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Evid Based Nurs 10:94 doi:10.1136/ebn.10.3.94
  • Qualitative

Lesbian women and gay men found that nurses often assumed they were heterosexual, which led to feelings of discomfort and insecurity


 
 Q How do lesbian women and gay men experience nursing care in hospital, and what do they regard as important to communicate about homosexuality and nursing?

DESIGN

Qualitative study.

SETTING

Uppsala, Sweden.

PARTICIPANTS

17 women and 10 men who were 23–65 years of age. They reported 46 nursing experiences as patients and 31 as partners. These nursing experiences included emergency care (n = 8), critical care (n = 5), women’s clinic (n = 11), obstetric care (n = 5), surgery (n = 15), orthopaedic care (n = 4), rehabilitation (n = 7), internal medicine (n = 9), cardiology (n = 3), oncology (n = 5), hospice care (n = 2), and psychiatry (n = 3).

METHODS

Participants were interviewed for 20–90 minutes about their experiences with nursing care. The interviews were audiotaped and transcribed. They were repeatedly read; responses were classified as positive, negative, or neutral; responses were divided into areas (eg, communication, attitudes, and degree of importance); areas were divided into categories (eg, “verbal” was a category for the area of communication); and different categories were analysed separately, and specific words were identified (subcategories). This analysis led to the identification of themes.

MAIN FINDINGS

Heterosexuality assumed as the social “norm” (heteronormativity). Nearly all participants felt that nursing staff had an underlying assumption that heterosexuality was the social norm. This assumption was communicated by brochures and other patient information provided in waiting rooms and public areas and by forms that requested personal information. Nurses admitting patients to wards also made this assumption when asking about family ties. Some routine procedures (eg, doing a pregnancy test even though the participant said she was lesbian) were based on the assumption that the participant was heterosexual. Partners also described experiencing negative non-verbal communication from nursing staff. They felt unaccepted as partners and were excluded and neglected by nursing staff.

Single and older. Participants stated that nursing care encounters were particularly difficult for single and older lesbian women and gay men because many of them did not have family support and practical help. Also, some felt that older gay patients needed to maintain some secrecy about their everyday lives and so would be more vulnerable and sensitive.

Knowledge. Participants thought there was a great lack of knowledge in society and nursing about the lives of gay patients. They felt that it was important for nursing professionals to meet homosexual and bisexual people so that they could gain insight and understanding about their lives. This exposure would help nurses to show compassion when dealing with gay patients.

CONCLUSIONS

Lesbian women and gay men found that nursing staff and institutions often assumed that all patients were heterosexual. These assumptions were reflected in the language used and the questions asked of them and their partners. By getting to know gay people, nurses could learn to show more compassion and less discomfort when caring for gay patients.

Commentary

  1. Kevin Corbett, RN, PhD, HDFA, PGCE
  1. Institute for Health Research, Liverpool John Moores University,
 Liverpool, UK

      Heternormativity is the way that everyday social practices within institutions make heterosexuality appear natural.1 The study by Röndahl et al shows how this phenomenon misleads people into assuming that everyone is heterosexual, which then negatively affects communication between nurses and gay or lesbian patients and their partners. These seemingly innocent practices actually lead nurses to ignore patient and carer needs. This apparent cruelty was shown in a quotation from a gay man reflecting on one nurse’s assumption that his life partner was not a “relative.” Sweden established civil gay and lesbian partnerships more than 10 years ago and so such ignorance is unlikely to be due to nurses lacking experience in providing nursing care to this client group. Swedish nurses also work within a framework of anti-homophobia legislation and professional codes that promote equality and outlaw discriminatory practice on the grounds of moral or religious beliefs.

      Incorporating social research that describes contemporary gay and lesbian social and family life2 into nursing curricula may help nurses to develop greater awareness of and sensitivity to the needs of gay patients. The qualitative descriptive study by Röndahl et al was designed to highlight the narratives of gay patients and partners experiencing discrimination; as such, the sample included people with a “story to tell” rather than those who were statistically representative. The findings show that nurses are failing to meet the needs of this particular client group. However, it is also clear that there are specific institutional and individual practices that nurses can influence relatively easily (eg, checking the language used in patient information leaflets and admission protocols) to improve the patient experience and inhibit further tacit and unintended discrimination.

      References

      Footnotes

      • For correspondence: Dr G Röndahl, Uppsala University, Uppsala, Sweden. gerd.rondahl{at}pubcare.uu.se

      • Source of funding: Uppsala County Council.

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