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Dalhousie Nursing : Cultural Competency "GLBTI" Presentation Febuary 2011
 

Dalhousie Nursing : Cultural Competency "GLBTI" Presentation Febuary 2011

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Dalhousie Nursing : Cultural Competency "GLBTI" Presentation Febuary 2011Developed for the BScN program at Dalhousie University School of Nursing.

Dalhousie Nursing : Cultural Competency "GLBTI" Presentation Febuary 2011Developed for the BScN program at Dalhousie University School of Nursing.

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  • Introduce Selves (quick background, graduated Dal 2009, ER and ICU Nurses) Our connection to this topic and why we are passionate about it. (Community Work, a missing aspect of current clinical practice) Thanks for coming. Stop and ask if there are questions or clarifications Midterms? Clinical Experiences to date? Where does everyone want to work when they are done? Ideas? Dreams? On to the meat and gravy
  • JONATHAN Acronym Definition – there are now people who think Q Q should be added to the list. Queer and Questioning. We speak for everyone but most of this presentation focuses on gay mens health issues– Impacts on Nursing practice – We Challenge you to change and develop cultural competency in your future practices” ---Fresh lenses on nursing practice. Conducting Health Assessments with diverse clients focus on communication Case Study Tool provided in the model of care Case study (opportunity for discussion)
  • DANIEL People identify with their sexuality along with ethnicity, race, class, religion, spirituality, etc. Intersex: “ Intersex in humans refers to intermediate or atypical combinations of physical features that usually distinguish female from male . This is usually understood to be congenital , involving chromosomal , morphologic, genital and/or gonadal anomalies, such as diversion from typical XX-female or XY-male presentations, e.g., sex reversal (XY-female, XX-male), genital ambiguity, sex developmental differences. An intersex individual may have biological characteristics of both the male and the female sexes” The point of this statistic is that GLBTI populations exist in urban and rural settings. We will all experience having a GLBTI client/patient at some point in our careers. Classically, GLBTI populations were thought to be urbanly based. GLBTI exhists everywhere according to the literature.
  • JONATHAN Even though we have the right to legally marry, the majority of couples choose to be common law. DEC 9/2004 Canadian Supreme Court ruled “allowing same sex couples to marry civally as per the same rights in the charter of rights and freedoms … officially became law July 20/2005. ** ONLY ONE YEAR TO BECOME MARRIED….. This is a cultural minority!~ Less than 1% “ presence” yes. “Population” no. This is because of the next point, which leads to under-reporting. We are seeing numbers increase over the last few years as GLBI is becoming more culturally acceptable in rural and urban geographical settings. Homosexuality is romantic and/or sexual attraction or behavior among members of the same sex or gender . Coming out: Accepting ones homosexuality (internally and externally) and displaying such in a public forum (family, friends, workplaces). You never just come out once, everytime you meet someone you ‘come out’. This is something GLBI clients have to do throughout their life. Imagine having to explain this to every new doctor, nurse, friend. Etc. Homophobia is a range of negative attitudes and feelings towards lesbian , gay , bisexual , and in some cases transgender and intersex people **LEARNED RESPONSE 7.)Internalized homophobia (or egodystonic homophobia) refers to negative feeling towards oneself because of homosexuality. (Could this be a case of self harm? Isolation? Disturbed body image? Disturbed self image? Depression? Anxiety? Failure to Cope. …… leads to secondary coping mechanisms…. Which are not always ‘healthy’ we will talk about that later…. 8.)DO NOT PRACTICE IN THE LENS OF HETEROSEXISM! DO NOT ASSUME EVERYONE IS STRAIGHT OR GAY FOR THAT MATTER. It is our duty to be unbiased practitioners. 9) Heterophobia describes reverse discrimination based on sexual orientation and implies an irrational fear of or aversion toward heterosexual people and institutions **LEARNED RESPONSE
  • JONATHAN -They do not disclose -Usually are in heterosexual female relationships -Often are married -Often have children -Very Illusive in regards to scientific data. -Impossible to identify without self disclosure.
  • JONATHAN GLBTI was punishable… and still is in some third world countries (Even in some first world countries anti-gay activists) Sex became free and ok to talk about. Taboos were lifted. Sex became ‘healthy’ AIDS/HIV became a ‘gay’ disease. First imposed to ‘gay men’ NO Sex reassignment surgery is covered in NS
  • JONATHAN IS our best guess. The biggest point of this slide is that no one knows for sure. There are a few strong theories though. Second semester sex characteristics are developed CT Scans, 90% efficacy rate. (Gay mens CC mates the size of a heterosexual female) They can identify this 90% of the time in trials.
