While healthcare agencies work to provide informed care to LGBTQ patients, the community still faces obstacles. In an article in Nurse.com, Michael Johnson, Ph.D., RN, chairman of the Gay and Lesbian Medical Association, Nursing Section, said sensitivity training is vital to LGBTQ care. “Some members of the LGBTQ community avoid seeking healthcare services because of previous negative experiences in which they faced discrimination,” Johnson said in the website article “How to care for the LGBTQ community’s health issues.” “Studies have shown most LGBTQ patients want to be able to share their sexual orientation or gender identity with their healthcare provider but are often reluctant to open up because they fear they may be treated badly or even refused care.” Also, LBGTQ patients may have specific concerns related to sexual orientation or gender identity following sexual violence. The concern may be related to the assault or interactions with the healthcare, legal or criminal justice systems, Sexual Assault Support Services of Midcoast Maine said in “LGBTQ+ Advocacy.” Some LGBTQ patient concerns include:

• Fear that officials (including law enforcement, healthcare professionals and counselors) won’t be sensitive
• Fear of being outed
• Fear of not being supported or believed

Meeting LGBTQ Sexual Violence Survivor Needs

Lyzanne Malfitano, a therapist and shift supervisor at the Chicago Rape Crisis Hotline, said LGBTQ victims — particularly transgender people — worry about harassment and abuse at the hands of providers, in her interview with Joyful Heart Foundation, an LGBTQ advocacy group. “Another challenge is thinking about how disclosing violence within intimate relationships may confirm some stereotypes about LGBTQ relationships being inherently inferior or unhealthy. It’s a lot for a person to have to weigh after experiencing violence.” The International Association of Forensic Nurses said victim-centered care for LGBTQ patients is vital and should include:

• Intake forms and documents with space for patients to write information about sexual orientation and gender identity rather than a checkbox
• Referring to victims using preferred pronouns or names
• Treating the patient’s LGBTQ status as confidential medical information
• Not showing surprise, shock, dismay or concern when a transgender patient reveals personal information

How Nurses Help Underrepresented Communities

Malfitano also said policies should be changed to ensure equal treatment for all victims of sexual violence, including removing gender-based language. LGBTQ victims should feel supported while receiving care, she said. “A survivor shouldn’t be turned away from necessary care because their gender marker is male, yet they might still be at risk for pregnancy as a result of assault. I also advocate for a change from the gender violence model, which is that sexual assault is a crime against women perpetrated by men,” Malfitano said. “This paradigm is really difficult for survivors who don’t fit that model and assume that services may not exist for them.” Some nurses who focus on LGBTQ care may choose to join an organization dedicated to addressing underrepresented communities or LGBTQ human trafficking. Many other nurses pursue advanced education to hone the skills to provide marginalized communities with proper care from local institutions. By making inclusive care the norm in medical institutions, nurse practitioners are able to lower the barriers to care for underrepresented communities, and hopefully reduce apprehension for patients to seek medical advice.