The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community is estimated to represent 3.5% of the adult popu- lation in the United States, roughly 9 million people.1 A substantial proportion of that number are people who identify as female.

QUAL WOM

The580

LGBTQ E

ITY EN Me

Journa

ducation: Earn Your “A”

The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community is estimated to represent 3.5% of the adult popu- lation in the United States, roughly 9 million people.1 A substantial proportion of that number are people who identify as female. This group suffers significant health disparities linked to a long-standing history of discrimination, stigmatization, and the denial of many civil rights.2 LGBTQ populations experience high rates of substance abuse, suicide, mental health

CARE FOR ’S HEALTH gan Spiekermeier,

DNP, WHNP

disorders, homelessness, obesity, sexually transmitted infections (STIs), and violence.1-4

LGBTQ persons are less likely to seek preven- tive services due to lack of insurance coverage or fear of stigmatization and discrimination.1

Women already face significant health disparities based on sexism; intersecting forms of discrim- ination (homophobia, transphobia, stigmatiza- tion, or even ambivalence) can compound the negative effects on women’s physical and mental health and overall well-being.5 Results from the Lambda Legal Health Care Fairness Survey revealed that respondents who identified as female within the LGBTQ population surveyed were more likely than their nonfemale coun- terparts to experience barriers to health care services, discrimination, and incompetent care.5

In the survey, female respondents were most affected by the denial of infertility services and taxation of same-sex partner benefits.5 There were greater percentages of female respondents

l for Nurse Practitioners – JNP

that reported being treated differently than other people at health care appointments and who felt that health care providers were unaware of LGBTQ-specific needs.5 Many female respondents cited barriers to care including: insufficient numbers of health care professionals trained to care for LGBTQ people; the possibility of being refused care based on gender identity or sexual orientation; and the fear of mistreatment.5 These barriers can lead to reluctance to seek care, and thus, poorer health outcomes for LGBTQ individuals and families.

Healthy People 2020 established a goal to “improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender individu- als.”2(p1) Although increased societal acceptance and legal nondiscrimination policies have improved access to health care and insurance for the LGBTQ community, policies do not guar- antee provider competence or freedom from discrimination.1 Despite recommendations from several expert panels for LGBTQ cultural competency training for health care profes- sionals, traditional medical and nursing education curricula provide limited to no content on LGBTQ issues.3 As a result, there is a shortage of clinicians who are knowledgeable and culturally competent in LGBTQ health.

Nurses comprise the largest portion of direct patient care providers and are often the first health care provider a patient encounters. Yet, nurses report that they do not feel comfortable or prepared to care for LGBTQ patients and desire additional education.4 As leaders in the nursing profession, advanced practice registered nurses could address the needs of the LGBTQ community. Proper training and education on gender and sexual minorities could foster trusting patient- provider relationships, increase identification of gender and sexual minority patients, and in- crease provider competency in assessment and diagnosis of health care problems impacting LGBTQ persons. By decreasing barriers to

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care, more LGBTQ persons may seek pre- ventive health services, have more confidence in the health care system, and live healthier and longer lives. Addressing gaps in education may benefit the LGBTQ population and the com- munity at large in the form of increased quality and quantity of life, reduction in disease transmission and progression, and decreased health care costs.2 For these reasons, it is imperative that the nursing profession take action within education institutions, health policy, and within communities to insure inclusive and culturally competent care for the LGBTQ population. The National LGBT Education Center of the Fenway Institute offers many online training, education, and resources for healthcare institutions to integrate into their programs.6 To aid in the integration of LGBTQ education into nursing curricula, national nursing standards and competencies should reflect stronger language or mandates for the inclusion of LGBTQ cultural competency training. Together these recommendations will likely improve nursing competencies in LGBTQ care and create a competent nursing workforce across all health care settings.

In conclusion, nursing has long been the most trusted profession that places the utmost importance on the role of patient advocate, yet, we have failed in our ethical responsibility to address the needs of our LGBTQ patients and families. As criteria for defining sexual orientation, gender identity and expression continue to evolve, letters are

ww.npjournal.org

being added to the acronym. The letter “A” has begun to appear to stand for “ally” to acknowledge those that stand ready to support the LGBTQ community. By advo- cating for strong LGBTQ content in health profession curricula, advanced practice regis- tered nurses could enable more clinicians to be prepared to apply evidence-based best practice for this vulnerable population and earn their “A.”

References

1. Kates J, Ranji U, Beamesderfer A, et al. Health and access to care and coverage for lesbian, gay, bisexual, and transgender individuals in the U.S. The Henry J. Kaiser Family Foundation. November 11, 2016. http://kff.org/disparitiespolicy/issue-brief/health-and-access-to-care -and-coverage-for-lesbian-gay-bisexual-and-transgender-individuals -in-the-u-s/. Accessed May 23, 2017.

2. Healthy People 2020. Lesbian, gay, bisexual, and transgender health. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian -gay-bisexual-and-transgender-health/. Accessed May 23, 2017.

3. Lim FA, Brown DV, Kim SM. Addressing health care disparities in the lesbian, gay, bisexual, and transgender population: a review of best practices. Am J Nurs. 2014;114(6):24-34.

4. Carabez R, Pellegrini M, Mankovitz A, et al. “Never in all my years.”: nurses’ education about LGBT health. J Prof Nurs. 2015;31(4): 323-329.

5. Lambda Legal. When health care isn’t caring: LGBT women. 2010. http://www.lambdalegal.org/sites/default/files/publications/ downloads/whcic-insert_lgbt-women.pdf/. Accessed May 23, 2017.

6. National LGBT Education Center: Fenway Institute. What we offer. https://www.lgbthealtheducation.org/about-us/lgbt-health-education/. Accessed May 23, 2017.

Megan Spiekermeier, DNP, WHNP, is a recent graduate of the ASU Women’s Health NP program. She can be reached at m.spiek14@gmail.com. Department Editor Denise G. Link, PhD, WHNP, FAAN, FAANP, who would like to hear your ideas for future columns, can be reached at deniseg.link@gmail.com.

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