Lesbian, gay, bisexual and transgender (LGBT) inclusion in nursing services: a reflective case study from stoma care

Abstract

Speaking with a female patient and her same-sex partner about their experiences of colorectal cancer and ileostomy surgery led to reflection on how specialist nursing care could be made more inclusive of the needs of lesbian, gay, bisexual and transgender (LGBT) people. The LGBT community includes people who are attracted to the same sex and/or identify as a different gender to the one they were assigned at birth. LGBT people in the UK have experienced a long history of discrimination and only begun to win legal protections over the past two decades, an experience that still affects the older generation especially. Compared with the general population, LGBT people are more likely to report poor health status, experience mental health issues and engage in risky behaviours; however, many are reluctant to attend healthcare services due to fear of discrimination. UK LGBT rights charity charity Stonewall surveys have revealed some discriminatory attitudes and widespread unconscious bias among health and social care staff. For health professionals, it can be a challenge to use the correct terminology to avoid causing offen ce, and there is a largely unmet need for inclusion training to improve their understanding and confidence to speak with patients about sexual preference and gender identity. However, confident LGBT inclusivity can be achieved with simple communication skills, such as equal treatment for same-sex partners, acknowledgement of post-transition names and pronouns and discretion in documentation, as well as awareness of verbal and non-verbal cues. Clinic environments can be made more LGBT-friendly with gender-neutral toilets, as well as wearable LGBT symbols, inclusive imagery and posters and literature that promotes LGBT rights, inclusion and support groups. Specialist nurses can act as role models and advocates for LGBT patients and colleagues in their area through small but impactful actions.