  • DANIEL You should be able to list this off in your sleep by now. Sexuality effects each of these determinants of health . Less income Less social supports Low education and literacy rates Higher unemployment rate Poor life skills (coping) … . Think about applying the determinants of health to this population and using your findings to mould your assessments. (*Caution: Never assume just be aware)
  • DANIEL Gay-alliances are being implemented in many settings but there is a lot of work to go. Social isolation can lead to depression and anxiety (ie. Negative Health outcomes)
  • DANIEL
  • DANIEL
  • JONATHAN How do we adequately address GLTBI health care concerns and related issues?
  • JONATHAN Entry level competency “ Life long process” -we are never experts and it’s ok to be wrong and admit it. Challenge your co-workers to practice to their full scope of cultural competence. This is what makes us RN’s!!!!!!!!!!!!!!!
  • JONATHAN Story: Many nurses feel uncomfortable proving care to GLBTI clients. Tell story of first job…. “You’re the expert, were glad we have you here” We will get you whenever we have a gay patient. …… *sigh* What about when im not working?
  • DANIEL Think of pride as a healing event
  • DANIEL Practitioners should be aware of and know how to deal with the following ….. Pt just goes through sex reassignment surgery, how do you heal their body and mind.
  • DANIEL There are issues affecting the accessibility of services for the GLBTI community… these are just some. We need to help people overcome and reduce stigma (education) in order to help alleviate these issues.
  • JONATHAN What about same sex co-habitation in nursing homes? How would your health assesment in first year on your client in N1020 have changed?
  • JONATHAN Points for reflection: -”Challenge the idea that we treat everyone the same” (ie: Sex after prostate surgery. Do we provide GLBTI appropriate teaching methods? -”Focus on safety and equity” As we all know this will open our therapeutic relationships and improve patient outcomes “ its about being aware--- know research and local resources. Leave a pamphlet in your staff room. Be aware that culture changes take time -Advocate politically.. (ex. Proper terminology in pamphlets for recovery pts) Its all comes down to reflecting on your own prejudices.
  • JONATHAN Develop a caring and sensitive manner towards the GLBTI assessment Its ok to be wrong. Make mistakes. Its ok to tell the client they are the experts and they can educate you.
  • JONATHAN Here are some examples
  • DANIEL We approached this topic through the ‘nursing process’ which you should all be familiar with
  • JONATHAN Example of harm reduction interventions: Using more lubricant if the patient is opposed to safe sex Teaching patients how to wash their sex toys. Teaching how to clean needles or how to locate needle exchanges (mainline/direction 180)
  • DANIEL
  • DANIEL
  • JONATHAN Here is an example of a model of care we like and use in our practice currently. There are many others out there. Research and become involved.
  • JONATHAN
  • DANIEL
  • DANIEL
  • DANIEL
  • JONATHAN
  • JONATHAN
  • DANIEL
  • DANIEL These are only a few resources ….
  • JONATHAN
  • **What if Mr Smith states “I need you to promise not to tell anyone else… including his wife”
  • DANIEL
  • TOGETHER

Dalhousie Nursing : Cultural Competency "GLBTI" Presentation Febuary 2011 Dalhousie Nursing : Cultural Competency "GLBTI" Presentation Febuary 2011 Presentation Transcript

  • Cultural Competency - GLBTI “ Sexual Orientation as a Determinant of Health” NURS 2080 Jonathan Veinot BScN RN Dan Cashen BScN RN
  • Outline
    • GLBTI Population
    • Social and Cultural Aspects of GLBTI community
    • Health risks and practices
    • Impacts on Nursing Practice
      • Communication
    • Case Study
    • Models of Care
    • Evaluation of services offered
    • Resources
  • What does GLBTI mean?
    • Gay, Lesbian, Bisexual, Transgender, Intersex, Questioning/Queer
      • Large umbrella term used in research to describe the population
      • Subcultures within each (eg. Twink, Bear)
      • Identity (sexual orientation)
    • Intersex : both male and female characteristics
    • 2% to 3% self-identify as gay (homosexual) in North America (Stamler and Yiu, 2008).
