Research project yields practical tips that everyone can put into practice
Jan 10, 2022, By: Kerry Marshall, Wanda Martin
Early nursing theories constructed models of health based on Eurocentrism and White supremacy (McGibbon, Mulaudzi, Didham, Barton, and Sochan, 2014). These early theories, along with the current culture within nursing — patriarchy, gender norms, a culture of efficiency, strict boundaries for educational curriculum, cutbacks within workplaces, apoliticism (Buck-Mcfadyen & Macdonnell, 2017) and hierarchies within medical professions (Dong & Temple, 2011) — challenge nurses in making significant and meaningful change toward an equitable health practice. Neutrality in nursing is deeply rooted and complex, and it is time to untangle the complexities and face the role that nursing may have in oppression.
My (K.M.’s) master of nursing thesis exploring the impact that heteronormativity and cisnormativity have on the fertility intentions and family planning experiences within the 2SLGBTQIA+ community. 2SLGBTQIA+ is an abbreviation that means two-spirit, lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual/agender and allies, and many other diverse sexualities and genders. This list is not exhaustive and is constantly evolving. Heteronormativity is the belief that being heterosexual is the preferred and normal identity; cisnormativity is the belief that the most normal identity is the one assigned at birth. We (K.M. and my supervisor, W.M.) discussed possible solutions to challenges that patients encountered when accessing health care.
As nurses, we need to acknowledge and understand that differences exist and that heteronormativity and cisnormativity are prevalent.
My master’s thesis included a research project with participants who described how there is no easy, one-size-fits-all effort to create safe, inclusive and equitable spaces for every individual as there are many complexities within identities and experiences. Considering the history and challenges nurses may experience in making meaningful change, as well as the privileged and trusted position that nurses hold within society, we are making a call to action for nurses to improve the health-care experiences of 2SLGBTQIA+ community members. This call is based on conversations with participants, my experience as a nurse, the academic literature and voices within the 2SLGBTQIA+ community. Although the call includes specific language and suggestions for the 2SLGBTQIA+ community, these actions can be implemented with any group that experiences oppressions due to systemic factors within health-care settings.
Our goal is to engage in conversation around actions that nurses can take to continue the discussion, challenge feelings of fragility and be more comfortable with the uncomfortable. If we never challenge, we will never change. Although empirical evidence on the outcomes of these actions is limited, we must be willing to try new things to continuously improve care and to advance the profession. We acknowledge that many nurses are working towards these calls within their practice, and while these calls are not exhaustive and may risk not being beneficial for everyone, we wholly believe that we need to accelerate action to change.
At the individual level, nurses can educate themselves about the 2SLGBTQIA+ community. There is a free, interactive course related to sexual orientation and gender identity that targets educating nurses (see the resource list). Additionally, depending on where nurses are located, many community organizations have resources for health-care providers. For example, within Saskatchewan, community organizations, such as OUTSaskatoon, have a plethora of information about sexual and gender orientations (see the resource list), and Saskatchewan Prevention Institute has many recorded webinars — for example, Trans and Non-Binary Sexual Health and Pregnancy and Human Sexuality 101 (see the resource list).
As members of the 2SLGBTQIA+ community constantly expend emotional labour educating nurses on what their identities mean versus obtaining the care and treatment they need, a basic understanding of gender and sexuality is invaluable (Boccomino, 2020). As nurses, we need to acknowledge and understand that differences exist and that heteronormativity and cisnormativity are prevalent, examine and reflect on how we may be incidentally perpetuating normative ideologies and then provide appropriate care to our 2SLGBTQIA+ patients.
In practice, nurses can use inclusive language and advocate for staff to have pronouns visible on their name tags. Nurses can also advocate for patient intake forms to become more gender-neutral, especially with the addition of patient pronouns (Boccomino, 2020). Again, patients continually having to explain or validate their identity is extremely emotionally laborious, and asking for pronouns has been a suggestion from the community that can help mitigate this problem (Boccomino, 2020).
Nurses can create journal clubs or interest groups to understand the effects that normative ideologies have on the 2SLGBTQIA+ community. Journal clubs are effective in improving understandings of different topics and can be helpful when implementing changes in practice (Häggman‐Laitila, Mattila, and Melender, 2016). The Rainbow Nursing Interest Group within the Registered Nurses’ Association of Ontario (RNAO) is an excellent example of nurses coming together to further understand the oppressions faced by the 2SLGBTQIA+ community (see the resource list). Specifically, the group provided recommendations to the federal government’s standing committee on health’s recent report, The Health of LGBTQIA2 Communities in Canada (2019), advocating for 2SLGBTQIA+ education for nurses and increasing funding for health coverage for the 2SLGBTQIA+ community.
