Small changes, big impact: A relational approach to emergency assessment for LGBTQ+ patients

Background: Emergency departments are often the first and sometimes only point of healthcare access for LGBTQ+ individuals, particularly in rural and remote communities. Despite growing awareness, many emergency nurses report uncertainty around queer terminology, gender diversity, and how to provide inclusive care without causing harm or discomfort while maintaining efficiency. For transgender and gender-diverse patients, negative emergency care experiences are associated with delayed care seeking, increased mistrust, and poorer health outcomes. While system-level change is important, meaningful improvements can also occur through small, relational shifts in everyday emergency assessment and communication. Objective(s): This presentation explores how embracing a relational approach to emergency assessment can improve health experiences and outcomes for LGBTQ+ patients. Specific objectives include: 1. Introducing sexual orientation and gender identity concepts using a simple, non-constraining framework grounded in four guiding questions; 2. Demonstrating how terminology is only one component of a broader relational approach to care; and 3. Identifying small, tangible actions emergency nurses can take to improve care for transgender patients, particularly in rural settings. Methods: Grounded in relational practice principles and informed by clinical and lived experience, this session uses a case-based and narrative approach. Queer terminology is introduced through a four-question framework designed to keep conversations focused, respectful, and adaptable, rather than prescriptive or label-driven. This structure helps reduce anxiety around “getting it wrong” while supporting individualized assessment. The session then broadens to examine how relational emergency assessment, centered on curiosity, respect, and responsiveness to context, supports safer, more equitable care. Rural emergency scenarios are used to illustrate how a single practitioner’s approach can significantly influence patient dignity, trust, and health outcomes when access to alternative services is limited. The presenter’s style is inclusive, realistic, and engaging, which has resulted in many requests for this presentation. Similar presentations have been delivered to Interior Health Authority’s Clinical Education department, the UBC/Interior Health Simulation Program, and the UNBC Rural Nursing Specialty Program. Results: Participant feedback from previous presentations demonstrates increased confidence in initiating inclusive conversations, improved understanding of gender diversity beyond terminology, and a shift away from checklist-based “cultural competence” toward relational responsiveness. Emergency nurses consistently report that framing learning as small, achievable actions increases their willingness to integrate inclusive practices into fast-paced clinical environments. Implications and lessons learned: Emergency nurses do not need to be experts in queer theory to provide affirming care. Small changes—such as how questions are asked, how uncertainty is navigated, how assessments are documented, and how advocacy occurs within the team—can have a disproportionately positive impact, particularly in rural communities. This presentation offers practical, immediately applicable strategies that reinforce the power of relational practice to improve equity, safety, and trust for LGBTQ+ patients in emergency care.