Making health care more inclusive and accepting of lesbian, gay, bisexual, transgender and queer/questioning patients means that seasoned providers and new clinical staff have opportunities to work together and bring barriers and solutions to the forefront.

That is just what two graduates of the Master of Science in Nursing (MSN) program at the USC Suzanne Dworak-Peck School of Social Work set out to do when they collaborated with one of their professors to publish an article in the Journal for Nurse Practitioners (JNP) in April 2020.

Adam “Akila” Aisner, MSN ’18, and Adrienne Marks, MSN ’18, worked with Clinical Associate Professor Michelle Zappas to produce “Primary Care for Lesbian, Gay, Bisexual, Transgender and Queer/Questioning (LGBTQ) Patients.”

It is okay to ask

The article aims to improve patient care and outcomes by discussing barriers that prevent health care providers from delivering comprehensive care to LGBTQ patients, and ways to overcome this. Nurses want to help their patients but may need to learn more about specific LGBTQ health and terminology. Journals like JNP are picking up on this, and producing issues which features several articles on LGBTQ care.

“A lot of people in health care don’t feel comfortable asking patients about gender identity or sexual orientation,” Aisner said. They may think they will offend the patient, but as Aisner and his co-authors wrote in their paper, patients often welcome the questions and are more than willing to answer them. With a little practice, providers can overcome their discomfort.

To help, the authors created a short glossary to help clarify and define some of the community’s terms. Among these are non-binary, which means an individual who does not identify as exclusively male or female; and cisgender, which means an individual whose gender identity matches their biological sex.

“At the end of the day, LGBTQ individuals are the experts when it comes to their own health and needs; health care providers can learn so much just from asking their patients,” Marks said.

Toward prejudice-free health care

Even as more LGBTQ people openly share information about their sexual and gender identities, they still face greater risk for substance abuse, risky sexual behavior, HIV, depression and suicide. Nurse practitioners and other providers must be adept in their assessment skills and astute in their ability to engage with patients and yield clinically significant information, the authors wrote.

Zappas, who has been on the faculty of the Department of Nursing since 2015, spent part of her career as a nurse practitioner working in the South Bronx in New York. There, she helped patients managing intravenous drug use as well as diabetes, hypertension, HIV or Hepatitis C. She eventually became an HIV specialist. Today, she remains an ally of the community.

“We’ve made progress, but more needs to be done to ensure that we’re breaking down the barriers to quality, prejudice-free health care,” Zappas said.

Among their recommendations are the use of established tools, such as the Patient Health Questionnaire-9, screenings for substance abuse, and the HIV Incidence Risk Index for Men who have Sex with Men (HIRI-MSM), that assess a patient’s level of safety and risk.

Mentoring the next generation

For Aisner, seeing his first journal article published fulfilled a professional desire he had for a long time. Zappas provided the guidance and support to make it happen, he said. She encouraged he and Marks to turn their class research projects into podium presentations at the 2019 California Association of Nurse Practitioners’ conference. Afterwards, Zappas suggested they turn their work into a paper and seek publication.

“I think it is so important to raise new ideas and get the conversation started among the nurse practitioner community,” Aisner said. He already has some ideas about what he would like to research and write about next. The wide range of topics he has in mind stem from issues, such as weight loss, that have come up in his nurse practitioner practice. “This article is just the beginning for me,” he said.

Both Aisner and Marks were part of the first cohorts of MSN students at the school, and Zappas taught them during the beginning, middle and end of their program. “I’ve been lucky to see their evolution,” she said.

Zappas enjoys the scholarly aspects of her professorial work and is a frequent contributor to journals. She feels pride at seeing both of her former students flourish in the MSN program and embrace the scholarship aspect of the work.

“We teach people to be clinicians but there is an important scholarly aspect as well,” she said.

Nurse practitioners care for people of all diversities and help them through challenging times in their lives. Learning to recognize, accept and care for individuals no matter what their race, gender or sexuality can make a real difference in their well-being.

“I’m so glad to see that idea resonate with this next generation of nurse practitioners, that we not only want to provide the best care for the LGBTQ community, but also add to the research so that other practitioners can benefit,” Zappas said.