LGBT

What is LGBT?
The “LGB” in LGBT refers to the sexual orientation of an individual, whether it is a man to a woman (heterosexual), woman to woman (lesbian) or man to man (homosexual or gay), and those who prefer both genders (bisexual)
The “T” in LGBT “stands for transgender or gender non-conforming, and is an umbrella term for people whose gender identity or gender expression does not conform to that typically associated with the sex to which they were assigned at birth” (Gates, 2013)
In the United States, there are more than 8 million adults, which is about 3.5% of the population, who identify as lesbian, gay, or bisexual. This is about the population that lives in New Jersey (Gates, 2013)
The LGBT (lesbian, gay, bisexual, and transgender) community is integrated in every race, religion, ethnically, age group, and social class.

Gates, G. J. (2013, March 28). How Many People are Lesbian, Gay, Bisexual and Transgender? Retrieved November 11, 2018, from https://williamsinstitute.law.ucla.edu/research/census-lgbt-demographics-studies/how-many-people-are-lesbian-gay-bisexual-and-transgender/

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Lesbian, gay, bisexual, transgender. (n.d.). Retrieved November 11, 2018, from https://www.apa.org/topics/lgbt/index.aspx

Purnell’s Model for Cultural Competence
Purnell’s Model lays down a foundation to understanding “the various attributes of a different culture, allowing nurses to adequately view patient attributes, such as incitement, experiences, and notions about healthcare and illness. This model is presented in a diagram with parallel circles that represent aspects of global society as well as the community, family, and person” (Allougami, 2016).

The model provides 12 culture domains with four outer rims: outer rims represents global society, second rim represents community, third rim was family, the inner rim represents person. The inner circle represents the 12 domains and the circle represents what we do not know about the subgroup
Albougami, A. S. (2016). Comparison of Four Cultural Competence Models in Transcultural Nursing: A Discussion Paper. International Archives of Nursing and Health Care,2(4). doi:10.23937/2469-5823/1510053

Purnell’s 12 domains
The first domain is related to culture. What is included is “the country of derivation, the geographical influence of the original and present home, political affairs, economics, educational status, and profession” (Allougami, 2016).

The second domain is about communication. This includes “ primary language and dialects, circumstantial effectiveness and convenience of the language, paralinguistic differences, and nonverbal communication” (Allougami, 2016).

The third domain is comprised of “family roles and organization, involves who heads the household in terms of gender and age. The organization of the family is affected by goals and priorities, developmental tasks, social status, and alternative lifestyles” (Allougami, 2016).

The fourth domain is about “workforce issues, including acculturation, autonomy, and the presence of language barriers” (Allougami, 2016).

Albougami, A. S. (2016). Comparison of Four Cultural Competence Models in Transcultural Nursing: A Discussion Paper. International Archives of Nursing and Health Care,2(4). doi:10.23937/2469-5823/1510053

Purnell’s 12 domains cont.
“The fifth domain includes factors of bio-cultural ecology, which encompass observable differences with respect to ethnic and racial origins, like skin color and other physical variations” (Allougami, 2016).

The sixth domain involves behaviors that are considered high- risk. This includes tobacco, alcohol consumption, or recreational drugs. This domain also includes physical activity and whether precautions are taken and safety (Allougami, 2016).

The seventh domain is about nutrition. This cann all depend on their place or origin. Each geographical place is accustomed to different foods and the significance to each food. Some groups of people are suffer from malnutrition and certain deficiencies due to their food consumption (Allougami, 2016).

Purnell’s 12 domains cont.
The eighth domain is about pregnancy. Each culture and religion views pregnancy differently. The pregnancy phase, the birthing phase, and the postpartum phase can be viewed and practices differently depending on each belief. This should be considered when dealing with different ethnic groups (Allougami, 2016).

The ninth domain involves death rituals. From culture to culture, death is viewed differently. Each ethnic group performs rituals differently and dictate how one should behave after a death.

“The tenth domain is spirituality, which includes religious practice, use of prayer, individual strength, the meaning of life, and how spirituality relates to health” (Allougami, 2016)

Purnell’s 12 domains cont.
The eleventh domain is about healthcare and healthcare practices. This includes practices traditional practices (like alternative medicine), “magical religious practices, chronic-disease treatment and rehabilitation, mental-health practices, and the roles of the sick” (Albougami, 2016).

“The twelfth and final domain, healthcare professionals, involves the perceptions and roles of traditional and folk healthcare practices” (Albougami, 2016).

(Purnell Model. , 2013)
Purnell Model. (2013, September). Retrieved November 11, 2018, from https://www.nasn.org/nasn/nasn-resources/practice-topics/cultural-competency/cultural-competency-purnell-model

Problems LGBT Community Faces
Depression and suicidal risk
“LGBT youth are 2 to 3 times more likely to attempt suicide” (“Lesbian, Gay, Bisexual, and Transgender Health”, (n.d.)
“LGBT youth are more likely to be homeless” (“Lesbian, Gay, Bisexual, and Transgender Health”, (n.d.)
Sexual provocativeness and increased substance use
“Gay men are at higher risk of HIV and other STDs, especially among communities of color” (“Lesbian, Gay, Bisexual, and Transgender Health”, (n.d.).
“LGBT populations have the highest rates of tobacco, alcohol, and other drug use” (“Lesbian, Gay, Bisexual, and Transgender Health”, (n.d.).

