On Being Inclusive

One of the things we strive for, given our mission, is to be inclusive within the Nursing Section.  That makes sense, as we are working to ensure that our health systems are inclusive of and responsive to all across the gender and sexual spectra.  Since we’re a group of humans, though, it is definitely a work in progress.

At this past Summit in Philadelphia, I was ecstatic to meet a couple of LPNs in attendance.  Having spent the first part of my clinical career in sub-acute and long-term care, I have a healthy respect for the knowledge and expertise of LPNs and the role they play in those settings.  In New England, it seems this is the primary area, along with home care, that LPNs remain a strong presence, as many hospitals have adopted RN-only policies, but I gathered from those I met at the Summit that this is not the case in other regions of the country.  LPNs and LVNs are part of our front-line of patient care, and we need them as much as any other nurse to help in this work.

We definitely want to make sure we’re inclusive of all our nurses, from LPN/LVN through APRN.  But I also heard from those nurses that they weren’t sure how they would be received, as their perception was that the Nursing Section is primarily for RNs, and particularly RNs in academia.  That’s not a perception that I think any of us want or intend to be projecting!

One item I identified as an obvious (and easy-to-fix) cue was our Twitter handle.  Originally, it was the Twitter handle of the research work group, so GLMA_RNs was intended to capture both the fact we were “research nurses” and that the group at the time was composed entirely of “registered nurses.”  Since that has evolved, and now that Twitter handle is for the whole section, however, that wordplay is obsolete and the handle definitely signals “we’re all RNs here.”  So it has been changed, and you can now find us on Twitter at @GLMA_Nsg .

If you are an LPN or LVN or just have thoughts on how we can be more inclusive of all nurses, please share those thoughts in the comments.

Banned or Not, Avoiding These Words is a Concern

In the wake of the article in the Washington Post on December 15 stating that the current administration has banned the use of specific words in budget documents from the Centers for Disease Control (CDC), including, “transgender,” “fetus,” and “evidence-based,” several organizations, including GLMA, have made statements opposing this.  

From GLMA: “This past year, the Trump administration has continually demonstrated that it is no ally of the transgender community, nor the entire LGBTQ community, by issuing policy to ban transgender individuals in the military, rescinding protection guidelines for transgender students in schools, eliminating gender identity questions from surveys of older Americans, and fighting gender-identity non-discrimination regulations in healthcare. This directive is yet another attack on transgender individuals.”

From the ANA: “From the very first days of Florence Nightingale’s work, nurses have relied on evidence-based practice to provide quality care. News stories indicating that the Administration told the CDC not to use words including “diverse,” “vulnerable,” and “evidence-based,” have sparked justifiable concern.”

In the Washington Post report, the CDC is said to have been given alternative phrases, as follow:

In some instances, the analysts were given alternative phrases. Instead of “science-based” or ­“evidence-based,” the suggested phrase is “CDC bases its recommendations on science in consideration with community standards and wishes,” the person said. In other cases, no replacement words were immediately offered.

This alternative is even more alarming for LGBTQ issues, since this “alternative” leaves wide open the ability of certain communities that do not wish to acknowledge LGBTQ existence, much less rights, to have the right to deny the science and evidence that points to serious disparities in our communities.

The CDC, while having no visible statement on the controversy on their own website, is disputing the claims in the original article.  Dr. Brenda Fitzgerald, director of the CDC, has issued several tweets on the theme that “There are no banned words.”  She also issued a statement to news outlets to this effect.  The Washington Post has acknowledged this statement in a follow-up editorial, but notes that even if this is an internal guidance as opposed to an external mandate it is still a concern, just a slightly different concern.

