Fall risk assessment and transgender pts?

Nursing Students LPN/LVN Students

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I feel a bit silly asking this question, but I'm just wondering...

I learned today that when assessing for fall risk, one point may be added purely for being male, because statistically, males are more likely to impulsively jump out of bed, be overconfident, etc.

But, what about transgender pts? Gender has become such a fluid concept. Anatomically, females are different from males (regardless of which gender a pt identifies with). Does the fact that a (biological) female exhibits traditional masculine traits make a difference? And when taking testosterone or estrogen, does that play a role? We watched a video on how to perform and explain the assessment to the pt - would a transgender pt be offended if I added a point for his/her sex? Am I looking into this too deeply? It's just something that came to mind... I'm a newbie, and I'm trying to understand everything and anything that comes my way. :down:

Thoughts? Experiences? I apologize if I've offended anybody.

Specializes in Critical Care, Education.

Hmm - fascinating issue. It would be a great topic for a nursing researcher.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Since I remain in the hospital (grrrrrrrrrrrrrr) and have plenty of time I am going to do some research on this model. It is simply stating that statistically males have more falls than females......interesting.....off to study.....LOL

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I also think that we need to be open to different thinking strategies and policies that may differ from " the standard" this is an international site

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Specializes in ER, Med-surg.

Since I highly doubt this fall risk model has been validated using a statistically significant number of trans patients, from a legal/ethical standpoint I would mark their score according to whatever gender they identify with as in their medical records.

It's not my job to misgender someone based on my theories of how their gender identity might interact with a statistical model, and if I had to defend my charting in court, I really wouldn't want to be trying to walk the nice lawyers through my reasoning regarding calling a person who legally identifies as female a male in my charting because I had a half-baked notion that despite their transition, their assigned gender at birth would affect their fall risk today.

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Specializes in Pediatric Hematology/Oncology.

I've only been taught the Morse Fall Assessment Scale. This other one....I'm with Esme. Gotta research this a little bit.

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Specializes in ICU.

It's the Hendrich II Fall Risk assessment and if you are male you automatically get one point, I'm sure it's based on evidenced based practice.

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Specializes in Psych ICU, addictions.

None of the fall risk tools that I've used have ever assigned someone points strictly because of their gender. But clearly they do exist.

If I'm going to go by a tool that does use gender...I would use the gender that they are listed in the EMR. Not because I'm denying their right to their identity or because I want to disrespect them in any way, but as far as EMRs go, patients are categorized as either male or female based on what they are biologically, or what they have completed transition to.

On a semi-related topic: most suicide screens give risk points to males.

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Hmmm very interesting question. The fall risk score we use does incorporate male/female. All of the trans patients I have had are MTF pre genital reassignment and I believe I charted that section as female. I don't have any evidence to back that up, I just felt like it was the right thing ethically?

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Specializes in To be determined..

It's not my job to misgender someone based on my theories of how their gender identity might interact with a statistical model, and if I had to defend my charting in court, I really wouldn't want to be trying to walk the nice lawyers through my reasoning regarding calling a person who legally identifies as female a male in my charting because I had a half-baked notion that despite their transition, their assigned gender at birth would affect their fall risk today.

Oh dear, somebody is snappy! It was just a question.

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Specializes in ER, Med-surg.

It was "just a question" that has some disturbing implications about both your grasp of evidence-based practice and your understanding of good assessment and documentation practices as well as sensitivity in caring for trans patients.

Go ahead, tell a trans patient some day that you're reverting to their assigned gender from birth in your charting based on a personal hunch about the biological basis of both gender and fall risk behavior and see how that goes over. "Snappy" would be your best-case scenario.

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Specializes in To be determined..
It was "just a question" that has some disturbing implications about both your grasp of evidence-based practice and your understanding of good assessment and documentation practices as well as sensitivity in caring for trans patients.

Go ahead, tell a trans patient some day that you're reverting to their assigned gender from birth in your charting based on a personal hunch about the biological basis of both gender and fall risk behavior and see how that goes over. "Snappy" would be your best-case scenario.

Monday was my first day of nursing school - I've had two days of lecture, and in one of them, we briefly looked over fall risk assessment. I have no idea why gender would be an issue on a fall risk assessment, so yes - it was just a question. Not something I have done, not something I would necessarily do - just a question. Devaluing and offending a trans patient is the last thing I would want to do.

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