Providing LGBTQIA+ Inclusive Care
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3/8/2021
Providing LGBTQIA+
Inclusive Care
Callie Harris MSN, RN, CMSRN
MSU College of Nursing
Instructor-Undergraduate, BSN
Student-Graduate, PhD
(Reed, 2020)
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Objectives
By the end of this presentation, the learner will be able to:
1. Provide safe and effective communication with using LGBTQIA+
inclusive terminology and approach
2. Identify LGBTQIA+ health and wellness disparities
3. Recognize unique health history and physical examination needs
and experiences of LGBTQIA+ patients
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LGBTQIA+ in Healthcare
• LGBT individuals make up at least 4.5% of the population
(Streed et al., 2019)
• 80% medical students don’t feel prepared to treat LGBT patients
(Streed et al., 2019)
• 65% LGBT physicians observed discriminatory comments of
LGBT patients by peers; 34% witnessed discriminatory care
(Bonvicini, 2017)
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Key Terms
• LGBTQIA+:
o Lesbian, Gay, Bisexual, Transgender, Queer/Questioning,
Intersex, Asexual/Agender, and others
o LGB, LGBT, LGBTQ, LGBTQ+, LGBTQIA2+…
o Sexual and Gender Minorities (in discussing disparities)
• Intersectionality: Holding multiple intersecting identities
which are outside of cultural norms
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Gender / Sexuality
Sex: Biological classification based on
chromosomes, sex organs, and hormonal makeup
Gender: Individual’s personal identity and/or
expression of masculinity or femininity
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Gender
Transgender: Gender identity does not match with
gender assigned at birth
Cisgender: Gender identity matches with gender
assigned at birth
Nonbinary/Gender Nonconforming: Gender
identity/expression does not align with gender
binary/gender assigned at birth
Intersex: Sexual organs do not align with the sexual
binary
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Sexuality
Lesbian/Gay: Women/men sexually and/or
romantically attracted to opposing gender binary
Bisexual/Pansexual: Attracted to two or more
genders/regardless of gender
Asexual/Demisexual: Does not experience sexual
attraction/sexual attraction only in the presence of an
emotional connection
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The Genderbread Personv3.3
Identity
Woman-ness
{ Man-ness
Attraction
Gender Expression
Feminine
{ Masculine
Expression
Sex
Female-ness
{ Male-ness
Sexually Attracted to Romantically Attracted to
(Women/ Females/ Femininity) (Women/ Females/ Femininity)
{ (Men/ Males/ Masculinity)
{ (Men/ Males/ Masculinity)
(Killermann, 2016)
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Communication
• Never assume gender or sexuality
o Includes non-LGBT patients
• Use LGBTQIA+ sensitive introductions
o Pronouns
o Titles
• Provide a safe environment
o Forms, literature
o Advocate
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Common Errors
o Gays, a gay
o Dead naming
o “Wants to be”
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LGBTQIA+ Disparities
(Leão, 2019)
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Mental Health
• LGBT-identifying youth are:
• 40-60% of LGBT-
o 24% more likely to report identifying patients suffer from
suicidal ideations chronic anxiety disorders
(Hafeez et al., 2017)
(Bostwick et al., 2010)
o 2-3x more likely to attempt • Internalized stigma
suicide
(Office of Disease Prevention and Health Promotion [ODPHP], 2020) increases with age
• 34% LGBT youth are bullied among older adults
(Yarns et al., 2016)
• 77% report depressive • Higher prevalence of
substance use disorders in
feelings; 41% received
LGBT adults with 2x increase
counseling
(Boswell et al., 2019) among LGB
(Yarns et al., 2016)
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Environmental Safety
• LGBT youth more vulnerable • In LGBT adults (45+), 60%
to human trafficking fear harassment in long-term
(Boswell et al., 2019)
care; 40% fear sexual
• LGBT account for 40% of orientation may negatively
homeless youth affect care
(Hafeez et al., 2017)
(Goldhammer et al., 2019)
• Homeless LGBT youth are less • Transgender and gender
nonconforming persons saw
likely to seek shelter
(Boswell et al., 2019)
37 violent deaths in the US in
• Familial acceptance of LGBT identity 2020
halves prevalence of suicide (Roberts, 2020)
attempts
(Ryan et al., 2010)
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Sexual Health
• Gonorrhea, Chlamydia, and HIV are 2x more prevalent in LGB
youth
(Hafeez et al., 2017)
• 23% of LGBT youth report being victims of sexual violence
(Hafeez et al., 2017)
• 84% of new HIV diagnoses are in Gay and Bisexual men
(Hafeez et al., 2017)
• Less likely to participate in routine preventative screenings
(Hafeez et al., 2017)
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Chronic Health Risk Factors
• Higher rates of overweight and obesity in LB females
(ODPHP, 2020)
• Higher rates of tobacco, alcohol, and drug use in LGBT
populations (ODPHP, 2020)
• LGB patients exhibit higher rates of hypertension, arthritis,
and heart disease
(Streed et al., 2019)
• Increased risk of breast, ovarian, endometrial, prostate,
testicular, anal, colon cancers
o Lower screening rates: Participation is significantly improved
when they are comfortable with and “out” to their providers
(Hafeez et al., 2017)
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Gender and Transition Care
(Chin, n.d.)
