Nurse’s Guide to Caring for LGBTQ+ Youth
Updated August 2, 2022 · 6 Min Read
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Learn how to provide culturally competent healthcare to LGBTQ+ youth, a vulnerable population in need of knowledgeable, compassionate, and skilled nursing care.
LGBTQ+ youth comprise a patient population that needs a culturally competent approach from thoughtful healthcare providers. If we can provide high-quality, unbiased nursing care for LGBTQ+ youth, we can more readily meet the needs of this group vulnerable to health disparities.
Previous experience of prejudice can be a deterrent to seeking care. Fear of stigma and encountering discrimination is a key factor that can contribute to LGBTQ+ youth avoiding contact with the healthcare system.
Nurses are in a unique position to create more equitable care for LGBTQ+ youth. As the largest segment of the healthcare workforce, nurses have more points of contact with patients than other providers.
Nurses can seize the opportunity to bridge the gaps of care, tapping into the potential for connection, trust, patient engagement, and decreased negative outcomes. Keep reading to find out more about how to care for LGBTQ+ youth.
Health Disparities for LGBTQ+ Youths
According to the National LGBT Health Education Center, such youth experience:
- Double to triple the likelihood of suicide attempts
- Increased likelihood of homelessness
- Higher incidence of bullying
- Higher risks of being infected with sexually transmitted infections (STIs) and HIV
There is also a higher risk of LGBTQ+ youth becoming victims of human trafficking. LGBTQ+ youth may also experience abuse by their parents or guardians.
The Center for American Progress further identifies common health disparities:
- Lower rates of screening for certain diseases
- Risk factors such as the misuse of alcohol, tobacco, and illicit drugs
- Sexual abuse and violence
- Social isolation
- Anxiety and depression
- Altered body image and eating disorders
Barriers to Care for LGBTQ+ Youths
Many barriers stand in the way of LGBTQ+ patients and youth accessing healthcare services, which can contribute to health disparities. Barriers to accessing care include:
- Being refused care based on perceived or actual sexual orientation or gender identity
- Difficulty finding culturally competent healthcare providers
- The cost of care and lack of health insurance
- Lack of access to affordable transportation
- Fears regarding privacy and lack of confidentiality
- Previous experiences of discrimination, dismissal, bullying, or criticism
In terms of providing information to LGBTQ+ youth regarding the availability of care, barriers include:
- Mistrust of the healthcare system
- A lack of sufficient relevant data on the LGBTQ+ youth population experience
- Misunderstanding on the part of providers regarding the correct use of inclusive, respectful language (such as pronouns, identifiers, etc.)
- Printed and online materials using outdated and incorrect language that excludes patients' own identified culture or group
For LGBTQ+ youth of color, the barriers are intensified when discrimination based on race or racial identity is superimposed over the barriers already faced by all LGBTQ+ youth.
Best Practices for Nurses Caring for LGBTQ+ Youths
Nurses and their colleagues can learn from others who have already blazed the trail in terms of best practices when it comes to nursing care for LGBTQ+ youth.
When practices based on previous success are adopted, crucial inroads can be made to decrease avoidable health disparities that affect LGBTQ+ youth. For instance, nurses should be aware of issues such as the cost, side effects, and access to certain medications and other treatments, like hormone blockers.
The following five best practices provide excellent ground in caring for LGBTQ+ youth.
- 1. Establish Confidentiality
Overcoming LGBTQ+ youths' mistrust of the healthcare system is vital. Ironclad assurances and actual protection of strict confidentiality are essential.
Privacy from parents and guardians, school personnel, and other authority figures is key. It is also important to help youths understand the implications of disclosing information to healthcare staff, especially when state laws on suicidal or homicidal ideation, sexual assault, abuse and neglect, and other circumstances mandate that a parent or guardian be informed.
At the beginning of one-on-one interactions, care providers should verify that confidentiality is sufficiently explained in a way that is consistent with pediatric guidelines and ethics. Confidentiality may also be established in patients' medical records by indicating specific information that may or may not be shared with certain parties.
