Sexuality And Interpersonal Violence
In discussing sexuality, it is important to consider sexual orientation, gender and biological sex. The term "LGBTQ" is frequently used in this context and encompasses a wide spectrum of different sexual orientations as well as differences in traditional gender assignment cues. These different sexual orientations and gender identities that exist need to be acknowledged and accounted for by society, and particularly nurses. Healthcare professionals should also have an understanding of what constitutes interpersonal violence, as well actions that need to be taken to protect a potential victim.
Sexuality and Interpersonal Violence
Sexual Orientation Origins and Beliefs
Though science is far from being able to reliably predict sexual orientation based on a DNA test, many researchers have set out to accomplish this. In 1993, the first notable progress was made at the US National Institute of Health, when researchers discovered a genetic link to homosexuality when studying groups of brothers (Hamer & Hamzelou, 2015). While certainly a breakthrough in the case for sexual orientation being innate, many involved hypothesized that epigenetic differences needed to be studied further. At the University of California, Los Angeles, Tuck Ngun was able to accurately classify 67% of participants in a 37-person study involving twin brothers when looking at epigenetic markers (Hamer & Hamzelou, 2015). Like other epigenetic changes, it may be that sexual orientation is both innate and developed over time. That is, a person must have the genetic predisposition, coupled with the environmental trigger for phenotype alteration.
As researchers are far from being able to scientifically prove what causes differences in sexual orientation, it can be helpful to acknowledge factors that are generally accepted. This can include the activation of the stress response when a potentially harmful physiological or psychological stressor appears. When joining this concept with the previous question about the origins of sexual orientation, it becomes important to think about how the subject is discussed. An individual who treats someone's sexual orientation in a negative light has the potential to cause lasting harm.
In a survey of lesbian and bisexual women, it was found that a belief in the innateness of sexual orientation was associated with less internalized stigma (Morandini, Blaszczynski, Costa, Godwin & Dar-Nimrod, 2017). Since the person casting someone's sexual orientation in a negative light is unlikely to believe that it is innate, it could be helpful to remind him or her that there isn't irrefutable evidence either way. If the hypothetical person in question is a nurse, it would be even more important to remind them that when people are vulnerable and under their care, it is their responsibility to practice beneficence and nonmaleficence. If he or she isn't a nurse, these ethical principles remain valid and they should to their best to avoid causing harm through lack of emotional support or even active harassment.
Nursing Roles to Decrease LGBTQ Stigma
The phrase “Lesbian, Gay, Bisexual, Transgender, Queer” describes a diverse group that includes factors such as sex, gender and sexual orientation. Those that identify as transgender have a sense of their own gender differing from their original sex assigned to them at birth. Members of the LGBTQ community share common experiences along the lines with stigmatization within the healthcare setting, though there are differences within each group that have important health implications. This can include factors such as considering their sexual history and current sexual practices. For example, the transgender population is diverse in gender identity expression and sexual orientation. There are different stages a person identifying as transgender goes through, from early stages where they confront their feelings to late stages, where they consider or carry out physical transition. Some choose to do a full sexual reassignment while others opt for partial. It is important that nurses, during an initial assessment, use inclusive language on forms. Nurses should not assume when talking to patients that they present themselves as “she or he” and consider asking how they prefer to be addressed. LGBTQ patients share the same health risk as any other person in the society but also face additional health risks that should not be neglected due to social stigma. For example, Gay and bisexual men are affected by higher than average rates of HIV. In 2016, “two thirds of diagnosed human immunodeficiency virus (HIV) infections in the United States were attributed to male-to-male sexual contact” (Mitsch, 2018). Screening for HIV and providing risk reduction education among the younger population should be implemented often to prevent spread.
