Advice for chief nurses on integrating LGBTQ+ inclusive practices into the healthcare system through centred qualitative exploration

Nguyen Cheirard; Labrag Gretha

doi:10.69725/shmw.v1i3.153

Authors

Nguyen C a. Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
Labrag G b. Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand

DOI:

https://doi.org/10.69725/shmw.v1i3.153

Keywords:

LGBTQ+ inclusion, chief nurse, Healthcare system, ERIC framework, Qualitative exploration

Abstract

Objective: This research aims to uncover effective strategies for fostering an equitable environment for LGBTQ+ individuals as well as potential barriers to achieving this and classifies these strategies based using the Expert Recommendations for Implementing Change (ERIC) framework.
Methods: We conducted a qualitative exploration using in-depth interviews with chief nurses at a selected sample of healthcare organizations throughout Thailand. Thematic analysis was performed to identify recurring themes and classify strategies according to the ERIC framework.
Findings: The study highlighted five factors that influenced the application of LGBTQ+-inclusive practices: corporate training programs, clarity in organization policy and directives, support from management, tackling culture in the organization, and (5) staff participation in continuous education. Training programs, as well as clear policy implementation, had the largest hits amongst these. The accessibility of information, combined with cultural and behavioral changes, could be contributing to the recent increase in segregation, the authors argue, and cultural resistance continues to be a significant barrier, suggesting that targeted efforts are needed to address underlying biases. Moreover, through community engagement and a digital learning tocreate breaking routes for inclusivity emerged as one of the innovative ways.
Novelty: The study uniquely integrates qualitative exploration and the ERIC-framework to yield actionable recommendations for chief nurses. It draws attention to other seemingly overlooked barriers including cultural resistance and suggests creative solutions customized to the socio-cultural setting of Thailand, not mentioned in other literature.
Research Implications: The insights provide practical advice for healthcare executives who want to foster inclusive settings for LGBTQ+ patients. The study highlights many of the necessary conditions tailored strategy, staff training, and policy implementation for achieving equity in health-care delivery.” These themes will provide guidance to chief nurses in Thailand as well as other areas where socio-cultural behaviours can govern clinical activity, and they provide a pathway to wider adoption of inclusive behaviours in global healthcare systems.

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Author Biographies

Nguyen C, a. Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand

Nguyen Cheirard

Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
Labrag G, b. Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand

Labrag Gretha

Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand

References

Acconcia, G., Perego, A., & Perini, L. (2024). LGBTQ activism in repressive contexts: the struggle for (in)visibility in Egypt, Tunisia and Turkey. Social Movement Studies, 23(2), 207–225. https://doi.org/10.1080/14742837.2022.2070739 DOI: https://doi.org/10.1080/14742837.2022.2070739

Ashdown-Franks, G., Firth, J., Carney, R., Carvalho, A. F., Hallgren, M., Koyanagi, A., Rosenbaum, S., Schuch, F. B., Smith, L., Solmi, M., Vancampfort, D., & Stubbs, B. (2020). Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes. Sports Medicine, 50(1), 151–170. https://doi.org/10.1007/s40279-019-01187-6 DOI: https://doi.org/10.1007/s40279-019-01187-6

Bristol, S., Kostelec, T., & MacDonald, R. (2018). Improving Emergency Health Care Workers’ Knowledge, Competency, and Attitudes Toward Lesbian, Gay, Bisexual, and Transgender Patients Through Interdisciplinary Cultural Competency Training. Journal of Emergency Nursing, 44(6), 632–639. https://doi.org/https://doi.org/10.1016/j.jen.2018.03.013 DOI: https://doi.org/10.1016/j.jen.2018.03.013

Essex, R., Dillard-Wright, J., Aitchison, G., & Aked, H. (2023). Everyday Resistance in the U.K.’s National Health Service. Journal of Bioethical Inquiry, 20(3), 511–521. https://doi.org/10.1007/s11673-023-10274-3 DOI: https://doi.org/10.1007/s11673-023-10274-3

Fu, M. X., Onanuga, S., Ye, X., Aiyappan, R., Zou, T., Smith, S., & Baptista, A. (2024). Patient voices and student insights into LGBTQ+ healthcare: a call for equitable healthcare through medical education. Medical Education Online, 29(1), 2405484. https://doi.org/10.1080/10872981.2024.2405484 DOI: https://doi.org/10.1080/10872981.2024.2405484

