TABLE 78-1 Definitions and Terminology
|Sexual orientation||This term is used to describe to whom a person is or is not attracted. Examples of sexual orientation include lesbian, gay, bisexual, pansexual, etc.|
|Gender identity||This term is used to describe which gender(s) a person may identify with, such as man, woman, genderqueer, etc.|
|Lesbian||A woman who is primarily attracted to other women and identifies as a lesbian.|
|Gay||An adjective used to describe an individual who is primarily attracted to people of the same sex and identifies as gay.|
|Bisexual||An individual who is attracted to both men and women and identifies as bisexual.|
|Pansexual||An individual whose romantic and sexual attraction are not dependent primarily on the sex of their partners and identifies as pansexual.|
|Transgender or trans||Individuals whose gender identification and/or expression differs from the sex assigned at birth. Trans men were assigned female at birth; trans women were assigned male at birth. Some have surgeries or use hormones to alter their bodies and some do not. Identifying as trans does not necessarily mean that an individual identifies with being a man or a woman; a transgender individual may identify with neither gender, both genders, or all genders. Note that the term transsexual may be seen as derogatory.|
|Queer||Some people do not identify their sexual orientation with terms like lesbian, gay, or bisexual, but consider themselves to be outside of the mainstream heterosexual identity. Many people use the term “genderqueer” to indicate that they do not fit gender norms. Queer is a derogatory term that has often been used as a slur against the LGBTQ+ community and has been reclaimed.|
|Non-binary or gender non-conforming||An individual who does not necessarily identify with being either male or female or may identify with being both male and female, or who does not feel that they conform to gender norms.|
|Agender||An individual who does not identify with any gender and may identify with being genderless.|
|Questioning||Some individuals are not sure what sexual or gender identification best fits them and are in the process of exploring identities. This can happen at any age.|
|Intersex||A small subset of the population is born with genetic, endocrine, and/or anatomical differences that place their bodies somewhere on the spectrum between male and female. Because of the stigma often associated with a body that does not conform to societal norms, many people with intersex conditions have similar experiences of hiding their condition or experiencing shame and guilt about it as do LGBT people. Some people with an intersex condition identify as LGBTQ.|
|Allies||Many people who do not identify as LGBTQ are strong and active supporters of the struggle for LGBTQ equality.|
|LGBT, LGBTQ, LGBTQ+, LGBTQI, LGBTQIA, and so on||Organizations vary in how inclusive they are regarding the varieties of sexual and gender identifications. The most common acronym is LGBT, but if the organization serves many people with other identities, they may choose to include them all in their written materials. Every agency must make decisions about whom to include (and whom to exclude) when they issue policies or statements about cultural sensitivity. They may choose to use terms from specific populations they serve, such as Two Spirit (used by many indigenous people in the Americas) or Same Gender Loving (used by many African Americans).|
|Behavioral terms||Men who have Sex with Men (MSM) and Women who have Sex with Women (WSW) are terms often used by public health professionals to encompass individuals who have sex with others of the same sex but who may not identify as lesbian, gay, or bisexual.|
|Pronouns||The pronouns that an individual identifies with. Examples include she/her/hers, he/him/his, they/them/theirs, ze/hir/hirs*, ze/zir/zirs*
*These are gender-neutral pronouns that someone may use if that individual does not identify with male or female pronouns.
|Please note that there are many other terms beyond the ones in this table; please make sure to check that they are appropriate and not derogatory before using them. Many terms may be reclaimed by the LGBTQ+ community and used by members of the community that may be offensive when used by people who do not identify as LGBTQ+.|
TABLE 78-2 LGBTQ+ Supportive Nursing Organizations)
|Nursing organization||Supportive statements and actions|
|American Nurses Association (ANA)||ANA Center for Ethics and Human Rights.|
|American Nurses Association. (2017, July 28). Statement in support of equality and human rights for the LGBTQ community.|
|American Nurses Association. (2015a). Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD:|
|American Nurses Association. (2010). ANA applauds House action to repeal ‘Don’t Ask, Don’t Tell.’ [Press release].|
|American Nurses Association. (1992a). Compendium of HIV/AIDS Position Statements, Policies, and Documents. Washington, DC: ANA.|
|American Nurses Association. (1992b). Discrimination Against Gays and Lesbians by Military. Washington, DC: ANA.|
|American Nurses Association. (1988). Personal Heroism, Professional Activism: Nursing and the Battle Against AIDS. Kansas
City, MO: ANA.