Another issue is that many health care providers fail to recognize the risk for cervical cancer in lesbians or bisexual women. The risk of cervical cancer among lesbians is frequently underestimated and unrecognized by both patients and healthcare providers. They are, in fact, at risk for HPV due to the fact that many have had previous sexual contact with men. According to research, “In four studies focused on cervical cancer in lesbians, between 63% and 86% (average = 77%) reported that they had sex with men in the past, and between 3% and 24% (average = 17%) reported having sex with men within the previous year” (Waterman, 2015). LGBTQ patients experience discrimination due to the homophobic attitudes of some nurses and other health care professionals. To advocate for the LGBTQ community, nurses should be sensitive to cultural differences and embrace diversity so as to provide an open environment.
People who identify as LGBTQ are minorities in the Untied states and face stigma. According to the American Psychiatric Association, “Severe antigay prejudice is reflected in the high rate of harassment and violence directed toward lesbian, gay and bisexual individuals in American society” (APA, 2018). Although for decades now, cultural and societal opinions have been improving, stigma continues to exist including in health care settings. As nurses see patients first and spend the most time with them, it is especially important to cultivate open and respectful therapeutic relationships. Inclusive acts such as asking a person about their preference on pronouns cultivates a safe space for a transgendered patient, as well exposure and education for all others. By modeling good behaviors and nonjudgmental communication, nurses have the ability to impact the overall well being of those who have been stigmatized.
Helping Society Understand Sexual Orientation Preferences
The context of understanding sexual orientation within society, like all social education, should begin with adolescents and young adults. Being able to target the youth early is beneficial because younger adults are more open to change and accepting of other individuals (Azwihangwisi, 2016). LGBTQ student organizations, the presence of LGBTQ-specific policies and programs, such as Gay-Straight Alliances and Anti-LGBT bullying help foster LGBTQ awareness within society.
In order to help assist the rest of society, LGBTQ awareness can also be utilized via the media. TV shows and movies that bring in a wide audience, but still positively feature LGBTQ characters help break down social misconceptions. TV shows such as Will and Grace, and recently, Modern Family, have helped achieve these goals.
The transition of a LGBTQ individual into who they become effects not only themselves but extends to their social support system as well. Family and friends play a pivotal role in the initial acceptance of the individual and this can be difficult for some. For those who have a challenge, the parents of a LGBTQ individual are the most hesitant to accept that their child has a different orientation that contradicts their biological sex (Logie, 2016). The reasons for lack of acceptance in parents generally are not manifestations of rejection of the LGBTQ lifestyle, but rather stem from typical parental protective factors such as believing that their child will get bullied. Therefore, they think that the best way to help their children survive and thrive in society is to help them fit in with their heterosexual peers (Logie, 2016).
The parents of the child believe that doing so is them acting out of care and concern; however, the LGBTQ child will believe that their parents are showing hate towards them (Logie, 2017). This lack of communication between parents and their children causes a misunderstanding that increases the chances of ongoing conflict within the family. Conflicts occur for many reasons but from the child’s perspective, stem from the lack of understanding on the parents end. Parents can help resolve this by sitting down with their child and finding out more about them and their lifestyle. An open dialogue allows for parents to learn first-hand from their child what changes they have been experiencing; along with the emotional aspect that accompanies this change. Being open within the family allows for trust and rapport to be built and allows the beginning of a strong family relationship.
An additional resource, which parents can utilize, is called Gender Spectrum Education and Training. This is an annual support group, which give support to LGBTQ families. It provides training on gender identity and expression for schools and providers to help gender nonconforming and transgender children and youth (Nama, 2017).
The Transition of Government, Civil Rights Groups and Religious Organizations
Over time in advocating for individuals with a different sexual orientation other than a heterosexual orientation? How can nurses take a leadership role in these areas? Advocating for individuals other than those with a heterosexual orientation is a multifaceted process. This issue must be addressed by multiple dimensions including government, religion and social dimensions (civil rights groups). Despite the complexity, these dimensions have transitioned overtime to advocate for those other than heterosexual orientation.
