Using Respectful Communication with LGBTQ+ People
Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people account for 5.6 percent of the US population according to 2020 Gallup data (Jones, 2021). Despite incremental change in societal attitudes, health disparities continue to be evident due to discrimination and stigma. Fear of self-disclosure regarding sexual orientation and gender identity has led to avoidance of health care, leading to a higher incidence of physical and mental health issues.
Nurses are the largest provider of health care and at the forefront to effect change. Yet, nurses are underprepared to meet the challenges and opportunities of LGBTQ+ people. Serving as a call to nursing education, Lim and colleagues conducted a national survey and found the average time spent in schools of nursing on LGBTQ+ content was 2.12 hours (Lim et al., 2015). The AACN Essentials for Professional Nursing Education call for competencies for person-centered care and population health (American Association of Colleges of Nursing, 2021). Concepts related to sexual minorities and integrated throughout the essentials include communication, compassionate care, diversity, equity, inclusion, ethics, practice, and social determinants of health.
This teaching strategy presented for students focuses on communication skills as the gateway to establishing an effective patient-nurse relationship with LGBTQ+ people. The activity can be a face-to-face or virtual experience.
Using Respectful Communication with LGBTQ+ People
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- Using Respectful Communication with LGBTQ+ People slides (full size with photos) or alternate Using Respectful Communication with LGBTQ+ People slides (smaller file size)
- Victor monologue audio file
- Susan monologue audio file
- Joe monologue audio file
- Monologue scripts for Victor, Susan, and Joe
- Facilitator Teaching Guide for Monologues
- ACE+ Suggested Readings and Resources
- Define terminology used by LGBTQ+ people.
- Utilize the ASK Model to gain awareness, sensitivity, and knowledge of LGBTQ+ populations.
- Assess effective communication skills during three LGBTQ+ auditory encounters.
- Describe the influence of discrimination, stigma, and ineffective communication on mental and physical health of LGBTQ+ people.
Select from the following suggested preparatory materials.
McElwain, S., & Carr, K. (2021). Providing affirming care for LGBTQ patients. Nursing Made Incredibly Easy, 19(3), 36-43. DOI: 10.1097/01.NME.0000741816.72913.cb
Morris, B. J. (2021). History of lesbian, gay, bisexual and transgender social movements. American Psychological Association, 1-12. https://www.apa.org/pi/lgbt/resources/history
Rice, D. (2019). LGBTQ: The communities within a community. Clinical Journal of Oncology Nursing, 23(6), 668-671.
LGBT Healthcare Training Video: “To Treat Me, You Have to Know Who I Am”: https://www.youtube.com/watch?v=NUhvJgxgAac
Jones, J. M. (2021, February 24). LGBT identification rises to 5.6% in latest U.S. estimate. Gallup. https://news.gallup.com/poll/329708/lgbt-identification-rises-latest-estimate.aspx
US Census Bureau. (2022). Census Bureau explores sexual orientation and gender identity. https://www.census.gov/library/stories/2021/11/census-bureau-survey-explores-sexual-orientation-and-gender-identity.html
Suggested Learning Activities
The ASK Model
The ASK modelTM is used in the activity as a framework for the LGBTQ+ communication activity (Eliason & Chinn, 2018; Henriquez et al., 2019). The model incorporates the concepts of awareness (A), sensitivity (S), and knowledge (K) when learning about new cultures and will guide the approach for learning effective communication with LGBTQ+ people.
AWARENESS: Review description with students
As providers of health care, we each bring our unique perspective to the patient-nurse experience – molded by our cultural beliefs, stereotypes, and values and influenced by media, family, friends, and religion (Eliason & Chinn, 2018; Henriquez et al., 2019). Reflection on our biases brings awareness to barriers that impact quality care. Tackling bias begins with raising awareness. Unconscious bias contributes to health disparities in LGBTQ+ people due to negative interactions and poor communication (Schultz & Baker, 2017). Awareness allows growth in verbal and nonverbal communication skills with LGBTQ+ people.
Foundational Knowledge: Overview and Introduction to Providing Respectful Care to LGBTQ+ People.
The PowerPoint offers foundational information on LBGTQ+ people and can be used as prework or just prior to group activities to set the stage for discussion and common understanding. The plus (+) sign indicates inclusion of other sexual and gender minorities not captured in the LGBTQ acronym. Information included in the file is listed below.
- Definitions and terminology used by LGBTQ+ people are offered and subject to change over time.
- Demographic information gives notice to the increased number of those who identify as LGBTQ+.
- Position statements from key professional nursing organizations provide guidance to nursing education and students.
- Research studies are discussed informing nursing education for inclusion of LGBTQ+ content in curricula.
SENSITIVITY: Review description with students
Sensitivity teaches us how to approach similarities as well as differences in culture. Sensitivity implores us to see each patient as a unique human being without assumptions or expectations and to embrace each new encounter with an open mind and heart (Eliason & Chinn, 2015; Henriquez et al., 2019). Sensitivity begs us to ask: How can I create an environment free of assumptions? How can I approach with an open mind?
Listening to Hear: Improving Communication and Inclusivity
Instructions: Have students form groups of 3-4 and close their eyes. Instruct the students to “Listen to Hear” about encounters that occurred between patients and health care personnel. Play each monologue audio file. Use the Facilitator Teaching Guide for Monologues to lead a discussion on what communication strategies could have been used for each monologue that would have enhanced the patient-health-care personnel relationship.
KNOWLEDGE: Review description with students
Knowledge is the third component of the ASK model. The purpose of this activity is to build effective communication skills through knowledge, awareness, and sensitivity about LGBTQ+ people. It should be recognized that people vary by race, ethnicity, socioeconomic status, age, educational preparation, gender identity, and sexual orientation (Eliason & Chinn, 2015; Henriquez et al., 2019). Communicating effectively gives the patient and health care provider important information to develop a plan of care to meet the specific needs of each person. By creating a psychologically safe environment using gender-affirming and health promotion practices, health disparities can be reduced for LGBTQ+ people.
Beyond the activity: Consider a discussion board or journaling to extend the learning.
The ACE+ Suggested Reading and Resources document is intended to provide nursing faculty with important background information needed to use ACE+ materials and resources.
Sabrina Beroz, DNP, RN, ANEF, CHSE-A
Healthcare Simulation Consultant