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.
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.
As a Christian myself let me admonish you that when, not if, when you get written up for being disrespectful to a patient by refusing to use their preferred pronouns you had better not use it as proof that you are being persecuted for your beliefs! You are NOT being persecuted for your beliefs you are being punished for your behavior. Don't make the rest of us look bad.
I can only say, "d**n!" Such amazing intelligence, education, openness, honesty, and personality!
You are so correct in your view that healthcare be patient focussed. As I mentioned previously in this thread, I had don some research (as part of an undergrad degree) in the area of human sexuality.
This is something that I believe that you, those that are transgendered, and very few others (if any) on this thread can comprehend: Sex between a cis male and a pre-op transwoman is straight (heterosexual) sex. Once one grasps this concept then they can see the irrelevancy of what one has between their legs.
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.
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.
I agree that it isn't. I am a woman and the stories that I am most familiar with are from women who shared them with me.
No its not my marriage. I chose my husband carefully with my head and not my "feelings" to avoid this among many other situations. You can feel strongly about someone elses struggles without having experienced them personally.
This is the part where I throw the flag on the field. NO ONE is forced to get married in this day and age. Even when my mom was a young woman in the 50's you might get a few comments/rumors thrown your way if you stayed single past a certain age but no one was being dragged from their homes and beaten. The truth is it is done selfishly to quiet family rumors, get inheritances, or just to have the right profile in a certain line of work. It is using someone in the worst kind of way and it simply isn't necessary. You can't pin your emotional abuse of another person on society.
My point was it sounded more like "male bashing." The kind of thinking that assumes all men are sexual predators and women can not be sexual predators. Please use the term "people" so as not to sound hateful or prejudicial against males.
About 1/3 of what I do involves forensics, and the best tool that I use is "root cause analysis." I don't get called in unless something really bad happens.
RCA in the scenario you present would come back to society's lack of acceptance and lack of options, and the stigma associated with LGBTI issues. Yes it was the PERSON'S fault, but a heterosexual relationship was all that society had taught and the only option (in most cases). Thankfully there is a new civil rights movement and enlightenment. The issue of gay marriage and Caitlyn Jenner are bringing the bigotry and hate that surrounds these issues to light and changing opinions.
Don't be. After many years together we have a beautiful family and are very much in love because I based my choice in husband on life long things that matter and not temporary feelings that fade away and have people in divorce court whining about how they grew apart and the children being torn apart isn't their fault because they have to chase their bliss or truth.
I know this has been stated many times throughout this discussion, but I will repeat... As a nurse we will repeatedly come in contact with patients who have different values and morals than our own. It would be a pretty boring life if everyone believed the same and thought the same about every situation. It is not about the nurse, it is about the patient. If someone born with a member wants to be called "Susie" and referred to as "she" then that is what should happen. You are entitled to feel and think whatever you want about this request, but it will NOT cause YOU harm to do it!!!! If it makes YOU feel better then you can say a little prayer for them...whatever makes YOU feel better. I am baffled that this is even an issue...nobody is asking you to change your way of thinking; we are asking that you consider, just for a moment, the feelings of your patient. If patients ever ask your feelings about transgender, please don't tell them...they are under your care to get better, not worse.
I'm a 60-year-old Orthopaedic Nurse, and I'm also transgender. Many years ago, I underwent a full medical and social male-to-female transition while working as the night nurse at one of those exclusive New England boarding schools. After such a public transition, I knew that any kind of stealthy existence was impossible, so I've never tried to hide my status, and have always been available for public forums, panels, etc. These days, I work in a busy, 45-doc Ortho clinic at a teaching hospital. Our Medical Center's Endocrinology department is known throughout the region as providing safe, compassionate care for transgender individuals of all ages. As part of their medical school experience, our med students (and residents) attend seminars and discussions with a wide array of people, including transfolk. I'm usually asked to take part in these, and I always try to make the point that this isn't just about us, the tip of the freaky iceberg, it's about providing safe, compassionate care for every patient, including those who you perceive as radically different from you. For nurses, that's at least as valid as for doctors. Because if you don't want to talk to us, to touch us, to be there with us, believe me, we know.
Hi Parakeet, I too am a conservative nurse who serves the LORD Jesus Christ but at the same time, I would address the individual as they wish to be addressed. I understand your argument. It's a similar argument I had with some of my brothers and sisters-in-Christ about giving clean needles to Heroin addicts. I do not condone the act by addressing someone by their particular wish because I know that these individuals are searching for something. And they won't find it how they are addressed.
I liked that example of the woman caught in adultery. Christ did not condone her behavior but He loved her in it. And it was that love that won her over. I have my beliefs on this topic and I stand on the side with Christ. And as an NP, my goal is to be able to provide love and care to everyone - equally and hopefully aid in reconciling them with the God who is willing to love them as they are.
This topic is of active interest to me at the time, I work full time in the Emergency department at a men's state prison. We have had two inmates in our facility that are receiving hormone therapy. For the most part this is not to much of an issue because they were just getting started in their transformation for lack of a better word. However, the issue seems to be when they begin to show breasts and other feminine attributes yet still have their male genitalia. Safety becomes an issue. Placing them with female inmates didn't work because female prisoners became pregnant, yet place them with male inmates and they get raped. It is certainly a dilemma and most of the time these inmates that are transgender end up in solitary for their own safety.
FlyingScot, RN
2,016 Posts
As a Christian myself let me admonish you that when, not if, when you get written up for being disrespectful to a patient by refusing to use their preferred pronouns you had better not use it as proof that you are being persecuted for your beliefs! You are NOT being persecuted for your beliefs you are being punished for your behavior. Don't make the rest of us look bad.