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Chest Binding
• Health Benefits: • Interventions:
o Decreases anxiety, depression, o Reduce intensity, duration or
suicidality frequency if experiencing
symptoms
• Negative health impacts: o Avoid using bandages, duct tape,
o Pain (74%) or plastic wrap.
o Rib fractures (2.8%) o Suggest layering sports bras,
o Numbness (15.7%) neoprene or athletic compression
o Lightheadedness or dizziness wear. Commercial binders?
(27%) o Practice good skin hygiene (keep
o Heartburn (11.1%) dry, address concerns quickly)
o Shortness of breath (46%)
o Skin infection (5.3%)
(Peitzmeier et al., 2017)
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Gender Sensitive Exams
• Breast, genitourinary, rectal examinations
• Discuss plan ahead of exam, including
purpose, chaperone policies
• Discuss safe terminology
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Transition Care
• Puberty Suppression
o GnRh agonists
o 8-14 y/o
o Impacts:
• Improved mental health
• No change in dysphoria
• Bone density
(Salas-Humara et al., 2019)
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Transition Care
• Hormone replacement therapy (HRT)
o Transgender men (AFAB)
o Intramuscular
o Testosterone
o Transgender women (AMAB)
o Oral, transdermal, intramuscular
o Estrogen with antiandrogen (Spironolactone)
(Wierckx et al., 2014)
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Transition Care
• Hormone replacement therapy (HRT)
o Long-term effects:
• Trans women:
o PE, VTE, CVA/TIA (oral > transdermal)
• Similar to oral contraceptives
• Worse with existing cardiac risk factors
o Improved mental health, decreased suicidality
• Trans men:
o Type 2 Diabetes
o Improved mental health, decreased suicidality
(Wierckx et al., 2013)
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Transition Care
• Gender affirmation surgery
o Decision to receive/not receive
• Personal Preference
• Cost/Coverage
– Living in state with transgender care protections
– Employer following Human Rights Campaign standards
• Informed consent vs. Letter of support
o Outcomes
• Aesthetic, functional, and sensory
• Smoking, binding, follow-up barriers
(Clary & Hannan, 2018)
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Sexual Practice Considerations
(Reed, 2020; Shvets, 2020)
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Sexual Practice Considerations
• Partner status
• Importance
• Role function
• Reproduction
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Let’s Talk About Sex and Gender
• How to discuss sexuality/gender
• When to discuss sexuality/gender
• When NOT to discuss sexuality/gender
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LGBTQIA+ Access
• Cost and Insurance
• Safety
• Rural environments
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How Can I Help?
• Advocate
• Attend trainings, CEU events
• Don’t make assumptions
• Non-normative assessment
• Inclusive language
• Practice, practice, practice
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THANK YOU
(Reed, 2020)
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References
• Bonvicini K. A. (2017). LGBT healthcare disparities: What progress have we made?. Patient Education and
Counseling, 100(12), 2357–2361. https://doi-org.proxy1.cl.msu.edu/10.1016/j.pec.2017.06.003
• Bostwick, W. B., Boyd, C. J., Hughes, T. L., & McCabe, S. E. (2010). Dimensions of sexual orientation and the
prevalence of mood and anxiety disorders in the United States. American Journal of Public Health, 100(3), 468-475.
https://doi.org/10.2105/AJPH.2008.152942
• Boswell, K., Temples, H. S., & Wright, M. E. (2019). LGBT youth, sex trafficking, and the nurse practitioner’s role. Journal
of Pediatric Health Care, 33(5), 555–560. https://doi-org.proxy1.cl.msu.edu/10.1016/j.pedhc.2019.02.005
• Chin, Louann (n.d.) Short black hair transgender girl with stick pride flag with flag being the focus of the image.
