Our current featured article is authored by Jennifer Searle, BSc, BScN, RN, titled “Queer Phenomenology, the Disruption of Heteronormativity, and Structurally Responsive Care.” In this article, the author reveals heteronormativity as a prevalent, but largely unacknowledged, source of structural harms for LGBTQ patients and discusses the importance of gaining an awareness of ongoing structural harms that are disproportionately experienced by vulnerable patient populations. She shared this background about her work for ANS readers, and we invite you to download the article while it is available for download and share your comments and insights related to this work:
I wrote this prior to being accepted into the doctoral program early, while I was completing the coursework for the Master of Nursing program. The paper was a major writing assignment that was supposed to explore a practice issue or experience. We were directed to use a theoretical lens to develop a manuscript for publication. Queer phenomenology was the methodology I had planned on using as a graduate student, but I have since switched to grounded theory for a number of reasons. The decision to leave queer phenomenology behind was largely informed by a realization that I no longer wanted to use an interpretive framework that sought to understand how heteronormativity is experienced within health care because this routinely caused me to re-engage with my own experiences of heteronormative-related harm.
As a lesbian, I experience harms that have been historically underrepresented, particularly in nursing literature. I often have to disclose personal experiences to illuminate the harms that heteronormative practices cause. I have found that those who do not experience such harms in their everyday realities often find it difficult to understand the risks of normativity to those who do not conform accordingly. This article does just that. I have taken an experience I had as a patient and used queer phenomenology to explain how being-in-the-world with heteronormativity causes harm to those who do not conform with the expectation of heterosexuality. I wanted to show both sides of a practice issue for this assignment and bring visibility to the intersection of my existence as both patient and healthcare provider. The systemic inequities that I experience are not unique to me as a lesbian or as a member of a historically marginalized group and like many others, I have come to anticipate being harmed. This informs my practice in ways that means I provide a level of care as a nurse that I have yet to receive as a patient. The risk of harm I was experiencing within my role as a graduate student became overwhelming and unsustainable. I felt as if I was always trying to convince others of the harm that characterizes my existence, which resulted in continued re-exposure to the trauma I experience in relation to discriminatory social structures. Some were easier to convince and I experienced most to be well-intended, but I came to realize that I must create distance between my harm and my work if I would be successful in finishing my graduate studies.
I believe this article reveals the necessity to provide care that has its intended impact and might even convey important insights into harm that resonates with members of dominant groups who have yet to gain an appreciation for the implications of professional education and training that inadvertently reinforces heteronormative assumptions. My understanding of harm has been expanded by queer phenomenology and it has provided me with a lens to make sense of a world that discriminates against me, but I did not feel as if my appreciation for how I might promote change within health care to address lesbian, gay, bisexual, transgender, and queer (LGBTQ) health disparities was furthered. Instead, I kept falling into a cycle of harm that has hindered my ability to focus on the purpose of my research. I want to know more about the process by which health services are delivered to LGBTQ patients by healthcare professionals who have received training that remains informed by a legacy of discrimination that once legitimized the stigmatization of non-heterosexuality via the pathologization of homosexuality. I no longer want to explore the ways in which people like me are harmed by a society that normalizes heterosexuality at our expense.
I believe the overall health system might be strengthened by narrowing the gap between health services provided by healthcare providers and those which are required to better meet the health needs of LGBTQ patients. Queer phenomenology will always shape my interpretation of the world around me and will likely inform the direction I take as a doctoral student, but its role in my work will be limited as such moving forward. Harm pulls focus on my ability to see a broader context and while I recognize that structural approaches can be overly deterministic and thus risk undermining the agentic possibilities available to individuals, this article reveals to me that agency will always be relative to structure. Those who are marginalized within broader society are likely to be constrained in their ability to re-act when they are re-exposed to structural harms. My experience as a patient as described in this article, demonstrates the role that healthcare professionals can take in understanding how a lack of reflexivity during the process of care delivery places patients at risk of being re-exposed to a lifetime of harmful assumptions, biases, and stereotypes. These subtler forms of harm often connect to personal, collective, and intergenerational traumas that are caused by social structures that discriminate, exclude, and marginalize individuals based on characteristics that they have no control over. As such, those who access health services are at an increased risk of being re-exposed to structurally-based forms of trauma.
As an educator, I recognize the ongoing gaps in nursing education in terms of perpetuating an assumption that marginalizing characteristics are visible and thus recognizable. I believe this sort of approach does us all a disservice. Members of equity seeking groups are not always recognizable; characteristics that relegate us to the margins are not always visible. Even if a person is visibly different, this does not mean that we, as healthcare professionals, can assume we know how a person’s lived reality is constructed alongside dominant cultures and normative expectations. Such an approach would surely reinforce stereotypes about groups rather than promote a layered understanding of individual circumstances in relation to structural conditions. This article is therefore offered as a means to explain that we, as healthcare professionals, must gain an appreciation for broader contexts of structural harm to situate individuals, understand their lived realities in safe and meaningful ways, provide what I describe as structurally responsive care, and minimize the risk of re-exposing patients to the traumas that characterize their existence.