The inception of pushing governmental boundaries most notably began with a famous supreme court case that was decided on June 25th, 2015. Prior to this, same-sex marriages were recognized on a state-by-state level. However, with Obergefell vs. Hodges, fourteen same-sex couples sued the government for not upholding the fourteenth amendment in allowing the recognition of their marriages having been solemnized in other states since not all states recognized same-sex marriages. It was then decided that same-sex couples had legitimate relationships across the country (Obergefell v. Hodges, 2015). Despite this step forward, there were other aspects on a governmental level that required adjusting. Now that this new genre of marriage was acceptable, steps were made to providing similar benefits as well such as society security, health insurance and life insurance among others (Holbrook 2016).
With the topic of same-sex marriages inevitably comes religious perspectives. Although traditionally against the concept of same-sex marriages, there are interpretations which would suggest otherwise with a trend of advocating for individuals who do not identify as heterosexual. Groups which prohibit same-sex marriage include American Baptist Churches, Church of Jesus Christ (Mormon), Islam, Lutheran Church-Missouri Synod, Orthodox Jewish Movement and the United Methodist Church to name a few (Masci, D. and Lipka, M. 2015). On the other hand, there are religious groups who are trending towards sanctioning same-sex marriages. Gene Robinson is a gay Bishop in New Hampshire who said, “Scripture says where love is, there is God Also. And they [religious people] see that love in our families, and I think people can’t help but be supportive”. An assistant professor of Religion at Centre College proposed that the Bible did not address same-sex marriage or the concept of gender-identity (Gay Marriage Top Pro & Con Arguments, 2017; Whitehead AL. , 2018). Additionally, 80% of the American Jewish population supports same-sex marriage since a Conference of Judaism in 1996 (St. John, S. 2014). Other religious organizations that have come out in support of same-sex marriage include the Presbyterian church, United Church of Christ General Synod and Unitarian Universalist Association.
Last are social issues affecting workplace, healthcare equality and domestic violence. In the United States, women and non-heterosexuals earn 78% that of men showing the inequality in work (Gingerich, 2017). In regards to domestic violence, 55. 2% of non-heterosexual teens said they were verbally harassed and 11. 4% reported physical assault because of their sexual orientation (American Psychological Association Task Force 2015). Considering this, the need for organizations promoting the welfare and healthcare of non-heterosexuals has arisen. Two-thirds of new HIV diagnosis’s are in bisexual men (Batchelder, AW. et al, 2018). Not only do these individuals need physical health-care given the high risk of sexually transmitted diseases, but also mental healthcare given the psychological trauma these individuals can experience. For example, depression is 17% higher in non-heterosexual men and substance abuse in twice or greater among non-heterosexual men. These numbers increase in those with commitment health issues like HIV where 47% met criteria for anxiety disorder, 22% for depression and 25% with substance abuse symptoms (Batchelder, AW. et. Al 2017). The first step in solving these issues is studying them and learning about them. Great strides have taken in investigating these relationships which will now foster greater attention in equity.
Nurses serve a vital role in the lives of their non-heterosexual patients. First is on a personal level by being non-judgmental and displaying empathy towards these patients. Many of these patients develop roadblocks to receiving healthcare because of lack of trust. It is known that these patients are at increased risk of contracting HIV and developing mental disorders (American Psychological Association Task Force 2015). Patients feel judged and thus withhold vital information which can impact their encounter with health providers. Therapeutic and empathetic conversation will help develop a strong relationship which will ultimately help the patient. Then once this relationship is developed, the patient will be more open to accepting any resources or information about specializing organizations which can further support them. It is also the nurses job to have well-researched outreach programs, social services and support groups which can help these patients further. A nurse has the capacity to greatly affect the lives of their patients, regardless of gender orientation.
Healthy Versus Unhealthy Sexual Relationships
A healthy relationship consists of responsibility, honesty, respect, and cooperation. In a healthy relationship, both partners involved maintain and respect each other’s boundaries, trust and believe in each other, and can admit to being wrong. If the couple is faced with an obstacle, they can overcome that obstacle with compromise and communication. A healthy partnership is interdependent instead of dependent or dominating (“What is a healthy relationship”, n. d. ). In an unhealthy relationship, one or both partners do not possess these qualities. Physical dating violence includes behaviors such as scratching, slapping, pushing, or choking and psychological violence encompasses insults, criticism, threats, or emotional manipulation (Garth, 2018). Any form of violence or abuse in a relationship is a clear indication that the relationship is unhealthy. Experiencing any type of violence in a relationship can affect mental and physical health and can result in depressive symptoms and suicidal ideations.
