Nursing's Transition: Creating Inclusive Healthcare Settings for Transgendered Patients
Transgender patients should be able to access healthcare without fear or ridicule. By advocating for the individual needs of our patients we can continue to strive for quality outcomes for everyone.
The waiting room is busy; she sits gently pulling at the edge of her new Summer dress. It seemed like such a smart buy earlier in the week but now leafing through the shiny guide she received at the new employee orientation she wonders if the bright blue flower pattern and sleeveless cut is a bit too flashy for the office. Next to her is the stack of paperwork which she has dutifully completed, such a joyful task. The clock ticks on, she chews nervously on her pencil. She thinks back to other appointments, ones similar to this, she breathes in and lets out a long sigh. Finally the door opens, the nurse steps out and calls loudly, "David, the doctor will see you now". She stands, a swirl of Azure wilted by a moment of ignorance.
The story of "David", although fictional, is based upon the realistic events of a Transwoman, assigned a male gender at birth, now identifying as a female. Transgender individuals often avoid seeking healthcare related to fear and the potential for discrimination. Nurses are often the first contact that patients make when receiving care so they play a crucial role in developing rapport with their patients and creating welcoming environments.
Transgender is the general term used when referring to people who identify with a different gender than what they were assigned at birth. It really is not possible to get an accurate count on the number of people in the world that are transgender since the statistics are sketchy due to under reporting. With the accomplishments of actress/producer/LGBTQ advocateLaverne Cox as well as the recent outing of Olympic athlete, formerly known as Bruce Jenner, transgender topics have become more acceptable in social media. However the potential for violence and discrimination are still major issues for most patients. It is for this reason that it is not uncommon for patients to limit interactions with providers based upon feelings of anxiety or negative past experiences.
Issues with insurance coverage for medically necessary gender-related care or inappropriate care, reprisal at work related to their gender identity/need for medical procedures, and general access to medical services needed within their communities are frequent worries for patients. Lack of continuity of care and noncompliance with treatment is cause for concern as it relates to such medical disorders such as diabetes, heart disease, substance abuse, HIV, and mental health conditions. In recent studies, transgender patients were found 9 times more likely to have attempted suicide than the average person. Social risks such homelessness and lack of support systems were known to be high stressors. Refusal of care by medical providers and discrimination were also key factors for suicide risk.
Transgender patients should be able to access healthcare without fear or ridicule. Barriers to care exist in all environments and need to be broken efficiently. It is extremely important to educate yourself and others within your workplace in an effort to create safe, inclusive, patient centered care facilities. Increased awareness of barriers that patients may have already encountered prior to our visit allows us to appreciate the potential for underlying apprehension and frustration they may be experiencing. Nursing staff may also have feelings of nervousness stemming from a lack of knowledge regarding Transgender patients. Our own approach and demeanor can allow us to better anticipate the needs of the patient to improve overall outcomes.
What can nurses do to reduce stigma and make their workplaces more sensitive to the LGBTQ/transgender community? Focus on making sure that you are properly educated and share your knowledge with your colleagues. Be sure to use transgender affirmative and inclusive language. Ask patients their preference for word choice, especially when using names, pronouns, and other words to describe their body. It is important to ensure that environments are welcoming to the LGBTQ/transgender community. This can be accomplished through the display of LGBTQ acceptance signage as well as educational materials in the waiting room. Lastly, never assume! Whether it is the gender of a person, sexual orientation, or the answer to another health related question, nurses cannot avoid asking the questions necessary to properly assess and care for patients even if they are embarrassing or difficult. Remembering to incorporate sensitivity from the beginning of our assessment all the way through care delivery is a must! Respecting the individual needs of our patients and advocating for quality care has always been the nurse's forte. Ensuring that we do all that we can for the transgender population to receive the healthcare services that they deserve should be no different.
This is a great article. As a nurse, who happens to be transgender, I can't emphasize enough to not make assumptions. No two transgender people are the same.
I have never dealt with this, but even though I can show compassion and service to many different kinds of people, I would have a very hard time supporting people with such a choice. I could care for them, but it does not mean I would be able to call them by the transgender person they want to be.
Note this, before you flame. I am writing from inexperience. However, if I were to claim a title not mine, even a woman, I would be seen as crazy. Say I declared I am now Queen Elizabeth of Great Britain. Chances are, if I pushed my self on others as such, I would end up on antipsychotics or in a mental hospital. It does not make sense for someone to be someone they are not.