    • Half of all same-sex couples in Canada lived in the three largest census metropolitan areas (CMA):
    • 21.2% — The proportion of all same-sex couples who resided in Toronto in 2006.
    • 18.4% — The proportion of all same-sex couples who resided in Montréal in 2006.
    • 10.3% — The proportion of all same-sex couples who resided in Vancouver in 2006
    • (Statistics Canada, 2006)
  • GLBTI Population
    • 45,300 — The number of same-sex couples in 2006 (Canada). Of these, about 7,500 (16.5%) were married couples and 37,900 (83.5%) were common-law couples.
    • Same-sex couples represented less than 1% of all couples (married and common-law) in Canada
    • Decreased rural presence compared and urban geography (Stats Canada, 2006).
    • GLBTI highly under-reported (ie. MSM)
    • Terminology
    • Homosexuality
    • “ Coming out”
    • Homophobia
    • Internalized Homophobia
    • Heterosexism : viewing the world through the lens of heterosexuality
    • Heterophobia
  • MSM/WSW
    • Harvey et al. (2006) describes MSM to be;
      • New in context to awareness
      • Enjoy having causal sex with men but not self identifying with the ‘gay’ community
      • Pose particular barriers to health promotion and disease prevention
  • Some history of GLBTI
    • History of isolation, murder and sodomistic behaviour
    • Gay Men (Homosexuals) referred to as a medical term
    • 1960’s : The Sexual Revolution
    • 1980’s AIDS scare lead the world into GRIDS & HIV connotations (these impressions still live strong in today's society)
    • Mental Illness DSMIII (1986 removed)
    • Gay Human Rights instated in 1993
    • In 2005 Canada became the fourth country in the world and the first country in the Americas to legalize same-sex marriage with the enactment of the Civil Marriage Act
    • One in Ten hate crimes reported in Canada relate to violence towards the GLBTI community (Stats Canada, 2006).
    • 2010: Sex reassignment surgery covered by provincial health care in British Columbia (except recovery/medical supply cost)
  • What makes us “Queer” ?
    • Combination of Biological, Social and Environmental factors.
    • Second Trimester in Pregnancy
      • Stress Hormone
        • Cortisol
        • Estrogen
    • Viral Theory
    • Corpus Callosum increased in size
      • Matches size of female anatomy
  • Before we go any further…
    • What is health?
    • “ Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 2008).
    • What determines our health?
    • 1. Income and social status
    • 2. Social support networks
    • 3. Education and literacy, i.e. health literacy
    • 4. Employment/Working conditions
    • 5. Social environments
    • 6. Physical environments
    • 7. Life skills
    • 8. Personal health practices and coping skills
    • 9. Healthy child development
    • 10. Biology and genetic endowment
    • 11. Health services
    • 12. Gender
    • 13. Culture
  • Social and Cultural Aspects of GLBTI community
    • Social Community
      • “ Gay” Places
        • Places that are identified by the community to harbor and facilitate open sexuality without consequences.
        • More common in urbanized areas than rural areas.
      • Increase occurrence of online communication.
        • Instant messaging
        • Dating/ “Cruising” websites
      • Lack of safe environments leading to social isolation at schools, workplaces, and public venues.
  • Social and Cultural Aspects of GLBTI community
    • Cultural Community
      • Stereotyping
        • Stereotyping occurs outside and within the gay community.
        • Those who identify with a subculture may not be accepted by that culture, which can lead to social and cultural isolation from within the community.
      • Cultures within Cultures
        • Any extraneous cultural beliefs will compound with gay community beliefs to create small pockets of communities within the gay community (Race, Religion, Gender, etc).
        • Gay Subcultures are born from physical and social parameters and are further compounded by extraneous cultural beliefs. (Bears, Twinks, Queens, etc.)
  • Social and Cultural Aspects of GLBTI community
    • Cultural Community
      • Practices amongst communities within cultures and subcultures will determine increased or decreased risk for undesirable health practices.
      • Each culture and subculture therefore requires unique interventions to educate and prevent undesirable health practices.
  • Refer Social and Cultural Aspects of GLBTI community
    • Challenge:
      • How to provide culturally competent care to a community that has unique social and cultural needs?
  • Our duty as Registered Nurses…
    • “ Respect diversity and demonstrate culturally competent nursing care”
        • CRNNS, Entry Level Competencies
  • Health Risks and Practices
    • Breaks down into a Physical, Social, and Mental Domains.
