Culture is More than Ethnicity

1. Culture is More than Ethnicity Best Practices for LGBTQI Communities

2. A LavenderHealth.org Production Peggy L. Chinn, RN, PhD, Mickey Eliason, PhD; Sue Dibble, DNSc, & Jeanne DeJoseph, CNM,PhD

3. What is LGBTQI? • Lesbian • Gay • Bisexual • Transgender • Queer/Questioning • Intersex

4. Many Cultures • Each group has a distinctive culture • Gay (male) cultures tend to be the most visible to the outside world • Lesbian cultures are less visible but very well developed • Queer cultures are emerging among younger men and women • B, T and I groups struggle for identity

5. Cultural “markers” • Dress and clothing • Gender bending • LGBTQ jewelry • Socialization patterns • Bars • House parties • Clubs and organizations • Language and the arts • Music, poetry, literature, symbols

6. Humor

7. Symbols

8. Cross-culture Issues • Prejudices and stereotypes within and among LGBTQI groups • Intolerance, particularly toward B and T individuals (bi or transphobia) • Incorrect assumptions about other groups based on one’s own sub-culture • Lack of knowledge about LGBTQI groups other than one’s own • Knowledge is difficult due to traditions (often necessity) to remain closeted

9. Family • A “code” term to indicate that someone belongs to the larger LGBTQI culture, or to one’s own sub-culture • One’s own personal “family” is chosen; may not include family of origin • Families of origin or procreation often estranged or fraught with tension

10. Importance of Code • Used to communicate belonging without revealing one’s identity to an outsider • Family • Member of the committee, choir, church, team, etc. • “We have spent time together” • Dropping the name of local or national LGBTQI establishment or event (“Michigan”) • “Friend of Dorothy” • Sister/brother of the inclination

11. Stigma • Robs LGBTQI people from genuine authenticity; coming “out” is a life-long, constant challenge • Real and feared rejection (discrimination) at home and at work • Plagued by hetero-normativity and gender-normativity • HIV/AIDS stigma • Internalized oppression • Medical classification as a disease • Religious beliefs that link sex and sin

12. Minority Stress • Heaped on top of typical stressors of living and coping in the world • All LGBTQIs belong to at least one other culture • All other cultures/groups include some LGBTQIs • Chronic • Arises from mutable social and cultural structures and processes rather than from individual risk factors or choices

13. Health Risks from Stigma • High rates of: • Alcohol, tobacco and drug use • Depression, anxiety, suicide • Body image and eating disorders (men more than women) • Domestic violence • Specific risks for disease among certain sub-groups (e.g. higher risk of breast cancer among lesbians, anal cancer among gay men)

14. Health Care Culture • When health care professionals know about many different populations they can provide better care, make better decisions, and make better referrals.

15. Health Care Culture • When health care professionals know about many different populations they can provide better care, make better decisions, and make better referrals. • Each health care professional is responsible to learn about the populations for whom they provide care or develop policies.

16. Health Care Culture • When health care professionals know about many different populations they can provide better care, make better decisions, and make better referrals. • Each health care professional is responsible to learn about the populations for whom they provide care or develop policies. • Background knowledge about LBGTQI health issues can assist both health care recipients and their direct care providers to focus their questions for each other.

17. Health Care Culture • When health care professionals know about many different populations they can provide better care, make better decisions, and make better referrals. • Each health care professional is responsible to learn about the populations for whom they provide care or develop policies. • Background knowledge about LBGTQ health issues can assist both health care recipients and their direct care providers to focus their questions for each other. • Dialogue from a position of mutual understanding is necessary to bring about equitable health care.

18. The ASK Model Awareness Sensitivity Knowledge Lipson, Juliene G. & Dibble, Suzanne L. (2005) Culture & Clinical Care, San Francisco, UCSF Nursing Press

19. Your ASK score • In your community: • Where do LGBTQI families find reproductive or adoption services? Child rearing education? • Where does an LGBTQI person get domestic violence counseling and protection? • Are there LGBTQI support groups for substance abuse recovery, and where are they? • Are there LGBTQI support groups for cancer survivors and families?

