Providing compassionate healthcare to members of the LGBTQ+ community requires an understanding of basic terms and definitions along with an awareness of the various barriers LGBTQ+ patients often face when seeking competent, inclusive healthcare. Nursing professionals can improve their competency and create an inclusive healthcare environment by educating themselves on the needs of LGBTQ+ populations.
Important Terms and Definitions
Many people often conflate sexual orientation with gender identity and expression. However, these two terms differ in important ways, according to the National LGBT Health Education Center.
Sexual orientation refers to a person's romantic and sexual preferences in a partner, including terms like gay, lesbian, bisexual, and heterosexual. Healthcare professionals should keep in mind that a patient's sexual orientation does not inherently define their gender or gender expression.
Gender identity refers to how a person manifests or expresses their gender, including male, female, or nonbinary. Nonbinary individuals do not identify with one specific gender, instead seeing themselves as somewhere on the spectrum of binary gender. Nonbinary people may also identify as gender-fluid or genderqueer.
Healthcare professionals should keep in mind that a patient's sexual orientation does not inherently define their gender or gender expression.
Beth Niernberg, a mental health counselor who works with members of the LGBTQ+ community, as well as transgender and nonbinary children and adults, specifies that even if patients outwardly appear to identify as male or female, they may identify otherwise.
"Their gender expression may not give you clues as to how they identify," Niernberg says. "So don't assume because they have polished nails and makeup on their face that they identify as a woman."
Niernberg further points out that healthcare professionals should not make assumptions about the gender of a patient or a patient's partner based on previous visits or records.
"Gender identity is deeply personal and may change across a lifespan, so you may treat someone who identifies as they/them at one visit and he/him the next," Niernberg says. "It's our job to check in at every visit."
Barriers to Care for the LGBTQ+ Community
Unfortunately, members of the LGBTQ+ community face many barriers when seeking care. This includes a lack of access to basic healthcare, sometimes stemming from a lack of health insurance or nearby healthcare providers not offering specific services LGBTQ+ patients may need.
Caroline Dorsen, the nursing chair of GLMA: Health Professionals Advancing LGBTQ+ Equality, mentions that a history of stigmatization and discrimination from healthcare workers presents another common barrier. Dorsen, an assistant professor at NYU Rory Meyers College of Nursing, focuses her research on aiding and educating underserved populations, including the LGBTQ+ community.
To aid in reducing these boundaries, Dorsen recommends that providers maintain a list of LGBTQ+-inclusive and affirming mental health resources to offer their patients.
LGBTQ+ patients who have had negative interactions with healthcare professionals may not continue to seek the care they need in fear of reliving those experiences. Niernberg says to be mindful of the trauma transgender and nonbinary people may hold from experiences in medical or psychiatric care settings.
"When encountering someone who may be defensive or struggling with PTSD, it's helpful to take a moment before you enter the room to read the chart carefully and think about the person in front of you," Niernberg says.
Creating an Inclusive Environment
Creating an environment of intentionality and accountability serves as a crucial part of caring for the LGBTQ+ population. Healthcare professionals should educate themselves on LGBTQ+ terminology and prepare to provide relevant health services to members of this community.
Mistakes in providing compassionate care, such as misgendering, can have serious negative impacts on LGBTQ+ patients. Remaining aware that LGBTQ+ patients may require a more empathetic and educated approach to care can help healthcare professionals provide these patients with competent, necessary services.
Mistakes in providing compassionate care, such as misgendering, can have serious negative impacts on LGBTQ+ patients.
Niernberg notes that one simple way to create an inclusive environment from the start is to make sure the patient forms have the appropriate fields on them for patients to specify their pronouns and gender.
"The best way to begin a successful visit is to make sure all of your forms reflect the diversity you see in your setting," says Niernberg. "Every form should be welcoming to every person."
Nurses and other healthcare workers benefit from adopting some common best practices for maintaining the best environment for both patient and provider.
Best Practices for Working with LGBTQ+ Populations
Providing the best care possible for LGBTQ+ patients starts with adopting some care practices specific to this population. The following tips provide some details on how to better communicate with LGBTQ+ patients, along with how to meet them where they are to serve their healthcare needs in a competent, educated environment.
Education on communication basics is a crucial aspect of providing compassionate care to LGBTQ+ patients. Nursing professionals should consider the following tips:
- Avoid assuming a patient's gender identity or sexual orientation. Assumptions made based solely on a patient's outward expression may be incorrect and result in unintentional disrespect toward that patient's identity.
- If the patient's charted information does not match their forms, never ask for their "real" or given name. Instead, consider asking for the name listed on their insurance, and then continue to refer to them by the name they provided.
- Follow the patient's lead. Use the terms they give for their name, gender, and sexual orientation.
