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 didn't do my nursing studies in the US, so I really don't know the scope of your education. One of the aspects of communicating with patients that was stressed by our teachers and during clinicals was empathy. Not to be confused with compassion. Empathy asks of the healthcare professionnal to try to understand what the patient is feeling. Compassion is (from latin) literally 'to feel with' the patient. Nobody is asking you to compromise your beliefs by accepting the patients choices in life (be it alcholosim, drug addiction, beating their spouse and children... or whatever) and feeling 'with them' their feelings, views and beliefs. However, as a healthcare professionnal, you MUST be empathetic : try to see where the patient is coming from and be accepting and non judgmental.
Yes, it is "one-sided" : we are providing care, it is not a quid pro quo relationship with the patient. If you feel very strongly that is it unfair for the patient to be able to be who he is while you have to be professionnal (whatever that may entail in your future workplace), you will not be able to practice.
Hi. I've been away at a wedding all weekend, and boy did this thread explode. As a mental health professional, I want to point out a couple of things. First, being transgender isn't a mental illness. It's not recognized as an illness by either APA (psychological or psychiatric). Also, the AMA has published a policy on the acceptance of transgender patients, students, and physicians (if anyone cares what the AMA thinks anymore). Links:
Wait, the APA doesn't recognize being transgender as a mental illness? Fact. Gender dysphoria is not intended to be diagnosed in everyone who is transgender according to Jack Drescher (APA DSM-5 subcommittee on sexual and gender identity disorders member), who said, "We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories. We wanted to send the message that the therapist's job isn't to pathologize." Thus, people who are living transgender without significant distress have no mental illness.
I don't diagnose your patients' thyroid disorders or rashes, please don't try and do the job of a PMHNP or psychiatrist as a way of discrediting the experience of a group of people. I don't have any problem with people having religious convictions, but don't pretend your position is based in science. It makes science look bad.
And I have noted before, there seems to be a huge trend of parents who are raising their children in a non-gender fashion. Which is being carried into the school systems, and new teachers are being taught to not address gender at all due to this trend.
The idea that there is even a debate here is ridiculous. This article can be equated to Willie Nelson writing a song about gay cowboys after the movie Broke Back Mountain came out, bandwagon anyone?
Come on nurses we already work with every freaking demographic out there and we treat them equally. I realize sometimes we see the name Andy and walk into a room and go "Oh **** its a female" but that does not make us sexist, for we auto adjust and move on. But articles like this reinforce the narrative of a protected class, like transgendered people are victims. Transgendered people are just that "people" as nurses we treat people not political driven media BS. We as healthcare professionals will adjust care as needed for all people, remember we can inadvertently harm one demographic by trying to cater to another. EQUAL CARE FOR ALL
But articles like this reinforce the narrative of a protected class, like transgendered people are victims.
Consisting trans people are assaulted, bullied,and battered at higher rates than the general public, are more likely to be killed, more likely to commit suicide, I'm surprised at this comment. While I hands up agree with most of your post, Trans people are victims, often of very tragic situations. I recently had a friend contact me because a gentleman from a bar had started stalking her after he found out she was trans. When I asked her why she hadn't called the cops, that's when I found out the cops themselves in her area were known for harassing trans women and she was just add scared of then as she was her stalker.
Consisting trans people are assaulted, bullied,and battered at higher rates than the general public, are more likely to be killed, more likely to commit suicide, I'm surprised at this comment. While I hands up agree with most of your post, Trans people are victims, often of very tragic situations. I recently had a friend contact me because a gentleman from a bar had started stalking her after he found out she was trans. When I asked her why she hadn't called the cops, that's when I found out the cops themselves in her area were known for harassing trans women and she was just add scared of then as she was her stalker.
Yes. I liked Secretperson's post for the same reasons, and also have the same objections.
Twice now in team conference a nurse has mentioned that a patient's neighbor/friend who had been helpful to both nurse and patient is trans, used in the context to describe the weirdness of the situation, ie patient has mental health issues affecting her self neglect (true) plus her friend is trans (completely irrelevant to the care of this patient but apparently it is in her perspective).
Now does she carry any of that prejudice with her? I don't know.
Ironically she took issue to me using race to unprejudicely refer to 1 out of 3 women in the conference room visiting our office, whose names neither of us knew. I referred to her as the Asian lady ie "Which one, the older lady or the Asian lady?" That came across as bigoted and backwards to her.
So I can't use the descriptor Asian but repeatedly pointing out the helpful neighbor is trans is okay.
D@jadelpn: I've read about that and I'm not sure how I feel about it. It's still other people imposing a false gender identity, only this time it's on all kids instead of just trans kids. It's pressure to pretend that gender doesn't exist.
I know exactly how I feel about it. Adults are disgusting when they impose gender ideologies on children. Pretending gender doesn't exist is just as wrong as my FIL who wouldn't allow his boys to have a play kitchen.
We can be compassionate to those who are challenged by being outliers in some way without utterly destroying the fabric of society.
How about we let our kids tell us who they are and then respond appropriately? That will look different in each family and for each child, but how about we start with that? That's going to mean that boys who like guns and cars have to be okay, as well as girls who like cooking and sewing. And girls who like guns and cars have to be okay along with boys who like cooking and sewing. It also means giving kids the freedom to try on identities without freaking out, but also without it having to mean anything about their future. My son dressed up in his sisters' princess outfits. So far he's a normal teenage boy.
Deal with whatever comes up compassionately and the best you can. Get more than one opinion on something challenging, not just those you're comfortable with. But also never expect society to be dismantled over you and your challenges.
The idea that there is even a debate here is ridiculous. This article can be equated to Willie Nelson writing a song about gay cowboys after the movie Broke Back Mountain came out, bandwagon anyone?
Come on nurses we already work with every freaking demographic out there and we treat them equally. I realize sometimes we see the name Andy and walk into a room and go "Oh **** its a female" but that does not make us sexist, for we auto adjust and move on. But articles like this reinforce the narrative of a protected class, like transgendered people are victims. Transgendered people are just that "people" as nurses we treat people not political driven media BS. We as healthcare professionals will adjust care as needed for all people, remember we can inadvertently harm one demographic by trying to cater to another. EQUAL CARE FOR ALL
Not everyone experiences healthcare the same way. For some people healthcare and healthcare providers are frightening, aggressive, condescending, or even dangerous. Pretending that there isn't a problem with the way people who are transgender (or HIV+ or gay) are treated only protects the people who hurt them. It's not enough to say we want equal care, because the system right now doesn't provide it. One small part of it - the part we have absolute control over - is how we think about and treat patients. So, we talk about those things because, generally speaking, they're not equal yet either.
Check out the statistics in these surveys. They're mind blowing.
Nurses are bullied by nurses, nurses also have higher suicide rates....I am speaking of patient care not a worldview. My post was a feeble attempt to rise above the "poor me" crap and treat people equal. My younger brother is mentally handicapped who was and is bullied, yet the last thing he wants is to be treated different because of this. (I am not equating trans with mental disability) Say what you will, but if you have to change your approach when you care for a trans gendered individual, you are a crap nurse.
Farawyn
12,646 Posts
I was raised Catholic. Most Catholics I know use BC.