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LGBT Health Disparities Persist, But Nurses Can Help

 |  By Alexandra Wilson Pecci  
   February 25, 2014

Healthcare providers are unable to optimally address a patient's health needs without knowing a person's sexual orientation. But assumptions of heterosexuality are the norm. Nurse leaders can work toward reducing heterosexism in healthcare.


Patti R. Zuzelo
EdD, RN, ACNS-BC, ANP-BC, CRNP, FAAN

On the surface, the healthcare needs of gay and lesbian people might not seem different than anyone else's. But institutionalized heterosexism in healthcare is a real barrier to quality care for the LGBT (lesbian, gay, bisexual, transgender) community, and nurse leaders are poised to help remove those barriers for patients.

"There are lots and lots of practice influences that do affect the health of people who are identified as LGBT," says Patti R. Zuzelo, EdD, RN, ACNS-BC, ANP-BC, CRNP, FAAN, a Clinical Professor of Nursing at the College of Nursing and Health Professions at Drexel University and past president of the National Association of Clinical Nurse Specialists. She will speak about this topic, including how clinical nurse specialists can improve healthcare and access for the LGBT community, at NACNS's annual conference next month in Orlando, FL.

Zuzelo says that healthcare often starts with "an assumption of heterosexuality that can be very uncomfortable for the patient." For instance, health assessments or registration forms often include questions such as whether the patient is male or female, married, or unmarried.

Nurses might thoughtlessly make presumptions about sexual orientation and say things such as "Is your wife with you?" to adult male patients. In states without marriage equality laws or where someone's employment is in danger due to their sexual orientation, being forthcoming about answering these questions can be awkward or difficult.

Without knowing a patient's sexual orientation, healthcare providers are unable to optimally address their unique health needs. According to HealthyPeople.gov, people in the LGBT community have high rates of psychiatric disorders, substance abuse, obesity, and tobacco use, to name a few.

Other barriers include end-of-life issues, healthcare decision making-rights, and lack of joint healthcare benefits. And transgender people can have unique and complex healthcare needs depend on where they are in the transition process.

Zuzelo says it's valid for people in the LGBT community to worry about being honest about their sexuality.

Sensitivity Needed
"You can lose your job. There are good reasons for people to be concerned," she says. "It's outrageous that people cannot go into their healthcare system… and be able to discuss and share [information about] their sexual orientation and not have to worry about that. It's healthcare."

Zuzelo says everything from nursing textbooks to assessment tools to the language that nurses use when talking to patients and their families are hetero-focused. But it's not necessarily because the care provider is prejudiced against LGBT people; instead, nurses and others are often simply unaware of such issues and disparities.

"I have to believe that this is because leaders in healthcare are not even aware that this [issue] exists," Zuzelo says.

Nurse leaders are in a position to work toward reducing heterosexism in their own practices, among their peers and staff, and within their healthcare institutions. One place to start: by simply suggesting changes to assessments or patient paperwork, such as adding options beyond "male" and "female" to the gender question.

The healthcare industry is lagging what's happening in the general culture. Just this month Facebook started offering US users some 50 additional gender options, such as "transgender," "cisgender," "gender fluid," "intersex" and "neither."

But nurses don't have to start from scratch.

Resources Available


"There's an arsenal of tools that can really influence the processes in place in your healthcare setting," Zuzelo says. She points to resources from Healthy People 2020, which includes LGBT health in its topics and objectives. There's also the Healthcare Equality Index which provides what Zuzelo says is "an opportunity for healthcare institutions to look to improve the way that they provide equitable and inclusive care." The HEI also acknowledges institutions that are Equality Leaders.

"I would think that this would be a mark of excellence that would be a good thing to have," Zuzelo says.

Other resources exist from the ANA and The Joint Commission.

Zuzelo says year after year, nursing is named the most-trusted profession by the public, so it's a nurse's responsibility to help every one of his or her patients feel like it is safe for them to be honest and forthcoming about their sexuality.

"As long as people feel threatened or uncomfortable with revealing or sharing… it stays covert," Zuzelo says. "It requires us, then, of being accepting of all the people we provide care [for]."

Alexandra Wilson Pecci is an editor for HealthLeaders.

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