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.
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.
I was thinking of it in terms of a questionnaire that everyone is filling out on admission, not a verbal question which they might believe is directed specifically to them for the reasons you mention above.
I was thinking of it in terms of a questionnaire that everyone is filling out on admission, not a verbal question which they might believe is directed specifically to them for the reasons you mention above.
And I was thinking of the typical hospital admission, where the nurse goes in with her WOW and asks all the "checkbox" questions verbally.
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.
If you are "sure" that it is "not right" to use the names and/or pronouns a transgender person requests to be known by, and you refuse to do so, it is your actions, not your beliefs, that make me believe that nursing is not for you. JMO.
We have a transgender member weighing in on this thread who has assured you that if you treat her this way, she will view it as discrimination and a violation of her patient rights, and she will report you to your administration or sue you if the behavior doesn't change or escalates.
Imo, you will encounter a limited number of health care facilities who will be willing to take on that kind of liability. And most will not tolerate behavior which their patients construe to be disrespectful, judgmental, and in violation of hospital policy.
Parakeet, I'm a serious practicing Catholic, yet I would call a transgender person by their chosen pronoun. What my Church teaches on the philosophical questions surrounding transgender issues is relevant, but bringing that to the patient is not my job. My job is to give them compassionate care, and calling them what they choose to be called costs me nothing and in no way compromises my belief system. Even if they were open to a discussion of my beliefs and opinions, when they need medical care is not the time and place. Refusing to address them by their gender pronoun when they're sick and in need of care is just kicking them when they're down.
To quote the Venerable Archbishop Fulton Sheen, "Tolerance applies only to persons but never to truth. Intolerance applies only to truth but never to persons. Tolerance applies to the erring; intolerance to the error."
In other words, save your advocacy and opinions for an appropriate venue, and just take care of the person in front of you like you'd want to be cared for.
You don't see how insulting and upsetting those questions could be for people who don't have gender identity issues?
What an interesting answer. I got the same response when I recommended asking about "heterosexual contact" when taking a sexual history. Why would someone get upset when the same question is asked of everybody? The only difference is that the automatic assumption of universal cisgender identity is dropped. Why would recognition of the possibility of a mismatch between gender presentation and gender identity be offensive, especially in a healthcare setting? It makes just about as much sense as being offended by getting typed and crossed for a blood transfusion.
Plus ... not asking makes very sure that the intersexed and trans are still completely ignored ... and I don't think that's good practice at all. Would it hurt to consider that a masculine woman or feminine man might be intersexed rather than just confused or troubled by gender misreading? Is it better practice, really, to communicate that the state of being trans or intersexed is something to be ignored, fixed or, even worse, punished ... just to keep cisgendered folk from having to be conscious of uncomfortable realities?
Besides, we're talking about healthcare delivery. If the patient cannot feel comfortable disclosing, important information will get lost and we will definitely not be able to provide optimum care. It is reasonable, if a patient comes out as trans, to ask if that's a problem for them, but if they say no ... drop it, is my advice. I think the patient's experience should be the focus, not my religion.
I know how hard this is for so many ... look at the struggle we're having to get homosexuals treated as variations-of-normal people, rather than as deformed monsters who need fixing or saving. And we don't even have an easy way to talk about it because the language doesn't exist. Yet.
Specializes in Acute Care - Adult, Med Surg, Neuro.
I don't particularly care either way unless it's clinically relevant. I think we do need to know the patient's biological gender. However if I get in report that they prefer to be identified as something else, I'll respect their wishes and go on my way. I don't have time to worry about these political issues on the clock and I don't care to discuss them at work. I'm paid to care for the patient, mind & body, despite my personal beliefs. It would not be healthy to the therapeutic relationship to go against the patient's wishes, especially on something that is not really going to influence the plan of care. Cellulitis etc doesn't care if you identify as male or female.
I don't particularly care either way unless it's clinically relevant. I think we do need to know the patient's biological gender. However if I get in report that they prefer to be identified as something else, I'll respect their wishes and go on my way. I don't have time to worry about these political issues on the clock and I don't care to discuss them at work. I'm paid to care for the patient, mind & body, despite my personal beliefs. It would not be healthy to the therapeutic relationship to go against the patient's wishes, especially on something that is not really going to influence the plan of care. Cellulitis etc doesn't care if you identify as male or female.
We have bigger fish to fry as nurses.
I agree wholeheartedly.
Furthermore, in those situations where gender identity is clinically important - think involuntary hospitalization for a suicide attempt, or the ER where a trans is taken after being beaten while turning tricks to pay for hormone therapy, or complications from binding, or gyn cancers in a non-surgical FTM - it would seem even more important to avoid undermining whatever sense of self exists for that patient.
If you're going to confront denial by declining to respect the patient's own self-description, be prepared to handle the fallout, including the moral fallout of possibly causing more damage than you're prepared or able to fix.
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.
Well it would not be compassionate, nor loving to not call people with what they identify with. And unless Jesus is gonna sign your paycheck, you will be serving your facility for 40 hours a week. And they tend to get a bit cranky when nurses don't uphold the facilities mission statements regarding dignity and respect. For everyone. People get fired for less. And declining to adhere to using pronouns and names that a patient identifies with is just not loving.
Most every transgender person I know one would not have one clue looking at them that they are biologically the opposite sex of which they identify. (And speaking of looking--Cripes on a Cracker-- my trans women peeps--they are so extremely beautiful that I am star struck, even 20+ years later.....) So perhaps you are calling people by their trans names/pronouns and not even realize it--so yes, what gender do you identify with and what pronoun would you like to be called is not a bad thing....
Horseshoe, BSN, RN
5,879 Posts
I was thinking of it in terms of a questionnaire that everyone is filling out on admission, not a verbal question which they might believe is directed specifically to them for the reasons you mention above.