Hafeez, H., Zeshan, M., Tahir, M. A., Jahan, N., & Naveed, S. (2017). Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus, 9(4), e1184. doi:10.7759/cureus.1184
Lesbian, Gay, Bisexual, and Transgender Health. (n.d.). Retrieved November 11, 2018, from https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health

Problems LGBT Community Faces, Cont.

Increased risk of physical health problems, lack of gender/sex-specific health care, and office-based care
“Lesbians are less likely to get preventive services for cancer” (“Lesbian, Gay, Bisexual, and Transgender Health”, (n.d.).
“Lesbians and bisexual females are more likely to be overweight or obese” (“Lesbian, Gay, Bisexual, and Transgender Health”, (n.d.).

Peer victimization and family rejection
“The Youth Risk Behavior Survey (YRBS) in 2016 showed that 34% of LGBT teens were bullied in school, 18% stated having forced sex, 23% were the victim of sexual violence, and 18% struggled with physical violence” (Hafeez, Zeshan, Tahir, Jahan, & Naveed, 2017).

Recommendations for Providing Culturally Competent Nursing Care
“Most importantly, healthcare providers must also be informed about LGBT health because of the numerous health disparities which affect members of this population. Sexually transmitted infections, including human immunodeficiency virus [HIV], eating disorders and body image disorders, suicide, substance abuse and depression are major concerns among some LGBT groups” (Keily, Lee, Lakenya, Green, & Skyes, 2016).

Nurses who are culturally competent help reduce barriers, related to cultural and linguistic, between patients, family, and medical staff, that may interfere with delivering effective health care.

Mitchell, Keily M.; Lee, Lakenya; Green, Ayana; and Skyes, Jasmine (2016) "The Gaps in Health Care of the LGBT Community: Perspectives of Nursing Students and Faculty," Papers & Publications: Interdisciplinary Journal of Undergraduate Research: Vol. 5 , Article 5.

Recommendations for Providing Culturally Competent Nursing Care, Cont.

Butler, McCreedy, Schwer, Burgess, Call, Przedworski, Rosser, Larson, Allen, Fu, And Kane (2016), suggest recommendation to helping nurses provide culturally competent care: “Educating staff on specific health disparities experienced by the LGBT communities and how to collect sexual and social history, using gender-neutral language on forms and communication, refraining from making assumptions about a person's sexual orientation or gender identity by asking directly about identity and sexual behavior, displaying LGBT-friendly symbols, and registering with the Gay and Lesbian Medical Association's online directory” (Butler M, McCreedy E, Schwer N, et al., 2016).

Butler M, McCreedy E, Schwer N, et al. Improving Cultural Competence to Reduce Health Disparities [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Mar. (Comparative Effectiveness Reviews, No. 170.) 3, Lesbian, Gay, Bisexual, and Transgender Populations. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361118/

Recommendations for Providing Culturally Competent Nursing Care, Cont.

Health care professionals should create an environment that is friendly, and welcoming toward the LGBT community and individuals. The Joint Commission published guidelines that recommend stepss that health care individuals can take to be more aware and provide the best care to this group (Felsenstein, 2018).

Felsenstein, D. R. (2018). Enhancing Lesbian, Gay, Bisexual, and Transgender Cultural Competence in a Midwestern Primary Care Clinic Setting. Journal for Nurses in Professional Development,1. doi:10.1097/nnd.0000000000000450

References
Albougami, A. S. (2016). Comparison of Four Cultural Competence Models in Transcultural Nursing: A Discussion Paper. International Archives of Nursing and Health Care,2(4). doi:10.23937/2469-5823/1510053
Butler M, McCreedy E, Schwer N, et al. Improving Cultural Competence to Reduce Health Disparities [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Mar. (Comparative Effectiveness Reviews, No. 170.) 3, Lesbian, Gay, Bisexual, and Transgender Populations. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361118/
Felsenstein, D. R. (2018). Enhancing Lesbian, Gay, Bisexual, and Transgender Cultural Competence in a Midwestern Primary Care Clinic Setting. Journal for Nurses in Professional Development,1. doi:10.1097/nnd.0000000000000450

References
Gates, G. J. (2013, March 28). How Many People are Lesbian, Gay, Bisexual and Transgender? Retrieved November 11, 2018, from https://williamsinstitute.law.ucla.edu/research/census-lgbt-demographics-studies/how-many-people-are-lesbian-gay-bisexual-and-transgender
Hafeez, H., Zeshan, M., Tahir, M. A., Jahan, N., & Naveed, S. (2017). Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus, 9(4), e1184. doi:10.7759/cureus.1184
Lesbian, Gay, Bisexual, and Transgender Health. (n.d.). Retrieved November 11, 2018, from https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health

References
Lesbian, gay, bisexual, transgender. (n.d.). Retrieved November 11, 2018, from https://www.apa.org/topics/lgbt/index.aspx
Mitchell, Keily M.; Lee, Lakenya; Green, Ayana; and Skyes, Jasmine (2016) "The Gaps in Health Care of the LGBT Community: Perspectives of Nursing Students and Faculty," Papers & Publications: Interdisciplinary Journal of Undergraduate Research: Vol. 5 , Article 5.
Purnell Model. (2013, September). Retrieved November 11, 2018, from https://www.nasn.org/nasn/nasn-resources/practice-topics/cultural-competency/cultural-competency-purnell-model

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