Case #1 TJ, a 32-year-old pregnant lesbian, is being seen for an annual physical exam and has been having vaginal discharge. Her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. She is currently taking prenatal vitamins and takes over the counter Tylenol for aches and pains on occasion. She has a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.
Cultural competence consists of integrating and transforming knowledge about individuals and groups into specific standards, policies, practices, and attitudes used in diverse appropriate cultural settings to increase the quality of services; and thus obtain better results (Centers for Disease Control and Prevention, 2015). Various factors such as beliefs, sexual orientation, culture, and specific lifestyles can determine an individual’s perception of health and care that should be taken into account when conducting a health assessment to provide optimal care for the patient.
As nurse practitioners evaluating a pregnant lesbian patient, we must respect regardless of her sexual preference or how she became pregnant. We must consider her specific cultural background, beliefs, sexual orientation, and lifestyles that may affect her health care options or influence her perception of her health, always respecting her opinion and decisions.
Having an excellent knowledge of the patient’s culture should not be formative to reach conclusions; instead, it should help ask questions more constructively without stereotyping the patient (Ball et al., 2015). TJ being lesbian, gay, bisexual, or transgender (LGBT), should receive care with due respect and sensitivity that allows him to feel comfortable and not feel stereotyped or discriminated against. The health questions during the evaluation should be simple, avoiding being discriminatory questions. Being a lesbian does not inherently affect a person’s health status; By creating the right relationship with the patient, we can learn more about high-risk behaviors that may affect her health care options and lifestyle (American College of Obstetricians and Gynecologists, 2012).
TJ should be evaluated like any other patient, considering her medical and psychological history to know the possible risk factors harmful to her and her pregnancy. As nurse practitioners, we must create good communication to obtain a clear history and physical evaluation to establish an individualized, appropriate, relevant, and supportive plan of care for each patient. Good nurse-patient communication will allow us a successful relationship during pregnancy and give us better results for the future mother and the baby, so the first interview is essential to build a close relationship between provider and patient (Ball et al., 2015). Successful communication is achieved with respectful communication techniques, realistic expectations, and pursuing objectives that respond to the patient’s interests. We must be flexible and receptive to TJ’s needs and differences and make the necessary changes to create a connection with her, leading to a trusting relationship. Providing care in a non-judgmental environment is essential to establishing a positive relationship.
TJ’s gender preference should not determine her daily practices and health history but should be considered with sensitivity in developing the questions we will ask (American College of Obstetricians and Gynecologists, 2012). Population-associated risk factors can help clinicians to ask focus questions and assess their risks. Likewise, knowledge of cultural and diversity distinctions should not be used for assumption but should help determine the patient’s health needs.
Women who identify with the LGBTQ community have traditionally faced many healthcare related barriers that impact their privacy and confidentiality, discriminatory attitudes and treatment from health care workers, limited access to health care and health insurance, and luck understanding of their health risks (American College of Obstetricians and Gynecologists, 2012). Many LGBTQ females have for years lived with the stigmas of society which treat this group with some form of distain and discrimination. However, since the enactment of the affordable act and significant changes in the last decade; many LGBTQ individuals can now access healthcare benefits and get recognition from federal and state government. However, such
practices have been around for decades making members of this community to feel maligned by society. As a clinician I should explore questions that will address her ability to access healthcare insurance, follow up care, and socioeconomic needs while pregnant.
Lesbian, gay, bisexual, or transgendered (LGBT) individuals receive more poor healthcare and often report a considerable degree of discrimination by medical students and practicing physicians causing them to avoid seeking medical care because of their sexual orientation (MacPherson, McMillan, Nama, & Sampson, 2017). I will also explore her mental health status by inquiring about any depression, mental health history, or behavior that can be at risk for her or her pregnancy. Domestic violence, discrimination, and abuse is common in this community; and it is therefore important to assess the patient for any signs of abuse or self- neglect. I should also asses her for any use of recreational drug use that can be harmful to her health while pregnant.
Sexual and gender minorities have many of the same health concerns as the general population, they experience some health issues at higher rates and face several unique health challenges (Kaiser Family Foundation, 2016). Some LGBTQ parents can be caught up in legal dilemmas that will need to be explored with social service such as naming parents on a birth certificate and parental right (Pharris et al., 2016). TJ should be treated like any pregnant female and therefore referrals to prenatal care, assessment of her understanding of pregnancy and care, diabetes history, how is she receiving the pregnancy news, family disease history, and past health history should be assesed to determine any health risks that can impact her or her pregnancy.
Maternal health is a priority for her while pregnancy because her health can impact her unborn baby. Legal question might arise such as naming of the child however, such questions should be also be explored so that the patient can get social services referrals for assistance prior to the child being born.
Targeted Questions
From the given scenario and risks, factors identified, focus inquiries will seek to gather as much as patient-centered information to address TJ’s medical needs while carefully considering her diversity. The targeted questions will be as follows:
What are recent changes in your pregnancy you experiencing that concerns you?
What mediations are you taking including over the counter?
Do you drink, smoke, or use any recreational drugs?
When was your last prenatal checkup?
Can you describe your usual diet and activity?
What is your marital status?
Did you have any health issues in the past?
Tell me the story of how you became pregnant?
How are you and your partner feeling about the pregnancy?
Are there any particular areas of concern?
Reference
American College of Obstetricians and Gynecologists. (2012). Health Care for Lesbians and Bisexual Women. Retrieved from https://www.acog.org/Resources-And- Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved- Women/Health-Care-for-Lesbians-and-Bisexual-Women
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Centers for Disease Control and Prevention (2015). Cultural Competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence
Kaiser Family Foundation. (2016, November). Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals in the U.S. Retrieved from https://www.kff.org/disparities-policy/issue-brief/health-and-access-to-care-and- coverage-for-lesbian-gay-bisexual-and-transgender-individuals-in-the-u-s/
MacPherson, P., McMillan, H. J., Nama, N., & Sampson, M. (2017). Medical students’ perception of lesbian, gay, bisexual, and transgender (LGBT) discrimination in their learning environment and their self-reported comfort level for caring for LGBT patients: a survey study. Medical Education Online, 22. Retrieved from http://www-tandfonline- com.ezp.waldenulibrary.org/doi/full/10.1080/10872981.2017.1368850
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