Giddens, J. (2018). Transformational leadership: What every nursing dean should know. Journal of Professional Nursing, 34(2), 117–121. https://doi.org/https://doi.org/10.1016/j.profnurs.2017.10.004 DOI: https://doi.org/10.1016/j.profnurs.2017.10.004

Heer, E., Peters, C., Knight, R., Yang, L., & Heitman, S. J. (2023). Participation, barriers, and facilitators of cancer screening among LGBTQ+ populations: A review of the literature. Preventive Medicine, 170, 107478. https://doi.org/https://doi.org/10.1016/j.ypmed.2023.107478 DOI: https://doi.org/10.1016/j.ypmed.2023.107478

Hughes, T. L., Jackman, K., Dorsen, C., Arslanian-Engoren, C., Ghazal, L., Christenberry-deceased, T., Lance Coleman, C., Mackin, M., Moore, S. E., Mukerjee, R., Sherman, A., Smith, S., & Walker, R. (2022). How can the nursing profession help reduce sexual and gender minority related health disparities: Recommendations from the National Nursing LGBTQ Health Summit. Nursing Outlook, 70(3), 513–524. https://doi.org/https://doi.org/10.1016/j.outlook.2022.02.005 DOI: https://doi.org/10.1016/j.outlook.2022.02.005

Javier, N. M. (2021). Palliative care needs, concerns, and affirmative strategies for the LGBTQ population. Palliative Care and Social Practice, 15, 26323524211039230. https://doi.org/10.1177/26323524211039234 DOI: https://doi.org/10.1177/26323524211039234

Jennings, L., Barcelos, C., McWilliams, C., & Malecki, K. (2019). Inequalities in lesbian, gay, bisexual, and transgender (LGBT) health and health care access and utilization in Wisconsin. Preventive Medicine Reports, 14, 100864. https://doi.org/https://doi.org/10.1016/j.pmedr.2019.100864 DOI: https://doi.org/10.1016/j.pmedr.2019.100864

Kamen, C. S., Alpert, A., Margolies, L., Griggs, J. J., Darbes, L., Smith-Stoner, M., Lytle, M., Poteat, T., Scout, N. F. N., & Norton, S. A. (2019). “Treat us with dignity”: a qualitative study of the experiences and recommendations of lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients with cancer. Supportive Care in Cancer, 27(7), 2525–2532. https://doi.org/10.1007/s00520-018-4535-0 DOI: https://doi.org/10.1007/s00520-018-4535-0

Ledingham, E., Adams, R. S., Heaphy, D., Duarte, A., & Reif, S. (2022). Perspectives of adults with disabilities and opioid misuse: Qualitative findings illuminating experiences with stigma and substance use treatment. Disability and Health Journal, 15(2, Supplement), 101292. https://doi.org/https://doi.org/10.1016/j.dhjo.2022.101292 DOI: https://doi.org/10.1016/j.dhjo.2022.101292

Logie, C. H., Perez-Brumer, A., Mothopeng, T., Latif, M., Ranotsi, A., & Baral, S. D. (2020). Conceptualizing LGBT Stigma and Associated HIV Vulnerabilities Among LGBT Persons in Lesotho. AIDS and Behavior, 24(12), 3462–3472. https://doi.org/10.1007/s10461-020-02917-y DOI: https://doi.org/10.1007/s10461-020-02917-y

Lubieniecki, G., Fernando, A. N., Randhawa, A., Cowlishaw, S., & Sharp, G. (2024). Perceived clinician stigma and its impact on eating disorder treatment experiences: a systematic review of the lived experience literature. Journal of Eating Disorders, 12(1), 161. https://doi.org/10.1186/s40337-024-01128-3 DOI: https://doi.org/10.1186/s40337-024-01128-3

Mark, T. L., & Parish, W. (2019). Opioid medication discontinuation and risk of adverse opioid-related health care events. Journal of Substance Abuse Treatment, 103, 58–63. https://doi.org/https://doi.org/10.1016/j.jsat.2019.05.001 DOI: https://doi.org/10.1016/j.jsat.2019.05.001

Martos, A. J., Wilson, P. A., Gordon, A. R., Lightfoot, M., & Meyer, I. H. (2018). “Like finding a unicorn”: Healthcare preferences among lesbian, gay, and bisexual people in the United States. Social Science & Medicine, 208, 126–133. https://doi.org/https://doi.org/10.1016/j.socscimed.2018.05.020 DOI: https://doi.org/10.1016/j.socscimed.2018.05.020

