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.
Well, as a heathen Pagan, I have no dog in the fight over where trans reality fits into a Christian universe.
When in doubt, do no harm. In my view, endangering a patient's sense of self is more likely to do harm than not. I hear that some peoples' concept of what good health looks like, and their own responsibility for encouraging it in thei interactions with patients, is very different from mine. I have also had times when what the patient needs is something I can't deliver. At those times, I can either redirect or say nothing at all.
@secretperson: you're right, to an extent, I think. One thing psych nurses have taught me, though, is that if the approach isn't working for what you need to accomplish, consider changing it. One learns to be careful of boundaries, especially one's own.
In my experience, the most practical approach is to simply be aware of trans reality and then ignore gender presentation unless it's clinically relevant. It's gonna come up, as you said.
As a Christian and a nurse, I treat all my patients with respect and professionalism. It's because I am a Christian that I am a nurse. Telling someone they shouldn't be both (as I have seen some posters do here) is unacceptable. Everyone has biases that they take into the workplace. They may not know it but they have them.
Total strawman. No one has said that one cannot be Christian and a nurse. No one has said a nurse doesn't have a right to their private opinions of their patients and their life choices. What HAS been said is that if you cannot put aside your Christian biases to give all patients care in a respectful manner, than you should not be a nurse. I'd say the same no matter the religion.
Refusing to call a transgender patient by the name they have requested falls into that category. Whether the reason is Christianity or simple bigotry, it's unacceptable for a nurse drawing a salary to refuse to treat the patient with the dignity she or he deserves. Parakeet stated that she would refuse to call a transgender her preferred name, and used her Christian beliefs as a justification and shield against criticism. Many posters here (and many of those posters are Christians) have called her on that.
The US is still one of the best places to live for religious freedom, but that is quickly deteriorating. Because the ones advocating for tolerance for all, are not showing it for Christians who believe their Bibles.
Also false. Christian nurses are free to believe their Bibles to their hearts' content. However, they are not allowed to use those Bibles as an excuse to be disrespectful of patients who they find to be in violation of the tenets within that book.
The bottom line is Jesus Christ died for all sinners. We all sin and fall short of the glory of God. But to accept the free gift of salvation Jesus offers, we have to admit we're sinners. Whether we're gay, straight or transgender. He offers that forgiveness for everyone. But society is increasingly condoning sin and telling people it's ok to do what you want as long as you don't hurt anyone. Well, when we sin we're hurting God. it doesn't matter whether you believe in Him or not. It doesn't change the fact of His existence and that we'll have to answer for what we do in this life. I may not believe in tractor trailers but it doesn't make me any less dead if I'm run over by one. Christians aren't perfect. We're sinners saved by grace. But we recognized our sin and received Jesus as our Saviour.
How's that for "inflicting" my religion on someone?
That's all very nice, but it has nothing to do with how transgender patients should be treated by their caregivers in the work place. Not only that, it is in direct violation of the Admin's instructions which were given several pages ago:
Once again I will point out.....keep your comments on topic. This is not the place to discuss/debate dogma, theology, religious beliefs, sin, or even why a person (patient) is the way they are. It is certainly not the place to label or personally attack people or use divisive, condescending, and derogatory comments.
Please respectfully discuss how we as nurses can provide professional and unbiased nursing care to transgendered patients.......which happens to be the topic of this discussion thread.
My only issue related to this topic is that I hope any trans getting care makes their biological sex known and it's noted in the chart conspicuously. As long as there isn't any surprises and they are honest about their biological sex, I don't care if they identify as a rock from the moon, I'll give them the best damn healthcare I have to offer.
My only issue related to this topic is that I hope any trans getting care makes their biological sex known and it's noted in the chart conspicuously. As long as there isn't any surprises and they are honest about their biological sex, I don't care if they identify as a rock from the moon, I'll give them the best damn healthcare I have to offer.
I am going to chime in on the Bible since it was brought up:
You shall love the Lord your God with all your heart, with all your soul, with all your mind, and with all your strength.'
The second is this: ‘You shall love your neighbor as yourself.' There is no other commandment greater than these.â€
The scribe said to him, Well said, teacher. You are right in saying, ‘He is One and there is no other than he.'
And ‘to love him with all your heart, with all your understanding, with all your strength, and to love your neighbor as yourself' is worth more than all burnt offerings and sacrifices.â€
And when Jesus saw that [he] answered with understanding, he said to him, You are not far from the kingdom of God.†And no one dared to ask him any more questions --Mark 12:30-34
Verse 33, "And ‘to love him with all your heart, with all your understanding, with all your strength, and to love your neighbor as yourself' is worth more than all burnt offerings and sacrifices.â€" shows that these 2 commandments supersede all of the original 613 commandments which were reduced to 10 and finally to 2 by Christ.
Most of the "613" commands were for the priests of that day; some were only for men (i.e. not shaving their beard or cutting their side hair); some only for women (i.e. to sleep outside the camp whenever they had their periods).
So for those of you that are female and cite religious convictions, you must sleep outside the camp (your house) whenever you have your period...
