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.
The real take-away here is that homosexuality and transgenderism are NOT learned behaviors, preferences, etc. because they are biologically based on the alchemy of testosterone and estrogen.
I have given a simplified explanation here, volumes can be written on any subject matter I have touched on.
And by their very nature do not automatically create victims in their expression. BIG difference.
Wow, you are completely off base. Do you really think our society will ever embrace pedophilia? While, I do believe pedophiles are "born this way" they don't deserve any of the same rights that LGBT people have. The major difference is, when I am with someone of the same sex, they are a consensual adult. Pedophile can't do that because children can't give their consent to sexual acts. That's the differences. I can't believe that I have to explain that to someone in the 21st century.
I will agree that when someone comes out of the closet when they have a wife/husband, it is tragic. However, I don't think anyone should stay in a marriage when they don't love or are not attracted to their partner. Like another poster said, this is often because of the stigma some people place on being gay or transgender (like some of the posters in this thread). If we lived in a world where people did not have to hide the fact that they are LGBT and can embrace their sexuality from an earlier age, then these kind of stories would be rare.
Absolutely.
The simple fact of one being a homosexual does not create victims. Major strawman being argued here about divorce. Not relevant to my point, but possibly being used as a way to legitimize hostility towards gays.
Wow, you are completely off base. Do you really think our society will ever embrace pedophilia? While, I do believe pedophiles are "born this way" they don't deserve any of the same rights that LGBT people have. The major difference is, when I am with someone of the same sex, they are a consensual adult. Pedophile can't do that because children can't give their consent to sexual acts. That's the difference. I can't believe that I have to explain that to someone in the 21st century.
I will agree that when someone comes out of the closet when they have a wife/husband, it is tragic. However, I don't think anyone should stay in a marriage when they don't love or are not attracted to their partner. Like another poster said, this is often because of the stigma some people place on being gay or transgender (like some of the posters in this thread). If we lived in a world where people did not have to hide the fact that they are LGBT and can embrace their sexuality from an earlier age, then these kind of stories would be rare.
1. Yes. It was only a short 50-60 years ago that the thought of society accepting homosexuals was far fetched. That is the other side of "progress". You can't choose a stopping point that suits you. As was touched on earlier the DSM listed pedophilia as a sexual orientation until political pressure got to them. Give it 40-50 years and see how attitudes change.
2. That is why pedophiles are always silent supporters of laws that lower the age of consent and have charts on their websites listing those ages by state. Once the age is lowered what was once a felony is now a misdemeanor. It's already happening so...
3. I agree. It is more wrong to marry someone as a shield against society/yourfamily/the pope knowing that you are not attracted to them and never will be. A society that you feel is destroying your life doesn't give you the right to destroy someone elses.
1. Yes. It was only a short 50-60 years ago that the thought of society accepting homosexuals was far fetched. That is the other side of "progress". You can't choose a stopping point that suits you. As was touched on earlier the DSM listed pedophilia as a sexual orientation until political pressure got to them. Give it 40-50 years and see how attitudes change.
2. That is why pedophiles are always silent supporters of laws that lower the age of consent and have charts on their websites listing those ages by state. Once the age is lowered what was once a felony is now a misdemeanor. It's already happening so...
If you really think about it, society is moving in the opposite direction that you think it is in regards to pedophilia. In the early 19th and 18th century, you could be in your thirties and marry someone who is 14 and no one would bat an eye. Try getting away with that today. Remember we are literally running pedophiles out of town. One municipality forced them to live under a bridge until the courts intervened. You're argument that Americans will embrace man on boy love, because we are now accepting of consensual homosexual relationships is just silly.
The fact remains, we have to do what is best for the pt, meaning to out aside our own "norms" and at least seek to understand our pt's norms in order for our patients to receive the best care.
If the roles were reversed, wouldn't we want that for ourselves???
I'm sure we are in the realm of pure derailment, but I wanted to share my musings from another posts on caring for transgender patients-still have that musing today...
1. Yes. It was only a short 50-60 years ago that the thought of society accepting homosexuals was far fetched. That is the other side of "progress". You can't choose a stopping point that suits you. As was touched on earlier the DSM listed pedophilia as a sexual orientation until political pressure got to them. Give it 40-50 years and see how attitudes change.
This is the definition of a slippery slope argument. There's no rational reason that once you start protecting groups of people you can't stop, because that's not how we decide whom to protect. We decide based on the merits of each group. The fact that transgender people expressing their identity doesn't inherently (by its very nature) harm anyone and pedophiles acting on their desire inherently does is absolutely a rational differentiation between the two.
Your second point is factually inaccurate and denies virtually all of the changes in laws in the last 20 years that are so strict teenagers having sex with one another can be charged as committing crimes against each other, but it's so far removed from reality I don't really want to engage you on it. I'm putting this here so other people reading this will know you're basically just making things up.
I am a transgender nurse. I have transgender patients rarely, but when I do, I often come out to them, and the relief they express tells me I've done the right thing. Coming to the hospital as a transgender person is terrifying; and as many of the comments here show, the general public, including nurses, have a generally poor understanding as to what being transgender means. Getting appropriate and adequate healthcare is not a given for transgender folks, rather, it is still an exception.
My brief story was published in the New York Times last week, along with the stories of many other transgender Americans.
If you really think about it, society is moving in the opposite direction that you think it is in regards to pedophilia. In the early 19th and 18th century, you could be in your thirties and marry someone who is 14 and no one would bat an eye. Try getting away with that today. Remember we are literally running pedophiles out of town. One municipality forced them to live under a bridge until the courts intervened. You're argument that Americans will embrace man on boy love, because we are now accepting of consensual homosexual relationships is just silly.
This is the definition of a slippery slope argument. There's no rational reason that once you start protecting groups of people you can't stop, because that's not how we decide whom to protect. We decide based on the merits of each group. The fact that transgender people expressing their identity doesn't inherently (by its very nature) harm anyone and pedophiles acting on their desire inherently does is absolutely a rational differentiation between the two.
Your second point is factually inaccurate and denies virtually all of the changes in laws in the last 20 years that are so strict teenagers having sex with one another can be charged as committing crimes against each other, but it's so far removed from reality I don't really want to engage you on it. I'm putting this here so other people reading this will know you're basically just making things up.
I am a transgender nurse. I have transgender patients rarely, but when I do, I often come out to them, and the relief they express tells me I've done the right thing. Coming to the hospital as a transgender person is terrifying; and as many of the comments here show, the general public, including nurses, have a generally poor understanding as to what being transgender means. Getting appropriate and adequate healthcare is not a given for transgender folks, rather, it is still an exception.
My brief story was published in the New York Times last week, along with the stories of many other transgender Americans.
I'm off to read your article but I want to ask you and others, is it apparent/open that you are transgender to your employer and coworkers? (I apologize for such a dopey question but I'm seriously in an isolated bubble where I live and work and I haven't had any direct experience).
I'm off to read your article but I want to ask you and others, is it apparent/open that you are transgender to your employer and coworkers? (I apologize for such a dopey question but I'm seriously in an isolated bubble where I live and work and I haven't had any direct experience).
Answering my own question after reading those amazing stories. I want to drive to Oakland right now though and kick someone hard in the shins.
Well, that article told everyone left over who didn't know. I transitioned on the job, then left my department for another one. I knew the rumor mill would catch up to me, so I told one person in the new department, and within a couple of weeks, it got around fast, as expected. I will eventually go to another employer, and I doubt I will disclose my gender change when I do.
Horseshoe, BSN, RN
5,879 Posts
And by their very nature do not automatically create victims in their expression. BIG difference.