_____________________________________________ Promoting the Health of Gender and Sexual Minorities
identity models, reading about the history of the gay sub- culture, watching documentaries related to diverse human sexuality, exploring educational Internet sites, or attending professional workshops addressing gay-related topics are excel- lent strategies for increasing personal awareness, sensitivity, and knowledge about the LGBTQIA population. Because increased contact with minorities has been found to be a very effective strategy for promoting understanding, a healthcare professional could increase interactions with members of the GSM community to reduce negative stereotyping, prejudice, and discrimination [157]. Keep in mind that gaining access to a subculture requires sensitivity, patience, and understanding because one’s interest in the community may be questioned by subculture members [158]. The second crosscultural communication skill area involves recognizing defensiveness and resistance and knowing its cause [156]. Problem behaviors arise when the healthcare profes- sional begins to impose personal values on others. Assuming that everyone is heterosexual and demonstrating a lack of knowledge about the health-damaging effects of stigma on the LGBTQIA population are two behaviors that may create defensiveness or resistance. Other problem behaviors involve making hostile or discriminatory statements, using slang, and telling or laughing at derogatory jokes about the GSM community. Because this active form of collusion furthers stereotypes, the healthcare professional should monitor his or her own behavior so that he/she remains sensitive and culturally competent. Failure to have wording on patient history and intake docu- ments that is inclusive of sexual minorities and partners could be problematic, as well. For example, do documents include space for a partner notation, or do they ask only for marital status (i.e., single, married, widowed, or divorced)? None of these words may be an honest answer in a gay patient’s mind. The Gay and Lesbian Medical Association offers guidelines for creating a safe and comfortable clinical environment (see Resources ). Intake information should also include an explana- tion about how confidentiality will be managed. Disclosing a patient’s sexual orientation without the patient’s permission should be avoided. Not only might “outing” the patient lead to patient defensiveness, but information about a patient’s sexual orientation is protected by the Health Insur- ance Portability and Accountability Act (HIPAA) [159]. In situ- ations when a patient’s disclosure may not remain confidential, some reassurance of respect could be provided if disclosure was always accompanied by the patient’s consent. Healthcare professionals should also be knowledgeable about the visitation policies of their healthcare agency. Policies and practices that are inclusive of partners and co-parents are valu- able measures that demonstrate cultural competence. The third crosscultural communication skill area requires tak- ing actions to reduce feelings of defensiveness and resistance in oneself and others. One of the most important activities for
the culturally competent healthcare professional is to examine one’s own feelings, values, and stereotypes regarding culture and, in this case, regarding human sexuality [34]. Examining one’s attitudes does not mean that the professional is approv- ing or condoning a specific orientation or behaviors. The healthcare professional need not necessarily change personal beliefs to provide culturally competent care. The healthcare professional must ask: “Can I recognize behav- iors in others that may indicate feelings of defensiveness and resistance?” Related to youth, the school nurse should observe for individuals who may be trying to make themselves invisible by isolating themselves from others. For example, are there students who are avoiding settings that may place them in a position to be questioned [87]? Adults and the elderly may isolate themselves as well. It seems unlikely that a sexual ori- entation that has been concealed for a lifetime will be easily or quickly revealed to anyone, even a well-intentioned healthcare professional. Anger, illness, and other manifestations of stress may be evident. Fortunately, many strategies can be suggested to help reduce defensive and resistant feelings. Promoting an atmosphere of openness and calm may be help- ful. Displaying posters, educational materials, and other materi- als of interest that are positive about the LGBTQIA community may signal the existence of a safe environment. For example, a sign in the waiting area that says, “We do not discriminate on the basis of age, race, sex, sexual orientation, gender identity, religion, language, or disability,” would be noticed by a GSM person. Showing equal respect for friends, partners, spouses, and relatives may also be helpful [160]. Being familiar with at least one of the sexual identity models discussed would assist the healthcare professional to assess at what point in the coming-out process an individual may be. For LGBTQIA youth, having this awareness could strengthen the planning related to their overwhelming need for anticipa- tory guidance [87]. Practicing nonjudgmental caring, by developing interviewing skills that employ inclusive terminologies, may also help reduce defensiveness. Speaking up when ridiculing remarks are made is vital. “That kind of joke has no place here” should be suffi- cient to send the message to a gay observer that the professional is sensitive to LGBTQIA concerns [161]. Demonstrating awareness that elderly LGBTQIA individuals may have fewer support systems is important. The American Association of Retired People provides Internet resources designed for elderly GSM persons. Individuals unable to use Internet services will need assistance with referral sources. Becoming familiar with appropriate LGBTQIA community referral sites is important as well. Contact local LGBTQIA sup- port agencies for information about their services. Referring GSM individuals to a GSM-related referral site is like referring a diabetic to the American Diabetes Association [159].
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