I would say that with the hostility some posters have shown Parakeet in this thread, that you wouldn't be so respectful of your Christian patients. While everyone wants to talk about how gay and transgender people are victims, they might want to research how many Christians are persecuted and killed worldwide. Compare the numbers. It's not even close. The US is still one of the best places to live for religious freedom, but that is quickly deteriorating. Because the ones advocating for tolerance for all, are not showing it for Christians who believe their Bibles.
I think I was completely justified in showing hostility toward Parakeet. There is a possibility, albeit very small, that she might be my nurse one day. I was just putting her or anyone else who thinks it's OK to misgender me or another transgender patient on notice that this behaviour is not professional or acceptable. I've struggled with my gender identity for many years and I've come to terms with who I am, and I am a much happier person because of it. To have someone invalidate all that I've have been through, in my opinion is an act of extreme disrespect. It's a slight that I have no intentions of letting go unanswered.
I don't care what religion, or lack thereof, anyone has. When that faith manifests itself in discrimination, is where I take issue. To insinuate that I would have issues taking care of Christians, because i won't allow one treat me with contempt is complete and utter nonsense. I've kept rosaries and oils in my desk for them to use in their rituals. I've included clergy members in my care planning process to make sure their spiritual needs were considered. Please don't paint me with your brush of intolerance.
The bottom line is Jesus Christ died for all sinners. We all sin and fall short of the glory of God. But to accept the free gift of salvation Jesus offers, we have to admit we're sinners. Whether we're gay, straight or transgender. He offers that forgiveness for everyone. But society is increasingly condoning sin and telling people it's ok to do what you want as long as you don't hurt anyone. Well, when we sin we're hurting God. it doesn't matter whether you believe in Him or not. It doesn't change the fact of His existence and that we'll have to answer for what we do in this life. I may not believe in tractor trailers but it doesn't make me any less dead if I'm run over by one. Christians aren't perfect. We're sinners saved by grace. But we recognized our sin and received Jesus as our Saviour.
Sorry, I don't buy it. You can't prove any of this is true.
Oh, and behalf of everyone in the transgender community, I would like to say thank you to all those who have said that they would have no problem being respectful of our choices. I'm glad their are people like y'all out there. :)
So for those of you that are female and cite religious convictions, you must sleep outside the camp (your house) whenever you have your period...
Um, yeah.....no. I live under the New Covenant in which Christ superseded all the ritual laws of the Old Testament like that one. I eat pork and my husband shaves, eat milk mixed with meat (cheeseburgers, lasagna), and wear mixed fabrics. Because I'm not Jewish. But nice try at a straw man.
I am so happy to see this article on AN! Wonderfully written and highly informative, OP!
Pronouns and names are a huge issue for those struggling with gender identity. Getting these right is the simplest way to begin developing a trusting relationship with patients because it shows that the nurse is on the patient's side. I am excited for the day when an admission assessment or health assessment includes the question "With what gender do you identify?" and "What pronouns do you prefer?"
I am excited for the day when an admission assessment or health assessment includes the question "With what gender do you identify?" and "What pronouns do you prefer?"
You don't see how insulting and upsetting those questions could be for people who don't have gender identity issues?
I don't know if I have exactly stated I will do such and such. Now that you mention it however, I might just draw my bottom line. I said before that I did not think it right to call a trangender person by their changed pronoun (I'm still thinking about actual name). Now I will say I am pretty sure I know it is not right. Sorry for stirring up the pot again, and this is my last post on this thread.
All of you know what I believe about this matter. And yes, there have been posters who have told me outright to even have such beliefs, whether I voice them or not, should entirely disqualify me from nursing on all accounts.
I will serve my LORD and Saviour Jesus Christ, and I will be compassionate and loving to those under my care. I have been in the past and will continue to do so. Nursing is my calling and no matter what the obstacles, I will seek to purse it to the best of my ability.
Why would that be upsetting or insulting? I check the box for female and she. On to the next question.
Let's take a woman with a deep voice and perhaps a less than curvy figure. She's struggled her whole life with being mistaken for male on the phone, on drive throughs, etc. and because of her figure, struggles to look and feel feminine and perhaps got derided as being a boy in school. (As the flat-chested girl on the HS cross country team, I know this happens because it did to me.)
Let's take a man with a higher-pitched voice who has the equivalent phone problem to our lady with the deep voice, and who perhaps doesn't have the expected physique or mannerisms of a typical guy, and has also been teased or mocked.
Both identify as their biological genders.
Do you think your questions will be helpful or make them feel safe and accepted? You'll just be one more jerk giving them the same crap they face every day.
Cookie cutter approaches don't work for humans because we're not cookies.
heron, ASN, RN
4,641 Posts
Well, as a heathen Pagan, I have no dog in the fight over where trans reality fits into a Christian universe.
When in doubt, do no harm. In my view, endangering a patient's sense of self is more likely to do harm than not. I hear that some peoples' concept of what good health looks like, and their own responsibility for encouraging it in thei interactions with patients, is very different from mine. I have also had times when what the patient needs is something I can't deliver. At those times, I can either redirect or say nothing at all.