About transgendered patients - page 2

Hello all, In addition to "working the floor" I also teach nursing, and two of my students this past week posed an excellent question. I had my (second year) students working on taking patient... Read More

  1. by   resumecpr
    Great question! It really got me thinking. My concern for transgendered patients is in the case of a traumatic injury requiring emergency release blood.
    I once had a patient with a GSW to the buttocks. The patient appeared to be female, with breasts, makeup, etc, and even a driver's license that said female. Upon further investigation (like a pelvic xray) we noted a penis tucked up against the thigh. Lucky for the patient, there was no significant damage and he/she was discharged soon after.
    The MD did take the time to explain the importance of explaining the transgender in order to avoid potential disaster in an emergent situation. I was in awe of this entire case. A definite lesson learned for many!
  2. by   CoffeeRTC
    It never hurts when you introduce yourself to ask "How do you like to be called? Do you identify with a particular gender?" and this can be a leading question to more relevant questions that a nurse would need for his/her assessment.

    Beleive it or not..we had this issue in our LTC. Private room was the answer. Then we had a few other residents that wanted a private room and started saying they wanted to be a male or female....boy did it get crazy until we had to remind them this wasn't high school...I know..I strayed from the OPs question.
  3. by   YEGRN
    Orange Juice and ResumeCPR, I really liked your answers -- many thanks! Again, thanks to all for your replies, as your information will make for a very "teachable moment" discussion when I meet with my students next week.

    Cheers, YEGRN
  4. by   ChristineN
    I found this discussion to be fascinating. As a nurse I have always been interested in how to provided not only excellent care of my pt's physical needs, but also how to meet their psycho-social needs, including gender identification. My employer is actually offering an in-service for nurses next month on nursing issues related to the care of transgender and LGBT pt's. I am excited to have the opportunity to attend, but have found myself wondering, how many employers actually even address this issue.
  5. by   KaroSnowQueen
    Several years ago we had this in an LTC. A "female" patient known as (fake name) Susie Brown. Wore makeup, ladies clothes, ladies jewelry. Had breasts, wore a brassiere, but also had a penis. Legal name (fake name) John Brown.
    Her chart said Susie (John) Brown.
    When we sent her out (we always called her by female prounouns at her request) we always put in parentheses at the top of the page ("transgender male to female), and explained to EMTs. Never had much of a problem. The worst complainers were some older lady CNAs who were astonished and possibly disgusted at what they believed was weird and immoral - they were told to respect the patients wishes and keep their opinions to themselves and off campus.
    Susie Brown always had a private room just so any other lady (or male) patients wouldn't be freaked out if they saw her in the bathroom.

    Also had a lady patient who had a very masculine husband, he had long hair, mustache, beard and sideburns. Some days he came to visit in his work clothes. Other days he came in wearing a bra, ladies sweater, skirt, hose and heels. He even wore Christmas earrings to the facility Christmas party, looked very festive! Always went by his male name. One brave nurse asked him about his "interesting choice of clothing on his off days" and he very simply smiled and said he felt more relaxed wearing ladies clothes. The wife never acted like anything was amiss, so she must have been aware of this for years.

    I say, whatever makes 'em happy and just go with the flow.
  6. by   phoenixrisingftm
    Thanks for asking a question that so often gets ignored! As a transgender person and an RN student, it can be frustrating to run up against the same brick wall time and time again!

    I know a lot of people have responded, but thought I would also add my $0.02.


    how does one respectfully ask if a) this is indeed the case, and b) how far along is the patient in their process of transition.


    If it's really not apparent by the way they are presenting (clothing, hair, makeup, etc.) or by name, a good way to start is by asking, "May I ask which pronouns you prefer?" If the patient is not trans identified, they might be confused by the question. But most transgender patients will appreciate being asked.

    It's important not to start asking irrelevant questions. If a patient is admitted to the ER for pelvic pain, asking questions about when/why they decided to undergo chest surgery is invasive and likely not going to be relevant to treatment. That said, there are many times when knowing information about hormones/surgery will be useful. Try to use neutral language, such as chest instead of breasts, or genitals instead of clitoris/labia/etc.


    Additionally, when is a transgendered individual considered to be anatomically male/female? (I'm assuming that hormone therapy and surgery have been done).

    Well that's a tricky question. many transgender people choose not to undergo genital surgery. There are many reasons: cost, function, risk of complications, aesthetics, etc. Currently, individual states get to identify the criteria for changing the sex marker on identification (though transgender people can now get passports with appropriate gender markers without genital surgery as a prerequisite).

    I'm assuming that this patient would be identified for medical purposes as "male," even though he wishes to be addressed and treated like a woman.

    It's important to ask transgender patients how they are identified with their insurance company. I cannot tell you how many diagnostics or labs I have had rejected initially because the provider listed my sex as female! Most insurance companies that I have dealt with are understanding that sometimes men need gyn exams or women needs prostate exams. They can put the request through manually to avoid the computer rejecting claims for sex-specific procedures. But if the marker on the paperwork does not match how the patient is listed with the insurance company, all of it will be rejected automatically.

