INVESTIGATING ADMINISTRATIVE OPPORTUNITIES TO PROVIDE AND IMPROVE LESBIAN, GAY, BISEXUAL, AND TRANSGENDER HEALTHCARE A CASE STUDY OF NORTHWESTERN HOSPITAL

The term homonegativity is part of an admittedly complicated construct that might generally be defined by affective responses and negative attitudes based on myths and stereotypes about same sex relationship .Terms related to this general definition include, but are not limited to, homophobia, heterosexism, and sexual prejudice. The majority of the literature supports that homonegativity is maintained through sociocultural norms. Demonstrations of homonegativity are various and may present as anxiety, discomfort, avoidance, anger and/or violence at the individual level (DeCola, 2012). On the larger sociocultural level, homonegativity operates through maintaining dominant heterosexual group authority, much like sexism or racism. The majority of the research on homonegativity has paralleled the oppressive nature of homonegativity with racism, and more commonly with sexism. Indeed some researchers feel so strongly about the correlation, they have suggested that integrative approaches between homonegativity and sexism are essential when studying either phenomenon. Given the gendered politics and problems associated with the nursing profession about which there is a very large volume of research this is a particularly appealing suggestion (Dickson & Rinaldi, 2012). In any case, the sociocultural cause variables most often cited in the literature include religiosity, education as well prevailing social mores, political opinion, as well as geographical location. In addition, these variables have most often been viewed as they relate to gender, race, age and/or social interactions with LGBT persons.

Homophobia, the fear, dislike, discrimination of lesbians and gay men; the behaviors based on such feelings. This discrimination can be seen in, “experiences of verbal harassment and physical assaults were asked in relation to both perceived sexual orientation and gender nonconformity” (Diaz, 2004). Studies and society shows us that discrimination has been around for quite sometime, and is not that much different today than it was back then. Social oppression, stemming from discrimination, is focused on the group but has impact on the individual. In the study of the discrimination of gay Latino men by Diaz (2004), he found “the social and sexual lives of many Latino gay men have been affected by at least three socially oppressive forces—poverty, racism, and homophobia”. Discrimination of sexual preference is as old as discrimination based on race, “a substantial number of Latino gay men in the United States share a history of social oppression on account of being poor” (Diaz, 2004), thus producing high levels of psychological distress.

Heterosexism, the discrimination, negative attitudes, and behaviors towards gays and lesbians by heterosexual people; the promotion and ideology of being in pure, opposite-sex only relationships. In the study of wanting to redefine homophobia over the years, due to the increase in the definition of homosexuality (no longer just man-man and woman-woman), Neisen (1991) “argues that the concept of homophobia should be replaced by the constructs of heterosexism (HSX) and shame due to HSX”. Social oppression still takes place in the form of discrimination; today it’s just expanded to include transgender, cross-dressers, and bisexuals. That oppression leads to shame about one’s homosexuality (Neisin, 1990).

Many religions preach to practice heterosexuality; they refer to homosexuality as a sin and a sentence of eternity in hell for their actions. It is not surprising this practice and discrimination is as old as the religions themselves, “there is a long tradition of exploring the association that religious belief and practice have with a variety of social issues” (Mavor, 2008). Social issues opposed on the GLBT are those such as prejudice, discrimination, and even attempts of exorcisms to force the ‘gay’ out.

Some of the major conflicts for this population, to avoid the oppression and discrimination, is to choose between how the truly feel and want to be and between how to act to fit in and be like everyone else. Mavor (2008) thinks a person’s conflict is in, “developing attitudes that are congruent with the norms of socially important groups or a tendency toward compliance with social conventions measured as a personality trait.

An organization’s employee manual on sexual orientation applies to both heterosexual and homosexual alike. Most manuals include references of sexual harassment, which can pertain to male on female, female on male or male/male, female/female, etc., or on-job sexual conduct, and even interagency relationships. In any case there is not sexual preference for the policies. The Equal Employment Opportunity Commission (EEOC) ensures that companies are not discriminating against any person regardless of race, age, gender, culture, religion, or sexual preference. Some companies have in place that it can not be asked or discussed.

Problem Statement

Perhaps in no greater way is this reticence illustrated at Northwestern Hospital that fails to require LGBT specific supportive patient and employee policies as a requirement in obtaining Magnet Status (Potter, 2010). The Magnet Status Recognition program at Northwestern Hospital purports to represent nursing excellence and it is nursing administrators that develop and review the Northwestern Hospital’s Magnet recognition process (Legal, 2013) according to their mission statement. No current evidence or research exists in how Magnet designated health care organization’s Directors of Nursing, who are instrumental in obtaining and continuing Magnet recognition, feel about LGBT patients, employees or LGBT people in general.

