Note: The author provides commentary on the article "Lesbian, Gay, Bisexual, and Transgender Health: Disparities We Can Change," also in this issue, by Fidelindo Lim, MA, RN.
Indeed, Mr Lim has provided an overview of lesbian, gay, bisexual, and transgender (LGBT) health issues that, sadly, have been missing from nursing curricula for far too long. Faculty may recognize that it is time for LGBT issues to be integrated into their teaching plans but many simply do not know where to start. Here are common fears and barriers that I have encountered and some suggestions to help overcome the barriers.
Barriers and Suggestions
I Am Heterosexual
"I am heterosexual and I don't know anyone who is LGBT; I just don't know anything about this population." Although many people believe they do not know anyone who is LGBT, in fact, most people do know someone-someone who has hidden this for years. It is not necessary to either be LGBT or to know someone who is to provide adequate content in your teaching related to LGBT health issues. Nurses care for many people who are LGBT in practice, many of whom do not disclose this fact when receiving healthcare. So here is the place to begin: learn why disclosure is so difficult for LGBT people and teach students how to create an interaction and context where it is safe for LGBT people to disclose if they choose to do so. The online only book, LGBTQ Cultures (also available on Kindle and Nook),1 provides an excellent orientation from which to begin.
Don't Have Time
"I don't have time to include another topic in my courses." Yes, time is a major challenge in all nursing curricula. However, given the severity of health disparities that persist for the LGBT population, the fact that LGBT people comprise at least 3% of the population (more than many racial minorities), and the fact that all healthcare providers do encounter LGBT people in their practices, it is incumbent on us to address this issue. Basic LGBT introductory content can be delivered to any group of healthcare students or providers in a 1- to 3-hour block of time. After introducing basic information, you can integrate understanding of LGBT issues as you present other content-inserting facts about LGBT disparities when you address specific healthcare concerns. For example, when your curriculum addresses breast cancer, you can include the fact about high risk for breast cancer among lesbians and a brief explanation as to why this disparity is thought to exist. You can also include case studies and case examples in which someone in the scenario is LGBT, exploring how that influences how that case could be approached. The education portion of the lavenderhealth.org Web site2 has a rich collection of case studies and suggestions for integrating LGBT issues in any healthcare provider curriculum.
Against Religious Beliefs
"LGBT lifestyles are against my religious beliefs (and/or my institutions beliefs)." If this is your concern, ultimately, you will need to resolve this in a manner that is comfortable for you. All nurses and other healthcare providers face this kind of tension when a patient's beliefs, desires, and needs contradict their own. And we certainly experience considerable distress when people for whom we care make choices that we believe to be harmful or unhealthy. However, it is our duty to provide compassionate and high quality of care to all in need of our service and expertise, including those whose values or actions are not like our own. If you cannot resolve the tension you feel related to addressing LGBT health issues yourself, consider ways you can make provisions for this for your students in the interest of ensuring their competency in providing care for LGBT people and their families. A recent article in the Journal of Christian Nursing, "Compassionately Caring for LGBT Persons in Your Faith Community,"3 addresses this issue and may assist in thinking about your own situation.
Negative Student Reactions
"I am afraid that some of my students will react negatively (and give me a poor teaching evaluation)." There are 2 steps that all faculty can take to address this fear in advance. First, discuss this concern with your faculty colleagues and administrators before the situation arises. Suggest that the faculty, as a whole, come to a mutual understanding of the importance of including this and any other potentially controversial content in your teaching. Then have a plan for addressing any student response in a constructive manner without compromising the content of the curriculum. Second, prepare to introduce LGBT content unapologetically and with confidence. Include acknowledgment that some people in any situation may be uncomfortable with this topic (as with other sensitive topics in the curriculum) and offer a time and place to listen and discuss any concerns that individual students have. Make this time available outside the classroom setting to proceed with the group objective that is your focus in the classroom.
Summary
If you have considered all of these issues and still feel uncertain about how to proceed, please contact the LavenderHealth team members using our contact form (http://fs7.formsite.com/chi08/form34/index.html). We are available to assist in any way we can!
References