The LGBTQ Community and Healthcare

Lesbian, Gay, Bisexual, and Transgender (LGBT) Community and Healthcare

Lesbian, gays, and bisexual are terminologies used to describe sexual orientation. Transgender is a person whose gender identity is different from their birth sex (Bristol, 2018 p. 2). The term LGBTQ is an umbrella term that identifies the community as one. More than 10 million people in the United States identify as LGBT (Bristol, Kostelec, & Macdonald, 2018 p. 2). The LGBTQ community faces many inequalities and discrimination for their lifestyle. Discrimination of the LGBTQ population correlates with poor health outcomes. Healthy People 2020 have adopted goals to improve the health of the LGBTQ population, and the Joint Commission recommends hospitals to provide education to serve the LGBTQ community better (Bristol, Kostelec, & Macdonald, 2018 p.2). Besides, LGBTQ patients have reported many negative healthcare experiences from healthcare professionals, ranging from using wrong pronouns to the refusal of care due to their lifestyle (Elliott et al., 2014).

Importance of LGBTQ Healthcare Training

When healthcare providers such as medical doctors, nurses, midwives, and supporting healthcare staff lack the proper knowledge of the LGBTQ population, it affects the quality of care that such population receives. Paradiso & Lally (2018) evaluated nurse practitioners for their knowledge, beliefs, and attitudes towards transgender patients. The study showed that even highly educated professionals with many years of practice lacked the confidence and expertise to care for the LGBTQ population (Paradiso & Lally, 2018). However, there has been a definite trend of increase in knowledge and awareness after healthcare professionals undergo competency learning and training regarding LGBTQ patients. Donisi et al. (2018) conducted a study showing a high significance of awareness of inequality and participants acknowledging the need to include LGBTQ perspectives in medical education after the course was completed.

Barriers and Knowledge Gap in LGBTQ Healthcare

With the growing population of the LGBTQ community and poor health outcomes, healthcare providers need to be aware of the oppression that the LGBTQ community faces to give quality care. Research also shows that healthcare professionals lack knowledge and awareness of the LGBTQ population. Even so, with proper training, the gap in knowledge seems to reduce. Training of healthcare professionals regarding LGBTQ populations is also likely to increase the awareness of the LGBTQ community.

Challenges Faced by LGBTQ Population in Healthcare

The LGBTQ population faces many barriers in healthcare compared to their heterosexual counterparts. This group also meets discrimination from health care staff and has to seek care from healthcare providers who lack the knowledge regarding their healthcare needs. According to Weinberger et al. (2016), "hostile provision environments and lack of cultural competence have linked to suboptimal transgender care and elevated risk behaviors" (p. 46). The LGBTQ community is not being provided with optimal care and in return, is at increased risk of poor health outcomes. Carabez et al. (2015) bring to attention the significant health issues that the LGBT population face, which has been identified by the Institute of Medicine (IOM). The authors state, "LGBT youth are more likely to be homeless, are two to three times more likely to attempt suicide. Also, LGBT populations have high rates of tobacco, alcohol, and other drug uses; lesbians and bisexual woman are more likely to be overweight or obese, and gay men are at high threat of HIV and other STDs especially among communities of color" (Carabez et al. 2015 p.323). Due to the poor health outcomes of the LGBTQ community, Healthy People 2020 Goals have identified the need to improve the health and safety of the LGBTQ community. The goals recommend that healthcare providers be educated concerning the oppression and discrimination that the community faces (Bristol et al., 2018 p.2).

Lack of Knowledge and Training in LGBTQ Healthcare

There is also a knowledge gap that healthcare providers face when it comes to caring and interacting with the LGBTQ population. Healthcare providers lack the essential knowledge, skills, and confidence to care for the LGBTQ community. Parameshwaran, Cockbain, Hillyard, and Price (2017) conducted a study to assess medical students regarding their training when caring for a transgender patient. The study showed that 84.9% of participants "strongly disagreed" or "disagreed" that they had received LGBTQ specific health care training (Parameshwaran et al. 2017, p.371). Similarly, Carabez et al. (2015) found in their parallel study that 79% of the 268 nurses interviewed had no LGBT patient-centered care training (Carabez et al. 2015, p. 325). Healthcare providers are not being educated and trained to care for the LGBTQ community regardless of the increasing acceptance that society has shown.

Effectiveness of LGBTQ Healthcare Training

Educational training for healthcare workers regarding the LGBTQ community has also shown significant effectiveness. Studies have demonstrated positive outcomes when healthcare providers and workers attend cultural competency training regarding the LGBTQ community. Lelutiu-Weinberger et al. (2016) presented that after 6-hours of training, health care workers of all levels had a decrease in negative attitudes towards transgender individuals and increased in transgender-related clinical skills. Moreover, there were increases in staff awareness of transphobic practices, and increases in self-reported readiness to serve transgender individual (Lelutiu-Weinberger et al. 2016, p. 51). Similarly, Hardacker et al. (2014) found a significant improvement of knowledge in healthcare workers after Health Education about LGBT Elders (HEALE) training was provided (p. 260). Participants felt that the training was beneficial and that it enhanced attitude towards LGBT patients (Hardacker et al. 2014, p. 261).

