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.
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.
Is GA paying for their transition? How does that work with inmates?
Jumping off some of the issues brought up in this thread: so I wonder if yesterday's Supreme Court ruling will present even more dilemmas for nurses who feel their religious beliefs can't and shouldn't be left at home when they put on their scrubs. Will they refuse to refer to a man's spouse as his "husband" if they believe homosexuality is a sin?
Jumping off some of the issues brought up in this thread: so I wonder if yesterday's Supreme Court ruling will present even more dilemmas for nurses who feel their religious beliefs can't and shouldn't be left at home when they put on their scrubs. Will they refuse to refer to a man's spouse as his "husband" if they believe homosexuality is a sin?
My husband and I have both been in the hospital and what you're describing has never become an issue. I see it becoming an issue when patients insist on a nurse addressing certain people in a way that they want them to and intentionally making trouble for them when they don't. I think if you just do your job and treat everyone with respect you shouldn't have these issues but I doubt it'll be left at that.
My husband and I have both been in the hospital and what you're describing has never become an issue. I see it becoming an issue when patients insist on a nurse addressing certain people in a way that they want them to and intentionally making trouble for them when they don't. I think if you just do your job and treat everyone with respect you shouldn't have these issues but I doubt it'll be left at that.
I'm not worried about myself. If I have a gay male married patient, I would have no problem referring to his spouse as his husband. My question relates to the poster(s) who have stated outright that because they believe it is "wrong" to refer to a transgender male to female as "she," they would therefore refuse to do so. Would they also refuse to refer to a gay male's spouse as "your husband" when speaking to the patient? It seems it would be a similar ethical dilemma.
One could also make the argument that it's the nurse who refuses to address patients in the way they want them to who would be the one "intentionally making trouble for them."
I work at a clinic that is the go to for patients who are transgender. I always ask what they prefer if I am unsure. So far, all have been very appreciative of my checking in with them.
Well, will you call me Susie brooks? Or better yet....will you call me heron (insert what your real name is- here)? lol. I wan't some answers. Because what I wont do, is allow or go along with, this " EVERYONE is confined to and held to logic and reality, EXCEPT for gay and trans people. It's either all or nothing. Either I can also be called, and TREATED AS, President Obama, because that's who and what Identify as (and i want secret service too), along with males who identify as women, being called women.............or, we're all held to REALITY. Its either all or nothing. 1 group can't be exempt.
Well, will you call me Susie brooks? Or better yet....will you call me heron (insert what your real name is- here)? lol. I wan't some answers. Because what I wont do, is allow or go along with, this " EVERYONE is confined to and held to logic and reality, EXCEPT for gay and trans people. It's either all or nothing. Either I can also be called, and TREATED AS, President Obama, because that's who and what Identify as (and i want secret service too), along with males who identify as women, being called women.............or, we're all held to REALITY. Its either all or nothing. 1 group can't be exempt.
So, if stuff is in caps it's more important, right?
I'm looking at your credentials and I cannot wrap my head around that vs your posts.
How do you treat your patients? Or do you refuse to treat certain groups?
I know this is a dates post but I came across a situation today in practice that made me look up what others have encountered. I am 100% with treating people with respect and compassion. At the end of the day we all struggle with something and being a compassionate and loving nurse has nothing to do with an individuals identity. As a health care professional, and as someone who has a medical license, that has taken numerous science and biology classes , I cannot in good conscience ignore what we know as truth. I am all for respecting a persons wish to be called or regarded as they desire but I cannot go as far as ordering a pregnancy test on a man. We need to also respect the biology and physiology. YESS 100% treat EVERY individual with respect, love and empathy, NO MATTER WHAT but also respect our intelligence and medical degrees. A biological MAN will NEVER get pregnant or have a menstrual cycle. We need to stop feeding into the delusion!
Funniest thing I've read in a while!
Farawyn
12,646 Posts
Is GA paying for their transition? How does that work with inmates?