Purpose of the Study

The purpose of this qualitative study is to investigate administrative opportunity to provide and improve lesbian,gay,bisexual, and trangender healthcare in Northwestern hospital.This study applies that the Health Belief Model to examine Nursing’s perception in overcoming homophobia and the relationship between perceptions and subsequent action to address homophobia and promote LGBT equality and inclusiveness (Potter, 2010). Modifying factors were conceptualized as nurse administrator’s beliefs (MHS) about LGBT rights and equality and demographic factors. Cues to action that triggered nurse administrator’s actions included recruitment and retention of nursing staff and reported patient satisfaction in nursing care received.

Research clearly shows evidence of homophobia in the nursing profession. Research also identifies that recruitment and retention efforts of nursing staff proves economical and reflects employee satisfaction as well as a direct effect on levels of patient care and reflected patient satisfaction. Successful recruitment and retention are exactly what magnet status looks toward obtaining and providing and yet makes no provisions to ensure equality among all patients and employees as it relates to sexual orientation. It stands to reason that this inequality might have unfavorable effects on nurse recruitment and retention efforts. It also stands to reason that this inequality might have unfavorable effects on patient satisfaction. In turn all these unfavorable effects stand to negatively impact the economic stability and/or growth of health care institutions (Potter, 2010).A qualitative research method with case study design to carry out this research. These method are appropriate because interviews gather information about their activities and the design is appropriate for the study of central phenomena. Relationships between nurse administrators’ demographic characteristics and their attitudes and beliefs about LGB rights were also explored (Kane-Lee, & Bayer, 2012).

This study intends to focus on addressing the strategies at Northwestern Hospital concerning homonegativity in hospital. The Healthcare Equality Index (HEI), put out by the Human Rights Campaign “was developed to give healthcare facilities the information and resources they need to ensure equitable, inclusive treatment for their LGBT patients” (2012) under the supposition that the majority of health care organizations would not want LGBT populations to suffer from negative experiences in the healthcare environment. The HEI sets forth four core practices for hospitals to provide to LGBT patients and employees, as well as additional best practices for hospitals to consider (Chance, 2013). Core measures include provision of patient non-discrimination policies including both sexual orientation as well as gender identity, visitation policies for both same-sex partners and parents, employment non-discrimination policies including sexual orientation and gender identity, as well as training in LGBT patient centered care at Northwestern Hospital.

Research Question

1. What are the attitudes and beliefs of LGBT patients regarding the medical services they receive at Northwestern Hospital?
2. What are the personal cues-to-action resulting at Northwestern Hospital in providing for LGBT inclusive environments at Northwestern Hospital?

Nurses fervently distinguish themselves from all other medical professionals as definitive patient advocates. In spite of this lofty claim of distinction, a significant portion of the population remains without representation from the nursing profession. In health care organizations, as well as in nurse academic settings the LGBT population has been essentially ignored. Diversity training in the nursing profession is quite narrowly defined, such that LGBT concerns and issues are most often overlooked. LGBT related research in nursing is embarrassingly scant. Opportunities for LGBT inclusive policies in health care organizations have been disregarded by the nursing profession. The health of the LGBT population has indeed suffered because of this neglect (Potter, 2010). One might have reasonably expected from such a large group of professional at Northwestern Hospital to patient-advanced and courageous leadership toward LGBT inclusiveness and equality. Further, one might reasonably have expected the impetus of such exemplary advocacy to have come from Magnet designated hospitals, self-described representatives of nursing excellence.

Methodology

The design of this study will be a qualitative method and semi-structured interviews will be conducted from the participants at the Northwestern Hospital. Directors of Nursing at Northwestern Hospital will be surveyed. Qualitative interviews help the researcher in assessing the views, and ideas about a given important problem and are most suited for descriptive interpretation of perceptions of respondents (Rubin, & Rubin, 2012). The case study will be appropriate for the design because I will be looking at the contemporary phenomena

Importance of the Study

Nurses fervently distinguish themselves from all other medical professionals as definitive patient advocates. In spite of this lofty claim of distinction, a significant portion of the population remains without representation from the nursing profession. In health care organizations, as well as in nurse academic settings the LGBT population has been essentially ignored. Diversity training in the nursing profession is quite narrowly defined, such that LGBT concerns and issues are most often overlooked. LGBT related research in nursing is embarrassingly scant. Opportunities for LGBT inclusive policies in health care organizations have been disregarded by the nursing profession. The health of the LGBT population has indeed suffered because of this neglect (Potter, 2010). One might have reasonably expected from such a large group of professional at Northwestern Hospital to patient-advanced and courageous leadership toward LGBT inclusiveness and equality. Further, one might reasonably have expected the impetus of such exemplary advocacy to have come from Magnet designated hospitals, self-described representatives of nursing excellence.

