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Samuel Merritt ABSN Culture Project

Samuel Merritt ABSN Culture Project

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Mca1 Project Mca1 Project Presentation Transcript

  • LGBT Community Emily Allen Whitney Burton Danielle Friedman Rebecca Heilman Sarah Rose
  • The LGBT Community
    • There are an estimated 8.8 million people that identify themselves as gay, lesbian, bisexual, or transexual in the United States.
    • In California, an estimated 5.2% (1,338,164 people) of the population identifies themselves as gay, lesbian, or bisexual.
    • The ability to provide culturally competent care for this people group is crucial in the U.S. and even more so here in California.
  • Homosexual Males and Females
    • Homosexual: characterized by a tendency to have sexual attraction toward another person of the same sex.
    • This community is one that is very diverse in race, age, and ethnicity. They come from many different walks of life and socioeconomic statuses.
  • The Homosexual Culture
    • The LGBT people group values
      • Community
      • Democracy
      • Equal Rights
      • The queer culture and heritage
      • Creativity
  • Bisexuality Basics
    • Bisexuality: “the potential to feel attracted to and to engage in sensual or sexual relationships with people of either sex”
    • Since most people are socialized as heterosexuals, bisexuality can be a part of a process of acknowledging one’s own homosexuality
    • Kinsey Study: 15-25% of women and 33-46% of men are bisexual
    (“Bisexuality Basics”, 2007) .
  • Bisexuality Basics
    • Unfortunately, since bisexuality doesn’t fit into either category of hetero- or homosexuality, the category of bisexuality is often ignored.
    • Bisexuals are often assumed to be either heterosexual or homosexual, since there is no stereotypical bisexual appearance or behavior.
    (“Bisexuality Basics”, 2007)
  • Biphobia
    • Bisexuality does not fit into the “either/or” heterosexist framework
    • Bisexuals cannot be defined by their partner, because they can have a same-sex partner, an opposite sex partner, or can be involved with both sexes at the same time
    • Bisexual men and women often feel invisible within this framework
    (“Bisexuality Basics”, 2007)
  • Myths About Bisexuality
    • Bisexuals are confused about their sexuality, and haven‘t made up their minds
    • Bisexuality implies that the person is involved with a man and a woman simultaneously
    • Bisexuals can only have committed relationship with an “opposite sex” partner
    • Bisexuals have a “homosexual side” and a “heterosexual side”
    (“Bisexuality Basics”, 2007)
  • Bisexuality Stereotypes
    • People become bisexual because it’s trendy and gets attention.
    • Bisexuality is a phase, especially in college-aged teens
    • Bisexual = available
    • Common names:
      • “ fence-sitters”
      • “ switchhitters”
      • “ AC/DC”
    (“Bisexuality Basics”, 2007)
  • Health Concerns for LGBT
    • Alcohol Use:
      • Bisexual and lesbian women report the highest rates of alcohol use and heavy drinking (which may be related to stress), compared to heterosexual and lesbian women
    • Tobacco Use:
      • Bisexual and lesbian women have higher rates of smoking than heterosexual women
    • Substance Use:
      • Bisexual and lesbian women have higher rates of drug use than heterosexual women
    (“Health Concerns for Bisexuals”, 2010)
  • Health Concerns for LGBT
    • Sexual Health:
      • Bisexual and lesbian women report higher risk sexual behavior than heterosexual women
      • Bisexual and lesbian women have the highest rates of combining substance use and sex
      • Bisexual and gay men who have sex with other men have an increased risk of HIV infection
      • Bisexual and gay men are more likely to report having a sexually transmitted infection
      • Bisexual men report less risky sexual behavior with males than do homosexual men
    (“Health Concerns for Bisexuals”, 2010) (“The Health Needs of Gay Men”, 1994)
  •  
  • Health Concerns for LGBT
    • Cancer:
      • Both men and women who have receptive anal sex with men are at a higher risk for anal cancer and HPV infection
      • Smoking is also a risk factor for anal cancer, and bisexual men and women have higher rates of smoking
    (“Health Concerns for Bisexuals”, 2010) (“Health With Pride”, 2010) (“The Health Needs of Gay Men”, 1994)
  • Health Concerns for LGBT
    • Fitness:
      • Some bisexual and gay men feel pressured to achieve the perfect body, and turn to compulsive exercising, eating disorders, and steroid use.