McCann, E., & Brown, M. (2018). The inclusion of LGBT+ health issues within undergraduate healthcare education and professional training programmes: A systematic review. Nurse Education Today, 64, 204–214. https://doi.org/https://doi.org/10.1016/j.nedt.2018.02.028 DOI: https://doi.org/10.1016/j.nedt.2018.02.028

McHugh, R. K., Votaw, V. R., Sugarman, D. E., & Greenfield, S. F. (2018). Sex and gender differences in substance use disorders. Clinical Psychology Review, 66, 12–23. https://doi.org/https://doi.org/10.1016/j.cpr.2017.10.012 DOI: https://doi.org/10.1016/j.cpr.2017.10.012

McPhail, D., Lorway, R., & Chevrier, C. (2022). Safe spaces that matter: Material semiotics, affective bodies and queer readings of clinical spaces in Winnipeg, Canada. SSM - Qualitative Research in Health, 2, 100126. https://doi.org/https://doi.org/10.1016/j.ssmqr.2022.100126 DOI: https://doi.org/10.1016/j.ssmqr.2022.100126

Nakkeeran, N., & Nakkeeran, B. (2018). Disability, mental health, sexual orientation and gender identity: understanding health inequity through experience and difference. Health Research Policy and Systems, 16(1), 97. https://doi.org/10.1186/s12961-018-0366-1 DOI: https://doi.org/10.1186/s12961-018-0366-1

Radix, A., & Maingi, S. (2018). LGBT Cultural Competence and Interventions to Help Oncology Nurses and Other Health Care Providers. Seminars in Oncology Nursing, 34(1), 80–89. https://doi.org/https://doi.org/10.1016/j.soncn.2017.12.005 DOI: https://doi.org/10.1016/j.soncn.2017.12.005

Shore, L. M., Cleveland, J. N., & Sanchez, D. (2018). Inclusive workplaces: A review and model. Human Resource Management Review, 28(2), 176–189. https://doi.org/https://doi.org/10.1016/j.hrmr.2017.07.003 DOI: https://doi.org/10.1016/j.hrmr.2017.07.003

Uhl-Bien, M., & Arena, M. (2018). Leadership for organizational adaptability: A theoretical synthesis and integrative framework. The Leadership Quarterly, 29(1), 89–104. https://doi.org/https://doi.org/10.1016/j.leaqua.2017.12.009 DOI: https://doi.org/10.1016/j.leaqua.2017.12.009

West-Livingston, L. N., Dittman, J. M., Park, J. A., & Pascarella, L. (2021). Sexual orientation, gender identity, and gender expression: From current state to solutions for the support of lesbian, gay, bisexual, transgender, and queer/questioning patients and colleagues. Journal of Vascular Surgery, 74(2, Supplement), 64S-75S. https://doi.org/https://doi.org/10.1016/j.jvs.2021.03.057 DOI: https://doi.org/10.1016/j.jvs.2021.03.057

Wingo, E., Ingraham, N., & Roberts, S. C. M. (2018). Reproductive Health Care Priorities and Barriers to Effective Care for LGBTQ People Assigned Female at Birth: A Qualitative Study. Women’s Health Issues, 28(4), 350–357. https://doi.org/https://doi.org/10.1016/j.whi.2018.03.002 DOI: https://doi.org/10.1016/j.whi.2018.03.002

Yu, H., Ancheta, A. J., Flores, D. D., Bonett, S., Meanley, S., Choi, S. K., & Bauermeister, J. A. (2024). Nurse leaders’ recommendations for implementing LGBTQ+ inclusive practices in health systems: A qualitative descriptive study. International Journal of Nursing Studies Advances, 7, 100262. https://doi.org/https://doi.org/10.1016/j.ijnsa.2024.100262 DOI: https://doi.org/10.1016/j.ijnsa.2024.100262

Yu, H., Flores, D. D., Bonett, S., & Bauermeister, J. A. (2023). LGBTQ + cultural competency training for health professionals: a systematic review. BMC Medical Education, 23(1), 558. https://doi.org/10.1186/s12909-023-04373-3 DOI: https://doi.org/10.1186/s12909-023-04373-3