Whether this list of words to avoid came from the administration as a directive or from within the CDC as guidance to help get the current administration and/or congress on board with their budget, the net effect is the same: to minimize and potentially erase the needs of at-risk groups, whether they be deemed vulnerable, eligible for entitlements, transgender, etc.  Assurances that “HHS will continue to use the best scientific evidence available to improve the health of all Americans” are sufficiently broad and vague as to not be reassuring at all.  As the GLMA statement says, “nothing short of a clear, strong statement [that the CDC will continue to use science-based approaches to improve the health and well-being of the full diversity of the American people, including transgender individuals] will fully absolve any doubts regarding the inclusion of transgender people in the communities that are served under the mission of the CDC.”

As we watch and wait to see what the ultimate outcome will be, the nurses of the GLMA Nursing Section remain committed to evidence- and science-based care of the full diversity of our patients, from the time they are a fetus until the end of life, including those who are vulnerable, who depend upon entitlements, and particularly those who are transgender.

Public Perceptions of Sexual Violence and the LGBT Community

Warning: This post contains sensitive content related to sexual violence.

2017 has been a year of renewed attention to sexuality, but in a different context than usual. From public protesting of sexual harassment at the Golden Globes to the resurgence of the #MeToo movement, people of all genders and sexual orientations have banded together to reclaim their sexual rights and fight against injustices in the face of political oppression. In fact, the problem of sexual violence has garnered so much attention that Time Magazine’s “Person of the Year” is the Silence Breakers– those individuals that, while unique, all shared a common story of sexual harassment or abuse. We know from research that sexual violence is an especially pertinent problem for sexual and gender minority persons, who are victimized at similar or higher rates than heterosexual counterparts. But what happens when LGBT identities are brought into the conversation as perpetrators?

When Kevin Spacey was accused of harassing young men, he took the opportunity not only to apologize, but also to publicly identify as a gay man. Some outspoken LGBT figures have claimed that this admission was little more than an attempt to “hide under the rainbow” instead of taking responsibility. Now we are forced to wonder how that reflects on our communities. As identities that have historically (and inaccurately!) been stereotyped as focused on sex, LGBT identities have often been marginalized and reduced to erroneous and demeaning stereotypes. However, we can also recognize the tension between avoiding this stereotype and the fact that sexual assault is, has been, and will likely continue to be a problem within the LGBT community. Given this tension, are LGBT individuals now portrayed in an even worse light when someone accused of sexual harassment apologizes and self-identifies in the same breath?

What we can take from this movement, in the midst of all the negative and “fake” news floating around these days, is that these important issues are being discussed. People of all genders and sexual orientations are standing up for their rights, sexual and otherwise. But here at GLMA, we’re interested in linking these discussions to what we know- so we’d like to put out a call to our readers. Do you know of research linking these ideas? How might these misguided ideas of identity and behavior be inaccurately reflected in future policy and stereotype reinforcement? What are your opinions, and how can we move forward in a positive and non-re-traumatizing manner?

For anyone who needs it, resources to LGBT friendly sexual violence resources.

LGBTQ election victories – a new GLMA Nursing resource!

Recent  U.S. elections (state, regional and local) resulted in a record-breaking number of history-making results – women, people of color, and LGBTQ people winning in unlikely places!  Just a few days before these elections hardly anyone would have predicted the kinds of victories that happened, but they happened!  This inspired us to document LGBTQ election victories in places all over the globe, and we started a list, with links to more information about the people in our “Resources” section on the GLMA Nursing website.  Check it out!  We know it is far from complete – we want to eventually include LGBTQ elected officials already in office at any level – from local school board, to city councils and mayors, to state legislatures.  If you know of someone we have not yet listed, please let us know.

Here is our list so far – from the November 7th and November 14, 2017 elections:

Allison Ikley-Freeman – Oklahoma State Senate (Elected November 14, 2017)

Andrea Jenkins – Minneapolis City Council (Elected November 7, 2017)

Danica Roem –  Virginia House of Delegates (Elected November 7, 2017)

Jenny Durkan. – Seattle, Washington Mayor (Elected November 7, 2017)

Lisa Middleton – Palm Springs, California, City Council (Elected November 7, 2017)

Tyler Titus – Erie, Pennsylvania School Board (Elected November 7, 2017)

2017 Nursing Summit

Cover Shot

The 2017 GLMA Nursing Summit in Philadelphia was an overall success.