    • Nutrition:
      • Bisexual and lesbian women eat fewer fruits and vegetables than heterosexual women and are more likely to struggle with healthy eating.
    (“Health Concerns for Bisexuals”, 2010) (“The Health Needs of Gay Men”, 1994)
  • Health Concerns for LGBT
    • Weight:
      • Bisexual and lesbian women have higher rates of obesity, compared to heterosexual women
      • More bisexual women are underweight than lesbian or heterosexual women
    • Heart Health:
      • Bisexual women report higher rates of heart disease than heterosexual women
      • Risk factors include smoking, high blood pressure, BMI, high cholesterol, and alcohol use
    (“Health Concerns for Bisexuals”, 2010)
  • Health Concerns for LGBT
    • Depression & Anxiety:
      • Bisexual and gay men and women report higher levels of both depression and anxiety than heterosexuals
      • This problem can be more severe for bisexual men and women who lack strong support systems, or who remain in denial
      • Adolescents and young adults have a high risk of suicide
    (“Health Concerns for Bisexuals”, 2010) (“The Health Needs of Gay Men”, 1994)
  • Health Concerns for LGBT
    • Mental Health:
      • Bisexual women have the lowest levels of emotional support
      • Bisexual and gay men have lower social support levels than do heterosexual men
      • Bisexual men and women have the lowest emotional well-being of any sexual orientation group
      • Bisexual men and women report higher levels of self-harm and suicidal thoughts and attempts than heterosexuals
    (“Health Concerns for Bisexuals”, 2010) (“Health With Pride”, 2010) (“The Health Needs of Gay Men”, 1994)
  •  
  • Health Care Implications for Bisexuals, Lesbians, and Gays
    • 87% of gay, lesbian, and bisexuals reported to have been discriminated against within the health care system
    • 70% report to have been insulted based on their sexual orientation
    • The overall response of the health care system to the needs of homosexual and bisexual patients has been minimal
    (Robinson & Cohen, 1996)
  •  
  • Health Care Implications for Bisexuals, Lesbians, and Gays
    • As nurses we must:
    • Advocate for all clients regardless of sexual orientation
    • Remove any personal prejudices from our care and challenge homophobia and biphobia whenever it is encountered.
    • Explore new ways to serve this often marginalized part of society.
    (Robinson & Cohen, 1996)
  • Health Care for the Transgender Community
    • Transgendered individuals identify with a gender that differs from their genetic or biological sex which includes FTM and MTF persons
      • Female-to-Male (FTM) - individuals born physiologically female but who identify with male gender roles
      • Male-to-Female (MTF) - individuals born physiologically male but who identify with female gender roles
    • May identify as gay, lesbian, bisexual, transsexual, or heterosexual
  • Health Care for the Transgender Community
    • Many "transition" to assume a life more congruent with their gender identity by:
      • Gender Role Changing- adopting the dress of and social roles associated with the opposite biological sex
      • Hormone Therapy - used to achieve some of the secondary sexual characteristics associated with the opposite biological sex
      • Gender Reassignment Surgery- surgically removing or reconstructing genitalia to functionally resemble the reproductive organs of the opposite biological sex
    (“Transgender Health,” 2005)
  • Health Care for the Transgender Community
    • Lack of:
      • population-based studies
      • health surveys with gender-variance variables
        • Statistical and epidemiological data specific to the TG community is-
          • Minimal
          • Inconsistent
    • A Step in the Right Direction
      • In 2002, FTM and MTF gender identifications became reporting options in publically funded HIV counseling and testing sites in California
    (Keller, 2009)
  • Cultural Considerations of the TG Community
    • Economic marginalization
      • Employment discrimination
        • 33% of TG individuals report job discrimination
      • Lower levels of education
    • Societal marginalization
      • Stigmatized, fringe group
      • Frequent estrangement from family and former friends
    • Professional marginalization
      • Sex work
        • estimates range from 42-59% for subgroups in TG community
          • Mental health disorders
          • HIV/STDs
          • Virus-related Cancers
          • Substance abuse
    • Transphobia prevents many transgendered individuals from seeking and/or receiving comprehensive health care
    (Keller, 2009)
  • Health Care Needs Unique to the Transgendered Client
    • Appropriate care of the original biological sex