- Try not to have others in the exam room if they do not need to be there.
When it comes to personal pronouns, "ask first" serves as the best rule of thumb for nurses, Niernberg says. The way patients look, their name, nor the procedure they are coming in for designate their gender identity. Asking is the only way to know a patient's preferred pronouns.
In early interactions with a patient, avoid using gendered pronouns at all. The National LGBT Health Education Center recommends using a patient's name, or referring to them as "you," rather than "miss" or "sir."
Sharing their own pronouns is another way nurses can provide a comfortable, welcoming care environment at the very beginning of a visit.
"Always introduce yourself with pronouns -- even if you think your patient knows yours already -- as they can use the opportunity to share theirs, which may have changed since you last saw them," Niernberg says.
When working with vulnerable populations, nurses and healthcare professionals must take note of their patients' preferred contacts and support systems.
"The LGBTQ+ community has historically relied more on 'families of choice' (as opposed to biological family) than heterosexual cisgender persons," Dorsen explains. "It is important to ask LGBTQ+ patients who their social supports are, who should be contacted in case of emergency, and if there is anyone who should not be contacted."
Intersectionality refers to the various connections between different facets of identity, including race, gender expression and identity, sexual orientation, socioeconomic class, and other markers. In healthcare settings, nurses and other healthcare professionals encounter patients from every intersection of identity. No two patients share the same life experience and background.
When providing care to LGBTQ+ patients, understand that identity markers, including gender expression and sexual orientation, remain fluid and may change. To foster an inclusive environment, maintain a non-judgemental attitude and follow the patient's lead. Remain mindful of body language and respond in thoughtful ways.
Creating this type of inclusive environment takes intentionality and consistency, Niernberg says.
"Building a relationship is key in creating a seamless treatment environment," she notes. "If they can know who they will see when they come in, they are more likely to seek treatment rather than avoid it."
Helpful Resources for Nurses
Learning about caring for the LGBTQ+ community requires some flexibility and a willingness to adapt and become educated. Fortunately, nurses can take advantage of available resources to better understand the needs of the LGBTQ+ community, along with how to foster a safe, inclusive healthcare environment.
- The Trevor Project The Trevor Project provides suicide prevention efforts for the LGBTQ+ community. The organization features a hotline that connects callers in need with trained counselors and other important resources.
- LGBT National Hotline The LGBT National Hotline provides phone, chat, email, and text lines for different demographics within the LGBTQ+ community, including youth and senior lines. The hotline also provides resources for allies.
- Trans Lifeline The Trans Lifeline offers emotional and financial support to trans people in need or crisis. Nurses can take advantage of many helpful resources, including a mailing list.
- Fenway Health Helpline Fenway Health provides LGBTQ+ helplines and peer listening lines 24 hours a day, seven days a week. The website also provides training programs for LGBTQ+ health providers.
- GLMA Healthcare Provider Directory The Gay and Lesbian Medical Association offers a useful directory of healthcare professionals who provide trustworthy care to the LGBTQ+ community. Nurses and patients alike can use the searchable directory to locate providers.
Caroline G. Dorsen, Ph.D., FNP-BC, is an assistant professor at NYU Rory Meyers College of Nursing. As a nurse scholar, nurse educator, and family nurse practitioner, Dorsen's passion is the interface between health and social justice. Her research focuses on health promotion, disease prevention, and reduction of healthcare disparities among underserved populations, including new immigrants, the homeless, drug users, and sexual and gender minorities. Her current research project explores the impact of gender affirmation on risk and resilience among transgender and gender-diverse people.
Dorsen has been a primary care provider at many community health centers. In her current clinical practice, she provides primary and gynecological care to homeless adolescents and adults. Dorsen serves as the vice-chairman of the Board of Directors of the Community Healthcare Network, the nursing chair of GLMA: Health Professionals Advancing LGBTQ+ Equality, and a senior associate editor of Annals of LGBTQ+ Public and Population Health. She is also the nursing lead for SARET, a National Institutes of Health-funded interprofessional substance use training program housed at the NYU School of Medicine.
Beth Niernberg, LMHC, has worked as a practicing mental health counselor since 1999. In the past 21 years, she has honed her skills as a trauma clinician working in group homes and residential settings, Boston Medical Center and Children's Hospital, The Trauma Center, and Children's Charter. She has also provided consultation to the Brookline Police Department and countless human service agencies.
As clinical director at My Life My Choice, she used her trauma-informed skills to support sexually exploited children. Niernberg has developed her private practice while working with people in the LGBTQ+ community, along with transgender and nonbinary children and adults. Niernberg provides training and support to schools, agencies, and service providers regarding best practices when working with LGBTQ+, transgender, and nonbinary children and adults.