Our new Chair, Caitlin Stover, and Past Chair, Michael Johnson, facilitated the events of the day.

Caitlin and Michael

Jesse Joad and Hector Vargas welcomed us at the start of the day.

Hector

After which, Caitlin Stover led us in an innovative “Speed Networking” exercise, enabling lots of new connections to be made.

Speed Networking

Throughout the day, we had “pop-up” presentations of student work.  These included

Kasey Jackman Nonsuicidal Self-Injury among Transgender People
Jessica Marsack Couple’s Coping and Health Maintenance Behaviors: Exploring Dyadic Stigma in American Gay Male Couples
Shannon Avery-Desmarais Cultural Humility: Is it Ready for Prime Time?

José A. Parés-Avila led a panel discussion on Intersectionality in the LGBTQIA Nursing Agenda with Alana Cueto, Andrew Fernandez, and Christina Machuca.  We also heard from Jeffrey Kwong, Walter Bockting, Kasey Jackman, Billy A. Caceres on the  Program for the Study of LGBT Health at Columbia University Medical Center.

After lunch, we gave our annual Nursing Excellence Award to the Mazzoni Center, Philadelphia’s Center for LGBTQ Health and Well-Being.  Pictured below is Ralph Klotzbaugh, our immediate past Budget Officer, with Dane Menkin of the Mazzoni Center.  Dane also gave a presentation entitled “Transgender Care: Protected, Honored, and Provided by Nurses”

Award Presentation

Jessica Landry and Todd Tartavoulle presented the preliminary results of the ongoing Louisiana State University educational initiative, Delivering Culturally Sensitive Care to LGBT+ Patients.

As always, we also broke out into smaller skill-building workgroups.  Stay tuned for more information on those!

During our business meeting, we confirmed our Leadership Team for 2017-2018:

Caitlin Stover, Chair,

Caitlin

 

Caroline Dorsen, Chair-Elect,

Caroline

 

Michael Johnson, Past Chair,

Michael.png

 

Diane Verrochi, Recorder,

Diane.png

 

Tracey Rickards, Budget Officer,

Tracey.png

 

Shannon Avery-Desmarais, Student Representative,

Shannon

 

Laura Hein, GLMA Board Liaison,

Laura.png

 

and our continuing Web Team.

Web Team.png

Next year, we’ll be having the 2018 GLMA Nursing Summit on October 10 at the Flamingo Hotel in Las Vegas, Nevada.  We hope to see you then!

The Joy and Challenge of Diversity

There is no doubt that in the GLMA Nursing Section we see more diversity than in any other gathering of nurses!  Every time we come together, I have the exhilarating experience of being among my own people – people who are living and showing to the world who we are from the inside out!  I happen to be a cisgender lesbian who by any

2005-05-26 13.39.25_preview

Peggy circa 1984

honest account can “pass” in the heteronormative majority world, although many of my friends guffaw and protest when I claim that this is so!  In most nursing gatherings, we see many strong women, and some men, who, while conforming to many norms of gender “presentation,” still show postures, behaviors, words and actions that clearly conform to mainstream hetero-reality of male-ness and female-ness. Do not get me wrong – there is nothing wrong with this particular presentation of self – the problem is that there is a certain conformity that makes those who “deviate” from the “norms” stand out as different.  When we gather as a GLMA nursing Summit, the tables are almost turned, wherein we see, and celebrate, so many expressions of identity that the “norm” is close to a minority!  For most of us there, we revel in the sense of being in the company of others who are showing our truth in visible ways – not to challenge any social or cultural norm, but simply to be who we are!

