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.
I only got through about one half of the comments. Based on what you have stated, it is my opinion that you should NOT be providing care to transgendered patients (or perhaps any LGBT patients, for that matter). Your strong (what might be described as very "black and white") belief system clearly is going to get in the way of your ability to provide compassionate care to transgendered patients or likely any patient you perceive as LGBT.
I believe the best thing for you to do in a clinical setting is to switch out patients assigned to you who are transgendered or who you perceive are anywhere on the LGBT spectrum with another nurse, if at all possible. Based on your posts I read, the very act of theorizing how you would respond to transgendered patients appears to be causing you a questionable amount of anxiety. In a clinical setting, there most often will be not time for you to weigh internal moral struggles over how to approach a patient/ situation. This fact might easily compromise the level of care your patients deserve and your future agency will demand of you, or it might actually work in your favor and allow you to put your beliefs aside and care for these patients as you would any other.
The point is, if there is ANY chance a patient picks up on your disapproval (and LGBT individuals are generally fresh on the scent of disapproval, most of them having endured their share of it), patient care unquestionably will have been compromised. One of the cornerstones of competent nursing care is the trusting relationships we build with our patients. Trust is shattered the second a patient feels invalidated, disrespected, or marginalized.
Every nurse will come across a situation/ patient in his or her career that challenges his or her moral compass. In this sense, your struggle is not foreign. One classic example that came up in a critical thinking class my first semester was how we would approach dealing with the parent of a pediatric patient admitted with injuries stemming from child abuse. However, the fact that your disapproval is aimed at a class of people and is so general in nature -- these individuals in your eyes are somehow "wrong" or "immoral" by their very existence -- this is what is most disturbing to me about your comments/ views and why I believe you should remove yourself from these patients' care if at all possible.
The other alternatives for you besides swapping patients with co-workers would be to abandon your plan to pursue a career in the nursing professional altogether, take a harder, more critical look at your own beliefs, or seek employment abroad (Saudi Arabia, perhaps) in an extremely conservative society where transgendered and other self-identifying LGBT patients would be rare or non-existent.
Personally I don't think it's impossible to be a nurse if you don't agree with certain lifestyles. The important part is to be honest with yourself. I do agree with the previous poster who stats that if the belief is so strong that it causes anxiety then ask for help from coworkers. My coworkers and I are honest with each other about what bothers us and how we can help each other and by doing so we can help each other out. It's a team after all. Understand that they may not always be able to help them.
these individuals in your eyes are somehow "wrong" or "immoral" by their very existence -- this is what is most disturbing to me about your comments/ views and why I believe you should remove yourself from these patients' care if at all possible.
The other alternatives for you besides swapping patients with co-workers would be to abandon your plan to pursue a career in the nursing professional altogether, take a harder, more critical look at your own beliefs, or seek employment abroad (Saudi Arabia, perhaps) in an extremely conservative society where transgendered and other self-identifying LGBT patients would be rare or non-existent.
This annoys me to no end. This dictating behavior that you people feel so comfortable with. That you can sit there and tell others what to believe in life and what base decisions they should make because of a personal belief structure that doesn't follow EXACTLY what you want.
How extraordinarily arrogant of you.
Welcome to life. Not everyone is going to reflect exactly what you want at any given moment. The very fact that you disapprove of someone else having an opinion opposite yours doesn't even cross your mind as ironic.
No matter what spin or how much shine you put on it you simply want everyone to fall in line with you. You aren't getting it, so step off.
I think there's some confusion between "genetic" and "innate", if something is genetic that would mean it is determined by the genetic code given to someone, and no there's not much evidence that being transgender is dictated by genetics.
