Exploring and Understanding LGBTQIA+ Bias in Health Care

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• Exploring & Understanding LGBTQIA+ Bias in Health Care presentation slides
  

Students will:

• Define key terms related to bias
• Discuss the impact of bias in health care
• Create a plan to decrease the impact of bias in health care

Have students review the following resources:

Documentary-Choose 1

Southern Comfort. (2001). Produced by Kate Davis

• This documentary details the final year in the life of Robert Eads, a transgender man who died of ovarian cancer after being refused treatment because of his gender identity.
• Available for streaming (for free, but with ads) on Tubi.
• Note that because this documentary is over 20 years old, some terminology used (such as transsexual, transgendered, genetic woman/man) is outdated.
• Content/trigger warnings: Death, family rejection/abandonment, medical neglect, slurs, brief mention of Ku Klux Klan, discussion of rape and domestic violence, misgendering
  

Gen Silent. (2010). Produced by Stu Maddux

• This documentary follows several LGBTQ older adults as they navigate aging and, for some, dying.
• Available for streaming on Kanopy. Many universities and public libraries provide Kanopy access.
• Content/trigger warnings: Transphobia/transmisia, homophobia, death/hospice care, suicide, conversion therapy/medical abuse, family rejection, misgendering, religious abuse
  

Video

YouTube. (2018). Kimberlé Crenshaw defines intersectionality. [Excerpt from TED Talk: The Urgency of Intersectionality]. https://www.youtube.com/watch?v=sWP92i7JLlQ

Reading

Casey, L., Reisner, S., Findling, M., Blendon, R., Benson, J., Sayde, J., & Miller, C. (2019). Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans. Health Services Research, 54(S2), 1454-1466. https:doi.org/10.1111/1475-6773.13229

Optional

After viewing the selected documentary, have students journal about one or more of the following prompts:

1. How did health care provider bias negatively impact the health of the documentary subject(s)?
2. What were ways the subject(s) of the documentary used community resources to enhance well-being?
3. What are strategies nurses can implement to counteract the bias experienced by the documentary subject(s)? 

1. Assign students key terms to look up and share with the class. Definitions are also provided in the slide deck.
   • Bias
   • Stigma
   • Discrimination
   • Microaggression
   • Social Determinants of Health (SDoH)
   • Health Disparities

      

2. Present PowerPoint presentation slides

    

3. View short video: The Clinic

   Instruct students to take notes comparing the two individuals in the clip:

   • What can be inferred from the body language and verbal cues of each patient?
   • How does the behavior of the provider differ for each patient?

      

     	Patient: Carolina	Patient: Damien
     What can be inferred from the body language and verbal cues of each patient?	Anxiety: uncertain facial expression; slightly furrowed brow; does smile slightly when speaking to doctor   Appears relaxed and reassured after visit, smiling	Anxiety: Tilting clipboard so other patients can’t see paperwork, tapping pen, furrowed brow, crumpling exam table paper, pursed lip breathing   Appears anxious and unsure after visit, shaking head, bouncing leg
     How does the behavior of the provider differ for each patient?	Greets patient, introduces self, asks how she is doing today   Line of questioning is about diet   Recommendation is for dietary changes   No discussion of STI testing even though symptoms are similar to Damien’s	No greeting or introduction, uses wrong name (note intake paperwork had line for preferred name that clearly stated ‘Damien’)   Line of questioning is about STI testing   Recommendation is for STI testing, stresses importance of ruling out before exploring other possible causes (assumption that illness is related to LGBTQ identity)

      

4. Discussion

• Ask students to compare their notes from the video to the materials previously covered in this lesson.
• Use students’ observations as a starting point for discussion on how provider bias influenced the care of the patients in the video.
• Help students identify how the bias of the provider in the video may lead to poor health outcomes for the transgender patient.
• Create a plan for intervening when a colleague demonstrates bias toward a patient. Consider role play if this is something you are comfortable facilitating in your classroom.

Optional Assignment: Connecting Teaching to Other Forms of Bias

• Have students select a group of people and reflect on what biases they might have about that group, where they learned those biases or stereotypes, and how that might influence their care of patients from that group.
• Alternatively, have students write on what they think other nurses/nursing students think about a group. That can remove the impulse to provide responses the student considers socially desirable, potentially leading to a more honest reflection.

National Academies of Sciences, Engineering, and Medicine. (2020). Understanding the Well-Being of LGBTQI+ Populations. National Academies Press.

S. Alexander Kemery, PhD, RN
University of Indianapolis