|American Nurses Association Convention ’80. (1980). American Journal of Nursing, 80(7), 1317-1332.|
|American Nurses Association Convention ’78. (1978). American Journal of Nursing, 78(7), 1231-1246.|
|American Academy of Nursing (AAN)||American Academy of Nursing (n.d.). Expert Panel on LGBTQ Health. Retrieved from http://www.aannet.org/expertpanels/ep-lgbtq-health|
|Expert Panel on LGBTQ Health. (2015a). American Academy of Nursing. Position statement: Employment discrimination based
on sexual orientation and gender identity. Nursing Outlook, 63(3), 366.
|Expert Panel on LGBTQ Health. (2015b). American Academy of Nursing position statement on reparative therapy. Nursing
Outlook, 63(3), 368. doi: https://doi.org/10.1016/j.outlook.2015.03.003
|Expert Panel on LGBTQ Health. (2015c). American Academy of Nursing. Same-sex partnership rights: Health care decision
making and hospital visitation. Nursing Outlook, 63(1), 95. doi: https://doi.org/10.1016/j.outlook.2014.12.016
|International Society for Psychiatric-Mental Health Nurses||International Society of Psychiatric-Mental Health Nurses. (2010). Position Statement on Reparative Therapy. Retrieved from|
|National Association of School Nurses||National Association of School Nurses (2017). LGBTQ students: The role of the school nurse. https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-lgbtq|
|National Student Nurse Association||National Student Nurses Association. (2016). Improving Professional Support and Advocacy for Lesbian, Gay, Bisexual,
Transgender, Questioning, Intersex, and Asexual (LGBTQIA) Nurses. Retrieved from
|American College of Nurse Midwives||American College of Nurse Midwives. (2012). Transgender/transsexual/gender variant health care. Retrieved from www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000278/Transgender%20Gender%20Variant%20Position%20Statement%20December%202012.pdf|
TABLE 78-3 Guidelines for LGBTQ+ Education)]
|LGBTQ+ inclusive Factors||Why||How|
|Inclusive language in syllabi, lectures, exams||Non-inclusive language contributes to enforced closeting and stigma||● Eliminate pronouns or use plural forms.
● Use “they/them” as both singular and plural.
● Avoid binary language
○ “people instead of “men” or “women”
○ “trans*” instead of “trans man/woman”
● Beware of language that assumes legal or casual heterosexual relationships – wife, husband, girl/boy friend. Use significant other, partner, spouse instead
|Create welcoming climates||There are likely to be a wide diversity of gender and sexual identities in the classroom; you cannot assume they are all “not gay”||● Display rainbow symbols throughout in offices, classrooms, hallways.
● Use posters that reflect diversity in family structures, relationships.
● Create and maintain space for LGBTQ+ students and faculty to be open about their identities.
|Clear and accessible anti-discrimination policies and actions||Prevailing cultures sustain tolerance of discrimination toward LGBTQ+ people||● Emphasize no-tolerance policies for LGBTQ+ discrimination in writing and frequent verbal affirmation.
● Follow through on even the slightest discriminatory words or actions.
● Include anti-discrimination language in course syllabi, and in discussions of all elements of each course.
● Address ethical issues related to inclusion and acceptance of diversity to promote wellness for all.
● Provide frequent forums for discussion of inclusive practices.
|Integrated LGBTQ+ issues in each and every element of the curriculum.||LGBTQ+ people and families are found in each and every population, and as part of every other “minority” group.||● Mention LGBTQ+ people in each and every lecture, class or clinical experience.
● Include case studies featuring LGBTQ+ people and families – at least 3 in every course – to emphasize the particular challenges of gender and sexual diversity in the contexts of common health challenges.
● Revise tools used to teach interviewing skills to assure that students learn appropriate language for gender and sexual identities and histories.