    I've been doing transgender education for many years and am now beginning to integrate hands-on nursing knowledge. I'm happy to chat more if you have other questions.You can find my contact info in my profile.
  7. by   BluegrassRN
    Quote from phoenixrisingftm

    It's important to ask transgender patients how they are identified with their insurance company.
    I would have never, ever thought of this. Thank you for your post, if was very informative.
  8. by   CanuckLPN73
    Quote from resumecpr
    Great question! It really got me thinking. My concern for transgendered patients is in the case of a traumatic injury requiring emergency release blood.
    I once had a patient with a GSW to the buttocks. The patient appeared to be female, with breasts, makeup, etc, and even a driver's license that said female. Upon further investigation (like a pelvic xray) we noted a penis tucked up against the thigh. Lucky for the patient, there was no significant damage and he/she was discharged soon after.
    The MD did take the time to explain the importance of explaining the transgender in order to avoid potential disaster in an emergent situation. I was in awe of this entire case. A definite lesson learned for many!
    GSW?? Gun Shot Wound is the only possible thing I can think of but that cannot be right...so what does GSW mean. Please pardon my ignorance.
  9. by   Flare
    i was thinking about this thread as my hospital had a transgendered patient yesterday that needed room placement. Fortunately we were able to place this individual in a private room and there were no issues with anyone feeling uncomfortable - but it did remind me of the complexity of the situation. There have been times that i haven't had *any* beds let alone a private room. Had this been one of those times i don't know where we would have placed this patient --as cohabitating with either gender would have been inappropriate.
  10. by   diane227
    I have had a good deal of experience with transgendered patients. I deal with the matter in a direct, polite manner. During my assessment I ask them directly where they are in their sexual reassignment process. If they regard themselves as female, they should be treated as such. Once sexual reassignment has been completed, they are considered to be male or female, depending on the transition that they made.

    The issue is where to place these patients in the hospital if you have to admit them and they have not yet made the full transition to male or female. I have always tried to assign these patients to private rooms. If that is not possible, then you have to assess each situation to determine how it should be managed. And this might require that you consult with the other patient in the room to see how they feel about the situation before placing the transgendered patient into that room.
  11. by   happy2learn
    Quote from studentpn73
    GSW?? Gun Shot Wound is the only possible thing I can think of but that cannot be right...so what does GSW mean. Please pardon my ignorance.
    GSW = gun shot wound (at least where I am)
  12. by   bustthewave
    Quote from Fribblet
    Gender is cultural; sex is biological.

    If a person has had sexual reassignment surgery, then they are now a transexual, and, for all intents and purposes, male or female (depending on which surgery they had).

    If they are using hormones and living as the opposite gender, then they are transgendered but biologically the opposite sex and should be identified as such in the medical record. However, it is perfectly acceptable to refer to this patient as the gender they prefer.

    In fact, no matter where a person is in their transition, I refer to and identify them in the manner they prefer. Some who are transitioning to a female, wish to be referred to by their chosen female name and with female pronouns. Others, when receiving medical care prefer their biological sex and given name. It depends on where they are in the transition and their own personal preference. But, when it comes to demographics, if they have not had reassignment surgery, then their biological sex is listed.

    This is just my understanding and perception. Hope it was somewhat helpful!
    Just a question here by a student and no more but - wouldn't the surgery make no difference in their biology? I mean it's all cosmetic, it doesn't change their hormones or their DNA, or their biological makeup correct?

    Of course you should call them by the name they prefer, and of course you should say she/he towards the preference, but wouldn't knowing the correct biological, birth sex be important to know for some treatments? Escpecially if we are talking about something like surgery? I'm just thinking that a transgendered male to female, would still lack ovaries, natural breasts, estregen, female reproduction abilities of any kind...

    If it wouldn't effect treatment than I guess the point is moot, but for effective care wouldn't this be important to document at least?
  13. by   GadgetRN71
    Quote from KaroSnowQueen
    Several years ago we had this in an LTC. A "female" patient known as (fake name) Susie Brown. Wore makeup, ladies clothes, ladies jewelry. Had breasts, wore a brassiere, but also had a penis. Legal name (fake name) John Brown.
    Her chart said Susie (John) Brown.
    When we sent her out (we always called her by female prounouns at her request) we always put in parentheses at the top of the page ("transgender male to female), and explained to EMTs. Never had much of a problem. The worst complainers were some older lady CNAs who were astonished and possibly disgusted at what they believed was weird and immoral - they were told to respect the patients wishes and keep their opinions to themselves and off campus.
    Susie Brown always had a private room just so any other lady (or male) patients wouldn't be freaked out if they saw her in the bathroom.

    Also had a lady patient who had a very masculine husband, he had long hair, mustache, beard and sideburns. Some days he came to visit in his work clothes. Other days he came in wearing a bra, ladies sweater, skirt, hose and heels. He even wore Christmas earrings to the facility Christmas party, looked very festive! Always went by his male name. One brave nurse asked him about his "interesting choice of clothing on his off days" and he very simply smiled and said he felt more relaxed wearing ladies clothes. The wife never acted like anything was amiss, so she must have been aware of this for years.

    I say, whatever makes 'em happy and just go with the flow.
    This brings up an excellent point. Not all transgendered people are interested in surgery. Some are transvestites who simply prefer to wear clothes that identify with the opposite gender. Doesn't mean they always dress this way and it doesn't necessarily mean they are gay either.

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