION
Effective health care is based on the foundation of
providing quality care to patients with a holistic
approach. Part of giving quality care is for the
Volume 13, Issue 5, May 2017
provider to begin by having an awareness of the
cultures of the patients they care for, including the
many cultures of the LGBTQI population(s). Having
this awareness will allow the health care provider to
begin to better meet the mental and physical needs of
the population for which they are caring.
References
1. Kosciw JG, Greytak EA, Palmer NA, Boesen MJ. The 2013 national school
climate survey: the experiences of lesbian, gay, bisexual, and transgender
youth in our nations schools. 2013. http://www.glsen.org/sites/default/files/
2013%20National%20School%20Climate%20Survey%20Full%20Report_0
.pdf/. Accessed November 25, 2016.
2. Grant JM, Mottet LA, Tanis JT. Injustice at every turn: a report of the national
transgender discrimination survey. 2011. http://endtransdiscrimination.org/
PDFs/NTDS_Report.pdf/. Accessed November 25, 2016.
3. US Centers for Disease Control and Prevention. Suicide trends among persons
aged10-24yearsintheUnitedStates1994-2012.2015. http://www.cdc.gov/mmwr/
preview/mmwrhtml/mm6408a1.htm/. Accessed November 25, 2016.
4. US Centers for Disease Control and Prevention. Sexual identity, sex of sexual
contacts, and health-related behaviors among students in grades 9-12 United
States and selected sites. 2015. http://www.cdc.gov/mmwr/volumes/65/ss/
ss6509a1.htm/. Accessed November 25, 2016.
5. School Health Policies and Practice Study. 2014.
6. National LGBT Health Education Center: Fenway Institute. Understanding the
health needs of LGBT people. 2016. http://www.lgbthealtheducation.org/wp
-content/uploads/LGBTHealthDisparitiesMar2016.pdf/. Accessed November
25, 2016.
7. National LGBT Cancer Network. Barriers to healthcare. 2016. http://www
.cancernetwork.org/cancer_information/cancer_and_the_lgbt_community/
barriers_to_lgbt_healthcare.php/. Accessed November 25, 2016.
8. National LGBT Health Education Center: Fenway Institute. Providing inclusive
services and care for LGBT people. 2016. http://www.lgbthealtheducation.org/
wp-content/uploads/Providing-Inclusive-Services-and-Care-for-LGBT-People/.
Accessed November 25, 2016.
9. National LGBT Health Education Center: Fenway Institute. Ten things:
creating inclusive health care environments for LGBT people. 2015.
http://www.lgbthealtheducation.org/wp-content/uploads/Ten-Things-Brief-
Final-WEB.pdf/. Accessed November 25, 2016.
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10. National LGBT Health Education Center: Fenway Institute. Building
patient-centered medical homes for lesbian, gay, bisexual, and
transgender patients and families. 2016. http://www.lgbthealtheducation
.org/wp-content/uploads/Building-PCMH-for-LGBT-Patients-and-Families
.pdf/. Accessed November 25, 2016.
11. Healthy People 2020. Healthy People 2020. 2016. https://www.healthypeople
.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health/.
Accessed November 25, 2016.
12. National LGBT Health Education Center: Fenway Institute. Collecting sexual
orientation and gender identity data in electronic health records. 2016.
http://www.lgbthealtheducation.org/wp-content/uploads/Collecting-Sexual
-Orientation-and-Gender-Identity-Data-in-EHRs-2016.pdf/. Accessed
November 25, 2016.
13. National LGBT Health Education Center: Fenway Institute. 2016. Building
patient-centered medical homes for lesbian, gay, bisexual, and transgender
patients and families. http://www.lgbthealtheducation.org/wp-content/
uploads/Collecting-Sexual-Orientation-and-Gender-Identity-Data-n-EHRs
-2016-pdf/. Accessed November 25, 2016.
14. Healthcare Equality Index. Healthcare Equality Index (HEI). 2016. http://www
.hrc.org/hrc-story/. Accessed November 25, 2016.
15. National LGBT Health Education Center: Fenway Institute. Glossary of
LBGT terms for health care teams. http://www.lgbthealtheducation.org/
wp-content/uploads/LGBT-Glossary_March2016.pdf/. Accessed November
25, 2016.
16. Gay Alliance. Safe zone: Train the Trainer Certification Program. 2016. http://
www.gayalliance.org/programs/education-safezone/safezone-train-the-trainer
-certification-program/. Accessed November 25, 2016.
Jessica Landry, DNP, FNP-BC, is an Nursing Instructor in the
School of Nursing at the Louisiana State University Health
Sciences Center in New Orleans. She can be reached at [emailprotected]
lsuhsc.edu. In compliance with national ethical guidelines, the
author reports no relationships with business or industry that
would pose a conflict of interest.
