A narrative review of the literature about people with intellectual disability who identify as lesbian, gay, bisexual, transgender, intersex or questioning.

This narrative review of the research literature presents a summary about the key issues facing people with intellectual disability (ID) who identify as lesbian, gay, bisexual, transgender, intersex or questioning (LGBTIQ). The aim of this review was to consolidate research of the topic; to identify whether any pilot studies reporting social/sexual/educational interventions had been published; and to offer some perspective on the type of future research required to better inform policy, practice and theory that may lead to better outcomes for people with ID who identify as LGBTIQ. Almost all of the research literature on the topic is either exploratory or descriptive which serves to outline the range of issues faced by people with ID who identify as LGBTIQ. Urgently needed as the next step, however, is a concerted effort to conduct a range of innovative educational and social interventions with collection of targeted and appropriate outcomes data.

Older lesbian women's health and healthcare: A narrative review of the literature.

AIMS AND OBJECTIVES: The purpose of this narrative review is to locate, evaluate and synthesise the evidence presented in contemporary literature, related to the experiences of older lesbian women. BACKGROUND: Lesbian women have been identified as having unique health needs. In conjunction with the usual challenges associated with ageing, lesbian women are burdened with additional complications because of their lesbian orientation. To promote optimal health, the distinct needs of older lesbian women need to be identified and considered by those responsible for planning and delivering culturally competent services/care and allocating resources to support healthy ageing. DESIGN: Narrative review is typically used to evaluate and synthesise health-related literature and involves the critical evaluation of included, empirical studies to form innovative conclusions and perspectives. METHOD: Database searches using relevant keywords and applying specific limits yielded 55 articles for initial review. Eventually, 45 articles were excluded and 10 qualitative, empirical articles were then appraised using the Critical Appraisal Skills Program tool. Subsequently, seven articles were identified as meeting the inclusion criteria and formed the basis of this narrative review. RESULTS: Data were extrapolated from the included articles and three themes emerged: support, resilience and disclosure. These themes formulate the findings of this article. CONCLUSIONS: Remarkably, very little contemporary literature exists that addresses the health and well-being of older lesbian women, and this cohort remain positioned on the peripheries of research and society. Older lesbian women continue to be marginalised because of their lesbian identity and actively cultivate support systems, negotiate disclosure and develop resilience to minimise the effects of their marginal position. RELEVANCE TO PRACTICE: Recognition that older lesbian women often create, and draw on, a family of choice for support is imperative. In addition, the clinical environment should be safe for older lesbian women to disclose their sexual orientation and other sensitive information.

Marginalised mothers: lesbian women negotiating heteronormative healthcare services.

Lesbian mothers share mainstream existence with other mothers by virtue of their motherhood, but remain marginalised by their non-heterosexual identity. This paper will draw on the qualitative findings of a recent Australian study that examined the experiences of lesbian mothers. Using a story-sharing method, data were collected using three methods; a demographic data sheet, in-depth semi-structured interviews and journaling. The findings demonstrated that participants experienced various forms of homophobia when interfacing with healthcare services and providers and included exclusion, heterosexual assumption, inappropriate questioning and refusal of services. Strategies used to avoid homophobia included screening and crusading.

Exchange and equality during data collection: relationships through story sharing with lesbian mothers.

AIM: To explore how reciprocity is achieved through a method of self-disclosure, namely story sharing. BACKGROUND: Self-disclosure through story sharing promotes trusting relationships between researchers and participants that support the collection of high quality data, particularly when participants are members of a marginalised group and may feel especially vulnerable when sharing sensitive information. DATA SOURCES: A qualitative study that examined the experiences of lesbian mothers. REVIEW METHODS: Strategies were carefully and deliberately implemented to engage in story sharing with the participants. DISCUSSION: Participants said that it made a positive difference to how safe and comfortable they felt once they knew at least some of the researcher's story. CONCLUSION: The collection of rich data is improved by using story sharing as a means of establishing reciprocity in qualitative research. IMPLICATIONS FOR PRACTICE/RESEARCH: Story sharing has the potential to improve the quality of the data collected in qualitative studies. However, strategies that promote the emotional safety of the researcher in this context will need further exploration.

Journaling: identification of challenges and reflection on strategies.

