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.
Specializes in Mental Health, Gerontology, Palliative.
Even though I cannot agree with you, I like the way you went about your reply. I prefer factual information. I just wanted to know how nurses who may not agree with transgender views would go about such a situation. I have seen a couple of posts that do help me out. Others may not agree with my religious views, but surely that does not mean I have no place in healthcare.
You dont have to agree with anything.
You do have an obligation to deliver the best nursing care you can do to each and every patient you encounter
Please keep in mind Dr. McHugh is also a deeply conservative Catholic, and as demonstrated by many previous posters, he may be expressing his OWN niases on the topic of transgenderism, rather than a view that is truly unbiased.
I'm lovin' this discussion. Not touching the question of religious beliefs since it's not up to me to validate them or not. I'm in the camp that individual beliefs do not justify the mistreatment of other humans. Nor do I think that the believers posting here are saying that. Kudos to the OP for the effort to resolve the dissonance she is experiencing.
Equally fascinating is the discussion of gender. There are those, myself among them, that dispute the assumption that individual gender is both immutable and strictly binary. While true that cis-gendered heterosexuality is the norm in that it represents the numerical majority of humans, it is not necessarily the only way to be a healthy, happy and morally good person. It's the "healthy" part that concerns us as nurses.
My long winded way to say the same thing as a previous poster who noted that being transgendered means different things to different people.
What I did not see on this site is any proof that transgender people are better off being forced to live as their birth sex. Just a bunch of anti-gay and anti-trans ranting.
Insert the word "black" instead of "gay" or "transgender" and I think most people would agree that the sentiments here are wholly unacceptable in modern nursing or in any arena. Nursing traditionally has always been dedicated to caring for the sick, impoverished, suffering and helpless, giving care where there is none, and giving comfort to those who are suffering. There are many, many studies that discuss the caring side of nursing and the importance of building relationships with patients and overcoming the nurses own pre-conceived ideas. I have read many papers and text books that aim to teach the nurse the importance of placing ones individual prejudices aside so that the patient may be adequately cared for both emotionally and physically. If you as a nurse are unable to do that, then I suggest further education, or even pursuing a different profession.
In effect, my conclusion is quite simple. I refuse to be drawn into an argument where the sole purpose of the conversation to force religious rhetoric upon me. I don't believe in your god, or any god, and therefore being gay does not break any "law" for me. I don't care what you believe...if I was your patient I would expect the same treatment as anyone else and if I saw any evidence of discrimination I'd have the hospital administration in there so fast your head would spin. All the acceptance, understanding and open hearts seem to be coming from the NON-religious people on this thread, and all the discrimination, judgment and hate seem to be coming from the so-called religious people. (My observation although I think others would agree it's a logical one). Perhaps those who commented might like to look inside their own heart and wonder why they are trying to pass hate off as religion. The extreme views (homophobic and transphobic) voiced here are so disgusting to me that I'm utterly amazed the posters have not been banned and this thread deleted. But then, homophobia and transphobia are the last "acceptable" discrimination, as long as it's disguised as religion, right?
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.
Nope. My hospital is Catholic affiliated, and we get loads and loads of LGBT patients. It's the location of the hospital that determines the patient population, not the affiliation.
Also, we won't dispense birth control, but if a patient brings in their own, pharm labels it, and nursing hands it over for the patient to self-administer.
We also have a Rabbi on staff in chaplain services also because there is a large Jewish community we serve.
Catholic hospitals are are not as different as one might think.
Specializes in Oncology; medical specialty website.
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?!
OK, I know what "LGBTQ" stands for, but what's the "I"? "In between"? "In transition"?
Dunno - could be "inter-sexual" or indeterminant. As we can see from the expansion of the alphabet soup, we "others" cover quite a bit of human territory.
Specializes in Oncology; medical specialty website.
Insert the word "black" instead of "gay" or "transgender" and I think most people would agree that the sentiments here are wholly unacceptable in modern nursing or in any arena. Nursing traditionally has always been dedicated to caring for the sick, impoverished, suffering and helpless, giving care where there is none, and giving comfort to those who are suffering. There are many, many studies that discuss the caring side of nursing and the importance of building relationships with patients and overcoming the nurses own pre-conceived ideas. I have read many papers and text books that aim to teach the nurse the importance of placing ones individual prejudices aside so that the patient may be adequately cared for both emotionally and physically. If you as a nurse are unable to do that, then I suggest further education, or even pursuing a different profession.
In effect, my conclusion is quite simple. I refuse to be drawn into an argument where the sole purpose of the conversation to force religious rhetoric upon me. I don't believe in your god, or any god, and therefore being gay does not break any "law" for me. I don't care what you believe...if I was your patient I would expect the same treatment as anyone else and if I saw any evidence of discrimination I'd have the hospital administration in there so fast your head would spin. All the acceptance, understanding and open hearts seem to be coming from the NON-religious people on this thread, and all the discrimination, judgment and hate seem to be coming from the so-called religious people. (My observation although I think others would agree it's a logical one). Perhaps those who commented might like to look inside their own heart and wonder why they are trying to pass hate off as religion. The extreme views (homophobic and transphobic) voiced here are so disgusting to me that I'm utterly amazed the posters have not been banned and this thread deleted. But then, homophobia and transphobia are the last "acceptable" discrimination, as long as it's disguised as religion, right?
You can't paint all religious people with the same brush. I am what you would call "religious," yet I would never think of mistreating or giving lesser care to a patient because of his/her sexual orientation. That is none of my business. The patient's care is my business.
Specializes in Oncology; medical specialty website.
Dunno - could be "inter-sexual" or indeterminant. As we can see from the expansion of the alphabet soup, we "others" cover quite a bit of human territory.
I meant no disrespect. I just never heard or saw that term before.
Dunno - could be "inter-sexual" or indeterminant. As we can see from the expansion of the alphabet soup, we "others" cover quite a bit of human territory.
Enough letters til there's hardly anyone left out and maybe we can get rid of them altogether?
I tend to forget that the LBGT community even needs to be a community, until I read things like this and then oh yeah, still got a mountain to climb.
Nope. My hospital is Catholic affiliated, and we get loads and loads of LGBT patients. It's the location of the hospital that determines the patient population, not the affiliation.
Also, we won't dispense birth control, but if a patient brings in their own, pharm labels it, and nursing hands it over for the patient to self-administer.
We also have a Rabbi on staff in chaplain services also because there is a large Jewish community we serve.
Catholic hospitals are are not as different as one might think.
Birth control, I forget that it's also against religious beliefs. How do/did Catholic* nurses ever reconcile compromising their beliefs with administering prescribed BC? Is that even an issue? Has there ever been a thread on this dilemma?
Whatever process for relaxing rules related to birth control and masturbation (we don't have anyone here who finds that sinful, do we?) needs to apply to sexual identity and gender issues. And then healthcare providers can provide care without needing so many articles discussing how not to apply prejudices to our patients. (I guess we'll never get rid of hateful prejudices but at least the morally conflicted ones).
Tenebrae, BSN, RN
2,021 Posts
You dont have to agree with anything.
You do have an obligation to deliver the best nursing care you can do to each and every patient you encounter