[Photograph]. Shutterstock. https://www.shutterstock.com/image-photo/short-black-hair-transgender-girl-stick-451005439
• Clary, S. & Hannan, C. (2018). Bottom surgery: What you need to know. Healthline.
https://www.healthline.com/health/transgender/bottom-surgery#insurance
• GLAAD (2012). Talking about LGBT people and equality: An ally’s guide to terminology. Movement Advancement Project.
https://www.glaad.org/publications/talkingabout/terminology
• Goldhammer, H., Krinsky, L., & Keuroghlian, A. S. (2019). Meeting the behavioral health needs of LGBT older
adults. Journal of the American Geriatrics Society, 67(8), 1565–1570. https://doi-org.proxy1.cl.msu.edu/10.1111/jgs.15974
• Grammarly (2020). 33 LGBTQ(IA+) terms you should know in 2020. Grammarly Blog.
https://www.grammarly.com/blog/lgbt-terms/
• Hafeez, H., Zeshan, M., Tahir, M. A., Jahan, N., & Naveed, S. (2017). Health care disparities among lesbian, gay,
bisexual, and transgender youth: A literature review. Cureus, 9(4), e1184. https://dx.doi.org/10.7759%2Fcureus.1184
• Johnson, C. (2018). Oslo Pride [Photograph]. Unsplash. https://unsplash.com/photos/G8CxFhKuPDU
• Killermann, S. (2016). The genderbread person. Http://genderbread.org
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References
• Leão, R. (2019). [Untitled Photograph]. Unsplash. https://unsplash.com/photos/0fw94cS9pMI
• McCutcheon, S. (2020). LGBTQIA rainbow love [Photograph]. Unsplash. https://unsplash.com/photos/sMnoDBdC1tE
• Office of Disease Prevention and Health Promotion (October, 2020). Lesbian, gay, bisexual, and transgender health.
Healthy People 2020. U.S. Department of Health and Human Services. https://www.healthypeople.gov/2020/topics-
objectives/topic/lesbian-gay-bisexual-and-transgender-health#two
• Peitzmeier, S., Gardner, I., Weinand, J., Corbet, A., & Acevedo, K. (2017). Health impact of chest binding among
transgender adults: a community-engaged, cross-sectional study. Culture, Health & Sexuality, 19(1), 64–75. https://doi-
org.proxy1.cl.msu.edu/10.1080/13691058.2016.1191675
• Reed, T. (2020). Bridge in Calgary Alberta [Photograph]. Unsplash. https://unsplash.com/photos/dB5dQh4UQqo
• Roberts, M. (2020). Marking the deadliest year on record, HRC releases report on violence against transgender and
gender non-conforming people. The Human Rights Campaign. https://www.hrc.org/press-releases/marking-the-
deadliest-year-on-record-hrc-releases-report-on-violence-against-transgender-and-gender-non-conforming-people
• Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health
of LGBT young adults. Journal of child and adolescent psychiatric nursing : official publication of the Association of Child
and Adolescent Psychiatric Nurses, Inc, 23(4), 205–213. https://doi-org.proxy1.cl.msu.edu/10.1111/j.1744-
6171.2010.00246.x
• Salas-Humara, C., Sequeira, G. M., Rossi, W., & Dhar, C. P. (2019). Gender affirming medical care of transgender
youth. Current Problems in Pediatric and Adolescent Health Care, 49(9), 100683.
https://doi.org/10.1016/j.cppeds.2019.100683
• Shvets, Anna (2020). Women sitting on floor and holding hands [Photograph]. Pexels.
https://www.pexels.com/photo/women-sitting-on-floor-and-holding-hands-4557549/
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References
• Streed, C.G., Siegel, J., & Davis, J.A. (March, 2019). Keeping our promise to LGBTQ+ patients. Association of
American Medical Colleges. https://www.aamc.org/news-insights/insights/keeping-our-promise-lgbtq-patients
• The Human Rights Campaign (n.d.). Glossary of terms. Tools for equality and inclusion.
https://www.hrc.org/resources/glossary-of-terms
• University of Michigan (n.d.) Gender confirmation surgery. Michigan Medicine. https://www.uofmhealth.org/conditions-
treatments/transgender-services/gender-confirmation-
surgery#:~:text=Male%2Dto%2Dfemale%20sex%20reassignment%20surgery&text=During%20this%20procedure%2C
%20a%20surgeon,used%20to%20make%20the%20labia
• Wierckx, K., Elaut, E., Declercq, E., Heylens, G., De Cuypere, G., Taes, Y., Kaufman, J.M., & T’Sjoen, G. (2013).
Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons:
a case-control study. European Journal of Endocrinology, 169(4), 471-478. https://doi.org/10.1530/EJE-13-0493
• Wierckx, K., Van Caenegem, E., Schreiner, T., Haraldsen, I., Fisher, A., Toye, K., Kaufman, J.M., & T'Sjoen, G. (2014).
Cross-sex hormone therapy in trans persons Is safe and effective at short-time follow-up: Results from the European
Network for the Investigation of Gender Incongruence. The Journal of Sexual Medicine, 11(8), 1999-2011.
https://doi.org/10.1111/jsm.12571
• Yarns, B. C., Abrams, J. M., Meeks, T. W., & Sewell, D. D. (2016). The mental health of older LGBT adults. Current
Psychiatry Reports, 18(6), 60. https://doi-org.proxy1.cl.msu.edu/10.1007/s11920-016-0697-y
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Questions?
(McCutcheon, 2020)
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