Health Center Leadership Perspectives Regarding Barriers to and Facilitators of Providing Culturally Responsive Care for Sexual and Gender Minority Patients

Why Won't Anyone Talk? Challenges Naming and Addressing Tokenism Within Health and Human Service Agencies Serving the LGBTQ+ Community

Workplace tokenism, the use of superficial efforts to appear equitable, which often leads to burnout of marginalized groups, is pervasive, even in health and human service organizations dedicated to improving their community's health and well-being. An original research project to identify interventions addressing tokenism within Lesbian, Gay, Bisexual, Transgender, Queer plus serving health and human service agencies in New York was unable to engage staff in focus groups. A follow-up survey with 41 potential participants reported burnout as the main reason for nonparticipation. Qualitative data revealed desired aftercare for the retraumatizing nature of sharing individual experiences. Utilizing a community-based participatory research approach with an antiracism lens may mitigate challenges addressing tokenism, thereby increasing workplace inclusion of our Lesbian, Gay, Bisexual, Transgender, Queer plus community.

Nurse leaders' recommendations for implementing LGBTQ+ inclusive practices in health systems: A qualitative descriptive study

Background

Discrimination against lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) individuals in healthcare settings remains a priority issue. Nurse leaders, who oversee the largest healthcare workforce, are critical in implementing inclusive practices to address LGBTQ+ discrimination, yet implementing LGBTQ+ inclusive practices and effective strategies is inconsistent. This qualitative descriptive study explored nurse leaders' perceptions of LGBTQ+ inclusive practices across the United States to inform recommended strategies within health systems.

Methods

Twenty-one nurse leaders (e.g., chief nurse executives) from diverse healthcare settings (e.g., children's hospitals and public health centers) in 12 states across the United States participated in semi-structured interviews from October to December 2023. Interview transcripts were analyzed using content analysis to (1) describe nurse leaders' definitions of LGBTQ+ inclusive practices and (2) identify effective strategies for their implementation.

Results

Nurse leaders defined LGBTQ+ inclusive practices to include delivering culturally responsive and competent care, fostering safe and affirming environments, integrating inclusivity into daily interactions and organizational culture, and supporting the needs of both LGBTQ+ staff and patients. Key implementation strategies included fostering a flexible organizational culture through open communication; a diverse workforce; and inclusive mission statements, policies, and strategic plans. Supportive infrastructure involved effective LGBTQ+ training and adapting electronic health record systems to include information on sexual orientation and gender identity. Active and interdisciplinary engagement from staff and leadership, as well as systematic data collection on patient and staff experiences, were essential for driving inclusivity. The advocacy highlighted included legislative support, discourse within the nursing profession, and the incorporation of LGBTQ+ inclusion into healthcare regulations and accreditation standards. Additionally, multisectoral partnerships with LGBTQ+ health experts and external organizations, along with multilevel evaluations, were recommended to develop tailored interventions and promote LGBTQ+ inclusive practices.

Conclusion

Implementing LGBTQ+ inclusive practices in healthcare is a multifaceted effort influenced by strategies at various levels. Promoting a supportive organizational culture, establishing comprehensive support structures, encouraging active engagement, and fostering community partnerships can address the needs of LGBTQ+ individuals more effectively. Future implementation efforts should tailor strategies to accommodate variability across healthcare settings and regions, ensuring that practices are both adaptable and sustainable.

Affirming LGBTQIA+ Youth in Inpatient Psychiatric Settings

Decades of research show that LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others) youth experience higher rates of psychiatric illness and present to mental health settings more often than their heterosexual, cisgender peers. General guidelines for working with LGBTQIA+ youth exist; however, little has been written about the unique challenges facing LGBTQIA+ youth and their families in inpatient psychiatric settings and strategies for ameliorating them. As LGBTQIA+ youth attempt suicide at much higher rates than their peers, inpatient settings see a disproportionate number of these youth. Providing LGBTQIA+ youth with affirming care during their inpatient admission therefore has the potential to shift mental illness trajectories of youth, increase family support, and reduce the number of lives lost to suicide. In this article, we outline specific barriers to affirming care in inpatient child and adolescent psychiatric settings and propose practical strategies that providers can implement to overcome these barriers.

Training Health Center Staff in the Provision of Culturally Responsive Care for Sexual and Gender Minority Patients: Results of a Randomized Controlled Trial

Purpose: The study was designed to evaluate whether an educational intervention to train the health center (HC) staff to optimize care for sexual and gender minority (SGM) patients could improve documentation of sexual orientation and gender identity (SOGI) and increase preventive screenings. Methods: Twelve HCs were matched and randomized to either receive a tailored, multicomponent educational intervention or a 1-hour prerecorded webinar. Documentation of SGM status and clinical testing was measured through analysis of data that HCs report annually. Nonparametric statistics were used to assess associations between baseline HC characteristics and outcome measures. Results: The HCs were geographically, racially, and ethnically diverse. In all but one HC, <10% of the patients were identified as SGM. Intervention HCs underwent between 3 and 10 trainings, which were highly acceptable. In 2018, 9 of 12 HCs documented SO and 11 of 12 documented GI for at least 50% of their patients. Five of 6 intervention HCs increased SO documentation by 2020, compared to 3 of 6 control HCs (nonsignificant, NS). Five intervention HCs increased GI documentation, although generally by less than 10%, compared to 2 of the controls (NS). Intervention HCs tended to increase documentation of preventive services more than control HCs, but the changes were NS. Conclusions: An educational intervention designed to train the HC staff to provide culturally responsive services for SGM patients was found to be acceptable, with favorable, but nonsignificant changes. Further refinement of the intervention using a larger sample of HCs might demonstrate the effectiveness of this approach. Clinical trial registration #: NCT03554785.

Addressing Gaps in Access to LGBTQIA + Health Education Resources: A Novel E-Learning Platform

OBJECTIVES

To reduce health inequities for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexually and gender diverse (LGBTQIA+) people, healthcare professionals need increased access to education and training resources on LGBTQIA + health. Web-based, asynchronous, electronic learning (e-learning) resources are critical for expanding the availability of LGBTQIA + health programs. This article presents the design and utilization outcomes of a novel e-learning platform for engaging healthcare professionals in LGBTQIA + health online continuing education.

METHODS

As of December 2022, the e-learning platform consisted of 293 resources within 17 topic domains. Modalities included: learning modules, recorded webinars, publications, videos, and toolkits. We conducted a descriptive analysis of the e-learning platform's website traffic and user engagement data. Google Universal Analytics and event tracking were used to measure website traffic, user locations, and publication downloads. Learning module and webinar completions were exported from the learning management system and run as frequencies.

RESULTS

Between January 1, 2020, and December 31, 2022, over 650,000 people from all U.S. states, 182 countries, and 31 territories visited the website. Platform users downloaded publications 66,225 times, and completed 29,351 learning modules and 24,654 webinars.

CONCLUSION

The broad reach and high user engagement of the e-learning platform indicate acceptability of web-based, asynchronous online continuing education in LGBTQIA + health, and suggest that this platform is filling a need in health professional education. Remote, online learning opportunities may be especially important in jurisdictions with bans on medical care for transgender and gender diverse youth. Future growth of the platform, paired with in-person and other online learning opportunities, has the potential to reduce gaps in LGBTQIA + health training, and mitigate LGBTQIA + health inequities.