It’s Complicated: Improving Undergraduate Nursing Students’ Understanding Family and Care of LGBTQ Older Adults

Abstract

Research has identified the need for improved cultural competence of health care providers regarding the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community’s needs. This article articulates the teaching approach and methodology of an unfolding LGBTQ family case study for undergraduate nursing students. This method provided a forum for exploration of personal biases and gender-affirming techniques, and addressed the challenges of aging for a transgender woman and family within the context of societal stigma and discrimination. Students gained knowledge concerning shifts in family structures and understanding of the nurses’ role encouraging inclusiveness and equitable access in health care settings, advocating for vulnerable populations, and addressing specific health concerns for transgender older adults. Student responses demonstrated increased knowledge of family diversity, and critical thought regarding the intersectionality of discrimination and aging. The findings revealed the case study methodology facilitated student understanding of the unique health and social issues for LGBTQ older adults within a family context.

Keywords

LGBT family nursing transgender older adult undergraduate nursing education

Get full access to this article

View all access options for this article.

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Bauer

G. R.

Hammond

Travers

Kaay

Hohenadel

K. M.

Boyce

(2009). “I don’t think this is theoretical; this is our lives”: How erasure impacts health care for transgender people. Journal of the Association of Nurses in AIDS Care, 20, 348-361. https://doi.org/10.1016/j.jana.2009.07.004

Bauer

G. R.

Scheim

A. I.

(2015). Transgender people in Ontario, Canada: Statistics from the Trans PULSE project to inform human rights policy. Retrieved from http://transpulseproject.ca/wp-content/uploads/2015/06/Trans-PULSE-Statistics-Relevant-for-Human-Rights-Policy-June-2015.pdf

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101. http://dx.doi.org/10.1191/1478088706qp063oa

Brennan

A. M. W.

Barnsteiner

de Leon Siantz

Cotter

V. T.

Everett

(2012). Lesbian, gay, bisexual, transgendered, or intersexed content for nursing curricula. Journal of Professional Nursing, 28, 96-104. https://doi.org/10.1016/j.profnurs.2011.11.004

Brotman

Ryan

Collins

Chamberland

Cormier

Julien

. . . Richard

(2007). Coming out to care: Caregivers of gay and lesbian seniors in Canada. The Gerontologist, 47, 490-503. https://doi.org/10.1093/geront/47.4.490

Brotman

Ryan

Cormier

(2003). The health and social service needs of gay and lesbian elders and their families in Canada. The Gerontologist, 43, 192-202. https://doi.org/10.1093/geront/43.2.192

Canadian Nurses Association. (2010). Position statement: Promoting cultural competence in nursing. Retrieved from https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/ps114_cultural_competence_2010_e.pdf?la=en

10.

Canadian Nurses Association. (2017). Code of ethics for registered nurses. Ottawa, Ontario, Canada: Author.

11.

Carabez

Pellegrini

Mankovitz

Eliason

Ciano

Scott

(2015). Never in all my years . . .: Nurses education about LGBT health. Journal of Professional Nursing, 31, 323-329. https://doi.org/10.1016/j.profnurs.2015.01.003

12.

College of Nurses of Ontario. (2009). Practice guideline: Culturally sensitive care. Toronto, Ontario, Canada: Author.

13.

Dailey

(1992). Developing case studies. Nurse Educator, 17(3), 8-11.

14.

Daley

A. E.

MacDonnell

J. A.

(2011). Gender, sexuality and the discursive representation of access and equity in health services literature: Implications for LGBT communities. International Journal for Equity in Health, 10, 40. https://doi.org/10.1186/1475-9276-10-40

15.

Day

(2011). Using unfolding case studies in a subject-centered classroom. Journal of Nursing Education, 50, 447-452. https://doi.org/10.3928/01484834-20110517-03

16.

Eliason

M. J.

Chinn

P. L.

(2018). LGBTQ cultures: What health care professionals need to know about sexual and gender diversity (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

17.

Eliason

M. J.

DeJoseph

Dibble

Deevey

Chinn

(2011). Lesbian, gay, bisexual, transgender, and queer/questioning nurses’ experiences in the workplace. Journal of Professional Nursing, 27, 237-244. https://doi.org/10.1016/j.profnurs.2011.03.003

18.

Eliason

M. J.

Dibble

DeJoseph

(2010). Nursing’s silence on lesbian, gay, bisexual, and transgender issues: The need for emancipatory efforts. Advances in Nursing Science, 33, 206-218. https://doi.org/10.1097/ANS.0b013e3181e63e49

19.

Erdley

S. D.

Anklam

D. D.

Reardon

C. C.

(2013). Breaking barriers and building bridges: Understanding the pervasive needs of older LGBT adults and the value of social work in health care. Journal of Gerontological Social Work, 57, 362-385. https://doi.org/10.1080/01634372.2013.871381

20.

