Linfield College DigitalCommons@Linfield Faculty Presentations Faculty Scholarship & Creative Works 7-14-2017 Incorporating Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Concepts into Nursing Curricula: What Nursing Faculty Should Know Paul Smith Linfield College - Portland Campus Julie Fitzwater Linfield College - Portland Campus Follow this and additional works at: http://digitalcommons.linfield.edu/nursfac_pres Part of the Gender, Race, Sexuality, and Ethnicity in Communication Commons, Health and Physical Education Commons, Health Communication Commons, Higher Education and Teaching Commons, Lesbian, Gay, Bisexual, and Transgender Studies Commons, and the Nursing Commons Recommended Citation Smith, Paul and Fitzwater, Julie, "Incorporating Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Concepts into Nursing Curricula: What Nursing Faculty Should Know" (2017). Faculty Presentations. Presentation. Submission 2. http://digitalcommons.linfield.edu/nursfac_pres/2 This Presentation is brought to you for free via open access, courtesy of DigitalCommons@Linfield. For more information, please contact digitalcommons@linfield.edu.
Incorporating Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Concepts into Nursing Curricula: What Nursing Faculty Should Know PAUL SMITH, PHD, RN, CCRN, CNE JULIE FITZWATER, MN, RN, CNRN LINFIELD GOOD-SAMARITAN SCHOOL OF NURSING PORTLAND, OREGON
Session Disclosure 1) Approval Statement This continuing education activity was approved by the Western Multi-State Division, an accredited approver by the American Nurses Credentialing Center s Commission on Accreditation. Arizona, Colorado, Idaho, and Utah Nurses Associations are members of the Western Multi-State Division. Approval # 72-17 2) Criteria for Successful Completion To receive contact hours, participants must check-in to the session using the barcode scanner, attend the entire session and then complete both the session evaluation and full conference evaluation by July 31, 2017. 3) Conflicts of Interest This educational activity does not include any content that relates to the products and/or services of a commercial interest that would create a conflict of interest. 4) Commercial Support There is no commercial support being received for this session.
Learning Outcomes Learning outcome 1: Attendees will be able to describe ways to incorporate LGBT content into nursing curricula. Learning outcome 2: Attendees will be able to identify resources appropriate for nursing students that may be integrated into nursing curricula. Learning outcome 3: Attendees will be able to identify specific health disparities that are applicable to the LGBT community.
Why is this Important? Lack of cultural competence by healthcare providers contributes to health disparities by deterring LGBT individuals from seeking medical care (IOM, 2011; Khalili, Leung, & Diamant, 2015) Shortage of health care providers who are knowledgeable and culturally competent in LGBT health Nurses revealed that they had no education or training on LGBT health issues identifying that LGBT health care education needs to start in nursing schools and programs (Carabez et al., 2015). Organizational Stance Joint Commission Healthy People 2020 National Student Nurses Association National League for Nursing
Cultural Competence An analysis of the core components of nine of the most frequently cited cultural competency theoretical frameworks allowed for an identification of four main themes: 1. An awareness of the diversity that exists among human beings, including self and others 2. An ability to provide care for individuals 3. Non-judgmental openness, including the ability to overcome prejudices 4. The understanding that cultural competence is a continuous process (Jirwe, Gerrish, & Emami, 2006)
Degree/Extent of Preparation that Nurse Practitioners Reported from their Nursing Programs Nursing Program Type and Cultural Competence 1 None 2 Little 3 Somewhat 4 Much 5 A Great Deal Pre-licensure programs (e.g., ADN and/or BSN) Nursing education to provide culturally competent care 2.7% 11.3% 35.7% 29.7% 20.6% Nursing education to provide culturally competent care to gay 17.7% 32.1% 32.8% 11.8% 5.6% and lesbian clients Nurse practitioner programs (e.g., MSN and/or DNP) Nursing education to provide culturally competent care 1.8% 8.0% 32% 35.9% 22.3% Nursing education to provide culturally competent care to gay and lesbian clients Nursing Education Reported 7.7% 24.6% 31.3% 24.8% 11.6%
Check Your Knowledge
How did you do? All answers are true based on HP 2020 LGBT youth are 2 to 3 times more likely to attempt suicide. LGBT youth are more likely to be homeless. Lesbians are less likely to get preventive services for cancer. Gay men are at higher risk of HIV and other STDs, especially among communities of color. Lesbians and bisexual females are more likely to be overweight or obese. Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGB individuals. Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers. LGBT populations have the highest rates of tobacco, alcohol, and other drug use.
Disparities Continued October 2016 National Institute of Health (NIH) announced the formal designation of sexual and gender minorities (SGMs) as a health disparity population for NIH research The term SGM encompasses LGBT populations, as well as those whose sexual orientation, gender identity and expressions, or reproductive development varies from traditional, societal, cultural, or physiological norms. Research shows that sexual and gender minorities who live in communities with high levels of anti-sgm prejudice die sooner 12 years on average than those living in more accepting communities (Hatzenbuehler et al., 2014) For many LGBT individuals, the minority stress they experience on the basis of sexual orientation and gender identity intersects with inequalities associated with race, ethnicity, and social class (IOM, 2011).
