Week 8 discussion comment.

Make a comment using your own words in each discussion but please provide at least one reference for each comment.

Do a half page for discussion #1 and another half page for discussion #2 for a total of one page.

Provide the comment for each discussion separate.

Discussion #1

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Discuss any “take-away” thoughts from the articles.

After reading both of these articles, I certainly had many take-aways on caring for LGBTQ individuals. Unfortunately, healthcare is primarily taught from the perspective of cisgender heteronormative individuals. Heathcare education, as described in both of these articles,  is not always inclusive to those who define themselves outside of the cisgender heteronormative viewpoint, leaving many patients feel ashamed, neglected, and ostrasized. Providers who recognize the need for further education and expansion on how to appropriately care for these patients also recognize the gap in our healthcare education system on this topic. However, there seems to be very little information and education on providing healthcare for LGBTQ pateints. In the article by Paradiso and Lally the authors highlight the lack of available published evidence with regard to transgender care, recounting one nurse’s disappointment when she could hardly find research on caring of transgender paitents after meeting and speaking with transgender people (Paradiso & Lally, 2018).

This gap in education of our healthcare providers only creates a further disparity in care for LGBTQI patients who find it difficult to find adequate care when they feel misunderstood, unaccepted, and fearful of discrimination.  Healthcare providers must be sensitive and create a comfortably inclusive environment for their patients, and seek to understand their patients’ experiences to be able to provide the best care. Avoidance of pronouns, assumption of stereotypes, and employing basic communication strategies help patients to feel at ease with their provider.

• How do you plan to make a positive impact on the care of LGBT patients when you become a NP?

I plan to make a positive impact on the care of LGBTQI patients when I become an NP by meeting each patient with benevolent and judgement-free care. I seek to create a safe and comforting environment for all my patients in order to foster a healthy patient provider connection, which allows for open, honest, and trusting communication. This allows me to treat my patient in their entirety, and elicit the best patient outcomes.

• What attitudes/behaviors/communication/understanding is important for the NP to have?

It is important for the NP to remain in a state of neutrality, and free all interactions from judgement and assumptions. Asking open ended and generalized questions allows for the patient to openly discuss their experiences, preferences, and gender/sexual identity. The provider should be supportive of the patient’s sexual orientation and gender. 

• What specific screenings / interventions will you incorporate into practice when providing care to a LGBT patient?

Specific screenings / interventions that should be incorporated into practice when providing care to a LGBTQ patient include risk factor assessments and discussing mental health and wellbeing. One of the articles states, “The CDC reported that gay, lesbian, bisexual, and students are 30.5% more likely to feel sad or hopeless, 13.6% are more likely to be victims of sexual violence, 23% are more likely to attempt suicide, 15.4% are more likely to use marijuana, and twice as likely to experiment with hallucinogenic drugs as their heterosexual peers at the same age.” Discussing these risk factors early with the patient can allow the provider to get the patient appropriate care sooner (Landry, 2017). 

Additionally, transmission of sexually transmitted diseases should be discussed and screened in virtually all patients, however, should be further discussed with some LGBTQ patients as some diseases are more prevalent in the LGBTQ community due to STD transmission with various sexual practices. 

Discussion #2

Reading the articles this week about the care and management of LGBTQI patients was certainly eye opening. Having many friends who identify in this group has been helpful if not invaluable on how to address what many providers would consider an uncomfortable conversation, or an uncomfortable situation. As the article mentioned, there was very little mention, if at all for me, in nursing school of care and treatment of transgender patients. In fact, more recently this has become more common at my facility. One problem we have run into however, that is also mentioned in one of the articles, is that a female to male transgender who still carries the female reproductive organs will still need to be screened for cervical cancer like he would have done in the past. This has posed a problem, however, because our system does not allow you to order a PAP smear on a male patient. Similarly we have been unable to order PSA levels on a female patient. I believe that self-limiting systems such as the one we use, tends to then push the provider to want to put the patient back in the “box” of the gender they were born into, rather than the gender they truly are and identify as. Although I wasn’t shocked by the numbers, I was severely disheartened reading the drastic disparity between numbers of heterosexual students who committed suicide vs gay lesbian or bisexual numbers. Higher levels of depression, suicidal ideation, and substance abuse can also go hand-in-hand with the LGBTQI population. 

 

As an NP, I hope to show each and every patient the respect they deserve, and spend the time with them to build a trusting rapport. Patients who trust their provider are more willing to open up about their feelings and insecurities, which can help address the mental health concerns that often go undiagnosed and untreated. It is important to ask the patient how they would like to be addressed, what pronouns they identify with, and asking them about any concerns they may have regarding their health care. I also intend to remain open and honest about any questions or disparities I may have, so that the patient can help me understand their concerns. I am not afraid to ask for clarification if it is something I do not understand. Just as I expect my patients to ask questions when they don’t understand something I may have told them, I will do the same. I believe showing the patient that you are taking a serious interest in making sure you deliver the best care possible for the patient will help build a long-lasting trusting rapport between provider and patient. As the provider it is important to allow open communication, ensuring a non-judgmental approach is always taken. 

 

Because there is such a disparity in reported depression and mood changes in LGBTQI patients, it is important to make sure to always ask the patient about their mental health and their moods. Asking the patient if they feel safe at home and in their relationships will give a picture of how safe they may feel at home. It is also important to screen the patient, as it is with any patient, about alcohol and substance abuse. If the patient has any signs of depression or anxiety, providing them with resources and support groups will help give them support that they may not have found elsewhere. It is important when caring for a transgender patient who may still have sex organs from the gender they do not identify with, to ensure that any screenings and tests still be performed. This could mean performing a PAP on a trans male, or a hernia exam on a trans female. It is imperative that during these exams that the patient is made to feel comfortable and not as if they are out of the norm. If the patient is taking hormone replacements, it is also important to monitor their hormone levels. Any introduction of estrogen should be monitored in someone with a family history of blood clots and strokes, or migraines.