Dalhousie Nursing : Cultural Competency "GLBTI" Presentation Febuary 2011
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Dalhousie Nursing : Cultural Competency "GLBTI" Presentation Febuary 2011Developed for the BScN program at Dalhousie University School of Nursing.
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Dalhousie Nursing : Cultural Competency "GLBTI" Presentation Febuary 2011
- 1. Cultural Competency - GLBTI “ Sexual Orientation as a Determinant of Health” NURS 2080 Jonathan Veinot BScN RN Dan Cashen BScN RN
- 21. NurseTV: Gay & Lesbian Health
Hinweis der Redaktion
- Introduce Selves (quick background, graduated Dal 2009, ER and ICU Nurses) Our connection to this topic and why we are passionate about it. (Community Work, a missing aspect of current clinical practice) Thanks for coming. Stop and ask if there are questions or clarifications Midterms? Clinical Experiences to date? Where does everyone want to work when they are done? Ideas? Dreams? On to the meat and gravy
- JONATHAN Acronym Definition – there are now people who think Q Q should be added to the list. Queer and Questioning. We speak for everyone but most of this presentation focuses on gay mens health issues– Impacts on Nursing practice – We Challenge you to change and develop cultural competency in your future practices” ---Fresh lenses on nursing practice. Conducting Health Assessments with diverse clients focus on communication Case Study Tool provided in the model of care Case study (opportunity for discussion)
- DANIEL People identify with their sexuality along with ethnicity, race, class, religion, spirituality, etc. Intersex: “ Intersex in humans refers to intermediate or atypical combinations of physical features that usually distinguish female from male . This is usually understood to be congenital , involving chromosomal , morphologic, genital and/or gonadal anomalies, such as diversion from typical XX-female or XY-male presentations, e.g., sex reversal (XY-female, XX-male), genital ambiguity, sex developmental differences. An intersex individual may have biological characteristics of both the male and the female sexes” The point of this statistic is that GLBTI populations exist in urban and rural settings. We will all experience having a GLBTI client/patient at some point in our careers. Classically, GLBTI populations were thought to be urbanly based. GLBTI exhists everywhere according to the literature.
- JONATHAN Even though we have the right to legally marry, the majority of couples choose to be common law. DEC 9/2004 Canadian Supreme Court ruled “allowing same sex couples to marry civally as per the same rights in the charter of rights and freedoms … officially became law July 20/2005. ** ONLY ONE YEAR TO BECOME MARRIED….. This is a cultural minority!~ Less than 1% “ presence” yes. “Population” no. This is because of the next point, which leads to under-reporting. We are seeing numbers increase over the last few years as GLBI is becoming more culturally acceptable in rural and urban geographical settings. Homosexuality is romantic and/or sexual attraction or behavior among members of the same sex or gender . Coming out: Accepting ones homosexuality (internally and externally) and displaying such in a public forum (family, friends, workplaces). You never just come out once, everytime you meet someone you ‘come out’. This is something GLBI clients have to do throughout their life. Imagine having to explain this to every new doctor, nurse, friend. Etc. Homophobia is a range of negative attitudes and feelings towards lesbian , gay , bisexual , and in some cases transgender and intersex people **LEARNED RESPONSE 7.)Internalized homophobia (or egodystonic homophobia) refers to negative feeling towards oneself because of homosexuality. (Could this be a case of self harm? Isolation? Disturbed body image? Disturbed self image? Depression? Anxiety? Failure to Cope. …… leads to secondary coping mechanisms…. Which are not always ‘healthy’ we will talk about that later…. 8.)DO NOT PRACTICE IN THE LENS OF HETEROSEXISM! DO NOT ASSUME EVERYONE IS STRAIGHT OR GAY FOR THAT MATTER. It is our duty to be unbiased practitioners. 9) Heterophobia describes reverse discrimination based on sexual orientation and implies an irrational fear of or aversion toward heterosexual people and institutions **LEARNED RESPONSE
- JONATHAN -They do not disclose -Usually are in heterosexual female relationships -Often are married -Often have children -Very Illusive in regards to scientific data. -Impossible to identify without self disclosure.
- JONATHAN GLBTI was punishable… and still is in some third world countries (Even in some first world countries anti-gay activists) Sex became free and ok to talk about. Taboos were lifted. Sex became ‘healthy’ AIDS/HIV became a ‘gay’ disease. First imposed to ‘gay men’ NO Sex reassignment surgery is covered in NS
- JONATHAN IS our best guess. The biggest point of this slide is that no one knows for sure. There are a few strong theories though. Second semester sex characteristics are developed CT Scans, 90% efficacy rate. (Gay mens CC mates the size of a heterosexual female) They can identify this 90% of the time in trials.
- DANIEL You should be able to list this off in your sleep by now. Sexuality effects each of these determinants of health . Less income Less social supports Low education and literacy rates Higher unemployment rate Poor life skills (coping) … . Think about applying the determinants of health to this population and using your findings to mould your assessments. (*Caution: Never assume just be aware)
- DANIEL Gay-alliances are being implemented in many settings but there is a lot of work to go. Social isolation can lead to depression and anxiety (ie. Negative Health outcomes)
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- JONATHAN How do we adequately address GLTBI health care concerns and related issues?
- JONATHAN Entry level competency “ Life long process” -we are never experts and it’s ok to be wrong and admit it. Challenge your co-workers to practice to their full scope of cultural competence. This is what makes us RN’s!!!!!!!!!!!!!!!
- JONATHAN Story: Many nurses feel uncomfortable proving care to GLBTI clients. Tell story of first job…. “You’re the expert, were glad we have you here” We will get you whenever we have a gay patient. …… *sigh* What about when im not working?
- DANIEL Think of pride as a healing event
- DANIEL Practitioners should be aware of and know how to deal with the following ….. Pt just goes through sex reassignment surgery, how do you heal their body and mind.
- DANIEL There are issues affecting the accessibility of services for the GLBTI community… these are just some. We need to help people overcome and reduce stigma (education) in order to help alleviate these issues.
- JONATHAN What about same sex co-habitation in nursing homes? How would your health assesment in first year on your client in N1020 have changed?
- JONATHAN Points for reflection: -”Challenge the idea that we treat everyone the same” (ie: Sex after prostate surgery. Do we provide GLBTI appropriate teaching methods? -”Focus on safety and equity” As we all know this will open our therapeutic relationships and improve patient outcomes “ its about being aware--- know research and local resources. Leave a pamphlet in your staff room. Be aware that culture changes take time -Advocate politically.. (ex. Proper terminology in pamphlets for recovery pts) Its all comes down to reflecting on your own prejudices.
- JONATHAN Develop a caring and sensitive manner towards the GLBTI assessment Its ok to be wrong. Make mistakes. Its ok to tell the client they are the experts and they can educate you.
- JONATHAN Here are some examples
- DANIEL We approached this topic through the ‘nursing process’ which you should all be familiar with
- JONATHAN Example of harm reduction interventions: Using more lubricant if the patient is opposed to safe sex Teaching patients how to wash their sex toys. Teaching how to clean needles or how to locate needle exchanges (mainline/direction 180)
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- JONATHAN Here is an example of a model of care we like and use in our practice currently. There are many others out there. Research and become involved.
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- DANIEL These are only a few resources ….
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- **What if Mr Smith states “I need you to promise not to tell anyone else… including his wife”
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- TOGETHER