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Making nurse education LGBT-friendly

A joint initiative between Stonewall and Cardiff University is embedding LGBT awareness in nursing degree courses.

A joint initiative between Stonewall and Cardiff University is embedding LGBT awareness in undergraduate nursing courses. Improving educators' skills in this area could reduce the pressure on LGBT students to fill in gaps in people's knowledge

One in ten health and social care staff involved in patient care say they have witnessed a colleague express the opinion that lesbian, gay or bisexual people can be cured.

The shocking finding came to light in the Unhealthy Attitudes survey, published in 2015 and commissioned by Stonewall, which campaigns for equality for lesbian, gay, bisexual and trans (LGBT) people.

There is still a very real problem in some pockets of the NHS, says the organisations chief executive Ruth Hunt. Stonewall has done a lot of work raising awareness with LGBT people around

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A joint initiative between Stonewall and Cardiff University is embedding LGBT awareness in undergraduate nursing courses. Improving educators' skills in this area could reduce the pressure on LGBT students to fill in gaps in people's knowledge  

One in ten health and social care staff involved in patient care say they have witnessed a colleague express the opinion that lesbian, gay or bisexual people can be ‘cured’.

The shocking finding came to light in the Unhealthy Attitudes survey, published in 2015 and commissioned by Stonewall, which campaigns for equality for lesbian, gay, bisexual and trans (LGBT) people.

‘There is still a very real problem in some pockets of the NHS,’ says the organisation’s chief executive Ruth Hunt. ‘Stonewall has done a lot of work raising awareness with LGBT people around their health needs and also trying to educate healthcare workers about the issues – but if I’m honest, it hasn’t worked very well.’

26% of LGBT staff said they had been bullied or poorly treated because of their sexual orientation

To address the lack of knowledge and understanding, they began to think about how they could help to develop a more inclusive health curriculum, ensuring that healthcare professionals of the future are better equipped to support LGBT patients.

‘The more information we can give to students at an early stage, the better it is for them,’ says Ms Hunt. ‘Any good nurse wants to do the best job they possibly can for their patients. But if they are lacking confidence, worried or trying to patch together information, that gets in the way.’

Working in collaboration with Cardiff University – which has just under 1,000 nursing students – they have helped to create the award-winning inclusive curricula project. This provides a training day and resources for healthcare academics to help them explore how their curriculum and teaching can be LGBT inclusive. ‘It’s a really innovative solution that’s had an incredible impact. We’re very excited about it,’ says Ms Hunt.

Bullying

The training package is also helping challenge prejudice experienced by some LGBT healthcare students, she believes. According to the Stonewall survey, carried out by YouGov, 26% of LGBT staff said they had been bullied or poorly treated because of their sexual orientation.

‘There’s a very real issue about how LGBT staff are treated,’ says Ms Hunt. ‘But when staff are able to be themselves, their expertise, knowledge and insight improves patient care. It’s an important matrix that the NHS has understood in relation to race. You see things about your own communities that others don’t.’

Senior lecturer Dave Clarke hopes that the initiative, by improving awareness among educators, will take some of the pressure off LGBT students.

‘Research shows that if you’re an LGBT student, you have to work to fill the gaps in people’s knowledge,’ says Dr Clarke, who jointly leads the project at Cardiff University. ‘You have to contribute and ask the questions to make a session inclusive.

‘It can put you in a difficult position, because most of the time you have to come out to do that, and you can also be seen as pushing a single agenda.’

To date, the university has run six day-long courses, attracting more than 60 healthcare academics.

A bid for funding

The project has been recognised with the university’s achieving excellence in equality and diversity award and an award given by the chief nursing officer for Wales. Now the project team are bidding for £12,000 of funding to help them expand the training to academics in other universities.

The course includes a booklet, Sexual Orientation: A Health and Social Care Curricula Resource, a slide presentation and information on relevant national and local resources and guidance.

Those attending take part in interactive exercises to develop their skills and confidence, based on case studies, role play and facilitated discussions.

This includes confronting important issues, such as what to do if:

  • A patient or colleague says something homophobic.
  • A colleague says they don’t want to work with a gay patient because their religious faith tells them homosexuality is wrong.
  • A patient or colleagues comes out to you.

‘The feedback has been good,’ says Dr Clarke. ‘The training makes people think differently.’

Inclusive curricula

Follow-up questionnaires show that participants are making changes to their courses that are being sustained in the longer term. ‘Sometimes they’re slight tweaks to lesson plans or case studies to make them more inclusive,’ says adult nursing lecturer Maurice O’Brien, who also leads the project, as part of a team of six.

‘Straight away they can see what they can do – little things that can make a significant difference.’

Examples include specifically talking about lesbians’ health needs during training on cervical screening, helping to debunk the widely held myth that they are not at risk of cervical cancer. This has meant that lesbians are twice as likely as women in general to have never had a smear test.

With a background working in HIV and AIDS, part of Mr O’Brien’s remit is to deliver education about sexual health. For many academics, sexuality is uncomfortable territory, he believes, with some reluctant to admit that the kinds of attitudes exposed by Stonewall’s research exist.

Everyone’s business

‘Academics often shy away from talking about issues such as sexual orientation,’ says Mr O’Brien. ‘Some are afraid of how to manage the discussion that might start and they feel awkward.’ Meanwhile the evidence detailing the experiences of some LGBT patients often horrifies students. ‘When I show undergraduates real case histories, it reduces some to tears,’ he says. ‘It needs to be tackled as seriously as any other instances of bad practice.’

‘When staff are able to be themselves, their expertise, knowledge and insight improves patient care. It’s an important matrix that the NHS has understood in relation to race.’

Alongside raising awareness of any unconscious bias there may be in the ways students are being taught, the training provides resources and improves knowledge of the main issues. ‘Consequently, academics have more confidence to make LGBT issues more transparent in their teaching,’ says Mr O’Brien. ‘We don’t want a little group of academics in the corner, banging a gay drum.’

Dr Clarke agrees. ‘We’re giving them some knowledge and skills so that when they do come across LGBT issues they can at least engage in the conversation,’ he says. ‘These conversations can be difficult but it’s possible for anyone to have them.

‘Hopefully our students will get these small messages threaded throughout the curriculum they study. That means that LGBT issues aren’t just talked about once or twice during their training, but they’re embedded in everything. The idea is to make it everyone’s business.’

Answering difficult questions

What should you do if a patient or colleague says something homophobic?

While often dismissed as harmless banter, this kind of language has a negative effect on everyone, says the resource guide. Alongside reinforcing negative perceptions of LGBT people, it leads to a general intolerance of being different and an environment that excludes people. As such, it should be challenged and reported every time you hear it.

Can you choose not to work with gay patients because you believe homosexuality is sinful?

While everyone has a right to their own beliefs, they cannot affect how you treat patients or colleagues, advises the guidance. You cannot refuse to treat an LGBT person or treat them poorly. This includes telling them that their sexual orientation is a sin, unnatural, an illness or that it can be cured. Those who think they may struggle to care for LGBT patients should seek training to improve their abilities in this area.


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About the author

Lynne Pearce is a freelance health writer

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