The Bible clearly defines men as men and women as women. It says that cross gender is an abomination to the LORD. By using gender specific pronouns with a cross gender person, I feel that would be giving support and establishing them in that mentality. Yes, by all means show compassion, but taking an example you used, I would not agree with an alcoholic that alcohol is beneficial to them and they should continue in their way, even though it is clearly destroying their life.
Since this is open on this topic, I want to know if other people can put themselves in my shoes. As a conservative nurse who serves the LORD Jesus Christ, what would you do in such a situation? For people who want to note that Jesus is compassionate, yes, He is. But though He advocated for the woman caught in adultery, He said, "Go, and sin no more." He did not tell her that her adultery was all right since it was her choice in life.
It is not a sermon. As a nursing student in a non-Christian nursing program, I am having to set Biblical foundations for how I will approach such matters later in life. Thank you for bearing with me.
I also wanted to address the people who said that they would have issues referring to me with feminine pronouns or who would use my former name (deadnaming in trans* slang). You do this at your own peril. Many of us get highly offended when you do such things. I know if I was to be disrespected in such a manner, I would definitely make sure an administrator is aware. I also would not hesitate to file a discrimination complaint. Many states are making it illegal to not accommodate people who are transgender and case law is on our side. Trust me when I tell you, a hospital will not hesitate to get rid of you rather then deal with the potential fallout that would arise from your intolerance. If you don't believe me, here is an example
If the offense in my opinion was egregious enough, don't think I won't hesitate to contact a state board of nursing.
I don't care what you feel that your god tells you or what you have read in some book. I expect to be treated with dignity and respect when I seek medical services. I won't tolerate anything less. Sorry if I come off as hostile, but I've dealt with transphobia my entire life. After awhile it gets to you.
I'm with Parakeet. "Trans" anything speaks to me of mental illness. If these people came in wanting to be squirrels or hamsters they would be treated for mental illness. The "trans" population is mentally ill and I'm not going to accept it. I will treat them with same respect and care I treat any other patient with, but I'm not going to accept what I consider outright deviance in my own life.
The people here who have the real problem are those of you eager to scream "bigot" and other nonsense at others.
I figure if an individual can be born intersexed with both male and female genetalia why can't there be a mix of gender characteristics otherwise less tangible? Who am I or anyone else to insist otherwise especially someone who otherwise doesn't have mental illness symptoms?
I'm with Parakeet. "Trans" anything speaks to me of mental illness. If these people came in wanting to be squirrels or hamsters they would be treated for mental illness. The "trans" population is mentally ill and I'm not going to accept it. I will treat them with same respect and care I treat any other patient with, but I'm not going to accept what I consider outright deviance in my own life.
The people here who have the real problem are those of you eager to scream "bigot" and other nonsense at others.
How are you treating them with the same respect and care when you flat out say they are mentally ill? The mental illness, gender dysphoria, is the result the distress of gender mismatch, caused by things such as people misgendering them or being afraid to present their true selves because of the fact that trans individuals are more likely to have people react violently to them.
I think the best comparison in this entire thread is the Witness nurse. Witnesses don't accept blood, but that doesn't matter in that nurses practice, it only matters in that nurses everyday life. I went to school with a Witness and asked her extensively about her beliefs on transfusion (super interesting to me), she said she didn't believe in it for herself personally, but she'd advocate for it for a patient who needed it. Because it wasn't about her, it was about the patient.
It's not about me or my beliefs, it's about my patients. My thoughts on the Trans issue don't matter. The patient matters. This shouldn't even be a discussion. Address the pt by the preferred identifier and if they ask you about YOUR beliefs remind them it only matters what they believe and that they will find no judgment from you.
How are you treating them with the same respect and care when you flat out say they are mentally ill? The mental illness, gender dysphoria, is the result the distress of gender mismatch, caused by things such as people misgendering them or being afraid to present their true selves because of the fact that trans individuals are more likely to have people react violently to them.
So how about the people who feel they are "trans-abled"? I bet you haven't heard of that yet, have you? There's a subset of people out there who feel they should have been born without an arm, or a legs or eyes or what have you. They try to attain surgery to correct what they feel is a mistake and get to the "true them". Sound like mental illness to you? It sure does to me.
Feel free to google for this, I'm not making it up.
Are you going to believe that people born with vision are anything less than mentally ill when they WANT to be blinded?
How are you going to reconcile your belief in transsexuals vs that of trans-abled?
Where does it stop? Is wanting to be a horse ok? Should society and individuals just overlook what is decidedly mental illness because it might actually offend someone?
I believe that is a nihlistic delusion, tutelary. Which is quite common in the DIAGNOSABLE MENTAL ILLNESS (you know, according to the DSM-5...) depression with psychotic features.
