Analysis of Learner Needs to Achieve Competence in LGBTQI Health Concepts
Summary of Instructional Problem
The healthcare needs of Americans are increasingly complex and healthcare reforms are charging providers at all levels to achieve significant improvements in the quality of the care provided. Standards of nursing care mandated by various practice and regulatory agencies such as the American Nurses Association (ANA), state licensing bodies, The Joint Commission (TJC) and facility practice policies required registered nurses to maintain competence in the care of individuals and families of diverse cultural backgrounds. In fact, TJC (the independent accrediting body for healthcare facilities that receive payment from Medicare) designates lesbian, gay, transgender, queer, and intersex (LGBTQI) persons as one such population warranting culturally competent care.
Current Conditions and Desired Conditions
Although registered nurses at every level of practice and education receive some instruction in the broad concept of cultural competence, LGBTQI populations are frequently overlooked as a group with its own unique cultural characteristics. This, in turn, contributes to a persistent disparity in healthcare. According to the Federal Interagency Forum on Aging-Related Statistics (2012), the Baby Boom generation will increase from 35 million to 72 million by 2030, encompassing nearly 20% of the U.S. population. Estimates of individuals who identify as gay, lesbian, bisexual or transgender are roughly 4% (Simone & Applebaum, 2009); these are very conservative estimates. This means that nurses will encounter 2-6 million aging LGBTQI Americans in need of healthcare at some point in their lives by 2030 (Simone & Applebaum, 2009).
Nurses and other healthcare professionals have consistently demonstrated little understanding of LGBTQI health issues, as evidenced by the dearth of nursing literature on LGBTQI health issues. There is a scarcity of evidence on nurses’ knowledge and attitudes of LGBTQI healthcare issues in general; a recent search of the nursing literature on LGBTQI Intimate Partner Violence, for example, produced scant results in the CINAHL databases. Of those retrieved, some report a significant difference exists in the attitudes of crisis center staff toward LGBTQI relationships and heterosexual relationships (Holt, 2011). General nursing texts and research reports label LGBTQI groups among special populations. Stigma in practice and bias in the literature and in nursing curricula contributes to a general ignorance of LGBTQI culture and healthcare needs.
The Joint Commission publishes a Field Guide for implementing LGBTQI-sensitive policies and practices for healthcare organizations. Likewise, the Human Rights Campaign (HRC) Institute publishes the Health Equality Index of U.S. healthcare organizations that self-enroll in a program of monitoring, evaluation and promotion of those institutions...