Blog Post: 6 Ways Forensic Nurses Should Be Supporting Their LGBTQ+ Patients
Access to quality health is an ongoing challenge that many people in the LGBTQ+ community face. In a world where social stigmas regarding sexual orientation and gender identity run rampant, it is difficult for someone who identifies as LGBTQ+ to know who they can disclose sensitive healthcare information to. Concerns for safety and fear of discrimination may cause them to omit details about their sexual behavior, reproductive health, and anatomy- details that healthcare providers need to create the most holistic treatment plan for their patients. Forensic nurses often see LGBTQ+ folks in their most vulnerable state - during a forensic medical exam following a traumatic event. Creating safe, affirming spaces is a crucial component to providing them with the excellent healthcare they deserve. Here are a few ways that forensic nurses can improve their practice:
Recognize the difference between sex and gender. The terms sex and gender are often used interchangeably, but they are not the same. Sex is a label assigned at birth by a medical professional based on their perception of the patient’s bodily characteristics (genitals, chromosomes, hormones, etc.) A person’s sex is often defined using the terms male and female, although we now know that there are many genetic and anatomical variations beyond this binary. Gender is a person’s concept of self as male, female, a blend of both, or neither. Gender can be expressed through appearance, behavior, or mannerisms, and may not align with the expected gender norms of society. For this reason, it is important to know both the patient’s sex and their gender identity.
Understand the importance of pronouns. Pronouns are words that can be substituted for nouns when a reader or listener already knows which noun is being referred to. Common pronouns can include “he/him,” “she/her,” or “they/them.” In many societies, pronouns reflect the sex or gender of the person to which they refer. However, this can be troublesome for people whose gender identity does not align with the prescribed gender norms of their culture. When a healthcare provider misgenders their patient, they send the unintentional message that they do not see or understand their patient’s gender identity. This can discourage their patient from sharing important information that relates to their anatomy, sexual behavior, and reproductive health. One way that forensic nurses can avoid this is by offering their own pronouns at the beginning of the patient encounter. (Ex. “Hi, my name is _______ and my pronouns are ______.”) When a nurse offers their pronouns first, it demonstrates to the patient that they can do the same.
Ask the patient what they would like to be called. It is sometimes necessary to use a patient’s legal name on their medical documents for identification purposes. However, there are many reasons why a person may not go by their legal name. Some patients prefer using a nickname. Some patients have changed their name following a divorce. Some patients have changed their name to better suit their gender identity. At best, when healthcare providers call their patients by the wrong name, it decreases familiarity and rapport. At worst, it can make patients feel unseen, unsafe, and traumatized. One way forensic nurses can avoid this faux pas is to ask, at the beginning of the patient encounter, “What name can I use while we are talking today?” To verify the patient’s identity, the nurse can follow up by asking for the patient’s date of birth. If the name and date of birth match the chart, the nurse has completed patient verification. However, if the patient’s name does not match what is listed in the chart, the nurse can also ask, “Can you confirm the last name that I would have in my medical chart for you?” This avoids a situation in which a patient is forced to use their deadname, while also allowing the nurse to verify their patient’s identity.
Reflect the language that the patient is using. Terms that patients may use for gender identity, sexuality, and even anatomy may differ from the terms commonly used in the medical world. For instance, a trans male or non-binary patient with breasts may prefer to call that area their chest. A patient may refer to their genitals using layman’s terms or slang. In order to affirm their patient's identity and build rapport, a forensic nurse should use the language that the patient is most familiar and comfortable with - regardless of their sexual orientation or gender identity. If a nurse is unsure, it is okay to ask, “I heard you use this term. Is it okay if I use it too?”
Familiarize yourself with terms and issues related to sexual orientation and gender identity. Everyone has blindspots and biases. Everyone can benefit from learning more about the world around them. With 7.6% of adults in the United States identifying as LGBTQ+, it is important for forensic nurses to understand the unique experiences of this population. Here are just a few terms and topics to explore: Transgender, Transman, Transwoman, AFAB, AMAB, straight, gay, bisexual, pansexual, asexual, nonbinary, pronouns, misgendering, deadnames, intersex, gender binary, transitioning, gender dysphoria, heteronormativity, etc.
Ask clarifying questions. Language is flexible, and sometimes words mean different things to different people. In order to provide appropriate assessment and/or treatment, forensic nurses should clearly define which sexual behaviors their patient is participating in. If a patient uses vague terms or euphemisms regarding their sexual behavior, ask them to specify what they mean. Although these conversations can be uncomfortable, they are an important part of identifying a patient’s unique risk factors, whether they are gay, straight, bisexual, pansexual, or any other sexual orientation. Plus, if a healthcare provider has established themselves as a safe person, their LGBTQ+ patients may be more willing to share these sensitive details.
According to a report from the Bureau of Justice Statistics, members of the LGBTQ+ community experience sexual violence and domestic violence at rates that are significantly higher than their straight and cisgender counterparts. For this reason, it is vital that forensic nurses educate themselves on LGBTQ+ issues, and work towards making their practice safer and more inclusive for all patients. The forensic nurses at DCFNE incorporate all of the aforementioned tips in their practice, and DCFNE is proud to offer one of the few 40-hour SANE-A training programs that includes a section dedicated exclusively to LGBTQ+ care. However, there is always room for nurses to learn, grow, and improve. This Pride Month, DCFNE encourages all forensic nurses to examine their practices and consider how they can provide better care for their LGBTQ+ patients.