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Culturally Competent Care of the LGBTQIA patient on inpatient psychiatric units

By Angela Brathovde posted 07-06-2017 11:16 AM

  

We are seeking feedback on how inpatient units are handling room assignments for LGBTQIA patients.  We have 3 inpatient units, one of which is an adolescent unit, ages 5-17. The current practice is to provide the patient with a private room if able, or cohort two LGBTQIA patients of the same gender, i.e.,  2 MTF or FTM patients would room together.

Do any hospitals assign a roommate of the gender that the patient identifies with? For example, if a patient identifies as female, assigning a room with another female. We are told that the transgender patient has a right to a room with a roommate of the gender the patient identifies with, with confidentiality and privacy considered, we would not tell the roommate or ask the roommate for permission regarding the same, and if the roommate has a problem with it, then the roommate can be moved.

We would be interested in finding out how other inpatient psychiatric units are handling that issue.

Angela Brathovde, MSN, RN, BC, HNB-BC

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05-01-2018 08:32 AM


  1. We haven’t seen this but it would seem like a private room would provide the most sensitive option for patients, if available. 

08-10-2017 05:04 PM

How about contacting some of the individuals we had speak at our spring conference about LGBTQ issues in the community?

07-10-2017 06:26 PM

Thank you for working on making your unit an inclusive and safe space!

Trans* patients should be treated according to their self-identified gender - if they are female-identified, they can be roomed with female peers, and so on. It is NEVER (ever ever ever) appropriate to room a patient with a peer of the opposite gender, and that goes for making a trans* female patient room on a male unit or vice versa.

You will encounter more gender-nonconforming (GNC) or non-binary patients, too. These patients can present more of a challenge, partly because the standard of care isn't as clear yet. In my inpatient adolescent experience, we let the patient determine whether they want to program and reside on the boys or girls unit (but they have to pick one, and can't flip-flop between milieus), and we often give them a single room.

Note: Be careful when using LGBTQIA as shorthand for transgender - gender identity is distinct from sexual orientation. It would not be appropriate to cohort patients just because they share a sexual orientation, and if you isolate a patient by not allowing them to have a roommate just because they are gay (or trans*) or only rooming them with people of the same sexual orientation, you could be violating their rights.

Room assignments should always be made with 1) patient safety, 2) patient dignity, and 3) maintaining a therapeutic milieu in mind. We wouldn't let a cisgender (non-trans*) or straight person refuse to have a trans* or LGB roommate any more than we would let them refuse to have a black or Jewish roommate - though you still want to make room assignments as harmonious (and safe!) as possible. And as always, HIPAA... 

WPATH (http://www.wpath.org/) is an excellent resource for providing care to trans* patients, and all inpatient nursing and medical staff should have a working knowledge of these standards.

07-09-2017 08:50 PM

Living in the Keys where we have a large LGBTQ population, we have not, surprisingly, encountered this situation often. When we do have a transgender patient we usually put him/her into a private room or double room by themselves. Once when we were full, we had to put a MTF into the male dorm. It didn't disturb the milieu, nor did the pt mind being in the male dorm. I suppose we could ask the patient what is more comfortable for them and try to accommodate as best we can.

Jezel Rosa RN