    • Risk for stereotyping the population
    • Lack of Access to Services
    • Lack of coping skills leads to an increase in risk taking behaviors.
    • Under-educated Health Care Professionals
    • Fear of acceptance leads many GLBTI members to avoid connections with the health care system.
    • Heterosexist Health Care System
      • Lack of GLBTI Policy, Diversity Training, etc.
      • Policy
  • Gay Pride
    • Pride is one week every year in which a city celebrates its gay community through events that help gay people to recognize their numbers, introduce services that may be unknown, and allows for people who may be afraid to express themselves in public to celebrate their individuality
  • Risk Assessment/Health History
    • Physiological Health
      • Cancer (*Anal, lung, liver), STI’s, HIV, Hep ABC, Anatomy/Surgical, unsafe-sex, Smoking, Steroid Use (Swami & Tovee, 2008)
    • Mental Health
      • Depression, Anxiety, Coping, Stigma, Stress, Suicide, Body image issues, anorexia, bulimia, self harm, social isolation
    • Social Health
      • Isolation, Support, Family, Education, Employment, Income, Family Doctor
    • Addictions
      • Alcohol, Tobacco, Illicit drugs (Cocaine, Ecstasy, Marijuana), IV Drug rate
  • Increased Risk of STI’s
    • “ Gay Men’s sexual risk taking
    • may be influenced by such
    • psychosocial factors as self-
    • esteem, mood prior to sexual
    • encounters, optimism or fatalism,
    • level of education and substance use”
            • (Peterkin & Risdon, 2003)
  • Access to Services
    • Barriers to receiving proper health care:
      • Fear of coming out to doctor, nurse, HCP
      • Lack of Knowledge of HCP/Support Organizations
      • Unbeknownst increased risk to STI’s and Cancers
      • Failure to accept sexuality
      • Fear of being diagnosed with illness
      • Health Care Services that are not prepared or capable of giving specified care to GLBTI population
      • Fear of testing and HIV
      • Fear of ridicule, stigma and judgements
      • Proper screening (mammograms, swabs)
  • GLBTI across the lifespan
    • Adolescents
      • Many “Queer and Questioning” Youth struggle to find their place in society
      • Sexual Exploration
      • Apprehension of GLBTI Health in school system
      • Coming Out (family, double lives, stress & coping)
        • Earlier in occurrence d/t mild acceptance in society
      • Bullying, Peer Pressure, Risky Behaviour
    • Adults
    • Elderly
      • What about the elderly?
      • Lack of research
      • Sex?
      • Under-reported
  • Break
    • Please take a 20 min break.
    • Video and Case Study when you return.
    • Thank you 
  • NurseTV: Gay & Lesbian Health
  • How do you find out …
    • … if someone is “Gay”?
    • … if a man is having sex with a man? ( MSM/WSW )
    • What do you say?
    • How do you ask?
  • Interview Questions
    • “ How do you self-identify?”
    • “ Do you consider yourself gay, straight, bisexual, etc?”
    • “ Do you have sex with Men? Women? Both?”
    • “ How do you define your sexuality?”
  • Implications for Nursing practice
    • Assessment
      • Comprehensive Health Assessment
        • Includes homosexual specific questions in a manner that eases the patient and facilitates sharing.
        • Avoids making assumptions of sexuality based on physical characteristics, mannerisms or appearances.
        • Uses effective therapeutic communication skills to facilitate a working relationship with the client.
      • Wellness Diagnoses
        • Identifies positive health behaviors and facilitates using strengths to enhance deficits.
        • Useful for patients with low self-esteem, distorted self image.
  • Implications for Nursing practice
    • Goals
      • Ensure to include the client in goal creation.
      • Be open to harm reduction interventions.
      • Be aware of barriers that may exist to the realization of goals.
  • Implications for Nursing practice
    • Planning
      • Use of available resources in your institution (GLBTI resource nurse, literature, colleagues, clinical resource nurse)
      • Collaborate with other health professionals to enhance care with a multi-faceted approach.
      • Be cognizant of the approach; include all determinants of health to help guide interventions.
      • Infrequent visits and lack of compliance create challenges for planning (never take it personally)
  • Implications for Nursing practice
    • Intervention
      • Use an appropriate ‘Model of Care/Tool’ to guide your interventions
      • Institution policies and procedures.