AIMS: To identify the challenges associated with using journaling as a method of data collection and to offer strategies for effectively managing those challenges. BACKGROUND: While journaling can be used for a variety of reasons, in the context of this paper, journaling refers to the process of participants sharing thoughts, ideas, feelings and experiences through writing and/or other media. Journaling is used in phenomenological research studies to record participant experiences in their natural contexts. DATA SOURCES: The findings are based on the experiences of the researchers during a qualitative study that explored the experiences of lesbian mothers and used journaling as one method of data collection. REVIEW METHODS: This is a methodological paper. DISCUSSION: Three main challenges affect journaling as a method of data collection: poor participation, feeling exposed and staying on track. Six strategies to promote participation in journaling are: coaching participants, limiting the journaling period, providing follow-up contact, promoting comfort, ensuring safety and providing clear content expectations. Each strategy is discussed and methods of implementing the strategies are offered. CONCLUSION: Journaling as a method of data collection has long been accepted as a valid method of accessing rich qualitative data. By acknowledging the common challenges associated with the process of journaling that are experienced by the participants, researchers employing this data collection method can promote constructive and valuable participation. IMPLICATIONS FOR FUTURE RESEARCH: Further research examining participants' experiences of journaling as a method of qualitative data collection would be useful in determining challenges, barriers and benefits of the method.

De novo Families: Lesbian Motherhood.

The aim of this recent Australian study was to explore the experiences of lesbian women choosing motherhood. Participants included 30 self-identifying lesbian mothers. Data were collected via interviews, data collection sheets, and online journaling. The interview and journaling data were analyzed using constant comparative analysis and subsequently illuminated three main themes: becoming mothers, constructing motherhood, and legitimizing our family. These papers described the journey to motherhood and specifically explored the various methods of conception and other decisions that participants made when planning their family, the challenge of heteronormativity in health care, and legitimizing the role of the non-birth mother in de novo families. This article aims to present the participants' experiences of motherhood that was a constant topic found woven throughout all three of the identified themes. Participants identified that they had a unique opportunity to create their own mothering roles in the absence of significant "lesbian mother" role models and that they were able to adjust and to adapt their roles depending on fluctuating circumstances.

Redesign of the model of nursing practice in an acute care ward: nurses' experiences.

OBJECTIVE: to describe nurses' experiences of the change associated with redesign of the model of nursing practice in an acute care ward in the preparatory and implementation phases. DESIGN: descriptive case study SETTING: a surgical ward in an acute care hospital in Greater Western Sydney SUBJECTS: fourteen registered and six enrolled nurses working on the surgical ward volunteered to be interviewed, eight in the preparatory phase and twelve six months into the implementation phase MAIN OUTCOME MEASURE: descriptions of nurses' experiences in the preparatory phase and six months into the implementation phase of the redesigned nursing practice model RESULTS: many nurses felt apprehensive in the preparatory phase, however, six months into implementation phase their willingness to trial the model was evident. Negativity pervaded both phases, as did their concerns for the quality of care being given. In the preparatory phase nurses described the clinical activities coordinator (CAC) role as having potential to be beneficial and this was realised to some degree six months into implementation phase. A preference for registered nurses over enrolled nurses as a dominant component of the staff was evident in both phases CONCLUSIONS: the struggle with the change that nurses experienced suggests redesign needs to be a more collaborative process involving strong communication and supportive education so nurses can empower themselves within the change.

Change process during redesign of a model of nursing practice in a surgical ward.

AIM: This paper reports a case study of nursing practice model redesign in a surgical ward at a large metropolitan acute care hospital in Sydney, Australia. BACKGROUND: Literature suggests that factors such as financial restraints and shortage of nurses necessitate redesign of nursing care. METHOD: A descriptive case study design was used. The nursing practice model was changed from a patient allocation model to a team-nursing model and a new role of Clinical Activities Coordinator was introduced. RESULTS: This study has confirmed that people need to be able to empower themselves to ensure an effective change process. It was also apparent in the case study that the staff were resistant to the redesign. CONCLUSIONS: Change is a difficult process, which needs to involve all stakeholders. The planning process needs to consider the characteristics of the context such as workload and skill required, and the measures such as patient and staff satisfaction and health outcomes.