Sexual minorities across the United States are at an increased rate of experiencing healthcare disparities than heterosexuals. Tabaac et al. (2020) established various forms of discrimination, including employment and family marginalization, that expose sexual minorities to poverty, increasing their risk of experiencing disparities in insurance coverage, health utilization, and unmet healthcare needs. Still, those who can afford the needed resources to access quality care, the sexual minorities comprising lesbian, gay, bisexual, and others, are victimized by discriminatory attitudes and treatment from some healthcare practitioners. In most cases, an LGBTQ patient is prone to maltreatment by a health practitioner because of preexisting prejudices about their sexual orientation. The Capstone project aims to quantify the existing healthcare disparities that are sexually oriented and crucial for generating evidence-based solutions that are policy and systematically informed to address the problem.
During my practicum, I intend to work with people who identify as gay within the healthcare context. The person may be a patient or colleague I share with a working space. For an expanded research experience, I aim to target LGBTQ as a group, not individuals, analyzing their various unmet health needs because of marginalization resulting from their sexual orientation. Various trends within the healthcare system suggest disparities targeting sexual minorities in the United States. A specific one is the Ryan White HIV/AIDS Program; this healthcare service only targets gay and bisexual men without considering the presence of women who identify as bisexual or gay (Tabaac et al., 2020). Also, the existing employment and insurance policies and practices like the Affordable Care Act fail to clarify the inclusion of sexual minorities in various insurance covers, pointing to healthcare access disparities (Tabaac et al., 2020). Thus, failing to identify the LGBTQ group within the healthcare context creates access barriers to healthcare for individuals who classify as gay or bisexual. As baccalaureate-prepared nurses, we aim to strive for an inclusive healthcare model and system, especially in a globalized world defined by diversity in all human care aspects. Thus, addressing sexual-orientation issues that cause healthcare disparities ensures efficient inclusion of the LGBTQ group in accessing quality and affordable care in the United States and universally.
Contextualizing the Sexual Minority Problem within the Nursing Care
Hughes et al.’s (2022) study identifies the CDC’s definition to describe health disparities as “preventable differences in the burden of disease, injury, violence, or access opportunity to quality care” (p. 514). The National Institute of Health (NIH) recognizes sexual and gender minorities as health disparities population. In that case, transgender people are at high risk of poorer health than cisgender people, with nursing being one of the healthcare units contributing to this problem. According to Hughes et al. (2022), health disparities grounded in prejudiced beliefs and attitudes expose the gay and bisexual population to psychological distress and suicide ideation. For instance, when patient identification forms only include male and female genders and refer to the remaining ones as others, a transgender patient is likely to feel marginalized and unwanted in the care facility. Given that nurses are the primary caregivers within the healthcare context, literature recognizes the severity of discrimination targeting sexual minorities. This issue should be addressed to improve the quality of care for the target group. The information is reliable because it is from a recent peer-reviewed article.
The literature further identifies barriers that make it challenging to implement evidence-based practices to address health disparities affecting sexual minorities. Legal and systematic obstacles like the recognition of gender, freedom of expression and movement, and other mainstream human rights make it challenging to eliminate health disparities targeting sexual minorities within a clinical setting (Zeeman et al., 2019). Also, the marginalization of sexual minorities is enhanced by the stereotypes formed by the mainstream culture and population, creating a barrier to addressing sexual minorities’ discrimination within the healthcare context. Evidence links wider social influences as a key barrier to addressing minority discrimination within healthcare systems (Zeeman et al., 2019). In that case, the solution should tackle societal causes and healthcare challenges. Besides, Reisner et al. (2021) research identifies nurses’ communication roles, including confidentiality, respect, medical knowledge, and proper communication skills, as key to reducing healthcare disparities among sexual minority groups. Nurses should use their knowledge and experience when interacting with transgender patients to propose policies that will improve their clinal outcomes when seeking treatment in any healthcare facility.
Critical to understanding and resolving transgender health disparities, the literature suggests a transcultural nursing model as a framework for improving LGBTQ care. The transcultural nursing framework emphasizes multicultural study and practices to understand similarities and differences between cultures (Medina-Martinez et al., 2021). The aim is to avail culturally congruent care that accommodates each person’s lifestyle, values, beliefs, and systems (Medina-Martinez et al., 2021). The transcultural nursing model helps nurse practitioners understand the beliefs and values of a transgender community to eliminate biased and discriminatory practices from the healthcare system.
State Board Nursing Practice Standards Impact on Transgender Care
Nursing professionals play an integral role in caring for patients who identify as LGBTQ with related gender variance. Rosa et al. (2019) study emphasize the presence of a nursing team in the healthcare context addressing the outpatient issues from first to concluding patient contact among hospital services. In that case, nursing standards, beliefs, and practices are central to improving inclusivity experiences for the population that identifies as transgender. Evidence points toward nursing practice standards promoting activities to improve health and prevent various diseases for the LGBTQ population (Rosa et al., 2019). Thus, nursing activities such as health promotion, education, and inclusivity campaigns demonstrate efficiency standards to eliminate sexual minorities’ discrimination within the clinical context.
