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.
Like I said, I am going to treat everyone with compassion. I am at the point right now where these issues are coming up in nursing school. I am just trying to learn how to deal with situations that are controversial to my beliefs.
What would you do if a person who is clearly a man, asks you to refer to him as a woman. How would you deal with that? I just don't know yet how I would act in such a situation. Nursing care is not my problem, I can give that to anyone who needs it. It is this sensitive part of people interaction that I do not yet have experience in.
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.
Compromise is easy. Just one word....and everything will be great? I can be compassionate without compromise. And not even saying that such a matter would come up. If the patient can be understanding as well, and know that some people have different views, it would work out much better.
The problem is, because what I believe is in direct opposition to matters such as transgender, I am going to get into trouble for it. It is kind of one sided though. I am compelled to bottle up what I think no matter what the circumstances, but a patient can claim to be anyone they choose and other people who might have different beliefs must not hurt their feelings? I understand, as a health care worker, that I would be held to a higher standard of accommodation than others.
It seems rather one-sided. It does not make sense to me......but then, not much makes total sense in the world today! Thanks for interacting with me.
It is NOT about you, Parakeet. It is about the person you are caring for and treating. Put your own biases askde and your own fears away and be present for them!
How they wish to be referred is not hurting you or causing you pain. Sheesh.
Compromise is easy. Just one word....and everything will be great? I can be compassionate without compromise. And not even saying that such a matter would come up. If the patient can be understanding as well, and know that some people have different views, it would work out much better.
The problem is, because what I believe is in direct opposition to matters such as transgender, I am going to get into trouble for it. It is kind of one sided though. I am compelled to bottle up what I think no matter what the circumstances, but a patient can claim to be anyone they choose and other people who might have different beliefs must not hurt their feelings? I understand, as a health care worker, that I would be held to a higher standard of accommodation than others.
It seems rather one-sided. It does not make sense to me......but then, not much makes total sense in the world today! Thanks for interacting with me.
It is one sided. You are getting paid and educated. The patient is sick and vulnerable.
Compromise is easy. Just one word....and everything will be great? I can be compassionate without compromise. And not even saying that such a matter would come up. If the patient can be understanding as well, and know that some people have different views, it would work out much better.
The problem is, because what I believe is in direct opposition to matters such as transgender, I am going to get into trouble for it. It is kind of one sided though. I am compelled to bottle up what I think no matter what the circumstances, but a patient can claim to be anyone they choose and other people who might have different beliefs must not hurt their feelings? I understand, as a health care worker, that I would be held to a higher standard of accommodation than others.
It seems rather one-sided. It does not make sense to me......but then, not much makes total sense in the world today! Thanks for interacting with me.
What does this even mean? How would you like the patient to "compromise" with you? Would you like a patient who is biologically male, but identifies as a female, to ask you to refer to them as half a man?
Yes, a patient came "claim to be anyone they choose" (not even going to get into how erroneously this is representing what it means to be transgendered). How does it HURT you to accommodate that? How does it change your day-to-day life in any way? Once again, when you are a nurse taking care of a patient, your job is to TAKE CARE OF THE PATIENT. It's not. about. you.
It is one sided. You are getting paid and educated. The patient is sick and vulnerable.
You took the words right out of my keyboard. :)
Parakeet, the patient has NO obligation to change in order to make YOU comfortable. However, as a nurse assigned to a patient who is sick and vulnerable, you are obligated as his CAREGIVER to address him as he or she has requested. You don't have to change your inner thoughts about the matter (though it would really be to your benefit to educate yourself about the SCIENCE of transgender issues), but you are required to be professional. And being professional means behaving in a way which does not make a sick person feel even worse, feel marginalized, disrespected, and judged according to religious values which that patient did not agree to be held to when he sought care at your facility.
I know its not about me. If it was, I would never have gone into nursing. But I would like to know if there is any place in healthcare for nurses to have their own convictions. I am not talking about the patient compromising, I am talking about a nurse who has strong convictions about what is right and what is wrong. I have been told to compromise my beliefs so it will not offend someone else.