1555-4155/17/$ see front matter
2016 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.nurpra.2016.12.015
The Journal for Nurse Practitioners – JNP 347
http://www.glsen.org/sites/default/files/2013%20National%20School%20Climate%20Survey%20Full%20Report_0.pdf/
http://www.glsen.org/sites/default/files/2013%20National%20School%20Climate%20Survey%20Full%20Report_0.pdf/
http://www.glsen.org/sites/default/files/2013%20National%20School%20Climate%20Survey%20Full%20Report_0.pdf/
http://endtransdiscrimination.org/PDFs/NTDS_Report.pdf/
http://endtransdiscrimination.org/PDFs/NTDS_Report.pdf/
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6408a1.htm/
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6408a1.htm/
http://www.cdc.gov/mmwr/volumes/65/ss/ss6509a1.htm/
http://www.cdc.gov/mmwr/volumes/65/ss/ss6509a1.htm/
http://www.lgbthealtheducation.org/wp-content/uploads/LGBTHealthDisparitiesMar2016.pdf/
http://www.lgbthealtheducation.org/wp-content/uploads/LGBTHealthDisparitiesMar2016.pdf/
http://www.cancernetwork.org/cancer_information/cancer_and_the_lgbt_community/barriers_to_lgbt_healthcare.php/
http://www.cancernetwork.org/cancer_information/cancer_and_the_lgbt_community/barriers_to_lgbt_healthcare.php/
http://www.cancernetwork.org/cancer_information/cancer_and_the_lgbt_community/barriers_to_lgbt_healthcare.php/
http://www.lgbthealtheducation.org/wp-content/uploads/Providing-Inclusive-Services-and-Care-for-LGBT-People/
http://www.lgbthealtheducation.org/wp-content/uploads/Providing-Inclusive-Services-and-Care-for-LGBT-People/
http://www.lgbthealtheducation.org/wp-content/uploads/Ten-Things-Brief-Final-WEB.pdf/
http://www.lgbthealtheducation.org/wp-content/uploads/Ten-Things-Brief-Final-WEB.pdf/
http://www.lgbthealtheducation.org/wp-content/uploads/Building-PCMH-for-LGBT-Patients-and-Families.pdf/
http://www.lgbthealtheducation.org/wp-content/uploads/Building-PCMH-for-LGBT-Patients-and-Families.pdf/
http://www.lgbthealtheducation.org/wp-content/uploads/Building-PCMH-for-LGBT-Patients-and-Families.pdf/
https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health/
https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health/
http://www.lgbthealtheducation.org/wp-content/uploads/Collecting-Sexual-Orientation-and-Gender-Identity-Data-in-EHRs-2016.pdf/
http://www.lgbthealtheducation.org/wp-content/uploads/Collecting-Sexual-Orientation-and-Gender-Identity-Data-in-EHRs-2016.pdf/
http://www.lgbthealtheducation.org/wp-content/uploads/Collecting-Sexual-Orientation-and-Gender-Identity-Data-n-EHRs-2016-pdf/
http://www.lgbthealtheducation.org/wp-content/uploads/Collecting-Sexual-Orientation-and-Gender-Identity-Data-n-EHRs-2016-pdf/
http://www.lgbthealtheducation.org/wp-content/uploads/Collecting-Sexual-Orientation-and-Gender-Identity-Data-n-EHRs-2016-pdf/
http://www.hrc.org/hrc-story/
http://www.hrc.org/hrc-story/
http://www.lgbthealtheducation.org/wp-content/uploads/LGBT-Glossary_March2016.pdf/
http://www.lgbthealtheducation.org/wp-content/uploads/LGBT-Glossary_March2016.pdf/
http://www.gayalliance.org/programs/education-safezone/safezone-train-the-trainer-certification-program/
http://www.gayalliance.org/programs/education-safezone/safezone-train-the-trainer-certification-program/
http://www.gayalliance.org/programs/education-safezone/safezone-train-the-trainer-certification-program/
mailto:[emailprotected]
mailto:[emailprotected]
http://dx.doi.org/10.1016/j.nurpra.2016.12.015
http://www.npjournal.org
Delivering Culturally Sensitive Care to LGBTQI Patients
The Staggering Statistics
Health Disparities In The LGBTQI Community
Vignette
Understanding Gender Fluidity
Providing Inclusive Quality Care
Affirming Clinical Encounters
Conclusion
References Nurse Practitioner Knowledge, Attitudes, and Beliefs When
Caring for Transgender People
Catherine Paradiso1,* and Robin M. Lally2
Abstract
Purpose: The aim of this study was to explore Nurse Practitioner (NP) knowledge, attitudes, and beliefs when
working with transgender people and to inform about Practitioner education needs.
Methods: A qualitative descriptive design was used to explore (NP) experiences. Focused semistructured
interviews were conducted in 2016 with 11 (N= 11) NPs in the northeastern United States who represent
various years of experience and encounters with transgender patients. The interviews explored NP knowledge
attitudes and beliefs when caring for transgender patients and described their overall experiences in rendering
care in the clinical setting. The interviews were professionally transcribed and analyzed independently and
jointly by two investigators using conventional content analysis.
Results: Four main themes and six subthemes were identified: Main themes include personal and professional
knowledge gaps, fear and uncertainty, caring with intention and pride, and creating an accepting environment.
Conclusions: NPs in this study perceive gaps in their knowledge that threaten their ability to deliver quality,
patient-centered care to transgender patients, despite their best intentions. These findings have implications
for changes in nursing practice, education, and research needed to address vital gaps in the healthcare of
transgender people.
Keywords: attitudes; beliefs; knowledge; nurse practitioners; transgender
Introduction
After years of discrimination in all areas of life,
transgender people are now prominently included in
the countrys civil rights agenda. Healthcare
discrimination is especially appalling. The National
Transgender Discrimination Survey (NTDS) identified
denial of healthcare, issues with provider ignorance of
transgender and gender nonconforming health needs in
preventative medicine, routine and emergency care,
and transgender-related services in 2011 and again in
2016.1,2 Such discrimination reduces access and deters
transgender people from seeking and receiving quality
healthcare.1
In 2011, the Institute of Medicine (IOM) addressed
health needs of transgender persons in their document
The Health of Lesbian, Gay, Bisexual, Transgender
People: Building a Foundation for Better
Understanding
describing stigma, discrimination, and lack of provider
knowledge and training as barriers to transgender
healthcare leading to significant health disparities.3
The need for transgender health research, although
included un