Nurses play a central role in improving transgender health outcomes, preventing illness, address readmission. A professional consensus recognizes the essentiality of improving transgender care through education, research, and practice (Hughes et al., 2022). Hence, nursing practitioners come together to create a national action plan that unifies the nursing role, agenda, and purpose to improvise healthcare policies targeting the LGBTQ population within a clinical context (Hughes et al., 2022). Regarding policymaking, nurses are well-positioned to influence clinical standards, laws, and practices that will eliminate healthcare disparities targeting sexual minorities. The nurses can influence the nursing curriculum through research and policy implementation to develop a course that recognizes sexual minorities and the challenges they face strategically to improve the population’s access to quality care.
Similarly, nurses can communicate their experiences with policymakers regarding sexual minorities’ health disparity issues. Their first-hand information may influence the health committee’s decision to implement inclusive policies to strengthen healthcare equity and equality. Nurses are well positioned to influence policy reforms from local, state, and federal legislation regarding improving the care of sexual minorities within a clinical context. The local, state, and federal policies on sexual minorities’ healthcare access and utilization influences nurse decision and behavior in treating patients that identify with this group. As a result, as nurse practitioners, we are responsible for ensuring that this policy does not promote marginalization based on sexual orientation or any other form of discrimination targeting an individual or group.
Leadership intervention to eliminate healthcare disparities targeting minorities should be rooted in the organizational policies and standards that promote equity and equality. Designing inclusive and non-discriminatory policies for the organization helps nurture a healthcare culture supporting sexual minorities’ needs (Valentine et al., 2021). Hence, nurses and other healthcare leaders should emphasize inclusivity beliefs and practices among caregivers to eliminate any attitude or behavior among health workers that could expose a member of a minority sexual group to discrimination. Also, healthcare management should ensure that all the standard clinical procedures recognize the sexual minority identity as a group and not generally categorize them. For instance, Healthcare institutions should use intake documents that inquire about a patient’s sexual orientation and not generally categorize people as male or female (Valentine et al., 2021). Such practices create an inclusivity environment that eliminates any care practice that could promote sexual minority discrimination. When these leadership interventions are implemented, health practitioners will concentrate on patient-centered care rather than being misguided by stereotypes about sexual orientation.
Addressing health disparities targeting sexual minorities should begin with training institutions. The healthcare leadership should collaborate with medical and nursing training institutions to readjust the curriculum that promotes diversity and inclusivity beliefs and attitudes among healthcare trainees. Also, the leadership should invest in workshops and conferences that instill these values in the current healthcare employee body. Transgender identity may be new to many healthcare workers necessitating the need to educate them about the cultural beliefs, values, and practices that make them an active social unit. Learning their identity will minimize and eliminate the prejudices that promote sexual minorities discrimination within the healthcare context. Improving communication, where practitioners emphasize respecting nurse-patient privacy and confidentiality, will enhance the needed trust between the people who identify as transgender and healthcare providers. Also, integrating a multidisciplinary approach to the group’s patient care helps address their various needs, including psychosocial challenges experienced within the healthcare context. As a result, multidisciplinary collaboration is ideal for improving sexual minorities’ access to quality care.
To summarize, the lesbian, gay, bisexual, and transgender groups are prone to experiencing health disparities because of their sexual orientation. The cultural values that make them a community contradict some mainstream sexual norms, beliefs, and practices. Nurse practitioners should be guided by a transcultural framework that allows us to identify similarities and differences between cultures to eliminate minority discrimination. Non-discriminatory policies and practices within the healthcare system help eliminate health disparities targeting the group. Significantly, the leadership should be at the forefront of promoting sexual minority inclusivity needs within the healthcare context.
Hughes, T, L., Jackman, K., Dorsen, C., Arslanian-Engoren, C., Ghazal, L., Christenberry, T., Coleman, C., Mackin, M., Moore, S, E., Mukerjee, R., Sherman, A., Smith, S., & Walker, R. (2022). How can the nursing profession help reduce sexual and gender minority related health disparities: Recommendations from the national nursing LGBTQ health summit. Nursing Outlook, 70(3), 513-524, https://doi.org/10.1016/j.outlook.2022.02.005
Medina-Martinez, J., Saus-Ortega, C., Sanchez-Lorente, M, M., Garcia-Martinez, P., & Marmol-Lopez, M, I. (2021). Health inequalities in LGBT people and nursing interventions to reduce them: Systematic review. International Journal of Environmental Research and Public Health, 18(22), https://doi.org/10.3390/ijerph182211801
Rosa, D, F., Carvalho, M, V, F., & Pereira, N, R. (2019). Nursing care for the transgender population: Genders from the perspective of professional practice. Revista Brasileira de Enfermagem, 72, 299-306, https://doi.org/10.1590/0034-7167-2017-0644
Tabaac, A, R., Solazzo, A, L., Gordon, A, R., Austin, B, S., Guss, C., & Charlton, B, M. (2020). Sexual orientation-related disparities in healthcare access in three cohorts of U.S. adults. Preventive Medicine, 132, https://doi.org/10.1016/j.ypmed.2020.105999
Valentine, S, E., Shipherd, C, J., Smith, A, M., & Kauth, M, R. (2021). Improving affirming care for sexual and gender minority veterans. Psychological Services, 18(2), 205-215, https://doi.org/10.1037/ser0000378
Zeeman, L., Sherriff, N., Browne, K., McGlynn, N., Mirandola, M., Gios, L., Davis, R., Sanchez-Lambert, J., Aujean, S., Pinto, N., & Amaddeo, F. (2019). A review of lesbian, gay, bisexual, trans, and intersex (LGBTTI) health and healthcare inequalities. European Journal of Public Health, 29(5), 974-980, https://doi.org/10.1093/eurpub/cky226