There is no arguing however that it is "innate" (something you are born with). I'm a little amazed that people who I would assume have had some basic exposure to human physiology could consider being transgender to be comparable to someone wanting to be a hamster or horse. All humans are programmed to differentiate during development to either a male or female, we are not programmed to differentiate between horse and human. We know without any doubt that this male/female differentiation can be inconsistent and result in contradictory differentiation, we can see it; there are those born with various combinations of male and female internal and external sexual organs and genitalia, so it's quite obvious that there can be inconsistencies in that differentiation. We know that the cognitive development of male/female self concept is prone to the same errors in differentiation that sex organs and genitalia are prone to, so we would expect to see the same inconsistencies between which gender someone identifies themselves as being cognitively, and the organs or genitalia that happened to form.
I'm sorry, are you suggesting that there is scientific evidence to support the fact that forcing a person to be who they do NOT want to be, will DECREASE suicides? Because forcing them to lead a life they don't want to live will somehow eliminate their "emotional problems"? Do you honestly not see how idiotic and cruel you sound?
Yeah we wouldn't want to bring actual science/statistics into a debate about your FEELINGS, would we?
Today we look at a report from The Guardian (UK) from July 2004 that included a review of more than 100 international medical studies of post-operative transgenders by the University of Birmingham aggressive research intelligence facility. They found "no robust scientific evidence that gender reassignment surgery is clinically effective." Seeing that they reviewed not just one study but 100 international studies makes this report alarming.
In my view, this shows that failure comes all too often for transgenders and it is so unnecessary. The Guardian reports:
After gender reassignment, there's still a large number of people who had the surgery but remain traumatized - often to the point of committing suicide.
Thirty-five years ago, in 1979, uncertainty about gender change success was surfacing. At Johns Hopkins Hospital concerns about the reported success rates of changing genders and whether Dr. Money had been falsifying the reports of sex change success prompted a review. Dr. Paul Mc Hugh commissioned Dr. Meyer to study post-operative transsexuals from the Johns Hopkins Gender Identity Clinic program. Dr. Meyer's results were far different than Money's reports of success a decade earlier and also validated the concerns regarding Dr. Money and his reports. Dr. Meyer said, To say that this type of surgery cures psychiatric disturbance is incorrect.†As a result of studying the results of Hopkins patients, Hopkins closed its gender clinic and university-based gender clinics around the country began to close. http://www.baltimorestyle.com/index.php/style/features_article/fe_sexchange_jf07
Also in 1979, Dr. Ihlenfeld, a former associate of Dr. Harry Benjamin, told an audience extreme care should be given in using cross gender hormones because 80% of patents who want to change their sex shouldn't do it. "There is too much unhappiness among people who have had the surgery," he said. "Too many of them end as suicides."IHLENFELD CAUTIONS ON HORMONES
Madeline Wyndzen, a transgendered psychology professor, writes, "50% of transgenders could be struggling with suicide attempts, regret, anger and unhappiness living in a transgender sub-culture rather than being part of the larger world.â€Transition?
I say it is important to take every precaution prior to surgery to avoid regret.
Injustice at Every Turn: A Report of the National Transgender Discrimination Surveysays a staggering 41% of transgenders surveyed report they have attempted suicide and that those who have medically transitioned and surgically transitioned have higher rates of attempted suicide than the general population. Ttransgenders have higher rate of HIV infections. They are more prone to heavy drinking and the use of drugs. They have high rates of homelessness, unemployment and extreme poverty, even more so in the more difficult economic times of the last 5 years.http://www.thetaskforce.org/downloads/reports/reports/ntds_report_on_health.pdf
I have made a big attempt at biting my tongue because some of the comments here are so outlandish, logic can't even save it.
At the end of the day, leave your damned opinions at home and care for the patient at that very moment, or ask for reassignment.
PS: it is more than likely that you have treated and cared for a LGBTQI person, or even worked with one (yes I am looking at you, Tutelary) without you even knowing. Most interactions do not go like "Hi my name is Steve, and I am here for an appendectomy... Also FYI I'm gay". Srsly?!
Specializes in psych, addictions, hospice, education.
I just watched a new tv show named "Becoming Us." It's about a family's adaptation to the father transitioning into a woman. It's done very caringly. So far, I recommend it.
Red Kryptonite
2,212 Posts
LOL ask around, babe. I'm one of the far RIGHT lunatics around here.