TABLE 78-4 Continuing Education Resources for LGBTQ+ Competent Care
|Provider education||AAMC: Videos and resources on diversity and inclusion https://www.aamc.org/initiatives/diversity/431388/videos.html|
|JCAHO Field Guide https://www.jointcommission.org/lgbt/|
|National LGBT Health Education Center, Fenway Institute https://www.lgbthealtheducation.org/|
|Re-examining LGBT Healthcare, National LGBT Cancer Network www.LGBTcultcomp.org|
|Lavender Health (2012) Educational materials for nurse educators including a syllabus, media references, and learning activities https://lavenderhealth.org/|
|National Coalition for LGBT Health, General health information, fact sheets, and they hold an annual meeting focused on LGBT health, https://healthlgbt.org/|
|Substance Abuse and Mental Health Services Administration (2012), Top health issues for LGBT populations information and resource kit. https://store.samhsa.gov/shin/content/SMA12-4684/SMA12-4684.pdf|
|Transgender care||World Professional Association for Transgender Health (WPATH) www.wpath.org|
|UCSF Center of Excellence for Transgender Health www.transhealth.ucsf.edu|
|Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society. Clinical Practice Guideline 2017|
|LGBT advocacy||GLMA: Health Professionals Advancing LGBTQ Equality www.glma.org|
|National Gay and Lesbian Task Force www.thetaskforce.org|
|National Resource Center on LGBT Aging www.lgbtagingcenter.org|
|Services and advocacy for LGBT elders www.sageusa.org/|
|Human Rights Campaign www.hrc.org|
Table 78-5 – LGBTQ+ Welcoming and Inclusive Services Checklist
|Yes||No||Institution or Agency Policies and Procedures|
|□||□||We have a nondiscrimination policy for staff members that includes sexual orientation and gender identity|
|□||□||We have a nondiscrimination policy for patients that includes sexual orientation and gender identity|
|□||□||Our mission statement is inclusive; it names LGBTQ+ people|
|□||□||We offer domestic partner benefits to LGBTQ+ employees|
|□||□||Patient confidentiality policies include how to deal with patients who do not want information about sexuality or gender on their records|
|□||□||Our sexual harassment policy includes LGBTQ+ issues|
|□||□||We have a procedure for staff or patients to grieve issues of discrimination based on sexuality and/or gender|
|□||□||Written notice is given to patients about when and for what reason information about them may be disclosed to a third party|
|□||□||All staff get basic training on LGBTQ+ people and issues at least once, and ideally ongoing|
|□||□||Some staff get advanced training|
|□||□||At least one staff member has expertise in working with LGBTQ+ patients|
|□||□||The board and senior management are actively engaged. This may take the shape of an LGBTQ+ task force or advisory group that works with the board and senior management as a “champion.”|
|□||□||All staff treat LGBTQ+ patients with respect and honor confidentiality|
|□||□||Staff members know how to intervene when patients act in a discriminatory manner to LGBTQ+ patients or their families|
|Inclusive Language: Forms/Assessments/Treatment|
|□||□||Written forms have inclusive language and encourage disclosure|
|□||□||Assessments are inclusive and encourage discussion of whether gender or sexuality issues need to be addressed in treatment|
|□||□||Case management, treatment, and aftercare plans include issues related to sexuality and gender if appropriate|
|□||□||Staff members are prepared to obtain an inclusive sexual history from all patients|
|□||□||Treatment groups, social activities, and all aspects of the institution are safe for LGBTQ+ patients (receptionists, laboratory technicians, housekeepers, ward clerks, kitchen staff, clergy)|
|Visibility of LGBTQ+People and Issues|
|□||□||We advertise employment opportunities in LGBTQI publications|
|□||□||The workplace has a defined and visible interest/support group that provides a safe space for LGBT nurses and allies to gather, network and socialize.|
|□||□||We have openly LGBTQ+ people on staff|
|□||□||We have openly LGBTQ+ people on the board of directors, community advisory panels, agency task forces, and so on|
|□||□||We have openly LGBTQ+ people as volunteers, sponsors, mentors|
|□||□||Our nondiscrimination policy that includes LGBTQ+ is prominently displayed|
|□||□||Families of LGBTQ+ patients are included in visitation policies and decision making|
|□||□||LGBTQ+ issues are discussed in treatment groups, health education sessions, case management sessions, and other group settings when appropriate|
|□||□||Posters, pamphlets, magazines, and other materials reflect our LGBTQ+ patients|
|□||□||We do outreach/market our services to local LGBTQ+ communities|
|Resources and Linkages|
|□||□||We have checked our referral sources to make sure that they are LGBTQ+-sensitive (home care, clinics for follow-up care, community agencies, and so on)|
|□||□||We have linkages to our local LGBTQ+ community|
|□||□||We screen clergy, guest speakers, volunteers, mentors, sponsors, and so on, to make sure they know that we are welcoming and inclusive of LGBTQ+ people|