Fast Braun

Hyndman

Foster

. (2010). Family nursing for undergraduate nursing students: The Brandon University family case model approach. Journal of Family Nursing, 6, 161-176. https://doi.org/10.1177%2F1074840710366565

21.

Fields

(2016). Gender inclusive care. Retrieved from http://www.matc.ca/files/GenderInclusiveCareResource.pdf

22.

Fredriksen-Goldsen

K. I.

(2014). Promoting health equity among LGBT mid-life and older adults: Revealing how LGBT mid-life and older adults can attain their full health potential. Generations, 38, 86-92.

23.

Fredriksen-Goldsen

K. I.

Cook-Daniels

Kim

Erosheva

E. A.

Emlet

C. A.

Hoy-Ellis

. . . Muraco

(2014). Physical and mental health of transgender older adults: An at-risk and underserved population. The Gerontologist, 54, 488-500. https://doi.org/10.1093/geront/gnt021

24.

Fredriksen-Goldsen

K. I.

Hoy-Ellis

Goldsen

Emlet

C. A.

Hooyman

N. R.

(2014). Creating a vision for the future: Key competencies and strategies for culturally competent practice with Lesbian, Gay, Bisexual, and Transgender (LGBT) older adults in the health and human services. Journal of Gerontological Social Work, 57, 80-107. https://doi.org/10.1080/01634372.2014.890690

25.

Fredriksen-Goldsen

K. I.

Kim

Barkan

S. E.

Muraco

Hoy-Ellis

(2013). Health disparities among lesbian, gay, and bisexual older adults: Results from a population-based study. American Journal of Public Health, 103, 1802-1809. http://dx.doi.org/10.2105/AJPH.2012.301110

26.

Fredriksen-Goldsen

K. I.

Kim

H. J.

Emlet

C. A.

Muraco

Erosheva

E. A.

Hoy-Ellis

C. P.

. . . Petry

(2011). The aging and health report: Disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Seattle, WA: Institute for Multigenerational Health. Retrieved from http://age-pride.org/wordpress/wp-content/uploads/2012/10/Full-report10-25-12.pdf

27.

Fredriksen-Goldsen

K. I.

Simoni

J. M.

Kim

Lehavot

Walters

K. L.

Yang

. . . Muraco

(2014). The health equity promotion model: Reconceptualization of Lesbian, Gay, Bisexual, and Transgender (LGBT) health disparities. American Journal of Orthopsychiatry, 84, 653-663. http://dx.doi.org/10.1037/ort0000030

28.

Gay and Lesbian Medical Association. (2015). Creating a safe clinical environment for Lesbian, Gay, Bisexual, Transgender, and Intersex (LGBTI) patients. Retrieved from https://www.glhv.org.au/sites/default/files/glma_guidelines.pdf

29.

Hirst

S. A.

Lane

A. M.

Miller

C. A.

(2015). Miller’s nursing for wellness in older adults (Canadian ed.). Philadelphia, PA: Wolters Kluwer.

30.

Iantaffi

Bockting

W. O.

(2011). Views from both sides of the bridge? Gender, sexual legitimacy and transgender people’s experiences of relationships. Culture, Health & Sexuality, 13, 355-370. https://doi.org/10.1080/13691058.2010.537770

31.

Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academies Press.

32.

International Family Nursing Association. (2013). IFNA Position Statement on Pre-licensure Family Nursing Education. Retrieved from https://internationalfamilynursing.org/2015/07/30/ifna-position-statement-on-pre-licensure-family-nursing-education/

33.

Jablonski

R. A.

Vance

D. E.

Beattie

(2013). The invisible elderly: Lesbian, gay, bisexual, and transgender older adults. Journal of Gerontological Nursing, 39, 46-52. https://doi.org/10.3928/00989134-20130916-02

34.

Joint Commission. (2011). Advancing effective communication, cultural competence, and patient- and family-centered care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) community. Retrieved from http://www.jointcommission.org/assets/1/18/LGBTFieldGuide.pdf

35.

LGBT Movement Advancement Project & Services, Advocacy for Gay, Lesbian, Bisexual, & Transgender Elders. (2010). Improving the lives of LGBT older adults. Retrieved from http://www.lgbtmap.org/policy-and-issue-analysis/improving-the-lives-of-lgbt-older-adults

36.

Lim

F. A.

Brown

D. V.

Jones

(2013). Lesbian, gay, bisexual, and transgender health: Fundamentals for nursing education. Journal of Nursing Education, 52, 198-203. https://doi.org/10.3928/01484834-20130311-02

37.