Could always work at a Catholic hospital where biblical principles guide the care if you're that concerned about being forced to compromise your beliefs. It may make running into gay or Trans patients less likely, but you probably still will.
Unfortunately, for purposes of this discussion, Catholic teaching is that merely being gay/transgender/bi or whatever, as in having the tendency or feeling that one is that way, IS NOT A SIN.
There are actions people can choose to take that are sinful, but only having the orientation is not a sin. Which makes sense as, while there is not proof it's genetic, these things don't seem to be what people choose, but how they feel themselves to be for whatever reason.
It's also against Catholic teaching to withhold care from people because you disagree with their choices. Basic human dignity argues against that as well. Besides, refusing to care for sinners means no one gets care. And since we're all sinners, makes you a hypocrite too.
I beg to differ, but it is not possible. Someone who defiantly breaks the laws that the LORD God set in place is not a Christian. A Christian is a person who has surrendered their entire life and will to the Lordship of Jesus Christ. Such a person would live as Christ wanted them to and not for their own desires.
And no, we have people in our church who have tattooed themselves before they came to Christ. They did so in ignorance, and now regret it. I do not consider them any less Christian than anyone else. Now someone who has knowledge of God's will and Word and does not obey it...they are in the wrong.
Okay, first, alternative sexual identities are deeply ingrained and almost every person that has them says they knew something was different about them since childhood. We have no proof any of it is genetic but we really don't know the causes. I tend toward an environmental/relational theory myself, with the possibility of certain genetic tendencies contributing. Whatever the cause, though, these people don't choose to be this way. Something that is not chosen IS NOT and can never be sin. And since most people know they're different well before they have any understanding of God's law, even if they were choosing it, it still can't be sin because one must freely choose to break God's law, knowing that is what they are doing, in order to commit sin.
Now, mature people who have been educated can make choices and perform activities, based on any number of motivations, that are sinful. The "age of reason" is about 7 because children start learning to use reason at about that age, but I think few children below 12 can truly be held accountable for actual sin.
As to your comment about tattoos, I about laughed myself silly on that one. The misinterpretation of a few Old Testament verses, which banned a specific type of pagan funerary tattooing, does not make decorating one's skin sinful. I'm a tattooed practicing Catholic, married to another tattooed practicing Catholic, and we know lots of others. We know tattooed Christians of other traditions as well. That whole "temple of the holy spirit" thing? Last I checked, temples are beautified and decorated. Content matters, obviously, but there is no reason Christians can't have tattoos.
So how about the people who feel they are "trans-abled"? I bet you haven't heard of that yet, have you? There's a subset of people out there who feel they should have been born without an arm, or a legs or eyes or what have you. They try to attain surgery to correct what they feel is a mistake and get to the "true them". Sound like mental illness to you? It sure does to me.
Feel free to google for this, I'm not making it up.
Are you going to believe that people born with vision are anything less than mentally ill when they WANT to be blinded?
How are you going to reconcile your belief in transsexuals vs that of trans-abled?
Where does it stop? Is wanting to be a horse ok? Should society and individuals just overlook what is decidedly mental illness because it might actually offend someone?
People who are transgender are not automatically mentally ill. It's possible to be trans* and be perfectly happy and well adjusted, especially after one transitions and starts living in the proper gender role. Often times the distress come from being forced to live a life, that we were not meant to live. I can tell you from personal experience, my life improved by leaps and bounds, when I decided that after thirty years, I would stop living as a man.
Gender identity is persistent and often manifests at an early age. Research show that attempts to use therapy to get transgender people to be comfortable living as their assign gender are never successful, and can often make things worse. They are so ineffective and damaging, that a few states have banned the practice in minors.
Also your attempts to compare us to people who want to cut off limbs are like comparing apples to oranges, and in my opinion, ridiculous. First off, not everyone who is trans* wants any surgical interventions. Gender confirmation surgery and hormone therapy does not disable anyone.
Research show that attempts to use therapy to get transgender people to be comfortable living as their assign gender are never successful, and can often make things worse. They are so ineffective and damaging, that a few states have banned the practice in minors.
We have to be careful not to make our glasses too rose-colored, also, though. There is also evidence that gender reassignment doesn't solve a fair number of transgendered people's problems. While for some, massively body-altering surgery ends up being the right path, others end up with regret and still unable to feel comfortable in their bodies. Then what do they do? We shouldn't get to the point where such irreversible steps are too easily accepted, causing more damage than help.
Miss Rayanne
41 Posts
This is a great article. As a nurse, who happens to be transgender, I can't emphasize enough to not make assumptions. No two transgender people are the same.