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, EDUCATION,ADMINISTRATION.
Secretperson- Healthcare professionals may work with every demographic but to say that we are already treating everyone equally would be delusional. We need reminders and education about how to improve and ensure that everyone is being treated equally. I am sorry to inform you but transgender patients have become victims .. victims of discrimination that is now costing them their lives. Please see the following link for an enlightening and scary story of one such patient. [COLOR=#1155cc]http://www.huffingtonpost.com/[/COLOR]2015/06/15/transgender-health-care_n_7587506.html?utm_hp_ref=gay-voices
To be honest I only read the first five pages. With that being said I believe in practical solutions vs. a who is right/wrong. I always think "ok, this person has to put on their uniform tomorrow, how do they handle it" ? I am a Christian as well and I do not agree with the "lifestyle" or whatever it is all called this year. I am a nurse while at work and my personal feelings stay at the time clockEVEN THOUGH my faith does not. I have found that direct eye contact with a smile and an introduction negates the need for any of the conflict described. I am amazed that anyone has time to be so sucked up into their patients personal life so much. I need their job. And as for the REAMS of research supporting one thing or another, weren't there REAMS of research by the same scientific community awhile back saying something completely different ? Many scientific opinions are little more than the result of immense political pressure in the name of progress. Since families and society as a whole seem to be improving perhaps they are right.
Specializes in MENTAL HEALTH, EDUCATION,ADMINISTRATION.
thanks! I was thrilled to be given the opportunity to write it :) Anything that we as nurses can do to bring positive attention to an area in need of advancement is progress.
Do Parakeet and NeoNatMom understand that there are REAMS of properly conducted research studies which indicate that sexual orientation is biologically determined? In which case, who sexually excites any given person is not a conscious choice, but part of who we are-no matter if we try to convince ourselves otherwise?
And if that someone is eight year old boys ? By your logic pedophiles are born this way and have no control over who sexually excites them. They claim that they have been this way for as long as they can remember and it is part of who they are. I only say that to remind everyone that we all have limits on what we find acceptable. Just because your line happens to be somewhere different than mine doesn't make you superior or a better nurse.
And as for the REAMS of research supporting one thing or another, weren't there REAMS of research by the same scientific community awhile back saying something completely different ?
Can you be more specific? I feel like people think science is wishy-washy, changing its mind all the time. This might seem true if you read about science in popular media, because they're pretty terrible about conveying anything realistic or meaningful about science. In reality science rarely completely overturns a theory, and if it does it does so very, very slowly. Usually what happens is a process of refinement, where an idea becomes more accurate over time.
This the neatest part of science to me, because when ideas are initially studied they're very murky, as though you're looking at them through a fog. In order to grab onto the idea you have to use very broad research, which kind of firms up where the edges of the idea are but doesn't give you much depth. As research progresses you have a better idea of what the boundaries of a concept are, and thus you can do more precise research, which gives you more narrow results, but with greater depth. This is like taking a magnifying glass to a small part of the concept. Over time, as you and other researchers peer at various parts of a concept up close, you can start merging all the data into a very clear, very precise representation of the concept.
And that's why things like mental illness change over time, as we develop better research based on earlier research, and answer questions we hadn't been able to answer before.
ETA: Also, things that sound sensational in the news usually aren't treated as such by researchers. When research was published that supported the idea that schizophrenia may be multiple, distinct disorders it made the rounds on the news and Facebook like it was a brand new idea, but within the research community pretty much everyone had believed that was true for about a decade. We'd seen the signs in tons of other research, so that paper merely supported a theory that already had pretty solid foundations.
Specializes in MENTAL HEALTH, EDUCATION,ADMINISTRATION.
I just wanted to take a moment to thank of all of you for your comments and say WOW! I am really happy with the level of interest that this article has sparked and received. I realize that not all of my fellow nurses share my views and some have views that are very much so the direct opposite of mine. For the most part that's ok as long as they can still give 100% to their patients and sleep at night with a clear conscience of the care they have provided, then so be it. As nurses and in the honor of Flo we accepted the challenge to "do all in my power to maintain and elevate the standard of my profession" and "devote myself to the welfare of those committed to my care". This doesn't mean we get to choose which patient scenarios apply. We have always been the advocate for our patient and must continue to do so even if the situations go against our own beliefs. If we stay focused on what are the facts --- Patients are in danger of being harmed or even dying because of discrimination within healthcare settings --- then we can get back on track with not "why are we doing this?" but "how can we do this better?" Keep it coming everyone! PS: I am attaching a this link again in case it got missed.
And if that someone is eight year old boys ? By your logic pedophiles are born this way and have no control over who sexually excites them. They claim that they have been this way for as long as they can remember and it is part of who they are. I only say that to remind everyone that we all have limits on what we find acceptable. Just because your line happens to be somewhere different than mine doesn't make you superior or a better nurse.
Such a slippery slope argument. Comparing someone who transgender which affects self image, and not even about their sexuality at it's core, to someone who experiences a sexual reaction to... it's not the same thing.
Being transgender, at it's core, is not illegal. Trans people can be any sexuality in the book. Being transgender is about how they feel about themselves, not what they are sexually attracted to.
Pedophila on the other hand, is wholy about what they are sexually attracted to. There is a choice involved when it comes to acting on sexuality. They need help in so many ways. Not all pedophiles have acted on their attractions, and should be encouraged not to.
Specializes in Critical care, tele, Medical-Surgical.
Just be compassionate. If YOU wanted to be addressed as a man and felt you were a man and someone was popping you some Vasotec, wouldn't it be SO EASY to just refer to you as MR. Parakeet, here is your Vasotec?
I have an amazing book for anyone to read. It's fiction and it's so beautifully written. It's called "Middlesex" by Jeffery Eugenides and it's about gender confusion and transgender, and hermaphrodites. And it is at least 5 years old.He also wote "The Virgin Suicides", whish is depressing and touching.
Thank you Farawyn. I think nurses should be aware than some people are intersex.
All people are not one gender. Some people are intersex.
I know two of them. One is a family member. The midwife who delivered her at home 80+ years ago registered her a male. She didn't know this until she applied for Social Security when she retired from her job.
She was born with a privy parts that now looks like a little boy's member.
She married a man and had four children. She is a woman with an unusual anatomy.
The other person confided in me that he didn't know until puberty. I don't know what he looks like because he neither told no showed me. He told me of the confusion, depression, and mental anguish for several years until deciding to remain a man.
I've cared for a few intersex people. I don't know whether or not they knew. It wasn't on the chart.
I cared for one transgender woman. I saw that in the chart after having given her a bedpan and noticing nothing unusual. She had adult children. She was once their father and is now their "aunt". She is good friends with her ex wife who calls her "sister". It seems very odd typing this, but my patient seemed like a normal woman with a nice family.
Intersex†is a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn't seem to fit the typical definitions of female or male. For example, a person might be born appearing to be female on the outside, but having mostly male-typical anatomy on the inside.
Or a person may be born with genitals that seem to be in-between the usual male and female types—for example, a girl may be born with a noticeably large privy parts, or lacking a lady partsl opening, or a boy may be born with a notably small member, or with a scrotum that is divided so that it has formed more like labia.
Or a person may be born with mosaic genetics, so that some cells have XX chromosomes and some of them have XY…
… Because some forms of intersex signal underlying metabolic concerns, a person who thinks she or he might be intersex should seek a diagnosis and find out if she or he needs professional healthcare.
Jessica Quigley
2 Articles; 20 Posts
We are there to provide nursing care.
Now if nursing tasks required violate your beliefs, by all means avoid those positions.
And being kind and not humiliating someone is always the right thing to do