      • Include resources for the individual that may help to provide a first contact point with the health care system.
  • Culturally Competent Model of Care
      • Cultural Desire
      • Cultural Awareness
      • Cultural Knowledge
      • Cultural Skill
      • Cultural Encounters
    Flowers, 2004
  • Cultural Desire
    • Genuine interest in promoting the well-being of GLBTI patients
      • Code of Ethics
      • Standards of Care
      • Community awareness
    Flowers, 2004
  • Cultural Awareness
    • A deliberate & thoughtful process that examines personal biases and stereotypes
      • Homophobia : the learned prejudice which manifests itself as fear, hatred, ignorance and/or exclusion towards sexual minority groups
      • Do you laugh when someone tells a homophobic joke?
    Flowers, 2004
  • Evaluating Cultural Awareness as Nurses
    • Take advantage of education opportunities related to GLBTI issues
    • Be aware of discriminatory practices in the workplace and monitor any disrespectful behavior
    • Encourage nursing programs to address issues that affect GLBTI individuals in the health care setting
    Flowers, 2004
  • Cultural Knowledge
    • Maintaining a current, ongoing understanding of health issues affecting the GLBTI population
      • Lesbians are more likely to be diagnosed at advanced stages of breast, cervical, ovarian and endometrial cancer
        • Increased interval between pap smears
        • Reported negative experiences with health care providers
        • Physicians wrongly assume lesbians are at lower or no risk
    Flowers, 2004
  • Maintaining Cultural Knowledge as Nurses
    • Research
    • Attending educational workshops
    • Literature
    • Improving communication skills
    • Developing relationships with members of different sexual orientations
    Flowers, 2004
  • Cultural Skill
    • Using effective communication and assessment skills to collect culturally relevant data
      • Admittance forms with the term “relationship status” (i.e. partner)
      • Including a transgender option in gender check boxes
      • Use open ended questions and gender neutral language
      • Ensure consistent physical assessment skills
    Flowers, 2004
  • Cultural Encounters
    • Exposing oneself to different aspects of the GLBTI community through repeated face-to-face encounters.
      • Conducting research does not necessarily represent the GLBTI community because of possible fear of exploitation
      • Get “out” in your community!
    Flowers, 2004
  • Evaluation of Resources
    • Stepping Stone
    • Manna for Health
    • Safe Harbour Metropolitan Church
    • CATIE
    • CTAC
    • ACCB (AIDS Coalition of Cape Breton)
    • NACS Northern AIDS Connection Society
    • AIDS Vancouver
    • AIDSMAP.COM
    • Canadian AIDS Society
    • Public Health Agency of Can
    • Captial Health GLBTI services
    • Dalhousie Legal Aid Society
    • Youth Project
    • Canadian Rainbow Health Coalition
    • Direction 180
    • Mainline Needle Exchange
    • Ontario Gay Men’s HIV Prevention Strategy
    • CNS Pride Health
    • Healing Our Nations
    • ACNS
      • Health Fund
      • Making Ends Meet
      • Support Counselling
      • Education
      • Resource Center
    • Halifax Sexual Health Center
    • DalOUT
    • Halifax Pride Committee
    • Venus Envy
    • Sexual Health Center
  • Case Study
    • P. Smith is a 39 year old man who is admitted to the general surgery unit. During your admission data collection, Mr. Smith reveals to you that he does not consider himself a gay man, but does have sexual encounters with other men. He appears embarrassed when sharing the information and avoids eye contact.
  • Case Study
    • What changes to your assessment will you make?
    • What are some strategies that can facilitate a comfortable environment for Mr. Smith?
    • Should this information be shared with other health care professionals?
  • Case Study
    • Mr. Smith continues to share with you, and reveals that he engages in unprotected sex regularly in group settings. Drugs are present, but he denies taking any.
    • He states that there are no ways to meet “his kind”, and has to resort to online chat sites to meet other gay men.
  • Case Study
    • What resources are available for Mr. Smith to help him meet other members of the GLBTI community in healthy settings?
    • What interventions are most appropriate to promote health?
    • Who should be involved in planning this intervention?
  • Awareness
    • Is the key to maintaining culturally competent care
    • Never fully competent, always growing and developing in our individual skill sets.
    • By being unbiased, caring and open to new knowledge and understanding, we can enhance our practice to meet our diverse client needs.
    • Thank you for your time 
    • Goodluck in your final exams and clinical intersession!