Despite the utter joy and celebration of this and other LGBTQIA gatherings, it is important to recognize the challenges that come along for the ride.  Together we represent not one, but many cultures – networks of others who fit (or mostly fit) where we are situated in the alphabet soup.  All of us are challenging the dominant hetero-normative cultures in some way – even, and especially, our allies.  But each of our alphabet groups have experiences, understandings, views of the world that emerge from their own particular identity.  I believe we may have more in common with one another than differences, but for me, it still it tends to come as a surprise when I recognize the significant differences that I had not yet imagined.  It is clear that each of us simply has a different “understanding” of the world. I know that I am still learning what it means to live in the spaces of identity that express who I am.  I recognize that despite my 40+ years of being completely “out” as a lesbian, I am still a beginner – I am still learning the nuances, the language, the possibilities faced by each person whose identity is different from mine.  As I experience the Summit, it seems clear that we are taking on the horrendous challenges of communicating with one another, being sensitive to one another’s experiences, and exercising the gentle art of generosity of spirit for those who are not yet “savvy” to another person’s particular ways of being.  Sometimes I cringe when someone makes a “mistake” (such as using the wrong pronouns) – sometimes I cringe when I realize I made a “mistake” (such as using the wrong pronouns)!!  But at least I cringe!!  This is what makes it possible to move on, coming to a space where we become more confident in our own identities, while celebrating and appreciating the rich diversities of others!

Despite these challenges  – what a gift, a true delight, a rare and wonderful time it is when we come together (no pun intended!!!).  If you are reading this and were not able to be in Philadelphia this year – plan now for Las Vegas – October 10th, and the GLMA conference through October 13th!  I certainly plan to be there and hope you can too!

Virtual Journal Club – Note From the Editor-in-Chief [of the AJPH]: Who Wants to Exclude Older LGBT Persons From Public Health Surveillance?

Squeezing in a fourth article before the Nursing Summit on September 13.  Here is the citation information to get started:

Morabia, A. (2017). Note From the Editor-in-Chief: Who Wants to Exclude Older LGBT Persons From Public Health Surveillance?. American Journal of Public Health 107(6), pp. 844–845. Retrieved September 1, 2017 from http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.303851.

This editorial examines several concerns around both the decision to remove a demographic question on sexual orientation from the National Survey of Older Americans Act Participants and the rationale given for doing so.  Morabia particularly takes a look at the methodology used to survey rare groups (and the lack of understanding that this decision showed) as well as the importance of doing so to ensure the health of these groups is given consideration in developing policy and allocating resources.  (This decision was reversed in June of this year.)

What are your thoughts on this editorial?  Do you feel that it balances concerns around health equity with concerns around methodology and whether the decision-makers understood it?  What might you have said/done differently if you were to write a similar opinion piece?

Those are just some starter questions.  Please don’t let them limit you!

Also, please suggest any articles you would like to discuss here.  It’s helpful if they’re freely available online, but that’s not an absolute requirement.

Virtual Journal Club – Delivering Culturally Sensitive Care to LGBTQI Patients

Our third Virtual Journal Club article is by another GLMA Nursing section member, Jessica Landry.  Here is the citation information:

Landry, J. (2017). Delivering culturally sensitive care to LGBTQI patients. The Journal for Nurse Practitioners, 13(5), 342-347. Retrieved August 3, 2017 from http://www.npjournal.org/article/S1555-4155(16)30828-5/fulltext .

This article gives what I imagine many reading this blog would consider very basic guidelines for providing culturally sensitive care to LGBTQI patients, which makes sense as it is published in a journal aimed towards nurse practitioners in general.  It also covers a lot of ground, including an overview of health disparities and barriers to care as well as a glossary of terms, a vignette to illustrate some of the challenges, and some suggestions on how to handle certain situations.

What are your thoughts?  Are there elements of this article you think would be particularly helpful in educating fellow nurses?  Are there elements you think you’d prefer to address differently?  Did this give you an idea for submitting a follow-up article of your own, perhaps, to continue the conversation?  Please comment with whatever thoughts you care to share.