I treat all of my patients the same. Image credit: Interaction Institute for Social Change
Examples of Curriculum Integration Faculty do acknowledge that integrating content is important, but do not feel they posses the knowledge and skills necessary to teach this content (Sirota, 2013) ücase STUDIES üsimulation ülanguage USE üsafe CLASS ENVIRONMENT üother THAN MENTAL HEALTH üpanels
CASE STUDY EXAMPLE https://www.aetcnmc.org/studies/lgbt.html Jenny, a 25 year old Native American male to female transgender person, wants to look into services that you provide. She has not legally changed her name so her documents display her given male name James. She is new in transition, dresses in t-shirts and jeans and still produces facial hair (which is exposed). She appears to be shy, jittery and very nervous, does not look anyone in the eyes. Jenny had unprotected sex one week prior and is concerned about her HIV status. Discussion Questions What would be the most appropriate way to start the encounter with Jenny? How could the biases and prejudices of the provider influence the interaction with the patient? How can barriers to care be identified and overcome with Jenny? Is it appropriate to administer an HIV test during this visit? If so, how would you go about getting informed consent from the patient? How can the provider find out more information about day-to-day hardships and challenges that Jenny may be experiencing? What can the provider do to provide culturally sensitive care to Jenny? Discuss other Cultural Competence issues that may impact retention into care and treatment
A FEW RESOURCES The Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health https://lavenderhealth.org Journals Gay and Lesbian Medical Association (GLMA) and the GLMA Nursing Section LGBTQ Cultures: What Healthcare Professionals Need to Know About Sexual and Gender Diversity (Second Edition) NLN ACES case study Advancing Care Excellence for Seniors (ACES) http://www.nln.org/professional-developmentprograms/teaching-resources/ace-s/unfoldingcases/julia-morales-and-lucy-grey
Findings from Open-Ended Questions: Pre-licensure Recurrent Comments nlittle to no education. nfocused on HIV/AIDS ncommunication is paramount nnonjudgmental, facing own biases, and treating with dignity nreligious affiliated nursing programs ncultural competence present; gay and lesbian not included
Recommendations for Undergraduate Education Foster open dialogue in the classroom to discuss the topic Address specific health concerns for LGBT individuals and addressing misconceptions Include specific clinical rotations that will allow for exposure to gay and lesbian clients Include guest speakers and/or panel discussions on related health issues/concerns facing the LGBT population Teach effective communication strategies Use case studies and simulation that include gay and lesbian clients Discuss resources for gay and lesbian clients with nursing students Address psychological aspects of care, including suicide prevention
Findings from Open-Ended Questions: NP Program Recurrent Comments nlittle to no education nemphasis on specific risk factors and health needs nemphasis on adolescent health nacceptance and dignity to provide safe practice environment nopen communication especially regarding sexual orientation naddressing homophobia or bias for self nlack of seeking treatment due to fear or previous experiences
Recommendations for Graduate Education Focus on the importance of relationships and families within the LGBT population. Have specific classes and/or content related to caring for transgendered individuals. Inform students of supportive services for LGBT individuals as well as resources available for clients and providers. Teach content that addresses specific health concerns and health risks for the LGBT population. Include guest speakers and panel discussions such as gay and/or lesbian individuals who have had experience with health care and providers. Teach effective communication strategies in order to engage with gay and lesbian clients and foster a safe environment. Explore evidence-based practice and research regarding care and health risks for this population. Inform students of supportive services for LGBT individuals as well as resources available for clients and providers.
Challenge
References Carabez, R., Pellegrini, M., Mankovitz, A., Eliason, M., Ciano, M., & Scott, M. (2015). Never in all my years... : Nurses education about LGBT health. Journal of Professional Nursing, 31(4), 323 329. Hatzenbuehler, M. L., Bellatorre, A., Lee, Y., Finch, B. K., Muennin, P., & Fiscella, K. (2014). Structural stigma and allcause mortality in sexual minority populations. Social Science & Medicine, 103, 33 41. doi: 10.1016/j.socscimed.2013.06.005 Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: The National Academies Press. Jirwe, M., Gerrish, K., & Emami, A. (2006). The theoretical framework of cultural competence. The Journal of Multicultural Nursing & Health, 12(3), 6 16. Khalili, J., Leung, L. B., & Diamant, A. L. (2015). Finding the perfect doctor: Identifying lesbian, gay, bisexual, and transgender-competent physicians. American Journal of Public Health, 105, 1114-1119. Sirota, T. (2013). Attitudes among nurse educators toward homosexuality. Journal of Nursing Education, 52(4), 219 227. doi: 10.3928/01484834-20130320-01
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