2.  The goal of this module is to help prepare future nurse leaders to sensitively assess and care for persons of the LGBTQ community.  It is essential for nurses to provide safe, compassionate, and unequivocal holistic care to all.

3.  L= Lesbian-- As an adjective, used to refer to female same-sex attraction and sexual behavior; as a noun, used as a sexual orientation identity label by women whose sexual attractions and behaviors are exclusively or mainly directed to other women. (Joint Commission, p.88)  G= Gay -- An attraction and/or behavior focused exclusively or mainly on members of the same sex or gender identity; a personal or social identity based on one’s same-sex attractions and membership in a sexual-minority community (Joint Commission, p.88)  B= Bisexual --One whose sexual or romantic attractions and behaviors are directed at both sexes to a significant degree (Joint Commission, p.87)

4.  T= Transgender --People whose gender identity or gender expression differ from their birth sex or prevailing ideas of masculinity and femininity (Joint Commission, p.91)  T= Transsexual —people who live as a sex not associated with their birth sex, after a process known as transitioning ( Joint Commission, p.91 )  Q= Questioning —A person, often an adolescent, who has questions about his or her sexual orientation or gender identity. ( Joint Commission, p. 90)  Q= Queer -- In contemporary usage, queer refers to an inclusive unifying sociopolitical, self-affirming umbrella term for people who are gay, lesbian, bisexual, pansexual, transgender, transsexual, intersexual, gender queer, or any other nonheterosexual sexuality, sexual anatomy, gender identity. (Joint Commission, p. 90)

5.  Heterosexual = individuals who identify as “heterosexual” or “straight” or whose sexual or romantic attractions and behaviors focus exclusively or mainly on members of the other sex or gender identity. (Joint Commission, p.89 )  Homosexual = As an adjective, used to refer to same- sex attraction, sexual behavior, or sexual orientation identity. This term is considered outdated and derogatory by many in the LGBT community (Joint Commission, p.89).  GNC = Gender-nonconforming refers to individuals whose external manifestation of their gender identity does not conform to society’s expectations of gender roles (Lambda Legal’s Health Care Fairness Survey, 2014)Lambda Legal’s Health Care Fairness Survey Definitions (cont’d)

7.  It is a mandate to conduct culturally sensitive research to better learn the needs and perspectives of LGBT individuals who enter the health care arena.  This Report recognized the difficulty in fairly and confidentially getting results that need to be obtained to better meet the health needs of these populations.

8. Looking at this graphic, you see how the LGBT community falls under each category on the left, with priority research topics in the center leading to better outcomes and culturally competent care on the right.

9.  “To treat me you have to know who I am” › http://www.youtube.com/watch?v=NUhvJgx gAac http://www.youtube.com/watch?v=NUhvJgx gAac  This is from the Trevor Project. It is a crisis hotline for persons who have not come out to their family members or are struggling with the acceptance of their sexuality. › http://www.youtube.com/watch?v=0RsTNzRVf do http://www.youtube.com/watch?v=0RsTNzRVf do

10. “Leaving aside issues related to HIV/AIDs, which are many, some of the more striking findings are that LGB youth (and likely ‘‘T’’ youth as well) commonly experience suicidal ideation, suicide attempts, and depression ; their rates of cigarette smoking, alcohol consumption and substance use are elevated ; and they are over-represented among the homeless.”  This statement on the increased morbidity and mortality for young persons dealing with LGBT issues further supports the need for nurses to be pro- active in fostering preventative health interventions for improved mental health and well-being in these populations.

11.  Respect for the individual and his/her family. Fear of implications with disclosure may interfere with a patient’s willingness to share, e.g.: › Transgender patients, therefore, have to carefully consider two disparate scenarios: on the one hand, failure to disclose transgender status to a health care provider may potentially lead to inappropriate or unsatisfactory care; on the other hand, disclosure of this information makes transgender people potentially more susceptible to prejudice and, in some instances, refusal of health care ( Redfern & Sinclair, 2014, p. 28)

12. › Elders of the LGBT community have their own struggles and health issues that need to be tended to in a respectful way. Their numbers are increasing and their vulnerability is evident in the literature. (Lim & Bernstein, 2012) › Families of LGBT parents are another community in which respect for both parents is essential. Children may be biological from previous marriage, artificial insemination, or step or adopted. Awareness of the parents’ orientation will foster better communication and individualization of care. (J.Burkholder & Burbank, 2012)

13.  Active Listening to learn important aspects of their life. Strive to be inclusive in all assessments: › "What name do you prefer to be called?" especially important for the transgender client › "Tell me about your support system." › "Do you have a partner?" › "Do you feel safe from everyone in your support system or family?" › “Does anyone verbally or physically abuse you?" › "Who are you comfortable with sharing information about your health in your support system?"