Assessment of the patient is the first step in identifying any type of intimate partner violence. Some risk factors for intimate partner violence include substance abuse, jealousy, and a family history of abuse/ violence (Halter, 2018). An important factor to consider is that the patient is unlikely to talk about what is really happening with their partner in the room. Make sure to conduct any interviews in private (Halter, 2018). Being understanding and professional helps to make the patient feel comfortable and more likely to open up. It is important to establish trust when interviewing a patient whom is suspected to be experiencing intimate partner violence. Being attentive and showing empathy can help the patient feel safe and not judged. Assess the patient’s appearance while conducting the interview. Someone who is subjected to violence may have bruises, scars, and other wounds all around their bodies, particularly around their face and chest (Halter, 2018).
Planning should primarily focus on the patient’s safety. If there is potential for a suicide or homicide, actions should be taken immediately to prevent that from happening. The nurse will inform the patient that any information suggestive of harm to the patient will be reported to local law enforcement or county health department when necessary. By law, reporting suspected or actual cases of abuse is mandatory (Halter, 2018). The nurse can then counsel the patient to help raise their self- esteem.
Emphasizing that people have a right to live without fear of violence can really make an impact on the patient (Halter, 2018). The nurse can also refer the patient to support groups out in the community so that they do not feel like they are alone. The nurse should inform the patient about shelters and safe houses in their area, so they know they have a safe place to go to if abuse occurs again (Halter, 2018). The nurse should also evaluate coping mechanisms of the partner who is experiencing abuse. Sometimes, patients resort to alcohol or other substances to numb the pain they are feeling (Halter, 2018). The nurse can then explore and teach the patient effective coping mechanisms, such as exercise or art therapy, to encourage them to express their feelings in a more positive way.
Recognizing and Assessing Violence in Relationships
Violence occurs in many ways and though it can happen between strangers, there are many times where it occurs in domestic relationships. Intimate partner violence can happen to any party in the relationship; however, it is more common for females to be victims. Assessing and recognizing abuse is an important aspect on how to eliminate violence from occurring. Though historically done only after suspicion of abuse is present, assessing those who are not showing signs may still be important. About 80% of women who were assessed for intimate partner violence were in fact victims (Manton, 2015). Asking direct question such as, “Do you feel safe in your home? ” are good indicators as to if there is abuse in the relationship. Evidence of physical abuse can be obtained during the head to toe assessment; however, it is important to not make assumptions about suspicious bruising before fully investigating.
Further questioning must occur and any evidence gathered must be documented as objectively as possible. If abuse is suspected, allow the patient to know that they are in a safe environment and ask if anyone close to them has caused the injury (Halter, 2018). Emotional abuse is harder to assess but equally as important to recognize. If the patient has low self-esteem or is withdrawn during the interview process while the potential perpetrator is present, this may be a sign that more information should be gathered. Someone can show signs of neglect by not performing activities of daily living such as grooming, not wearing clean clothes, or having untreated medical conditions (Halter,2018). It can be difficult to talk about, but being a patient advocate for vulnerable groups is a key role in nursing. Nurses are mandated reporters for children, elderly, and the intellectually delayed, but for those that do not fall into such categories, it is important to provide resources and support. First, the nurse needs to assure the patient that they are in a safe space. Building rapport with these patients is important because if they are being abused, their ability to trust is usually decreased. Once the patient discloses the information, nurses must give them the proper resources. Some emergency departments give a card with domestic hotline numbers and other resources to those who disclose information. This way, the card may be placed in a small place where they can hide it but someone else will not find it (Manton, 2015). The most important thing to remember is to be nonjudgmental and respectful. These patients have been through traumatic events and nurses must give support and care so they can benefit from the resources available.