The Need for Mandatory LGBTQ Healthcare Training

Whereas some people might argue that further education or training concerning giving care to the LGBTQ is unnecessary, this notion is not true. Carabez et al. (2015) pointed out that some nurses might say they are comfortable caring for LGBTQ patients. Therefore, they do not need further training because they "treat everyone the same" (p.323). Likewise, Hardacker et al. (2014) found that participants who chose not to attend HEALE training were identified by their peers as 'uncomfortable' and 'forced' to attend the training and felt they already 'treated all their patients the same' (p.261). However, the significant poor health outcomes are alarming enough to determine that the LGBTQ population is not being treated like everyone else. Lelutin-Weinberger et al. (2016) discussed a national survey (n=6450) that was conducted to examine the injustice transgender individuals face. The study presented that 19% of the transgender were denied care due to their gender identity, 50% had to teach their providers about transgender issues, and 28% postponed seeking care due to the anticipation of discrimination or financial difficulties (Lelutin-Weinberger et al. 2016, p.46).

Conclusion

Research regarding training and education of the LGBTQ community is relatively recent. Limited studies have been done on the effectiveness of healthcare workers being trained to care for LGBTQ patients. However, the limited number of projects that have been done have had a common theme; that is, healthcare providers do not have enough training and training works. Research has also investigated the readiness of healthcare providers of different levels and found that regardless of the level of education, there is a lack of confidence when caring for the LGBTQ community. Even the San Francisco Bay, which is an area densely inhabited by the LGBTQ community, found that a significant number of nurses had no LGBTQ training (Carabez et al., 2015).

Creating awareness of the discrimination that the LGBTQ community faces in healthcare is the first step to implement change for this group of the population. It is clear that the LGBTQ community is an underserved population, and that affects their health outcomes. Providence Regional Medical Center in Everett, Washington (PRMCE) prides on serving their community. The mission statement for this center clearly states that they stand by serving all, especially those who are poor and vulnerable, where the LGBTQ community is not an exception (Providence, 2018). Although PRMCE values are based on Catholic doctrines, which may not agree with the LGBTQ lifestyle, it is still a hospital that strives to serve all.

Currently, PRMCE does not have a policy for their healthcare workers to attend educational training regarding care for the LGBTQ community. However, mandatory training should be considered since research shows that even physicians lack proper training to care for this vulnerable population. As declared above, there is a gap in research on the effectiveness of training healthcare providers to serve the LGBTQ community better. However, when the HEALE curriculum was presented to healthcare workers of all levels of education, it showed a significant increase in knowledge. Participants even rated their own experiences with the curriculum, and over 95% of participants rated the curriculum as "excellent" or "good" (Hardacker et al., 2014 p.261).

The Joint Commission (TJC), an organization that surveys and accredits healthcare organizations, strongly supports the quality of care to patients regardless of their social or personal characteristics. The institution supports the right for all patients to be treated with dignity and respect in the healthcare setting (Steuer & Davis, 2017). TJC issued an LGBT Field Guide in 2011 to guide healthcare workers to ensure that the LGBTQ patients receive quality care. Although, the organizations such as TJC's push for hospitals to educate their staff to care for the LGBTQ community properly it is still not good enough. Therefore, there needs to be more research to support the push for mandatory training.

References

Bristol, S., Kostelec, T., & Macdonald, R. (2018). Improving Emergency Health Care Workers’ Knowledge, Competency, and Attitudes Toward Lesbian, Gay, Bisexual, and Transgender Patients Through Interdisciplinary Cultural Competency Training. Journal of Emergency Nursing. doi:10.1016/j.jen.2018.03.013

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: Official Journal of the American Association of Colleges of Nursing., 31(4), 323-329.

Donisi, V., Rosinska, M., Zakrzewska, K., Farinella, F., Pawlega, M., Rodzinka, M., . . . Amaddeo, F. (2018). Training health and mental health professionals to improve attitudes, knowledge, and skills in providing healthcare for LGBTI people. Journal of Psychosomatic Research, 109, 99-100. doi:10.1016/j.jpsychores.2018.03.048

Elliott, M., Kanouse, D., Burkhart, Q., Abel, G., Lyratzopoulos, G., Beckett, M., . . . Roland, M. (2014). Sexual minorities in England have poorer health and worse health care experiences: A national survey. Journal of General Internal Medicine: JGIM., 30(1), 9-16.

Hardacker, C. T., Rubinstein, B., Hotton, A., & Houlberg, M. (2013). Adding silver to the rainbow: The development of the nurse's health education about LGBT elders (HEALE) cultural competency curriculum. Journal of Nursing Management, 22(2), 257-266. doi:10.1111/jonm.12125

Lelutiu-Weinberger, C., Pollard-Thomas, P., Pagano, W., Levitt, N., Lopez, E., Golub, S., & Radix, A. (2016). Implementation and Evaluation of a Pilot Training to Improve Transgender Competency Among Medical Staff in an Urban Clinic. Transgender Health., 1(1), 45-53.

Paradiso, C., & Lally, R. M. (2018). Nurse Practitioner Knowledge, Attitudes, and Beliefs When Caring for Transgender People. Transgender Health, 3(1), 47-56. doi:10.1089/trgh.2017.0048

Parameshwaran, V., Cockbain, B., Hillyard, M., & Price, J. (2017). Is the Lack of Specific Lesbian, Gay, Bisexual, Transgender and Queer/Questioning (LGBTQ) Health Care Education in Medical Schools a Cause for Concern? Evidence From a Survey of Knowledge and Practice Among UK Medical Students. Journal of Homosexuality., 64(3), 367-381

Providence Regional Medical Center Everett. (2018). Retrieved from https://washington.providence.org/locations-directory/r/regional-medical-center

Steuer, K., & Davis, K. (2017, August 15). Respecting Gender Identity in Healthcare: Regulatory Requirements and Recommendations for Treating Transgender Patients. Retrieved from https://www.americanbar.org/groups/gpsolo/publications/gpsolo_ereport/2017/march_2017/respecting_gender_identity_healthcare_regulatory_requirements_recommendations_treating_transgender_patients/