LGBT Healthcare Disparity: Theoretical Framework

Introduction: Research of Literature (ROL): Steps and Strategies

In the contemporary nursing environment, diversity can be viewed as the source of both numerous opportunities and major concerns. On the one hand, diversity allows for the design of new nursing strategies. On the other hand, not all healthcare experts may be open enough to accept the changes, which may trigger conflicts and reduce the quality of care, as the current LGBT issue shows.

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Several scholarly databases, including NCBI, ReseatchGate, PubMed, Medscape, etc., were used to locate the relevant articles. The following keywords were used: “LGBT needs,” “LGBT healthcare,” “quality healthcare,” and “healthcare model(s).” In the course of the search, the preferences were set for the articles that were published in 2012 or later so that relevant and correct data could be retrieved. Furthermore, the range of articles was restricted to peer-reviewed only. Thus, the credibility of the study could be maintained.

Summaries of the Articles: What Has Been Found

Albougami, Pounds, and Alotaibi (2016) explore the models of cultural competence in their study. According to the authors, four key frameworks deserve close scrutiny as possible tools for improving the quality of care in the contemporary environment (Albougami et al., 2016). The Leininger Sunrise Model, Giger, and Davidhizar Transcultural Assessment Model, Purnell Model for Cultural Competence, and Campinha-Bacote Model of Cultural Competence in Healthcare Delivery are considered in the study as the best tools for managing diverse patients’ needs. Stating that there has been a significant change toward the use of Transcultural Nursing as the foundation for meeting the patients’ needs in a manner as efficient as possible, Albougami et al. (2016) define Campinha-Bacote model as the most reliable one.

Ingram (2012), in turn, specifies that the Campinha-Bacote model should be used as the primary tool for improving healthcare practitioners’ cultural competence and, thus, increasing the quality of the provided services. The study indicates that the suggested model is especially important for providing an impetus that will compel healthcare experts to engage in the consistent acquisition of diversity-related knowledge and the appropriate skills. Therefore, Ingram (2012) makes it quite clear that the model can and should be used as the basis for building the program that will allow addressing the lack of quality care for the members of the LGBT community. Furthermore, the theory must be utilized as the means of eradicating prejudices against LGBT people from the healthcare environment.

When considering the particular implications of the lack of awareness and basic diversity skills among healthcare practitioners, one must mention homophobia and unsatisfactory treatment leading to negative patient outcomes, as a recent study states (Parameshwaran, Cockbain, Hillyard, & Price, 2017). Particularly, a drop in the number of positive patient outcomes can be deemed as the direct result of the lack of awareness about LGBT issues among healthcare practitioners. Parameshwaran et al. (2017) suggest that the problem under analysis should be addressed by teaching healthcare practitioners about gender identity and sexuality as crucial components of their patients’ identities.

The identified step is likely to help eliminate a range of issues, such as the correct use of gender pronouns with the representatives of the LGBT community (e.g., homosexuals, transsexuals, transgender patients, etc.). Furthermore, improving healthcare practitioners’ understanding of the LGBT community and the needs of its members, one is likely to manage the problem of disparity in the healthcare environment, thus, preventing the instances of discrimination against LGBT patients (Parameshwaran et al., 2017).

The article suggests that the problem of misgendering and the similar issues occurring in the context of the contemporary healthcare environment should be addressed by setting a specific example for healthcare practitioners to follow. Particularly, Parameshwaran et al. (2017) promote the concept of leading by example as the tool for helping healthcare practitioners use the right gender pronouns when talking to LGBT patients. By setting a strong example, one can build the premises for a transfer to a more diverse and multicultural environment, where the needs of LGBT patients are taken into account accordingly.

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The suggested approach is likely to help manage the barriers to efficient care, such as critical personal beliefs, personal concepts of inappropriateness, etc., also improving the quality of communication between a patient and a healthcare practitioner (Parameshwaran et al., 2017).

Grubb, Hutcherson, Amiel, Bogart, and Laird (2013), in turn, suggest that the change in the relationships between healthcare practitioners and the representatives of the LGBT community should start with the reconsideration of the modern nursing curriculum. To be more specific, the authors maintain that the principles of appropriate communication with the target population should be taught to students so that they could apply the relevant nursing skills when addressing LGBT-related cases.

According to the authors of the study, the essential information about human sexuality and gender should be included in the range of information that the course should cover. The concepts such as “sexual orientation, gender identity, and sexual and gender expression” (Grubb et al., 2013) should be viewed as the crucial characteristic of patients based on which a healthcare practitioner must define the further course of actions, starting with the development of an appropriate communication strategy. Thus, the opportunities for reducing the threat of biases can be created. It is assumed that the identified approach toward teaching healthcare practitioners is bound to improve patient outcomes even in the instances in which healthcare practitioners have no previous experiences of tending to the needs of LGBT patients (Grubb et al., 2013).

