Chapter 2 – Inclusive Approaches to Health Assessment
Case Application: Cody
Cody is a 16-year-old who identifies as a transgender male. He presents to the emergency department with anxiety. While at hospital, he experiences discrimination from hospital staff by being misgendered and not being called by his preferred name. In this virtual simulation game, you can see Cody’s interactions with the healthcare system. https://soginursing.ca/eresource/index.html#/lessons/rf4jDfaDQfwab1IIq3E6xF6zF-9o4jkT
LGBTQI2SA+ individuals have historically experienced stigmatization, discrimination, and marginalization in society and in accessing healthcare.
Initial interactions during a health assessment can affect whether the client feels comfortable disclosing their sexuality and gender identity, and whether they will return for services (Bosse et al., 2015). When talking to clients about gender and sexuality, always avoid making assumptions.
It is important to have even a basic understanding of gender identity. Gender identity is one’s sense of their gender, often identified as male or female, and can be classified as cisgender or transgender: an individual who identifies as cisgender has a gender identity that aligns with their sex at birth, whereas an individual who identifies as transgender has a gender identity that is incongruent with their sex at birth (Bourns, 2019). Individuals who identify as non-binary may not identify as male or female, or they may identify with no gender, or as a gender other than male or female, or as more than one gender (James et al., 2016). Within the Indigenous population, those who identify as Two-Spirit may describe their gender, sexual, or spiritual identity as a person who embodies both a male and a female spirit (TransCare BC, 2017).
Sexuality refers to an individual’s experience and how they express themselves sexually. A person refers to their sexual orientation based on who they are sexually attracted to. Individuals who are attracted to the opposite gender identify as heterosexual, whereas those who are attracted to the same gender identity as homosexual. Individuals who are attracted to two genders may identify as bisexual (Rainbow Health of Ontario, 2020). Heteronormativity is the assumption that heterosexuality is the norm, which remains prevalent (Searle, 2019). It is critical to be aware of heteronormative assumptions during a health assessment.
For example, imagine you are doing a health assessment on an 18-year-old female with the identified pronouns she/her. If you are asking about her sexual activity and ask if she has a boyfriend, you have made a heteronormative assumption, which can have negative effects on trust and the nurse–client relationship. Instead, ask if she is sexually active, who she has sex with, and her sexual orientation.
Stigma, discrimination, homophobia, and transphobia have created social isolation and mental health challenges, including suicide risks, for LGBTQI2SA+ individuals. Therefore, it is important to ensure an inclusive and gender-affirming environment during each health assessment.
Here are a few strategies for fostering inclusive health assessments with LGBTQI2SA+ individuals:
- Before every interaction, reflect on the beliefs or assumptions that you have about LGBTQI2SA+ individuals and how these assumptions may conflict with the principles of inclusive health assessments
- When meeting a new client, introduce yourself with your name and pronoun and ask which name and pronoun they use. This normalizes gender identity and reduces stigma for transgender and individuals.
- When doing an assessment, ask the client their preferred words for their body parts. Using the term genitals instead of vagina or penis can be important for transgender and non-binary individuals (Bosse et al., 2015).
Bosse, J., Nesteby, J., & Randall, C. (2015). Integrating sexual minority health issues into a health assessment class. Journal of Professional Nursing, 31, 498-507. http://doi.org/10.1016/j.profnurs.2015.04.007
Bourns, A. (2019). Guidelines for gender-affirming primary care with trans and non-binary patients. http://www.transforumquinte.ca/downloads/Guidelines-and-Protocols-for-Comprehensive-Primary-Care-for-Trans-Clients-2019.pdf
Rainbow Health Ontario (2020) LGBT2SQ terms and definitions glossary. https://www.rainbowhealthontario.ca/news-publications/glossary/
Searle, J. (2019). Queer phenomenology, the disruption of heteronormativity, and structurally responsive care. Advances in Nursing Science, 42(2), 109-122. https://doi.org/10.1097/ANS.0000000000000258
The Trans PULSE Canada Team (2020). Health and health care access for trans and non-binary people in Canada. https://transpulsecanada.ca/research-type/reports
Trans Care BC. (2017). Gender-affirming care for trans, Two-Spirit, and gender diverse patients in BC: A primary care toolkit. http://www.phsa.ca/transcarebc/Documents/HealthProf/Primary-Care-Toolkit.pdf
refers to people who do not follow other people’s ideas or stereotypes about how they should look or behave based on the sex they were assigned at birth.