    • Appropriate care of anatomical changes resulting from-
      • Hormone Therapy (HT)
      • Gender Reassignment Surgery (GRS)
    (“Transgender Health,” 2005)
  • Health Care Needs Unique to the Transgendered Client
    • Mental Health Care
      • Required prior to:
        • Hormone Therapy (HT)
        • Gender Reassignment Surgery (GRS)
      • Provider:
        • Evaluates patient's mental state and coexisting psychiatric conditions
          • TG patient's suffer disproportionately from mental illness
        • Evaluates patient’s eligibility for HT or GRS
        • Provides access to supportive resources
    (“Transgender Health,” 2005)
  • Current Health Care Barriers to the TG Community
    • Medical care
      • Bias and discrimination in the medical community
      • Delayed medical care
      • Lack of gender-variance variables in health surveys
      • Lack of cohort studies and lack of research on long-term hormone effects
    • Mental Health
      • Few providers who are experienced with TG patients
      • Reluctance to seek care; limited access to care due to insurance policies
      • Negative exposure to insensitive providers
      • Negative reaction to sex and gender transitioning from peers
    • Hormone Therapy
      • May not be covered by insurance
      • Risks associated with unsupervised therapy; increased risk of some forms of cancer
    • Surgical Intervention
      • Cost prohibitive
      • Few experienced surgeons
      • Post-operation complications
    (Slide taken directly from “Transgender Health,” 2005)
  •  
  • Tips for Working with TG Clients
    • Welcome transgender people by advertising services in the LGBT community and prominently displaying transgender-positive cues in your organization
    • The Golden Rule- Treat transgender clients as you would want to be treated
    • Remember to always refer to transgender clients using the name and pronoun that corresponds with their gender identity
    • If uncertain about a person's gender identity, ask politely for clarification
    • Help establish an effective policy for addressing discriminatory comments or behaviors in your organization
    • Always focus on providing excellent care and refrain from indulging in questions out of curiosity
    • Remember it is inappropriate to ask transgender clients their genital status if it is unrelated to their care
    • Always adhere to HIPAA guidelines- Never disclose a client's transgender status to anyone who does not have the explicit right to know
    • Become knowledgeable about transgender health care issues
    (Slide directly quoted from “10 Tips for Working,” 2002)
  • References
    • Brown University Health Education. Health Concerns for Bisexuals . 2010. Retrieved from http://brown.edu/
    • Center for Disease Control. Lesbian, Gay, Bisexual, and Transgender Health . 2010. Retrieved from http://www.cdc.gov/lgbthealth/
    • Gates, G.J. (2006). Same Sex Couples and the Gay, Lesbian, Bisexual Population: New Estimates from the American Community Survey . Los Angeles. The Williams Institute, UCLA School of Law
    • Gay and Lesbian Medical Association. (n.d.). Mission. Retrieved from http://www.glma.org/index.cfm?fuseaction=Page.viewPage&pageId=532
    • “ Health With Pride- Bisexual Health”. Retrieved from http://www.healthwithpride.com
    • Robinson, G. & Cohen, M. (1996). Gay, lesbian, and bisexual health care issues and medical curricula . Canadian Medical Association Journal, 155(6), 709-711.
    • UC Riverside LGBT Resource Center. Bisexuality Basics . 2010 . http://www.out.ucr.edu
  • References
    • HealthCommunities.com. (2005). In S. J. Swierzewski (Ed.), Transgender health . Retrieved from http://lgbthealth.healthcommunities.com/ transgender/index.shtml.
    • Keller, K. (2009). Transgender health and HIV . Retrieved from http://lgbthealth.healthcommunities.com/transgender/index.shtml
    • Taylor, A.,Robertson, A. (1994) The health needs of gay men: a discussion of the literature and implications for nursing. Journal of Advanced Nursing, 20(3):560-6.
    • Transgender Law Center (2002). 10 tips for working with transgender individuals . Retrieved from http://transgenderlawcenter.org/pdf/ Provider%20fact%20sheet.pdf
    • Transgender Health Care Access Project. (2002). Medi-Cal and gender reassignment procedures . Retrieved from http://transgenderlawcenter.org/ pdf/MediCal% 20Fact%20Sheet.pdf
    • Transgender Law Center (2002). Transgender health care access project . Retrieved from http://www.transgenderlaw center.org/healthcare_access.html
    • The Royal College of Nursing. (2003). The Nursing Care of Lesbian and Gay Male Patients or Clients. Retrieved from http://www.rcn.org.uk/__data/assets/pdf_file /0007/78577/002018.pdf