MSN, RN
In America today, disparities (inequalities) exist in healthcare and the health of specific populations due to a lack of “health insurance coverage, affordability, access to and use of care, and quality of care,” according to KFF.
Genetics (risk factors) and social determinants of health can directly affect an individual’s health behavior and health outcome, while KFF also noted that discrimination and racism can negatively affect physical and mental health and create “inequities across the social determinants of health.”
Health disparities exist today in underserved populations, such as people of color, specific age groups, ethnicity, religion, socioeconomic, immigrants, and some minority groups such as the lesbian, gay, bisexual, transgender, and queer (LGBTQ) population.
Social behavior, socioeconomics, and lack of access to (and quality of) care also contribute to poor health.
When it comes to the lesbian, gay, bisexual, transgender, and queer (LGBTQ) population, health disparities exist due to their differences in their sexual behavior and their health risks, “but others are associated with social and structural inequities, such as the stigma and discrimination that LGBT populations experience.” A lot of these people from this minority group don’t have health insurance and avoid or delay treatment due to fear of discrimination and LGBTQ bias that is present in healthcare, according to a Nursing literature review.
Discrimination adds to this health disparity since discrimination, racism, and bias towards different populations can lead to a dysfunctional/nontherapeutic patient-to-nurse relationship. For example, when someone first seeks help for a health concern, be it the hospital setting or outpatient appointment, the nurse is usually their first point of contact. If we are unfriendly or have certain biases, the patient might refuse to interact with us, or we might inadvertently judge them. In this situation, the patient’s unique needs would never be revealed, and their health concerns would never be addressed.
Nurses must understand a patient’s social determinants of health and health risks. During an initial interview, we must assess and uncover any barriers to providing quality healthcare. Information obtained during the initial interview should include ethnicity, religion, marriage status, sexual activity, fear of going home or history of violence, transportation problems, smoking or drug abuse, suicidal thoughts, ability to pay for healthcare, and medical history.
How a patient wants to be identified is also imperative since “proper use of gender identity terms, including pronouns, is a crucial way to signal courtesy and acceptance,” according to an NPR guide on gender identity terminology. We should also ask how a patient wants to be identified during the initial encounter. The information obtained should include the patient’s legal name, preferred name, gender born, current gender identity, and current relationship status. For example, the identity information needs to include:
Discussing the pronouns a patient prefers can break the ice so the patient and provider can get to know each other better. To start the conversation, we can first address the pronoun we identify with (she, he, they/them). If we accidentally call the patient the wrong pronoun after our initial assessment, we can apologize for our mistake and move on. Showing a “simple gesture of apologizing quickly and moving on shows the other person that you care,” according to NPR.
As nursing students, we learned how to care for a patient with a specific medical diagnosis. Not much time was spent caring for patients from different populations with the same medical diagnosis. But not all patients are treated the same. Protocols can change depending on a patient’s race, sex, age, religion, culture, social determinants of health, and risk factors.
For example, when it comes to nursing education, a national survey “found that the estimated median time devoted to teaching LGBTQ health in nursing school was 2.12 hours.” We need additional training and competencies to help correct this lack of education, so we feel more comfortable caring for any population.
Cultural competencies, according to the Nursing literature review, can teach us about healthcare disparities related to specific populations, heighten our knowledge of any barriers or risk factors they might have, and help us increase our communication skills on how to have a welcoming attitude. Developing a trusting, therapeutic relationship is imperative to assessing our patients’ risk factors accurately.
While caring for any patient, we need to use a patient-centered approach to help our patients feel safe and respected, and we need to use shared decision-making treatment plans, so the patient is involved in the plan.
To help a patient from any diverse group feel welcomed and safe, we need to be aware of our biases that might interfere with our therapeutic relationship and respect the patient’s wishes regarding how they would like to be addressed
We need to assess their gender identity and sexual behavior so we can understand their possible health risks and advocate for the recommended health screening tests to be done. A patient’s social determinants of health, sexual history, and gender identity can be obtained through open-ended questions during the history interview or from a questionnaire the patient fills out before the appointment. Some patients might feel better filling out a confidential questionnaire.
To help the patient feel more confident sharing this sensitive information, we should advocate for developing pamphlets or additional literature addressing any confidential information. The literature should be shared with all the new patients, so they have extra resources and phone numbers in case they are hesitant or afraid to reveal too much information during the initial visit. The additional resources could include phone numbers for social workers (in case a patient needs help signing up for medical insurance or for help reporting crimes of violence or fear of returning home), drug addiction help centers, suicide hotlines, transportation options, etc.
Process improvement has been linked to having diversified teams with people sharing ideas to develop the best solution. Nurses are at the forefront. Nurses should advocate for interdisciplinary teams to be developed where we work. The team should include employees from different populations to discover and eliminate disparities.
The multidisciplinary team could help work on the organization’s nondiscriminatory statement and post it in waiting rooms and breakrooms for all to see. They could work with the organization to develop educational pamphlets for patients. They could also work with the human resource department to ensure that the nondiscriminatory statement and cultural competency are included in the new employee orientation and advocate for employee benefits that include the partners of any employees from the LGBTQ group.
As nurses, we need to set aside any biases we might have and learn how to improve our communication with a welcoming attitude to eliminate healthcare disparities. A trusting, therapeutic relationship is essential to accurately assess a patient’s health risks, support systems, and psychoeducational needs. We need to treat each patient holistically and offer shared decision-making care. Nurses need to advocate for a welcoming work environment and encourage their employers to post the organization’s nondiscriminatory statement in waiting rooms for all to see.
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