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.
(Sorry, was responding to the person who said it would be insulting to cisgender folks to ask them what pronouns they prefer and what gender they identify with.)
I did get some flak initially, yes. Never direct--the blowback was more about my perceived competence or lack thereof. I do still get some knuckleheads who think they're being subtle when they address a group of women with me in it as "Ladies", or one time a macho MD said to me and a male PCT, "Hello, MEN--and I use that term loosely. Just kidding."
Fairly minor crap like that. The comments around my competence bother me much more, frankly.
I did get some flak initially, yes. Never direct--the blowback was more about my perceived competence or lack thereof. I do still get some knuckleheads who think they're being subtle when they address a group of women with me in it as "Ladies", or one time a macho MD said to me and a male PCT, "Hello, MEN--and I use that term loosely. Just kidding."
Fairly minor crap like that. The comments around my competence bother me much more, frankly.
You are talking numbers NOW but in your PP you stated that there are NO victims. I didn't say they were victims of homosexuality but a homosexual does create victims when their "truth" finally takes priority in their lives and they destroy the family that they have been a part of for __ years. I'm sure you'll state how the wives/children are all fine with dad leaving to be with Ted and the wife is happy that he is happy. I have seen the devastation that comes when a married man starts sleeping with men and those wives/children are victims of HIS lies and deceit. Society did not make promises to them or take vows HE did. Finding out that your 15 year marriage was a lie born out of selfishness is no joke and it DOES victimize. How about embracing your truth without mass casualties.
Conqueror,
Why is this only the fault of men? I know many women who have left their husbands and broken up families because they realized they are lesbian or trans. To be brutally honest, it sounds as if this was your marriage. It is also the fault of society NOT accepting of people being who they are where they are (almost) forced in to a relationship that does not fit them. It is (usually) only when they get to the point of suicide that they make that change.
Good day:
What I find interesting is our government did a recent census of the LGBT community, and found ~ 1.8% of all Americans declare themselves to be a part of this community. While all individuals need to be treated with respect, it's interesting to me that certain parties continue to push the issue as if the 1.8% number was closer to 10%.
1.8% that admit it. The reality when you take into account sexual fluidity is that the number is higher than 10%. Read my previous posts in this thread. Straight, gay, bi only describe a moment in tin time and that can be a label that is in constant flux. There are also many people that consider themselves straight because they only have an occasional same sex encounter.
What difference does it make if it is 1.8%, 10%, or 50%? Do we need a certain number of people in a group before they are treated with respect and dignity?
I did get some flak initially, yes. Never direct--the blowback was more about my perceived competence or lack thereof. I do still get some knuckleheads who think they're being subtle when they address a group of women with me in it as "Ladies", or one time a macho MD said to me and a male PCT, "Hello, MEN--and I use that term loosely. Just kidding."
Fairly minor crap like that. The comments around my competence bother me much more, frankly.
I congratulate you on being yourself and thank you for sharing your story. It is sad that there are so many ignorant people.
Why is this only the fault of men? I know many women who have left their husbands and broken up families because they realized they are lesbian or trans. To be brutally honest, it sounds as if this was your marriage. It is also the fault of society NOT accepting of people being who they are where they are (almost) forced in to a relationship that does not fit them. It is (usually) only when they get to the point of suicide that they make that change.
1.8% that admit it. The reality when you take into account sexual fluidity is that the number is higher than 10%. Read my previous posts in this thread. Straight, gay, bi only describe a moment in tin time and that can be a label that is in constant flux. There are also many people that consider themselves straight because they only have an occasional same sex encounter.
What difference does it make if it is 1.8%, 10%, or 50%? Do we need a certain number of people in a group before they are treated with respect and dignity?
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.
The other pedophiles visit or relocate in areas where laws can be easily manipulated or weak or the people don't know about them. Others know where to satisfy their sexual gratification. Check this one as an example. Pedophiles finding a safe haven on the "dark net" - CBS News
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).
Don't worry, it's a valid question. I am fairly certain my current employer is aware of my transgender status. They had to run my background check which required that I give my previous name. Also at the time, I was hired, my license still had an M. However it is something we don't talk about. My state has strong protections for transgender people, so must employers here won't ask. Fortunately, I have yet to run into any problems and I believe I have very good working relationship with my colleagues.
Specializes in Family Medicine, Tele/Cardiac, Camp.
1. Thank you, OP. This post is extremely important and long overdue. I did most of my grad research and papers on GLBT issues in relation to nursing and truly appreciate this gaining more attention.
2.
...I just wanted to know how nurses who may not agree with transgender views would go about such a situation. I have seen a couple of posts that do help me out. Others may not agree with my religious views, but surely that does not mean I have no place in healthcare.
I'm not sure how to address the statement "may not agree with transgender views" because to me that's like asking someone's opinion on a fact. "Do you think the sky is blue?" for instance. Transgender people exist and have since the beginning of time. Healthcare disparities exist for them. Both have been shown to be true. I have a trans family member, many friends, and have dated 2 trans people. I also identify as bisexual, was raised as Roman Catholic, went to a very liberal college and live in one of the most liberal cities in the country. BUT...I've also encounted my fair share of patients whose beliefs do not gel with mine.
3. It is beyond critical that we are able to care for ALL PATIENTS regardless of our differences. Not to do so is not only unethical and potentially illegal, but also devastating to the patient who a) will end up getting poor or improperly biased care and b) may therefore decide not to seek out future health maintainance which - as has already been mentioned - is a huge issue for all GLBTQI people. (Q meaning queer or questioning and I typically meaning intersex in my experience).
4. I was taught in nursing school, that it's typically a good idea for us to leave our values at home. Simply, this usually allows the patient to project a bit of what they need on us and it lets them feel safer. If my hospice patient needs to hear the Lord's Prayer because it'll help her sleep when she's so frightened, I'll say it with her even though I no longer consider myself Christian and am somewhat uncomfortable saying it. If my gay chemo patient's partner needs to talk to me about how she and her dying partner met, I'll listen. If listening to my male patient go through the dozens of sexual partners he's had that week in order to pinpoint who might have given him syphillis, then I'll help him try to figure it out. If my Witness patient, whose hct was 8 was refusing blood, that was his right. Only rarely have I opened up to a patient so honestly about my true opinions and that's been because I know they shared them and needed some kind of solidarity at the time.
5. For what it's worth, this is how *I* have addressed patients who have asked me tough questions that go against my beliefs when I was doing a clinical rotation in the south this past year.
Sarcastic Patient: "So massachusetts passed that marijuana law, hunh? What do you think about anyone being able to get drugs now?"
Me: "I think there are a lot of pros and cons with the issue and there are many differing opinions."
Disgusted Patient: "There are so many gays now. No one was gay when I was your age. What do you think about that?"
Me: "I think there are many different types of people in this world and as a healthcare worker its my obligation to respect and care for everyone."
Bam. You're not lying. You're not compromising your beliefs. You are stating truths and you are being respectful to all patients.
HOWEVER...if you are legitmately cocerned that you won't be able to keep your personal feelings and beliefs to yourself, then I do respectfully suggest you either expose yourself to more LGBT people to learn more about the population (studies have shown this has been one of the strongest predictors of whether or not someone ranks as homophonic along certain scales) or consider a profession that allows you to be vocal about your beliefs.
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13 Posts
No, why is that insulting?
(Sorry, was responding to the person who said it would be insulting to cisgender folks to ask them what pronouns they prefer and what gender they identify with.)