This study can act as a reservoir to initiate training specific to LGBT issues at Northwestern Hospital is suggested as even within broader diversity initiatives, the LGBT issues have often been omitted hence, there is a need to define diversity more broadly than just race and ethnicity, and to recognize that LGBT people are found within every other form of diversity. Policies regarding LGBT specific training “allow trainers to present accurate information about homosexuality; dispel common misperceptions and lower anxiety among heterosexual employees. Chance, (2013) reveals a similar suggestion for educational programmes that promote comfort and confidence in addressing sexuality in nursing as well as to dispel existing blissful unawareness, which may heighten the fear of ‘different’ or unknown lifestyles that can affect attitudes and relationships in nursing. ‘Blissful unawareness’ of colleagues and patients sexual orientation may in fact be bolstered by a patient’s discomfort to disclose their sexual orientation, or by colleagues choosing avoidance strategies or ‘counterfeiting’, whereby a colleague may choose an active strategy that involves constructing a false heterosexual identity at Northwestern Hospital. Essentially, patients and colleagues may choose to ‘closet’ themselves according to situational contexts, or rather those situations perceived as unwelcoming, intimidating or exclusive.

Population and Sample

The snowball sampling will be used for this study. Snowball sampling allows the researcher to recruit respondents that are in lesser number in the given set of population (Flick, 2009). For instance, recruiting subjects from small subgroup can lead to more subjects for the study. Predominant age among respondents is from 18 and above. The sample consists of 43 LGBT who have the experience of receiving medical services at Northwestern Hospital both in OPDs and inhospital care and the directors of nursing. The ethical liabilities of the respondents will be taken in account for restoring the autonomy and confidentiality of the participants. Moreover, the personal information about the respondents will not be disclosed to any authority and the data collected will be stored in a password stored computer. The information documented as followed was shared with all the interested parties on the study site. There are no anticipated risks to participants in this study. When answering questions in this study, some participants might experience embarrassment, discomfort, emotional pain, sadness, or stress. This is a risk of answering some survey questions (Rubin, & Rubin, 2012). Although, we would encourage study completion, a participant can discontinue participation in this study at any time.

References

Chance, T. F. (2013). Going to Pieces over LGBT Health Disparities: How an Amended Affordable Care Act Could Cure the Discrimination That Ails the LGBT Community. J. Health Care L. & Pol’y, 16, 375.

DeCola, P. R. (2012). Gender Effects on Health and Healthcare. Handbook of Clinical Gender Medicine, 10.

Díaz, R., Ayala, G., & Bein, E. (2004). Sexual Risk as an Outcome of Social Oppression: Data From a Probability Sample of Latino Gay Men in Three U.S. Cities. Cultural Diversity and Ethnic Minority Psychology, 10(3), 255-267. doi:10.1037/1099-9809.10.3.255.

Dickson, G. L., & Rinaldi, A. P. (2012). Preventing disparities in primary healthcare for LGBT patients. Prevention in Counseling Psychology: Theory, Research and Practice, 4, 15-20.

Flick, U. (2009) the introduction to qualitative research London, Thousand Oaks, New Delhi: Sage

Kane-Lee, E., & Bayer, C. R. (2012). Meeting the needs of LGBT patients and families. Nursing Management, 43(2), 42-46.

Legal, L. (2013). When Healthcare Isn’t Caring: Lambda Legal’s Survey on Discrimination Against LGBT People and People Living with HIV 2010.Available at www. lambda legal. org/publications/when-health-care-isnt-caring (last accessed November 6, 2013).

Mavor, K., & Gallois, C. (2008). Social group and moral orientation factors as mediators of religiosity and multiple attitude targets. Journal for the Scientific Study of Religion, 47(3), 361-377. doi:10.1111/j.1468-5906.2008.00415.x.

Neisen, J. (1990). Heterosexism: Redefining homophobia for the 1990s. Journal of Gay & Lesbian Psychotherapy, 1(3), 21-35. doi:10.1300/J236v01n03_02.

Rubin, J. & Rubin, I. (2012): Qualitative Interviewing: The Art of Hearing Data. Sage Publications

Potter, J. (2010). Meeting the healthcare needs of LGBT populations: An end to invisibility. Grand Rounds.