By MARTY LEVINE
School of Nursing faculty members have developed an interactive learning module and resource toolbox to show healthcare providers — as well as their own students and those at other institutions — best practices in LGBT healthcare.
“We need to approach everybody in an inclusive manner … to be aware of any implicit bias as we approach our patients,” said Nursing faculty member Brenda Cassidy, one of the authors of the resources along with colleagues Betty Braxter and Andrea Fischl.
There are no curriculum guidelines nationally for such modules in nursing education and it is not yet taught in many nursing programs, Cassidy said. Healthcare providers “want to say or do the right thing but they didn’t have an introduction” to the topic in their education, she adds.
Most providers aren’t trying to be prejudiced, Cassidy emphasized, but are rather harboring unconscious discrimination, “mostly because they didn’t have training” in how to be more welcoming.
Nursing students and faculty at Pitt — including members of Pitt Queer Professionals and the Rainbow Alliance — as well as healthcare providers who work with LGBT patients provided focus groups to guide the development of the module: “They helped us to understand what is really important to include in this introductory training,” Cassidy said.
And the module is not medical training, she explained: “It’s about having a welcoming environment and having the right terms to be gender neutral. That’s really what’s missing and causes health disparities and discrimination in this population.”
She cited the American Association of Colleges of Nursing’s push to improve academic nursing programs’ ability to prepare working nurses for a diverse patient population, including LGBTQIA+ individuals (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex and asexual and/or aromantic). The association says that fewer than 20 percent of nursing students get such preparation, and that a third are ill-at-ease when attempting to provide care for LGBT patients.
Attitude and perception have consequences. Cassidy pointed to the Pennsylvania LGBTQ Health Needs Assessment of 6,500 people from 2020, which found that almost 25 percent had experienced discrimination from healthcare providers and more than 40 percent had found themselves blocked from receiving proper care. The state Department of Health that same year showed that the LGBT population has higher rates of everything from tobacco use and obesity to cancer, HIV and mental health issues. Another state study found 25 percent of LGBT people are not sharing their status with healthcare workers, with 33 percent fearing a negative reaction or believing there is simply lack of knowledge about their health needs and concerns.
“If they have had negative experiences in the past, they delay seeking treatment,” Cassidy said of LGBT individuals, which doesn’t allow them to receive the proper screenings and treatment. Trans patients have higher diagnoses of cervical cancer, for instance, if they present as male but still possess biologically female body parts.
Thus, among the subjects in the School of Nursing’s new toolbox are those related to LGBT terminology, trauma-informed care, older adults, youth, disability status, minority care, homelessness, socioeconomic factors, substance use, health care specific to non-binary and transgender care, reproductive care and care of LGBT veterans, alongside a compendium of local resources.
The learning module covers LGBT terminology and statistics on health disparities and respectful communication, giving learners practice in using gender-inclusive language in different scenarios.
It is now part of a four-year research study between Pitt and the Louisiana State University Health New Orleans School of Nursing, which also looks at an advocacy program and simulations designed for undergraduate nursing students. Baylor University is also currently using the module, and Pitt Nursing is promoting it for more schools to adopt. The National Association of Pediatric Nurse Practitioners has made it available to pediatric nurse practitioners as well.
In addition, Pitt Nursing’s Doctor of Nursing Practice program has several projects that use both the module and toolbox within community health departments and outpatient behavioral health clinics for the aid of nurses there.
The module and toolbox have been in the works since 2018. It was piloted with graduate and undergraduate students in 2019 and the nursing school has now been using it with some undergraduate and graduate nursing classes.
Outcomes here have been “very good,” Cassidy said, with large improvements in “knowledge, attitudes and clinical preparedness.” She has certainly noticed the changes in her own pediatric nurse practitioner students, in the clinical course she teaches on adolescent health, and among the students who accompany her to see patients at Children’s Hospital’s Center for Adolescent and Young Adult Medicine.
“In this clinic we see LGBTQIA+ youth,” she said, “and my students who have completed this module are so much more comfortable approaching these youth in a more inclusive manner and asking them about sexuality now that they have taken this module.”
Marty Levine is a staff writer for the University Times. Reach him at martyl@pitt.edu or 412-758-4859.
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