Lim

F. A.

Johnson

Eliason

(2015). A national survey of faculty knowledge, experience, and readiness for teaching lesbian, gay, bisexual, and transgender health in baccalaureate nursing programs. Nursing Education Perspectives, 36, 144-152. http://dx.doi.org/10.5480/14-1355

38.

Marcellin

R. L.

Scheim

Bauer

Redman

(2013). Experiences of transphobia among trans Ontarians. Trans PULSE E-Bulletin, 3(2). Retrieved from http://transpulseproject.ca/research/experiences-of-transphobia-among-trans-ontarians/

39.

Mayer

K. H.

Bradford

J. B.

Makadon

H. J.

Stall

Goldhammer

Landers

(2008). Sexual and gender minority health: What we know and what needs to be done. American Journal of Public Health, 98, 989-995. https://doi.org/10.2105/AJPH.2007.127811

40.

McDowell

Bower

K. M.

(2016). Transgender healthcare for nurses: An innovative approach to diversifying nursing curricula to address health inequities. Journal of Nursing Education, 55, 476-479. https://doi.org/10.3928/01484834-20160715-11

41.

McNeil

P. L.

Elertson

K. M.

(2018). Advocacy and awareness: Integrating LGBTQ health education into the prelicensure curriculum. Journal of Nursing Education, 57, 312-314. https://doi.org/10.3928/01484834-20180420-12

42.

Merryfeather

Bruce

(2014). The invisibility of gender diversity: Understanding transgender and transsexuality in the nursing literature. Nursing Forum, 49, 110-123. https://doi.org/10.1111/nuf.12061

43.

Meyer

I. H.

(2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674-697. https://dx.doi.org/10.1037%2F0033-2909.129.5.674

44.

Peel

McDaid

(2015). “Over the rainbow”: Lesbian, gay, bisexual and trans people and dementia project summary report. Retrieved from http://dementiavoices.org.uk/wp-content/uploads/2015/03/Over-the-Rainbow-LGBTDementia-Report.pdf

45.

Purdon

Palleja

(2018, June 28). “We’re going back into the closet”: LGBTQ seniors wary of being “out” in long-term care facilities. Canadian Broadcasting Corporation. Retrieved from https://www.cbc.ca/news/canada/lgbtq-seniors-long-term-care-homes-discrimination-1.4721384

46.

Quinn

G. P.

Sutton

S. K.

Winfield

Breen

Canales

Shetty

. . . Schabath

M. B.

(2015). Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ) perceptions and health care experiences. Journal of Gay & Lesbian Social Services, 27, 246-261. https://doi.org/10.1080/10538720.2015.1022273

47.

Radix

Maingi

(2018). LGBT cultural competence and interventions to help oncology nurses and other health care providers. Seminars in Oncology Nursing, 34, 80-89. https://doi.org/10.1016/j.soncn.2017.12.005

48.

Registered Nurses Association of Ontario. (2007a). Position statement: Respecting sexual orientation and gender identity. Retrieved from https://rnao.ca/policy/position-statements/sexual-orientation-gender-identity

49.

Registered Nurses Association of Ontario. (2007b). Embracing cultural diversity in health care: Developing cultural competence. Retrieved from https://rnao.ca/bpg/guidelines/embracing-cultural-diversity-health-care-developing-cultural-competence

50.

Roterman

(2017). High use of acute care hospital services at age 50 or older. Retrieved from https://www150.statcan.gc.ca/n1/pub/82-003-x/2017009/article/54855-eng.htm

51.

Shaffer

(2005). Transgender patients: Implications for emergency department policy and practice. Journal of Emergency Nursing, 31, 405-407. https://doi.org/10.1016/j.jen.2005.06.017

52.

Shipherd

J. C.

Green

K. E.

Abramovitz

(2010). Transgender clients: Identifying and minimizing barriers to mental health treatment. Journal of Gay & Lesbian Mental Health, 14, 94-108. https://doi.org/10.1080/19359701003622875

53.

Statistics Canada. (2017a). Annual demographic estimates: Canada, provinces and territories, 2017. Retrieved from http://www.statcan.gc.ca/pub/91-215-x/91-215-x2017000-eng.htm

54.

Statistics Canada. (2017b). Same-sex couples in Canada in 2016. Retrieved from http://www12.statcan.gc.ca/census-recensement/2016/as-sa/98-200-x/2016007/98-200-x2016007-eng.cfm

55.

Stein

G. L.

Beckerman

N. L.

Sherman

P. A.

(2010). Lesbian and gay elders and long-term care: Identifying the unique psychosocial perspectives and challenges. Journal of Gerontological Social Work, 53, 421-435. https://doi.org/10.1080/01634372.2010.496478

56.

Wright

L. M.

Leahey

(2013). Nurses and families: A guide to family assessment and intervention (6th ed.). Philadelphia, PA: F. A. Davis.