Also, the articles chosen so far have come from a biweekly report I receive from EBSCO about new articles on LGBT health.  These are just the ones that happened to jump out at me for one reason or another, though.  If you have come across an article you’d like to see discussed here (or have written one!), please share that in the comments as well.

 

Virtual Journal Club – A grounded theory of bisexual individuals’ experiences of help seeking

For our second virtual journal club “meeting,” I chose the following article.  Unfortunately, what I do not have is a live link for this one.  I’m hoping that many here will have access through their academic or clinical institutions.

MacKay, J., Robinson, M., Pinder, S., & Ross, L. E. (2017). A grounded theory of bisexual individuals’ experiences of help seeking. American Journal Of Orthopsychiatry87(1), 52-61. doi:10.1037/ort0000184

As any work using grounded theory would, this has a lot to dig our teeth into!  I’ll give a bit of a summary here for those not able to access the full article.

The authors start with a discussion of mental health disparities of bisexual-identified individuals as compared with both heterosexual- and gay- or lesbian-identified individuals.  While acknowledging that the data are not as robust as might be ideal, the authors feel confident that this population’s experiences are distinct enough to merit exploration.  The authors also expressed a hope that, while the population chosen was bisexual people, that this could serve as a more general case study of help-seeking by a group impacted by minority stress (p. 52).

In their breakdown of participant demographics, the authors note that the orientation identities covered include, bisexual, fluid, pansexual, queer, and two-spirited (p. 54, table 1).  It’s interesting to note that while 20% of participants identified as First Nations, only 10% identified as two-spirited, an identity specific to First Nations and Native American people.

The authors framed help-seeking as a process, with the stages being “Consideration of Services,” “Finding Services,” and “Accessing Services” (pp. 55-56).  They then went on to analyze themes that emerged around factors that influenced participants’ choices and actions during these stages.

Many of the barriers to access discussed were general, such as the fact that non-biomedical care (i.e. therapy other than medication) required out-of-pocket payment and that the overall Mental Health Services (MHS) in Canada tend to treat medication as first-line treatment.  Finding practitioners with positive and accepting attitudes towards lesbian, gay, and bisexual (LGB) people was also identified as a barrier.  More bisexual-specific barriers included history of poor experiences with providers around their identity such as being told bisexuality does not exist (p. 56).

Facilitators to access also emerged, such as socioeconomic privilege, self-advocacy, and the existence of some resources specifically for locating affirming practitioners (pp. 57-58).  Unfortunately, these facilitators for some imply some of the same barriers for others (finances, availability of information on which practitioners are bisexual-accepting).

The authors acknowledge that negative anecdotes were prevalent in their findings.  For example, they note that the financial barriers led to delaying care until the symptoms being experienced became urgent.  They also noted the importance of social networks in facilitating locating LGB-positive providers.  Many participants reported their first experiences with MHS had been at university, where care was freely available, and the authors include in their implications a recommendation that Ontario MHS look at replicating that model to facilitate wider access (pp. 59-60).

Another implication and recommendation that will surprise no one here is to improve the curricula of mental health providers.  One sentence here stuck out to me in particular:  “It is important for service providers, even those that are affirming of nonheteronormative relationships, to be competent at working with individuals whose experiences and identities are difficult to categorize in binary terms” (p. 60).  In the previous article discussed, the focus was on people whose gender identity does not fit into “neat” binary categories.  Selecting these two articles back-to-back as both focusing on non-binary identities wasn’t planned, but is a happy coincidence.

What are your thoughts?  Do you find the process model of help-seeking the authors used to be helpful, or would you have taken a different approach?  What do you think of their idea that this (or any) specific minority group could be seen as a case study for minority groups in general?  What would you think are the key take-aways for nurses whose primary practice area is mental health, whether in Ontario where the study was or elsewhere?