Ever-Expansive Care: Supporting LGBTQ Patients and Families

Abstract and Introduction

Introduction

I cannot remember the specific instance of when someone first prayed for me using my pronouns, but I will never forget the feeling. It still washes over me to this day when someone offers their voice in prayer for me using they/them pronouns as they, in turn, fully honor me and my story. It feels like coming home after a weary journey. Much of my existence as a nonbinary person is erased daily – I must constantly advocate for myself as I educate and forgive. When someone prays for me, though: "May Meredith have peace, let them know they are loved…," my whole being is filled with teeming energy and affirmation all at the same time. I am a spiritual care provider, and in my years of preparing for and doing this work, I have been prayed for many times. When I experience the feeling of reassured wholeness as someone uses my pronouns in prayer, it keeps me going. Prayer is intimate to me – a blessing of one person bestowing their heart for another. One may or may not find the practice of prayer as something of significance to them and their journey, but I truly believe in the impact we as health care providers can have through every interaction when we offer someone this kind of deep respect and knowing. When we understand an identity in the LGBTQ community and make the conscious effort to use the pronouns and name a transgender or nonbinary person uses, we offer wholeness, blessing this person and their existence in a world that too often offers them shame. We make a difference.

Table 1. Glossary of Common LGBTQ Terms
Terms Relating to Sexuality	Terms Relating to Gender
Lesbian	Sex Assigned at Birth
A term that refers to a woman who is emotionally, romantically, and/or physically attracted to other women.	Assigned sex is a label given at birth based on medical factors, including hormones, chromosomes, and genitals (commonly labeled as female, male, or intersex).
Gay	Gender Identity
A term used to describe people who are emotionally, romantically, and/or physically attracted to people of the same gender. In the past, only men who are attracted to men have used the word "gay." Now, it is common for "gay" to be used more broadly by anyone who is attracted to the same sex or gender.	Simply put, our internal understanding and experience of our own gender. Gender identity does not always correspond to biological sex. Additionally, gender identity is a separate concept from sexuality and gender expression.
Bisexual	Transgender
A term used to describe people who have the capacity to form attraction and/or relationships to more than one gender.	An umbrella term used to describe people whose gender identity differs from the sex they were assigned at birth. Many transgender people will transition to align their gender expression with their gender identity; however, you do not have to transition in order to be transgender.
Queer	Gender Binary
A term used by some LGBTQ people to refer to an identity that expands outside of heterosexuality. Historically a pejorative term for people who are LGBTQ, the word has since been reclaimed by some members of the LGBTQ community. Due to its varying meanings, it is best to allow for someone to self-identify with this term before using it.	The concept that there are only two genders, male and female, and that everyone must be one or the other. This view of gender is now understood to be too limited for the breadth of humanity and how we understand ourselves.
LGBTQ	Nonbinary
An acronym that collectively refers to individuals who are lesbian, gay, bisexual, transgender, or queer. The Q may also stand for questioning, referring to those who are still exploring their sexuality and/or gender. Others identity also exist in the LGBTQ community, such as "asexual," "pansexual," and "two-spirit," to name a few. It is common to see this acronym in a variety of ways, often with a "+" at the end to signify that more identities are being named with these letters.	Used to describe people who experience their gender identity and/or the expression of their gender as outside of the male-female gender binary. A nonbinary person may ask you to use a non-gendered pronoun when referring to them, such as "they/them." Some people use a combination of pronouns, such as "she/they" or "he/they" or "any pronouns." It is best practice to ask which pronouns someone uses.

Table 1. Glossary of Common LGBTQ Terms

Terms Relating to Sexuality

Terms Relating to Gender

Lesbian

Sex Assigned at Birth

A term that refers to a woman who is emotionally, romantically, and/or physically attracted to other women.

Assigned sex is a label given at birth based on medical factors, including hormones, chromosomes, and genitals (commonly labeled as female, male, or intersex).

Gay

Gender Identity

A term used to describe people who are emotionally, romantically, and/or physically attracted to people of the same gender. In the past, only men who are attracted to men have used the word "gay." Now, it is common for "gay" to be used more broadly by anyone who is attracted to the same sex or gender.

Simply put, our internal understanding and experience of our own gender. Gender identity does not always correspond to biological sex. Additionally, gender identity is a separate concept from sexuality and gender expression.

Bisexual

Transgender

A term used to describe people who have the capacity to form attraction and/or relationships to more than one gender.

An umbrella term used to describe people whose gender identity differs from the sex they were assigned at birth. Many transgender people will transition to align their gender expression with their gender identity; however, you do not have to transition in order to be transgender.

Queer

Gender Binary

A term used by some LGBTQ people to refer to an identity that expands outside of heterosexuality. Historically a pejorative term for people who are LGBTQ, the word has since been reclaimed by some members of the LGBTQ community. Due to its varying meanings, it is best to allow for someone to self-identify with this term before using it.

The concept that there are only two genders, male and female, and that everyone must be one or the other. This view of gender is now understood to be too limited for the breadth of humanity and how we understand ourselves.

LGBTQ

Nonbinary

An acronym that collectively refers to individuals who are lesbian, gay, bisexual, transgender, or queer. The Q may also stand for questioning, referring to those who are still exploring their sexuality and/or gender. Others identity also exist in the LGBTQ community, such as "asexual," "pansexual," and "two-spirit," to name a few. It is common to see this acronym in a variety of ways, often with a "+" at the end to signify that more identities are being named with these letters.

Used to describe people who experience their gender identity and/or the expression of their gender as outside of the male-female gender binary. A nonbinary person may ask you to use a non-gendered pronoun when referring to them, such as "they/them." Some people use a combination of pronouns, such as "she/they" or "he/they" or "any pronouns." It is best practice to ask which pronouns someone uses.