Nurses should practise in a trauma-informed manner, which is imperative for working with diverse populations (Fleishman, Kamsky, and Sundborg, 2019). Nurses can start by incorporating aspects of trauma-informed care into their practice by introducing themselves and their role, being aware of their body language and providing expectations for appointments and services (Fleishman et al., 2019). Because trauma-informed care was introduced in 2005, the literature surrounding the efficacy is lacking, but early indicators suggest that it can be effective in reducing retraumatization when working with a variety of populations (Barajas & Martinez, 2020).
Within nursing practice settings, nurses can speak with their managers and colleagues and share resources about the 2SLGBTQIA+ community. We can write to our regulatory bodies to advocate for cultural humility and trauma-informed care and for learning about the 2SLGBTQIA+ community to be mandatory within nursing education or yearly practice competencies. As activism can take on many forms — including policy change, lobbying, educating and creating coalitions (Florell, 2021) — nurses have many options within their practice to make changes for the 2SLGBTQIA+ community.
We can educate new nurses on the importance of cultural humility and trauma-informed care in practice. Considering the intersections of identities within the 2SLGBTQIA+ community, educating nurses on singular identities is not enough; we must teach ways in which nurses can alter their practice to benefit the care of all patients. Cultural humility involves an awareness of the power imbalances that exist and seeking a shift in one’s way of being in the world (Foronda, Baptiste, Reinholdt, and Ousman, 2016). Cultural humility involves nurses listening to their patients’ voices and practising critical self-reflection, self-awareness and egolessness (Foronda et al., 2016). We can also shift curriculums to educate nursing students on the importance of trauma-informed practice, considering that some health-care services can be retraumatizing for people (Fleishman et al., 2019). Trauma-informed care is rooted in safety, transparency, empowerment and responsiveness to different cultures (Fleishman et al., 2019).
There are many complex and nuanced factors that come with making change and taking action. As we understand it, this is not a linear, straightforward or basic task; achieving equity is highly complex and the nursing profession faces many internal challenges. Perhaps we should start with asking the right questions and recognizing the nursing role in perpetuating oppression. By doing so, we will also embrace the power that nurses hold and the potential they have to act for change.
Barajas, L., & Martinez, G. (2020). Effectiveness of trauma-informed practice. In Symposium on undergraduate research and creative expression. Retrieved from https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1930&context=cus
Boccomino, H. (2020). Five ways to be an LGBTQ patient ally. Retrieved from https://www.apta.org/article/2020/07/21/five-ways-to-be-an-lgbtq-patient-ally
Buck-Mcfadyen, E., & Macdonnell, J. (2017). Contested practice: Political activism in nursing and implications for nursing education. International Journal of Nursing Education Scholarship, 14(1). doi:10.1515/ijnes-2016-0026
Dong, D., & Temple, B. (2011). Oppression: A concept analysis and implications for nurses and nursing. Nursing Forum, 46(3), 169-176. doi:10.1111/j.1744-6198.2011.00228.x
Fleishman, J., Kamsky, H., & Sundborg, S. (2019). Trauma-informed nursing practice. Online Journal of Issues in Nursing, 24(2), 1-9. doi:10.3912/OJIN.Vol24No02Man03
Florell, M. C. (2021). Concept analysis of nursing activism. Nursing Forum, 56(1), 134-140. doi:10.1111/nuf.12502
Foronda, C., Baptiste, D.-L., Reinholdt, M., & Ousman, K. (2016). Cultural humility: A concept analysis. Journal of Transcultural Nursing, 27(3), 210. doi:10.1177/1043659615592677
Häggman‐Laitila, A., Mattila, L. R., & Melender, H. L. (2016). A systematic review of journal clubs for nurses. Worldviews on Evidence‐Based Nursing, 13(2), 163-171. doi:10.1111/wvn.12131
McGibbon, E., Mulaudzi, F. M., Didham, P., Barton, S., & Sochan, A. (2014). Toward decolonizing nursing: The colonization of nursing and strategies for increasing the counter-narrative. Nursing Inquiry, 21(3), 179-191. doi:10.1111/nin.12042
Standing Committee on Health. (2019). The health of LGBTQIA2 communities in Canada. https://www.ourcommons.ca/Content/Committee/421/HESA/Reports/RP10574595/hesarp28/hesarp28-e.pdf
Kerry Marshall, RN, MN, is a PhD student at the University of British Columbia. She recently completed her master’s of nursing at the University of Saskatchewan, where she began to indulge in her research interests of social justice; reproductive rights; and public, community, and 2SLGBTQIA+ health.
Wanda Martin, PhD, is an associate professor at the University of Saskatchewan whose work engages systems thinking and the use of novel methodologies addressing public health problems for applied outcomes. Her program of research is on the United Nations’ Sustainable Development Goals , specifically focused on health equity, food systems, and climate change.