Running head: CARE DELIVERY MODEL 1

Care Delivery Model

Angela Purgiel

Ferris State University

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There is a severe knowledge deficit related to the lesbian, gay, bisexual, and transgender (LGBT)

population and health care. The Unites States health care system does not have the tools nor the

education it needs to properly serve this community. With the implementation of an education

program using the Precede-Proceed model, nursing students can be better equipped to properly

care for the LGBT population. Through the use of case studies and simulation labs the nursing

students can gain exposure to real life situations and translate their education to real life

applications in the work force.

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Care Delivery Model

The more research that is conducted on the lesbian, gay, bisexual and transgender

(LGBT) population the larger the identified need is. With health disparity statics at an alarming

all time high, intervention related to health care education is greatly needed. LGBT youth are 2

to 3 times more likely to attempt suicide and LGBT youth are more likely to be homeless, to

name a few ("LGTB," 2014). With nurses at the forefront of caring for this population it is

imperative to ensure adequate education is available to nursing students across the Unites States.

The care delivery model that would most likely aid in the planning and evaluation to

improve health for this population is the Precede-Proceed model. This care delivery model fit

best because it is the easiest to understand and is important to the overall success of the

implementation of this vulnerable population. This care delivery model was also selected

because the underlying fundamental disposition is that “health and health risks are caused by

multiple factors and because of this, efforts to impact change must be multidimensional” (Cupp

Curley & Vitale, 2012, p. 169). This is important for this population because solutions will be

multidimensional as the factors influencing this population are complex. There are many factors

influencing the overall health of this population, for example discrimination and victimization,

along with inadequate education for the health care community.

There are five steps that need to be addressed in order to implement education for this

population.

Step 1 Determine population needs- “As the health care needs of the lesbian, gay,

bisexual, and transgender (LGBT) population become increasingly important, health care

professionals require appropriate academic and clinical training in preparation for the increased

demand for culturally competent care” (Lim, Brown, & Jones, 2013, p. 198).
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Step 2 Identify health determinants of these needs- “The Institute of Medicine’s (IOM,

2011) consensus report highlighted the lack of science-based knowledge on the health of LGBT

individuals owing to the lack of research in LGBT health and the U.S. Department of Health and

Human Service further underscored the existence of health disparities and the lack of

compassionate services for LGBT individuals” (Lim et al., 2013, p. 199). Other barriers affecting

this population are access to adequate to health insurance, employment, housing, marriage,

adoption (Lim et al., 2013).

Step 3 Analyze behaviors and environment determinants of health needs- “Many surveys

that are administered on national and state levels do not collect demographic data on sexual

orientation or gender identity, thus making it difficult to acquire an accurate sense of how many

individuals in the United States identify as LGBT (Lim et al., 2013, p. 200). Along with the lack

available surveys there is also a fear to admit to being a member of LGBT for fear of

discrimination.

Step 4 Outline Factors that predispose, reinforce, or enable behaviors- “Homosexuality

has been criminalized and pathologized throughout history. Although homosexuality was

declassified as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders in

1973 repercussions are still felt today”. This is also influenced by the “prevalence of mental

disorders in LGBT individuals compared with their heterosexual counterparts” (Lim et al., 2013,

p. 199).

Step 5 Ascertain interventions best suited to change behaviors- Exposure to LGBT

education must be implemented into all nursing programs. Review of the nursing schools

teaching materials should include, “examining textbooks, course assignments, clinical

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affiliations, patient assignment, and simulation scenarios for deficiencies in LGBT-related

content” (Lim et al., 2013, p. 201).

One of the most effective ways to include educational material on this population would

be in the form a simulation labs. Scenarios should be developed by specially trained and highly

educated staff members with special interest related to LGBT. Topics should range from

transgender individuals to same sex partner issues. Also inclusion wording should be addressed

to not discriminate against this population. According to Lim et al. simulation is one of the

solutions for overcoming the limitations of traditional clinical education (Lim et al., 2013, p.

200). This article also suggests individuals designing simulation curricula should include LGBT

identities when creating scenarios (Lim et al., 2013,).

Another important way in to incorporate LGBT education into the nursing curriculum is

through the use of case studies. Case Studies “may be infused with LGBT identities and may ask

application-type questions that highlight best practices in cultural sensitivity”(Lim et al., 2013, p.

201). It is easy to adapt almost any case study question by simply asking the class “how would

you handle this situation if the patient was a member of LGBT community”?

Not only is important for nursing students to have adequate education related to this

population in order to properly care for the patients but it is “projected that approximately

150,000 to 300,000 nurses are LGBT” (Lim et al., 2013, p. 200). Not only will better education

for this population benefit the patient but it will also give you a better understanding of who you

are working with.

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References

Cupp Curley, A. L., & Vitale, P. A. (2012). Population-Based Nursing Concepts and

competenices for advanced Practice. New York, NY: Springer Publishing Company,

LLC.

Lesbian, Gay, Bisexual, and Transgender Health. (2014). Retrieved from

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25

Lim, F. A., Brown, D. V., & Jones, H. (2013, April). Lesbian, gay, bisexual, and transgender

health: fundamentals for nursing education. Journal of Nursing Education, 52, 198-203.

http://dx.doi.org/10.3928/01484834-20130311-02