November is a month of remembrance. November 20th is an important day in the transgender community. It is a day to remember members of the community who have been murdered in hate crimes. As an ally of the trans community, I will be attending the local ceremony. As a member of the queer community and a healthcare professional, I feel it’s important that I be there. Being supportive to a community that must self-organize a day of remembrance as an act of solidarity and resistance in response to countless unsolved murders (and complete and utter cis-apathy) seems quite necessary to me. As I am in attendance, I plan on listening to what is said so I can learn how to better support the most vulnerable members of the queer community. I think that it is important that healthcare professionals start listening. We need to find out what it is like to navigate a system that has a limited understanding of how cis-privilege shapes the medical space. The barriers must be countless.
For those healthcare professionals who have yet to be reflexive on the impact of their heteronormative cis-exclusive practice, use today as an invitation to start listening. You can then join those of us who have already begun the process of informing our practice to be more inclusive. It promises to be a life-long and humbling learning experience.
To those who have lost and for those who continue to experience both micro and macro-aggressions on a daily basis: please know that there are healthcare professionals who are listening with the goal to hold space with you and advocate for trans-accessible healthcare.
I share the following links in the spirit of continuing the conversation:
My favorite gender justice center is South House.
We are delighted to welcome Jennifer Searle to our team of bloggers!
Jennifer is a queer-identified intersectional feminist from Halifax, Nova Scotia. She holds a BScN, as well as a BSc in Biology and Social Anthropology, both from Dalhousie University. In addition to beginning what will certainly be a rewarding career as an RN, Jennifer is also currently working as a Research Assistant at Dalhousie for Dr. Lisa Goldberg (who is also on our Blog Team). Their research uses queer and feminist phenomenological methodologies to study and explain (in an attempt to improve upon) gender & heteronomative practices in healthcare. Jennifer is excited to be included in such important work as a representative of the LGBTQ+ community, and to continue to educate herself on the most current healthcare practices and theories.
We are delighted to have Jennifer join us, and look forward to what I know will be valuable contributions to this blog!
Have you ever experienced or witnessed conditions that harm workers who are LGBTQ? Perhaps you have not even thought about this problem, but we know that it exists in far too many situations. In an effort to address this issue, the GLMA Nursing Section has launched the Workplace Climate Project to encourage changes designed to overcome workplace homophobia. The Scale consists of 10 items that cover the most fundamental ways that a workplace can become affirming and inclusive of LGBTQ workers.
There are 3 major ways that you can use the scale:
- As a teaching/presentation tool. Each of the items on the Workplace Climate scale are presented here in a slide show
- As a self-assessment tool. Here you can see all 10 items of the Scale, and download a PDF file of the Scale to use as a handout to be used to assess everyone’s knowledge of their workplace.
- To report your unit’s “Perfect 10.” When your workplace unit has achieved all 10 items on the Scale, use the electronic form here to register your achievement with GLMA Nursing! They will post your achievement on the GLMA Nursing website and announce your achievement!
In addition to the suggestions that the GLMA Nursing website proposes, we encourage you to use this resource and find your own creative ways to promote an affirming and inclusive workplace for all!
If you have not heard yet, the U.S. Department of Health and Human Services announced a ruling that is a huge advancement in the provision of health care to LGBT people. In the new final rules from the Centers for Medicare and Medicaid Services (CMS) and the National Coordinator of Health Information Technology (ONC), all electronic health systems (EHR) certified under Stage 3 of Meaningful Use are required to allow users to record, change, and access data on sexual orientation and gender identity!
If you are not familiar with Meaningful Use, here is a website that gives a quick overview of the objectives and different stages. In essence, Meaningful Use is using EHR technology to improve quality and safety, engage patients, and improve care coordination. Providers and hospitals need to meet certain criteria to attain Meaningful Use, qualifying them for payment incentives.
Although this latest ruling does NOT require providers and hospitals to collect sexual orientation and gender identity data, it does require EHR vendors to build these questions in their systems. Moreover, the ruling adopts replacing outdated and offensive terminology and replacing them with best practice questions.
It is a victory in the advancement of understanding LGBT health disparities!
The Fenway Institute published a press release on this announcement and is worth the read!
Having spent much of my clinical practice as a perinatal nurse, working in the US and Canada, and being a member of the LGBTQ community, it is not surprising that one of my great passions as an educator and researcher is in the area of queer birthing practices. In particular, my scholarship has largely explored phenomenological and feminist questions that address the taken-for-granted practices of nurses and primary care providers in their relationships with women, where gender and queer practices intersect in the context of birth.
Despite health care changes to diversity initiatives and cultural competency programs, that provide more inclusive definitions of culture beyond ethnicity and race, in addition to the relevance of cultural humility and safety approaches that have educated nurses on the limitations of their own knowledge and sense of privilege (Goldberg, 2014), there continues to be a lack of understanding in how to work equitably across difference in birthing contexts with queer women, where the standard(s) for treatment have been historically and institutionally grounded in a sociocultural privileging of heterosexuality (Goldberg, 2009). Insofar as birthing posits heterosexuality as taken-for-granted, the historical narrative of birth continues to reinstate discriminatory patterns of oppression. As such, relationships outside of the assigned birthing norms are often described as “other,” independent of best practice guidelines developed to support nurses and other primary care providers in their commitment to the provision of equitable care.
