LGBTQ+ Visibility in Nursing (1) PDF

LGBTQ+ inclusivity and visibility in healthcare – the role of the RN Matt Townsend Lecturer in Healthcare Education. LGBTQ+ Lead – Learning and Teaching. E: [email protected] Aims and objectives : By the end of this session, students will be able to Recognise LGBTQ+ culture within an historica...

LGBTQ+ inclusivity and visibility in healthcare – the role of the RN Matt Townsend Lecturer in Healthcare Education. LGBTQ+ Lead – Learning and Teaching. E: [email protected] Aims and objectives : By the end of this session, students will be able to Recognise LGBTQ+ culture within an historical context and position it within modern-day socio-political contexts, demonstrating an awareness of key legislation pertaining to LGBTQ+ advancements and rights Be able to culturally locate LGBTQ+ communities and consider the implications of cultural competency and congruence in modern-day nursing practise Demonstrate an awareness of issues relating to LGBTQ+ inclusivity and visibility in healthcare, and the role of the RN in ensuring the delivery of gold standard person-centred care “ […] make sure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged” Standard Standard Standard 1 20 7 Kindness Honesty Respect Consider cultural Integrity sensitivities to Fairness Compassion better understand Without and respond to Recognise people’s personal discrimination diversity and health needs Be aware of the Avoid influence of your assumptions behaviour Action Plan aligns with – Universal Declaration of Human Rights International Covenant of Economic, Social and Cultural Rights UN Convention on the Elimination of All Forms of Discrimination Against Women UN Convention on the Rights of the Child UN Principles for Older Persons  Themes. Evidence. Action. A Human Rights and Recognition B Safety and freedom from discrimination C Nation of sanctuary for asylum seekers and refugees D Healthcare, Social Care and Welfare E Inclusive Education F Communities, Private and Family Life G Participation in Welsh Life: Culture and Sports H Inclusive workplaces I Impact of Covid-19 Click here for the Action Plan  We’re here! We’re Queer… LGBTQ+  63% of LGBTQ+ patients found the Rainbow flag (i.e. the Pride Flag) improved their healthcare experience Inclusive posters and health promotion materials portraying LGBTQ+ relationships as normative constructs promoted Trust and patients built stronger relationships Rainbow lanyards being work by staff demonstrated allyship, knowledge and understanding of LGBTQ+ issues (patient were more likely to feel that they could be open about their sexual and/or gender identity) Covid-19, Rainbows and patient adherence Disassociation of rainbow flag from LGBTQ+ allyship has witnessed an increase in LGBTQ+ reluctance to access healthcare Confusion for LGBTQ+ patients as to what the rainbows on display mean  Allyship or Covid-19 unity? Re-closeting of LGBTQ+ patients = increase in  1861 Death penalty removed. 1970 Replaced with Gay Liberation 1533 10 years hard 1951 Front founded Buggery labour + life First known 1988 Act imprisonment British Section 28 Acts of Sodomy transgender brought into moved from woman law ecclesiastical undergoes sex (enforceable court to the reassignment until 2003) State surgery 1828 1968 Buggery Act WHO lists repealed. homosexuality Replaced by as a Offences “Mental Against the 1921 Disorder” Person Act Attempt to 1981 make lesbian First UK case of acts illegal. Bill AIDS rejected by both Houses  2003 2013 Marriage 2021 Employment Queen Elizabeth II (same-sex Equality announces couples) Act Regulations Conversion Therapy 1992 Equal marriage come into force ban will be brought WHO removes rights 2010 before parliament homosexuality “soon” The Equality from its list of - Act mental No ban without the disorders trans (2022) 2011 2021 2003 Gay and Blood donation Section 28 Bisexual men law changed repealed can give blood for some men (England, “after 1 year who have sex Wales, NI) deferral 2020 with men 2004 period” Same-sex - Gender marriage Trans people Recognition Act becomes legal < 16 yrs can passed in NI consent to puberty blockers  What do you understand by the term “Culture”? To what extent is Culture inherited? “Culture is […] a complex whole, which includes knowledge, beliefs, arts, morals, laws, customs, and any other capabilities and habits acquired by man as a member of Society.” - Tylor, 1871 “[T]he learned and transmitted knowledge about a particular culture with its values, beliefs, rules of behaviour and lifestyle practices that guides a designated group in their thinking and actions in patterned ways” - Leininger, 1978. p. 491 Culture has 4 main characteristics: Learned from birth through the process of language acquisition and socialisation Shared by all members of the same cultural group Adaptation to specific activities related to environmental factors A dynamic, ever-changing process Andrews and Boyle (2012).  