Nurses can better inform youths of their available care options by adopting a forthcoming position on these requirements. This can help you to build trust through transparency. It is only when confidentiality can be assured and protected at all points of interaction that youths can truly feel empowered to share sensitive information that may be vital to their care.
- 2. Understand Concepts, Terms, and Definitions
Gaining the trust of the LGBTQ+ youth patient population means that nurses and healthcare providers must understand, and remain aware of, changes in LGBTQ+ concepts, terms, and definitions that such patients and their peers commonly use.
If a healthcare provider displays ignorance regarding the appropriate use of common terms (like genderqueer, gender fluid, nonbinary, transgender man, transgender woman, etc.), or if the provider fails to display humility when offered feedback about their lack of knowledge, those behaviors can lead to an avoidance of care by the patient.
Worse, it could lead to mis-, over-, or underdiagnosis by the provider, which can have lasting effects on patients.
When a provider is uncertain of a term used by a patient or how to address a specific issue in a competent manner, honesty, humility, and authentic curiosity go a long way toward furthering trust and a positive rapport.
The National LGBT Health Education Center recommends the establishment of an environment where colleagues are comfortable correcting one another when incorrect language is used in caring for patients. Working together, colleagues can create a supportive culture of accountability that raises the bar for quality of care.
- 3. Create an Inclusive, Welcoming Environment
An inclusive and welcoming environment comprises various aspects of a healthcare facility's approach to populations such as LGBTQ+ youth.
When a transgender individual makes use of a healthcare institution, an act as simple as using the restroom can be filled with anxiety. Gender-neutral restrooms allow individuals to take care of their personal needs without unnecessary worry. Intake forms and other paperwork should allow for the expression of patients' chosen gender identity, sexual orientation, and self-definition. The National LGBT Health Education Center's guide to creating inclusive forms and policies is a valuable resource in this regard.
For example, paperwork related to patients' gender identity should not be limited to checkboxes for "man" or "woman." It should instead offer an option to write in a patient's own gender or genders. It can also have a list of many gender options where the patient can choose more than one.
Gender should never be conflated with sex, which should offer "male," "female," and "intersex." Inclusive signs, pamphlets, and literature geared toward the LGBTQ+ patient population can also foster a sense of safety and acceptance. Recognition of World AIDS Day, Pride events, and National Transgender Day of Remembrance are examples of ways in which healthcare institutions can help LGBTQ+ patients feel recognized as valid members of the wider community.
- 4. Focus on Equity
According to an article published by the Pediatrics Clinic of North America on inclusive and affirming environments for LGBTQ+ youth, a focus on equity of access is crucial. The authors outline several key factors:
- Care must be provided to "all groups of lesbian, gay, bisexual, transgender, queer, and questioning youth."
- It must be ensured that "services are inclusive of and sensitive to the needs of diverse racial/ethnic groups of LGBTQ youth, including those of color and who are non-native English speaking patients."
- Services must be provided "to all LGBTQ youth regardless of ability to pay."
- 5. Provide Ongoing Training
The LGBTQ+ landscape in the 21st-century United States is not unchanging or static. The development of language and identity is fluid and will continue to evolve over time.
Ongoing and up-to-date training is crucial for the healthcare system and its providers to remain aware of best practices and clinical approaches for LGBTQ+ youth.
Nursing care for LGBTQ+ youth is central to the fulfillment of equitable care by all providers and organizations, and robust culturally competent training is paramount.
Helpful LGBTQ+ Resources for Nurses
• Focus on forms and policy: creating an inclusive environment for LGBT patients. (n.d.).
• Hadland, S, et al. (2017). Caring for LGBTQ youth in inclusive and affirmative envornoments.
• Krehely J.(2009). How to close the LGBT health disparities gap.
• Providing inclusive services and care for LGBT people. (n.d.).
Page last reviewed April 21, 2022
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