LGBT+ Competent Care

Abstract

Over 11 million U.S. adults identify as lesbian, gay, bisexual, or transgender. Occupational health nurses must understand issues specific to this population to deliver competent care.

An estimated 4.5% of working-age adults in the United States identify as lesbian, gay, bisexual, transgender, or another sexual and gender minority (LGBT+) (Newport, 2018). To provide quality care for all workers, occupational health nurses must recognize personal assumptions or bias and should understand LGBT+ population’s specific terminology. GLAAD (n.d.), an advocate for cultural change surrounding sexual orientation and identity, uses the acronym LGBTQ in their glossary of terms. Lesbians are women with an enduring physical, romantic, or emotional attraction to other women. Gay usually refers to men but describes people attracted to others of the same sex. Bisexual defines a physical, romantic, or emotional attraction to people of the same or another gender, which may differ over a lifetime. Transgender is an umbrella term for nontraditional gender expression, or when gender identity differs from that assigned at birth. The Q in LGBTQ means queer or questioning; yet queer may be derogatory depending on context and personal preference; “+” is preferred by some as being more inclusive.

Understanding the continuum of sex, gender, and sexual orientation is important for providing competent care. Biological sex is more than external genitalia, rather it is the complex interplay between anatomy, chromosomes, and hormones. Sexual orientation describes one’s persistent physical, romantic, or emotional interest for another person. Gender identity is the internal sense of gender, typically male or female; other identities include non-binary, agender, or gender fluid. Gender expression is how gender is displayed and defined by cultural cues that communicate masculine, feminine, both, and androgynous. Names, pronouns, appearance, and speech signify social identity. Cisgender describes a person whose biological sex and gender identity are aligned, but gender identity or expression does not determine sexual orientation. Recommended educational tools like “The Genderbread Person” can further help with understanding gender-related terminology and concepts (Killermann, 2019).

LGBT+ individuals face health disparities resulting from stigma and discrimination and may have had negative health care interactions (Office of Disease Prevention and Health Promotion [ODPHP], 2020). Lack of trust with the health care system may result in LGBTQ+ individuals overlooking their health care needs even as they have higher incidences of depression, anxiety, eating disorders, suicidality, substance abuse, and certain cancers (Fadus, 2019; Graham et al., 2011; ODPHP, 2020). LGBT+ workers health may be affected by discrimination accessing health insurance, employment, housing, and retirement benefits plus inadequate social programs and insufficient health care providers competent to address LGBT+ needs (ODPHP, 2020).

Respectful communication about sexual health helps an occupational health nurse obtain beneficial information needed to serve LGBT+ workers (Fadus, 2019). Open-ended questions can help the occupational health nurse distinguish between sexual behaviors and sexual orientation or identity. Health care terms like MSM (men having sex with men) and WSW (women having sex with women) focus on behaviors, not identity. Occupational health nurses should avoid misgendering based on the worker’s expressed identity; rather ask for the pronoun they prefer and apologize if you misspoke. Use inclusive language like “partner” rather than “husband” or “girlfriend.” Similarly, occupational health nurses should diligently maintain worker confidentiality and advocate for workplace policies and procedures that protect LGBT+ workers. The Centers for Disease Control and Prevention resources include LGBT Health (https://www.cdc.gov/lgbthealth/index.htm); telehealth consultations for transgender patients are available from Project Health TransLine (http://project-health.org/transline/). Knowledge of terminology and available resources will help occupational health nurses provide competent care for the LGBT+ worker population.