Abstract
This exploratory qualitative study draws attention to an area of nursing practice that has received little attention in research. The study aims to gain insight into the unique needs and perspectives of lesbian and bisexual (LB) women facing diagnoses of reproductive cancer. The analysis of interview data, collected from six LB women facing cancer and one healthcare professional, highlighted the women’s needs for support and identified ways in which being identified as LB, in some situations, limited access to support for themselves and their partners.
In addition to these relational impacts, which the authors clearly describe, it is of interest to me that the story goes beyond individual healthcare providers’ knowledge and actions. The data also suggest that the lack of a clear organisational philosophy of care that is inclusive creates ambiguities for patients and healthcare professionals alike. In this case, the women are left to look for signals from healthcare providers that they would be ‘safe’ and that their identities and personal relationships would be recognized and respected in how care was being provided. Rather, it appeared to be more typical that healthcare professionals’ actions were interpreted as being unsupportive because the professionals lacked awareness of, or were indifferent to, the women’s identities and personal relationships.
The analysis, however, also begins to unpack the complexities associated with healthcare relationships and the assumptions inherent in them. For example, while some participants clearly presented themselves to the care providers as Lesbian or Bisexual women, other study participants spoke about the dilemmas they faced in trying to decide whether they should represent themselves as Lesbian or Bisexual to nurses and other care providers. The participants indicated that they could not always anticipate how the information might impact the care they received. In addition, a number of participants noted that typically the healthcare providers, which included but were not limited to nurses, appeared to assume the women held a heterosexual orientation. The analysis illustrates that the prevailing assumptions operating in practice are heteronormative. This creates an environment of ‘exclusion’ and thus has the potential to marginalise LB women and negatively impact the care they receive from their healthcare providers.
The study has implications not only for health professional education, but also for sites of practice. There is a need for explicit policies of inclusion. Moreover, as this study has shown, what is needed is more than information. Clinicians also need to develop their abilities to engage in critical reflection in order to enhance their awareness of the ways in which their assumptions operate. A critical stance could be drawn upon to help organisations and clinicians working within them to recognise the value of explicitly recognising the ways in which tacit assumptions operate to structure interpersonal relationships and ultimately to shape the ways in which care is experienced and provided.
Future research on these issues with healthcare providers, including nurses, may shed light on the challenges clinicians face in navigating this social terrain, and help to identify the nature of information and organisational supports needed to shift the prevailing normative stance in order to improve LB women’s access to needed supports in this and other practice contexts.