Cultural sensitivity | Cultural responsiveness An important element in achieving cultural sensitivity is in how RNs view those in their care Key components: Compassion, Trust, Acceptance, Respect (NMC link here?) Key factor – Learning to ask the right questions! Papadopoulos, 2018, p. 47 “Culturally competent and compassionate care is excellent care and this should be afforded to all people. As health professionals, we should always endeavour to do the right thing for the right reason” - Papadopoulos, 2018, p. 51. Cultural awareness - Think about your own cultural background  how does it impact your belief system? - Do you have prejudice / are you judgemental? Cultural knowledge - How do we gain cultural knowledge? - What health inequalities do LGBTQ+ people come up against? 2018 UK Government Office Survey – LGBTQ+ patients and service users have a more negative experience of healthcare compared to non- LGBTQ+ people 40% of transgender respondents experienced negative treatment when accessing healthcare 21% patients note their needs weren’t met 18% of transgender patients received “inappropriate curiosity” 46% of LGBTQ+ patients did not feel comfortable Examples of care from clinical practise What do you think about these episodes of care? Has there been a breach of care? How does this impact the patient? What could you have done as the RN? Getting my vaccinations and having routine blood tests before commencing a nursing position. The RN and I were talking for a while and through the course of our conversation, I happened to mention my husband. She then went quiet and stuttered and fell over her words before then saying… “Well, just to reassure you, if your HIV results do come back positive, then I don’t want you to worry. You can still work as a nurse because we aren’t allowed to discriminate against you for that now.” Josh is a transgender man being nursed on a surgical ward. On handover, the night nurse explained that Josh was transgender and needed a bedpan to void urine and not a bottle. Later that morning, Josh called me, desperate to use the toilet. The HCSW had given Josh a urine bottle when he told her that he needed to pee. Later, I spoke to the HCSW who said that she was sorry, stating that she “forgot that Josh wasn’t a proper man. All the other men in the bay use bottles and because he looked like a man I forgot he wasn’t actually one …” Key issues at play Equality vs Equity Microaggression Conversation with a ward sister about some research I am currently undertaking. Matt: Evidence shows that HCPs aren’t very good at providing inclusive care and that as a result LGBTQ+ patients often receive suboptimal levels of care Sister: Well, I’m sorry Matt but I take a little offence at that. I don’t care what my patients are or identify as. Whether they’re LGBTQ or straight or whatever, it doesn’t impact the level of care I provide. I treat everyone the same, regardless of who or what they think they are.  Conversation overheard in a staff room. [News feature on the TV about Pride] RN1: I don’t really get it. Why do they have to have a pride? You don’t see straight people parading around being drama queens and shoving it in your face. They’re just attention seeking […] and another thing, what is this whole gender non-binary rubbish? RN2: I know. Don’t get me started. You’re either male or female. You can’t just say that you don’t have a gender. You can’t not be, ‘coz then that means you don’t exist. If you’ve got a dick, you’re male. If you’ve got boobs, you’re a woman. They should all just stop. Enough of A transgender man, recently diagnosed with an aggressive breast cancer attended a clinic appointment. He let the receptionist know on his arrival that the appointment was made under his previous female name and could they let the RN know and to call him with his correct (male) name. Receptionist refused, stating that the appointment was made when “you were a woman”. Patient was called forward for his appointment in the waiting room with his previous incorrect name. When he returned home, the patient telephoned the clinic and asked for his records to be updated. Records weren’t updated. Next letter sent was with his birth name and reference to being female. The patient felt that he couldn’t attend his next appointment. Because of non-attendance, he was removed from the clinic’s list Let’s talk statistics: In Wales, 36% of health and social care staff report never having received any form of E&D training, with only 5% of patient-facing practitioners reports they’ve received LGBTQ+ training (Chandler, 2020) When asked, only 13% of RNs feel able to meet the needs of their LGBTQ+ patients (Stonewall, 2018) 44% of patient-facing staff have heard colleagues making negative remarks about LGBTQ+ patients/service users (Marie Curie, 2017)  57% of Health Care Professionals do not believe that someone’s sexual orientation / gender identity is relevant to a patient’s health needs (Marie Curie, 2017) despite research that LGBTQ+ disparities in healthcare leads to suboptimal care and detrimental outcome (Robinson, 2019) NHS-Wide survey (5000 respondents) – 25% of staff admitted to hearing homophobic language in the clinical environment, and 20% have heard transphobic rhetoric (Somerville, 2015) NHS Long Term Plan (NHS, 2019) commitment to tackle health inequalities for LGBTQ+ people Barriers to accessing healthcare – LGBTQ+ people experience higher levels of health disparity Higher rates of depression, anxiety, alcohol & drug misuse, self-harm and suicide (Gonzales & Henning- Smith, 2017; Hafeez et al., 2017) Less likely to access non-emergency health and social care  How friendly / welcoming are our hospitals? Ward environments Gendered Bays Side rooms Critical Care / Unscheduled Care environments Hospital admission paperwork? MICROAGGRESSIONS Gendered bathrooms and toilets Mother and baby changing facilities Parent Parking Gendered bays in hospitals – What about ITU / CCU / A&E? What defines gender? What if you identify as gender non-binary? Inappropriate questioning (particularly when caring for trans patients and service users) Misusing someone’s pronouns Careful with the term “preferred pronouns” Unconscious biases Making assumptions  NOK / chosen family / significant others Advanced directives, POAs Extremely important especially in EOL care! Dynamism of relationships Multiple NOKs? Polyamory Where do you stand legally as the RN? Do we need to do some additional preparatory work with our patient / service user? Think about a time where you may have a patient that will disagree and/or challenge an LGBTQ+ patient. How do we deal with this? Where does our duty of care lie? Are we able to challenge the aggrieved patient? What does our NMC Code of Conduct say? What are your Health Board’s values? Mary Louise Pratt (1991) – CONTACT ZONES “Social spaces where cultures meet, clash and grapple with each other [and] can be found in contexts of highly asymmetrical relationships of power […] where cultures fail to appropriately understand each other” Can be seen in nurse-patient relationships where the RN and patient fail to understand each other. How then, can we get overcome this rift? Let’s talk about death, baby!  Death avoidance RNs not that good at dealing with EOL care and death Leave it to palliative care team – they’re the professionals (?!)  End-of-life care as LGBTQ+ What matters when we are dying? Religion vs Spirituality Are we best placed to handle end-of-life conversation? Remember, queer people die too… Good quality of life = Good quality of death Relationships (making amends | resolving conflict) Meaningfulness of life Feelings of self-worth Bucket lists Leaving a legacy Death denial culture – are we too formulaic in “What really annoys me is that I’m going clinical practice? to kick the bucket before ticking items of it” Are RNs in acute wards appropriately skilled to deliver competent end-of-life care (regardless of “Honestly now, Matt, You’ll never know clinical speciality)? how refreshing is it that you’re talking to me about my death. It kind of makes it Research suggests that RNs are notoriously bad less of an issue, if you get me?” at dealing with the concept of dying (bio- medical model still very much influencing - Patient practice) “Thank you for helping us get ready to The RN as ‘death professional’ say goodbye” We are often the people our patients / service “Thank you for making me realise that users and, latterly, family friends and carers will death isn’t something frightening. I didn’t look to for support, advice, and reassurance want to be scared of my son” - Patient’s mother ‘Hiding who I am’ – Marie Curie 2016. Main findings – Anticipatory Discrimination Complexity of Religion and Spirituality Assumptions about identity and family structure Unsupported grief and bereavement support  Anticipatory Discrimination Older LGBTQ+ people have lived through times when identifying openly as lesbian, gay, bisexual or trans could mean, for example, being arrested, being defined as mentally ill and in need of treatment, or losing one’s job, family or children. How does this affect them when needing to access EOL care? Loss of control – handing the reins to someone else How can we reassure patients? Visibility  Complexity of Religion and Spirituality Evidence suggests that palliative and end-of-life care services may not always ensure LBGTQ+ patients and their families have the same spiritual needs addressed at the end of their life as any other patient. Gay men and transgender people in particular may be concerned that they will be treated with hostility  Assumptions about identity and family structure Health and social care professionals often assume that LGBTQ+ people using services are heterosexual. Trans people similarly report that they are often referred to by the pronouns of their birth gender, asked insensitive questions about being trans, or even ‘outed’ as trans in front of other patients and staff. QUESTION S?