14.  Presence as an intervention is important in establishing trust. Nurses need to take time to be present with the LGBT patient and family, and not avoid them.

15.  Understand and identify your biases so that you can change your attitudes if needed.  Understand your own attitudes toward LGBT issues.  Try to learn about the laws in the state or country in which you practice regarding same sex marriage, adoption/foster care, and partner adoption.  If you don’t know, ask!

16.  Gather as much information as necessary to understand as clearly as possible the family composition and specific requests by the family.  Work with the hospitals, doctor’s offices, and other health care staff to make the setting friendly to all types of parents.

17.  What does the health reform mean for the LGBT community? › The ACA (Obamacare) means affordable new coverage options, limits on discrimination based on sexual orientation and gender identity and coverage even if a person has a preexisting condition. And those are only some of the benefits. (http://www.glma.org/ )http://www.glma.org/

18. The American Association of Colleges of Nursing, and the Quality and Safety Education for Nurses (QSEN) project advocate for nurses to gain cultural competence and to provide culturally sensitive care to all people of various spiritual/religious, cultural, and lifestyle orientation.American Association of Colleges of NursingQuality and Safety Education for Nurses (QSEN) project “As the largest group of health providers in the United States, and by virtue of their scope of practice, nurses are in a position to bridge health disparities and provide culturally sensitive care across the lifespan.” (Lim & Bernstein, 2012, p. 174) This is our challenge and our goal

19.  The Fenway Institute—The National LGBT Health Education Center The Fenway Institute  The Gay and Lesbian Medical Association– health professionals advancing LGBT equality The Gay and Lesbian Medical Association › Guidelines for Caring for LGBT patients Guidelines for Caring for LGBT patients  The Joint Commission: › Advancing Effective Communication, Cultural Competence, and Patient and Family Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide.A Field Guide  Healthy People 2020—LGBT Health Healthy People 2020  Caring for LGBT Patients—a resource from Univ of Michigan. Great “how to” on questions that need to be asked. Caring for LGBT Patients

20.  American Association of Colleges of Nursing (2008). Tool kit of resources for cultural competent education for baccalaureate nurses. Retrieved from http://www.aacn.nche.edu/education-resources/toolkit.pdfhttp://www.aacn.nche.edu/education-resources/toolkit.pdf  Anastas, J.W. (2013). Policy, practice and people: current issues affecting clinical practice. Clinical Social Work Journal. 41. pp. 302–307 DOI 10.1007/s10615-013-0454-1  J. Burkholder, G., & Burbank, P. (2012). Caring for lesbian, gay, bisexual, and transsexual parents and their children. International Journal Of Childbirth Education, 27(4), 12-18.  Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: The National Academies Press.  Lim, F. A., & Bernstein, I. (2012). Promoting awareness of LGBT Issues in aging in a Baccalaureate nursing program. Nursing Education Perspectives, 33(3), 170-175. doi:10.5480/1536-5026-33.3.170  Redfern, J.S. & Sinclair, B. (2014). Improving health care encounters and communication with transgender patients. Journal of Communication in Healthcare, 7(1), 25-40. doi:10.1179/1753807614Y.0000000045

21.  Rounds, K. E., Burns McGrath, B., & Walsh, E. (2013). Perspectives on provider behaviors: A qualitative study of sexual and gender minorities regarding quality of care. Contemporary Nurse, 44 (1). Pp. 99-110.  The Joint Commission. (2011). Advancing effective communication, cultural competence, and patient and family centered care for the lesbian, gay, bisexual, and transgender (LGBT) community: A field guide. Retrieved from http://www.jointcommission.org/lgbt/ http://www.jointcommission.org/lgbt/  When Health Care Isn’t Caring: Transgender and Gender- nonconforming People: Results from Lambda Legal’s Health Care Fairness Survey. Retrieved from: http://www.lambdalegal.org/sites/default/files/publications/ downloads/whcic-insert_transgender-and-gender- nonconforming-people.pdf http://www.lambdalegal.org/sites/default/files/publications/ downloads/whcic-insert_transgender-and-gender- nonconforming-people.pdf