dentify one evidence-based intervention to reduce health disparities in the selected population.
The hot spot I chose is Arizona and the selected population is the lesbian, gay, bisexual, transgender and queer (LGBTQ) community. I chose this state because I worked as a nurse in Arizona in cities like Phoenix, Scotsdale and a few others. One of the Phoenix LGBT Communities is located in the North close to Roosevelt Avenue. I was in this state for 5 years and my first apartment rental was from a gay young man. I did community nursing where I visited patients at home. It is not easy discussing this subject but I feel very strongly about this minority and what they have to go through. I have had the privilege to work very closely with families who are either gay or have gay children. To be honest, my biases were finally broken down as I allowed myself to feel deep empathy for these folks after listening to some of their stories and the plight they face.
By addressing the health disparities that are so prevalent in this community and the need for health equity through evidence-based solutions; by developing a therapeutic framework to expressly ground the principles of health equity concerning this community that is so stigmatized, advance practice nurses, stakeholders and funders of this process can incorporate practices that are inclusive as they embark on working with this population.
Specifically, since I have worked closely with families with teen-age youths that are either lesbian, or gay, I understand what this community goes through at home, at school and with their neighbors. In one of the instances, I had parked my car in front of the patient’s house when I came to do an oasis assessment. The harassing neighbors that hated the family because the two ‘moms’ were lesbians, came and pitched a basketball hoop very close to my car and told the parents of my patient to ask me to move my car because her kids wanted to play basketball on the street. This was just a hate-driven move against anyone that associated with the lesbians. Now we are talking about neighbors that do have a large yard and could pitch a basketball net anywhere in their yard. This incivility resulted in an altercation between the two families. The family I came to work with had just bought the home but since the purchase it was one form of harassment after another. It was not until I worked with them and other gay families that I discovered what this community suffered. Seeing their plight and listening to their stories I was forced to examine my own biases against this minority group of people.
Anyway, that aside, one issue that the family discussed with me is that of healthcare inequality and how they had suffered discrimination this area amongst other areas. I consider evidence-based interventions and strategies that could leverage science to promote equity-focused healthcare for youths and families as a worthy cause. Starting an educational organization whose curriculum is run by LGBTQ researchers, educators, program designers, relevant publishers,/writers/editors, and techies, all contributing their sympathetic skills and talents to advance advocacy to improve lives and promote equity has become something I would very much like to pursue. I now reside in Massachusetts and I keep running into the same issue in community nursing as well as school nursing.
My interest for this Arizona community runs deep with good reason. I find myself driven by their mission to advance healthcare equity and opportunities for youths and families especially those parents that are reluctant about getting fair healthcare treatment. I also saw how their children found it difficult maintaining a steady attendance in school due to the fear of stigmatization and ridicule. Laws are in place to protect, but the public is still not sensitive enough to the needs of this community and are very subtle in the way they practice discrimination and bias within the healthcare industry.
Advanced practice nurses have a responsibility to educate nurses in our hospitals and healthcare facilities. Our doctors also need proper education on how not to discriminate against the LGBT community. Advance practice nurses must educate school nurses to exercise their leadership roles in fostering safety by being supportive in our school environment. They must deal with the unfairness and inequality to bridge the gap in gender discrimination and health disparities. Collaborating with the school and the community to advocate for change in policy will go a long way to improve outcomes (Shattuck et al.)
Here in Massachusetts, I once visited the The Alnite Alliance Group made up of connected voices that meet monthly and presently, they do zoom meetings and consider this place a safe hangout location where all LGBTQ members can assemble and be free to express their challenges.
In the near future, I intend to build a strong, dynamic partnership and collaboration with this group so I could better inform the interdisciplinary team to seek strategies that foster funding for LGBTQ cultural competence while lessening the healthcare disparities. It all begins with educating the public and raising awareness about their gender and sexual orientation/identification. My motto is, fairness for all especially when it comes to healthcare. Everyone deserves fairness, whether or not we disagree with their lifestyle choices and orientation. The masses need to understand that everyone deserves to live in a safe and healthy community and to participate equally in economic opportunities, affordable and medically precise and inclusive healthcare services.
Through education and training and evidence-based research, I hope to positively make an impact in areas such as reproductive health including the prevalence of HIV that is so common with this population. For the youth, school-based mental health and wellness will be emphasized. Also addressing the drugs, alcohol and experimentation with tobacco products as stress relief will be addressed. Teaching inclusion science and healthcare equity and how to recognize incivility, where to go to get justice will be part of the strategic interventions of the program. With the assistance of the gay/lesbian parents and their children, we will collaboratively design customized, evidence-based programs and services to adequately and accurately address the current healthcare disparities still prevalent in the LGBTQ community.
Consider how the selected intervention addresses at least one of the CLAS standards.
One of the CLAS standards that seem to stand out to me is how an advanced practice nurse can demonstrate sensitivity towards the culture of the lesbian, gay, bisexual, transgender and queer community. Worthy of consideration for the nurse are culture and gender as key components, foundational to inform practice improvement leading to quality care (Surikova et al., 2020)
One of the challenges community nurses face is the discomfort they feel when they suddenly are faced with having to address patients’ sexual behaviors. This is particularly true with the LGBTQ community, a factor that can result in serious consequences (Landry, 2017).
Sometimes it only takes minor adjustments in a provider’s approach to make a significant difference in the life of patients to improve health outcomes especially with the healthcare disparities this group faces.
There are mental, emotional, biological and psychological issues ranging from anger, guilt, shame, feelings of unworthiness, violence, fear, anxiety, suicide contemplation, safety issues etc. all needing to be addressed, not ignored. As health care professionals it is our job to make sure we do not shy away from addressing issues around their sexuality when it is called for. Part of cultural competence is being culturally sensitive to the above-mentioned needs in order to provide top quality mental and emotional healthcare for our patients.
When we demonstrate a sense of comprehension and empathy towards the patients’ culture, and when we avoid a judgmental approach toward their gender orientation, we show understanding and accommodation, thereby building the trust that is necessary for improving outcomes and eliminating disparities.
How can nurse leaders and healthcare providers be advocates and work in the best interest of their patients if they harbor a repulsive or negative attitude towards those with gender differences that is termed non-conventional? I had to deal with my own biases when I got assigned to families with two moms or two dads. At first it was awkward and challenging because I was not prepared for this and had never been in very close proximity with the LGBTQ group. But as time went on, the walls got eroded because I chose to approach it from a scientific and evidence-based standpoint. Many nurses from my organization simply could not do it for some reason and I think it is simply ignorance.
Gender flexibility orientation is something nurses must educate themselves about. Just as discrimination due to race, culture, religious beliefs, and age is wrong, discrimination because of gender orientation is equally wrong and unethical. It is a form of incivility because we are responsible for equity-based healthcare.
References
Shattuck, D. et al. (2020, Aug). Recruitment of Schools for Intervention Research to Reduce Health Disparities for Sexual and Gender Minority Students. Journal of School Nursing 36(4) 258-264.
Landry, J. (May, 2017). Delivering Culturally Sensitive Care to LGBTQI Patients. The Journal for Nurse Practitioners, 13(5):342-347
Surikova, J., Payne, A., Miller, KL., Ravaei, A., & Nolan, RP. (2020, July, 18). A cultural and gender-based approach to understanding patient adjustment to chronic heart failure. Health Qual Life Outcomes, 18 (1), pp. 238. DOI: 10.1186/s12955-020-01482-1
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