20. Your ASK Score • What is your approach to exploring sexuality and gender with a new patient/client? • What do you do/say when you hear an off-color remark about LGBTQI people? • Does your workplace have public, visible signals that LGBTQI people are welcome? • When is the last time you had a conversation with an LGBTQI person about their health care experiences?

21. Your ASK Score • True or false: • People can change their sexual orientation if they want to • Sexual trauma in childhood is not related to being LGBTQ • Lesbians hate men • Children who are taught facts about LGBTQI issues might become LGBT or Q • A child is 100 times more likely to be molested by heterosexual men than by gay men

22. Ten Key Things YOU Can Do • Number 10: Understand the far-reaching effects of social stigma on LGBTQI people,their families, and communities. • Read the book LGBTQ Cultures:  What Health Care Professionals Need to Know About Sexual and Gender Diversityhttp://www.nursingcenter.com • Listen to the experiences of LGBTQI individuals

23. Ten Key Things YOU Can Do • Number 9: Know inclusive language and how to use it in written and oral communications. • Become comfortable with LGBTQI words and phrases • Revise all forms to be inclusive of LGBTQI groups • Learn inclusive language for your histories and health interviews

24. Ten Key Things YOU Can Do • Number 8: Develop written policies that are inclusive of LGBTQs and their families. • Include sexual orientation and gender identity in your non-discrimination policies • Include LGBTQ families in all employee benefits • Be informed about local laws, and how they affect LGBTQ individuals and families

25. Ten Key Things YOU Can Do • Number 7: Recognize the broad diversity and creativity of LGBTQ family structures. • Advocate for LGBTQI families to be welcomed and included in visitation and decision-making • Include LGBTQI families in posters, photographs, brochures, and advertising • Ask “who is important to you, and who do you want to be involved in your experience?” instead of asking about “family members”

26. Ten Key Things YOU Can Do • Number 6: Develop policies and procedures for confidentiality and recording of information about sexuality and gender in patient records, and for dealing with inappropriate comments in verbal communications among staff. • Ask permission to include sexuality orientation and gender identity in written records • Develop zero tolerance for slurs, jokes and gossip involving sexuality and gender

27. Ten Key Things YOU Can Do • Number 5: Recognize the legal issues • Have forms and information available for LGBTQI families for release of information, power of attorney for health care, guardianship, etc. • Know the legal implications in your state regarding the rights of LGBTQI individuals and families, and how to best protect one’s rights and interests as LGBTQIs

28. Ten Key Things YOU Can Do • Number 4: Know the potential consequences of stress related to stigma • Assess for substance abuse, including tobacco dependence, mental health problems, body image and weight issues, unsafe sexual practices, and domestic violence as well as physical health problems • Help clients/patients understand their risks as related to stigma, not their sexual or gender identity

29. Ten Key Things YOU Can Do • Number 3: Celebrate the diversity of LGBTQI communities, based on differences in age, racial/ethnic identities, geography, immigration status, language, socioeconomic class, and education. • Treat every patient/client as a unique individual and do not assume that you know anything about them based on some visible presenting characteristic • Seek out diversity training that considers the intersections of multiple oppressed identities rather than viewing each one separately.

30. Ten Key Things YOU Can Do • Number 2: Understand the effects of homophobia/biphobia/transphobiain the health care workplace for LGBTQ employees. • Welcome LGBTQI employees to acknowledge their identities and families of choice • Assure zero tolerance for harassment or discrimination based on sexual or gender identity

31. Ten Key Things YOU Can Do • Number 1: Reflect on what it might be like to be an LGBTQI patient in your health care setting • Reach out to your local LGBTQI communities to make sure they know they are welcome in your agency • Assess the needs of your local LGBTQI communities and assure that your agency is addressing these • Invite LGBTQI consumers to provide feedback about your services and setting

32. Are You Ready? List 3 things you personally are ready and willing to do to assure that your care for LGBTQI communities is the BEST it can be