The study suggests that a two-hour cultural model should be used to convey the essential message to the students. The incorporation of pre-curricular readings, a short movie on the subject matter, and a series of lectures coupled with a “Patient as Professor” panel into the teaching sessions are bound to provide the learners with the experience that they need, thus, allowing them to develop the skills and abilities for tending to the specific need soft eh LGBT population.

Similarly, Fredriksen-Goldsen et al. (2014) offer a healthcare model that will ostensibly help reduce the effect of LGBT disparities in healthcare, if not eliminate them at all. According to the authors, it is the lack of research in the target area that defines the existence of biases (Fredriksen-Goldsen et al., 2014). To enhance the further study of the subject matter, Fredriksen-Goldsen et al. (2014) present the Health Equity Promotion Model (EPM). EPM opens opportunities for an extensive study of a range of issues associated with meeting the needs of LGBT patients. For instance, it helps explore LGBT communities and their properties, such as heterogeneity and intersectionality.

Furthermore, the framework allows defining the impact that the structural and environmental context has on managing the needs of LGBT patients. Finally, EPM helps promote health and the relevant behaviors successfully by encompassing the behavioral, social, psychological, and biological processes in the target population Fredriksen-Goldsen et al., 2014). Therefore, the authors point to the fact that the process of managing LGBT patients’ needs will require a deeper insight into the culture of the community and a detailed analysis of the complex constructs on which the concept of gender is based. The reconceptualization of the LGBT disparities through the lens of EPM is bound to lead to the enhancement of resilience and the elimination of the risk factors that reduce the quality of care for the target population.

ROL: Current State of Research and Level of Exploration

As the overview of the articles provided above shows, there are significant gaps in the management of LGBT patients’ needs. Particularly, the issues associated with prejudices against the LGBT community that healthcare practitioners may have, as well as the effects that the said prejudices have on the quality of care, require further analysis. Moreover, it is necessary to introduce a viable strategy that could help address the problems that will be discovered in the course of the analysis. Particularly, the means of speeding up the process of knowledge and skills acquisition among healthcare practitioners for the further successful management of LGBT patients’ needs will have to be considered.

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Theory Selected for the Evidence: Culture Care Diversity and Universality

To explore the issues associated with the lack of knowledge of the LGBT population’s needs among healthcare experts, one should consider using the theoretical framework provided by Campinha-Bacote and known as the Process of Cultural Competence in the Delivery of Healthcare Services. The framework helps view the process of delivering the relevant healthcare services to the LGBT population as the task that requires the consistent acquisition of the information about the LGBT community, the specific issues that they are facing, the pressure of prejudices which they are forced to experience, etc. (Ingram, 2012).

The culturally conscious model of care sets the bar for the quality of the services very high and compels the staff members to learn more about the target population. This is even more important. The theoretical framework sheds light on how the prejudices against the LGBT community are formed in the context of the healthcare environment, and how they can be eradicated.

Principles of the Theory: Making Sure that the Crucial Needs Are Met

According to the primary tenets of the theory, cultural competence must be part and parcel of the healthcare practice. Therefore, healthcare practitioners must acquire the relevant knowledge and skills regularly so that they could provide the services of the required quality to the target population. Targeting the factors that make LGBT patients vulnerable and eliminating them from the realm of healthcare can be deemed as the key focus of the framework (Albougami et al., 2016).

Thus, the Process of Cultural Competence in the Delivery of Healthcare Services must become the foundation for building a program for improving healthcare staff’s competencies. Particularly, the tool ill help address the prejudices against LGBT patients and help healthcare experts understand the needs of the target population better. While the process of changing the healthcare practitioners’ stance on the subject matter is likely to be quite long, it is bound to lead to impressive outcomes as long as the said theoretical framework is incorporated into it.

References

Albougami, A. S., Pounds, K. G., & Alotaibi, J. S. (2016). Comparison of four cultural competence models in transcultural nursing: A discussion paper. International Archives of Nursing and Health Care, 2(3), 53-57. Web.

Fredriksen-Goldsen, K. I., Simoni, J. M., Kim, H. J., Lehavot, K., Walters, K. L., Yang, J., & Hoy-Ellis, C. P. (2014). The Health Equity Promotion Model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. American Journal of Orthopsychiatry, 84(6), 653-663. Web.

Grubb, H., Hutcherson, H., Amiel, J., Bogart, J., & Laird, J. (2013). Cultural humility with lesbian, gay, bisexual, and transgender populations: a novel curriculum in LGBT health for clinical medical students. MedEdPORTAL Publications, 9, 9542. Web.

Ingram, R. R. (2012). Using Campinha-Bacote’s process of cultural competence model to examine the relationship between health literacy and cultural competence. Journal of Advanced Nursing, 68(3), 695-704. Web.

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Parameshwaran, V., Cockbain, B. C., Hillyard, M., & Price, J. R. (2017). Is the lack of specific lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) health care education in medical school a cause for concern? Evidence from a survey of knowledge and practice among UK medical students. Journal of Homosexuality, 64(3), 367-381. Web.

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