“Nurses can do better”: experiences of LGBTQI+ migrants with nurses and other healthcare professionals in Canada




Haghiri-Vijeh, Roya

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This dissertation starts with a foreword chapter that discusses my situatedness in research which aims to understand the experiences of LGBTQI+ migrants with nurses and healthcare professionals in Canada. This is followed by an overview of literature on the experiences of LGBTQI+ people in their migration trajectories and interactions with social and healthcare professionals. I close the foreword chapter with a discussion of my methodology and research approach. I then present four manuscripts that I prepared for publication and an afterward chapter. In the literature review, I discuss how, over the past two decades, some nurses, along with social and mental healthcare providers, child and youth workers, public service providers, and legal service professionals, in collaboration with migrants, LGBTQI+ people, or those at the intersection of identities, have strived to advance safe and affirming spaces for LGBTQI+ migrants. Despite the work of these scholars, practitioners, and activists, some nurses continue to have a limited understanding of the experiences of LGBTQI+ migrants in the Canadian context, and LGBTQI+ migrants continue to have troubling experiences with nurses. For this reason, the following question undergirds this dissertation: What have been the experiences of LGBTQI+ migrants in their interactions with nurses and other healthcare professionals (NHCPs) in Canada? Within my dissertation, I analyze LGBTQI+ migrants’ encounters with NHCPs by applying a Gadamerian hermeneutic approach with intersectionality as an analytical lens. Utilizing this approach, I conducted 18 semi-structured, in-depth, individual interviews. Two groups of individuals participated in this study: (a) 16 LGBTQI+ migrants who received care from nurses and other healthcare professionals in Canada; and, (b) five nurses or nursing students who experienced, observed, heard, or witnessed the provision of nursing care to LGBTQI+ migrants. Of the latter, three also identified as LGBTQI+ migrants. Three nurses identified as registered nurses, one nurse identified as a registered practical nurse (also known as licensed practical nurse in some provinces) as well as a student in a nursing degree program, and one nurse identified as an educator. Approaching analysis from an intersectional lens, I observed how LGBTQI+ migrants’ experiences were shaped by considerations of physical, mental, and spiritual well-being, which intertwined with race, ethnicity, migration status, sexual orientation, gender identity, and gender expression. Furthermore, I found that migration status added another layer of complexity to the marginalization of LGBTQI+ people, which required intentional allyship from nurses. Chapter two consists of the first manuscript, “Gadamerian Hermeneutics with Intersectionality as an Analytical Lens,” in which I provide an account of the methodological research approach to understand experiences of underserved people, namely LGBTQI+ migrants. Chapter three includes the second manuscript, “Experiences of LGBTQI+ Migrants with Nurses and Other Healthcare Professionals in Canada,” in which it becomes evident that LGBTQI+ migrants’ experiences encompassed both challenges and supportive care in their encounters with nurses and other healthcare professionals. With attention to micro, meso, and macro health policies, the informants identified that feeling inferior to and unacknowledged by NHCPs often created challenges for them in navigating the healthcare system. This leads to the fourth chapter, titled “‘If You Can Just Break the Stigma Around It’: LGBTQI+ Migrants’ Experiences of Stigma and Mental Health.” In this manuscript, I illustrate the multiple forms of stigma that negatively affected LGBTQI+ migrants’ mental health. Here, three themes are discussed: (a) the intersectional experience of stigma, (b) stigma related to fear and safety, and (c) participants’ calls for affirming practices that promote inclusive health services and supports. Given the contextual utility of these findings, I build on existing literature which corroborate that changes in nursing education, practice, and policy need to occur to provide diverse LGBTQI+ migrants with care that addresses trauma-informed and violence-informed practices. In chapter five, the title of “‘Ally Theatre is a Problem’: LGBTQI+ Migrants’ Experiences with Nurses in Canada” arose directly from some informants’ concerns about performative allyship. In the final chapter, or afterward, I provide a synthesis of the dissertation, including implications of its findings for nursing practice, education, policy, and ¬¬research. Intentionally, the final chapter is called an afterward, and not afterword, because I cannot claim that the chapter will outline my final words, since it acts, instead, as a bridge for future scholarship. Here, I elucidate how LGBTQI+ migrants addressed trauma and accessed resources with resiliency, even while they encountered barriers to accessing much-needed healthcare services. This dissertation centres on the voices of an understudied population, LGBTQI+ migrants, receiving nursing and health care in Canada.



LGBTQI+, Migrants, Nurses, Healthcare professionals, Intersectionality, Gadamerian Hermeneutics, Complexity, Interpretive Phenomenology, Newcomers, Refugee, Stigma, Racism, 2S/LGBTQI+, Heteronormativity, Nursing Education, Policy, Practice, Education, Research, Affirming care and affirming practices