Advanced practice nurses' provision of care to lesbian clients: Creating safe space

This Grounded Theory study was undertaken to determine what approach select advanced practice nurses (APNs) used in their provision of exemplary care to their lesbian clients. The basic social process of “Creating Safe Space” was discovered.; Ten (APNs), Nurse Practitioners and Nurse Midwives, were interviewed about their care for lesbian clients. Through the use of both verbal and behavioral scripting the APNs indicated to their clients that they were open to hearing the client's concerns, and that they understood the implications of the stigma associated with the client's lesbianism. Openness and understanding were displayed to varying degrees by the APNs. Openness was ordered on a continuum that ranged in complexity from having a basic socialization to the need to provide equal care to all patients and ended with proactively seeking potentially stigmatizing information. Between these two extremes were the behaviors of having an awareness of there being lesbian clients in their practices, to being willing to make efforts to change default scripts, to being mindful of the diversity of clients.; Understanding of stigma was also ordered on a continuum ranging from a baseline knowledge of having patient's with particular needs to the far end where the APNs made links between the client's psycho/social/sexual life and physical complaints. In the intermediate steps of the continuum were awareness of appropriate testing based on the client's lesbianism, willingness to discuss the physical aspects of the client's lesbianism and mindfulness of the potential for harm to the client if confidentiality is breached. Comparisons are made to Blooms Taxonomy of Educational Objectives (1956), and to Benner's model of skill acquisition for nurses (1984).; Recommendations for curriculum include adaptation of the American Nurses' Association 1986 document addressing cultural diversity in the nursing curriculum (ANA, 1986) to focus on sexual minorities as a subculture. Practice recommendations include provider education either through video or written materials. References to resources are included.