We use feminist phenomenology to frame the research we do and to address queer birthing questions in the context of health care, and specifically nursing practice. While this is not a methodology given primacy in healthcare research, it nevertheless provides a robust framework for addressing issues of power and privilege in relation to perinatal provider practices and their impact on affirming and/or diminishing lived space across difference. In particular, this methodology has been useful in our work, insofar as it provides a means for articulating the complexities of birthing within health care systems and structures pervasive with heteronormative practices that negatively influence and potentially harm queer women’s birthing trajectories. To read more about queer birth and/or feminist phenomenology, the following may provide insight into these important areas for nursing practice, research and education:
Article: Equitable Health by Lisa Goldberg
Feminist Phenomenology and Medicine
Queer Birthing Relationships web site
On Female Body Experience
We are delighted to have Lisa Goldberg to our team of bloggers for LavenderHealth.org! Lisa is an Associate Professor and Caritas Coach in the School of Nursing, Dalhousie University, Halifax, NS. Her educational and research scholarship builds on her clinical expertise as a perinatal nurse and uses innovative feminist and queer phenomenological methodologies to examine the taken-for-granted and relational practices of nurses, primary care providers, and women in contexts of birth (and beyond) against the institutional landscape of gender, power, and heteronormativity. More recently, having completed the Caritas Coach Education Program through the Watson Caring Science Institute (WCSI), her scholarship has integrated new strategies for more deeply understanding LGBTQ health in relation to its systemic invisibility within curricula and nursing education more broadly. To see more of Dr. Goldberg’s scholarship, visit the following link to her home page at Dalhousie University: (http://www.dal.ca/faculty/healthprofessions/nursing/faculty-staff/faculty/lisa-goldberg.html) or her most recent research with colleagues related to queer birthing practices in rural Nova Scotia: (http://lgbtqbirthing.weebly.com).
Welcome, Lisa! We look forward to hearing more from you in the weeks ahead!
It is no secret that LGBTQ topics are almost nonexistent in nursing school curricula. Although there is limited data to back up this claim, one recent study found that nursing students are exposed to approximately two hours of instruction related to LGBTQ health (Lim, Johnson, & Eliason, 2015). There are many reasons for the scarcity of LGBTQ content in curricula, such as no mandates from the accrediting bodies, lack of LGBTQ content in textbooks, and lack of knowledge and awareness among nursing faculty.
After co-authoring the above referenced article with Drs. Lim and Eliason, I was feeling pretty dismal about the lack of LGBT topics in nursing school curriculum. But something else happened… I started becoming more perceptive of the LGBT work that was happening around me. For example, a heterosexual cisgender colleague of mine who worked in a neighboring institution had developed a simulation scenario that allowed nursing students to practice caring for a transgender patient. That same colleague also approached her university’s provost to champion for the inclusion of LGBT topics throughout the nursing school’s undergraduate curriculum. Her request was successful and received a small grant to test the new content. Just after learning about the work of my colleague, I heard that a group of senior-level BSN students at my own institution was spearheading a project to increase LGBT knowledge among their student peers. They developed a 13-minute video titled, “LGBTQ Communication and Cultural Awareness for Nursing Students.” They got permission from an instructor to show the video to 35 junior-level nursing students. They administered a pre- and post-test to the students and found that the video was markedly effective at improving knowledge about LGBT health. I am now at a new institution and have already identified work being done by colleagues and students to improve LGBT health.
Over the past four years, I have taken undergraduate nursing students to work with the most vulnerable communities, such as the homeless, refugees from war torn countries, and veterans battling mental illness and addiction. I always told my students to look for the positives in the communities. Even though I have preached the “half glass full” attitude to my students, I tend to forget to do that in my own work. Moreover, like many other people in academia and health care, I spend so much time working in my “silo” that I forget to look at the great things people are doing around me. I am learning that if I take a walk outside the confines of my office and listen to what other people are doing, I am pleasantly surprised by the work others are doing to improve LGBT health. It reminds me that we are collectively heading down the right path!
A large study began this past June to gather data from thousands of LGBT individuals in the U.S. using an Apple app. The study originates from the University of California-San Francisco, the Population Research in Identity and Disparities for Equality, or PRIDE, Study is a two-part longitudinal study that could impact the way researchers and educators understand, treat and teach about LGBT health.
If you are interested in participating, please do! I just signed up and started the process! the study will last 6 to 9 months, and they estimate that the time commitment is about 15 minutes per week! You participate using the mobile app! The consent process is clear and easy to understand, and there is no shortage of detailed information about the study and the people who are conducting the research. One thing I like is that you can follow basic information about the study as you go – for example, how many people are participating. Today there are over 14,000 participants!
To learn more, go to http://www.pridestudy.org/. Check it out!