All this aside, there will most likely be a point where I will be challenged by someone who is cross gender about what I believe, no matter how well I care for them. Even if I said nothing at all, I will face some point where I will be asked what I believe....and I will have to speak out.
It was good to hear the opinions of seasoned nurses. If what I am posting is too controversial, I can stop posting on this thread. But just think, you also got to see how I am working out this issue from my point of view.
I have been told to compromise my beliefs so it will not offend someone else.
No you haven't. You've been told to keep your beliefs to yourself when you are at work and not inflict your values of right and wrong on your patients. When you become a patient some day, do you want a hospital employee of another religion inflicting their beliefs on you? Telling you that according to their religion, you are behaving in ways which they know to be "wrong"?
I don't understand the compromise of beliefs. A Christian believes Jesus is their savior, caring for a transgendered person doesn't compromise that. Calling John Jane doesn't compromise one's Christian beliefs, you still believe Jesus is your savior and can continue to do so in your assigned gender. It doesn't change one thing in your relationship with God, except that you're missing the message.
I know its not about me. If it was, I would never have gone into nursing. But I would like to know if there is any place in healthcare for nurses to have their own convictions. I am not talking about the patient compromising, I am talking about a nurse who has strong convictions about what is right and what is wrong. I have been told to compromise my beliefs so it will not offend someone else.
All this aside, there will most likely be a point where I will be challenged by someone who is cross gender about what I believe, no matter how well I care for them. Even if I said nothing at all, I will face some point where I will be asked what I believe....and I will have to speak out.
It was good to hear the opinions of seasoned nurses. If what I am posting is too controversial, I can stop posting on this thread. But just think, you also got to see how I am working out this issue from my point of view.
parakeet, you can keep your convictions while still respecting the wishes of your patient. for example you are Christian. how would you feel if you had an atheist nurse who didn't respect what YOU believe. also, remember not everyone is Christian and even Christians have differing opinions on what it is to be Christian.
also:
1 corinthians 13:13
"Right now three things remain: faith, hope, and love. But the greatest of these is love."
and of course john 8:7
When they kept on questioning him, he straightened up and said to them, "Let any one of you who is without sin be the first to throw a stone at her."
I believe you are compassionate but you have to do what's right for the patient because misgendering or calling a Transgender person by their old name can cause them to have disphoria and people need to feel safe and comfortable with their nurse not judged.
Compromise is easy. Just one word....and everything will be great? I can be compassionate without compromise. And not even saying that such a matter would come up. If the patient can be understanding as well, and know that some people have different views, it would work out much better.
The problem is, because what I believe is in direct opposition to matters such as transgender, I am going to get into trouble for it. It is kind of one sided though. I am compelled to bottle up what I think no matter what the circumstances, but a patient can claim to be anyone they choose and other people who might have different beliefs must not hurt their feelings? I understand, as a health care worker, that I would be held to a higher standard of accommodation than others.
It seems rather one-sided. It does not make sense to me......but then, not much makes total sense in the world today! Thanks for interacting with me.
I am having a hard time following your thought process, but here goes....
I understand that in your personal life, you are perhaps devout on what is noted in the Bible. There are lots of things in the Bible that any one person picks and chooses to follow/not follow. And please excuse me if in fact you do not wear pants (which is considered biblically as women dressing as men....which could be relevant in this, but topic for another thread), that you don't cut your hair (again, biblically based), you do not wear makeup, you cover your head in church, or that you cleave and submit to your husband as you are his property (again, all biblically based).
My point is that the "trouble" you believe that you will get into with ---who, God?------could very well be the same "trouble" you would get into for many other things that you may or may not do. Any of which could be discounted biblically.
In your nursing practice, there will be many times that you may not like and/or "approve" of how people live, who they are, what they do. And base it on biblical directives. Your biblical directives have no place in how you treat a patient. It doesn't make you a sinner to care for someone who goes against your religious belief system, no more that you imposing your thought process on how they can "sin no more" on a patient.
It would behoove you that going forward, take personal counsel with your religious leader on your perceptions. Do not reflect them on a patient. People who are ill are disease processes that deserve care and treatment. Do not get into "well, if I call this patient a 'him' as opposed to their assigned gender, then I will be a sinner". I call it bipolar bible bingo.....pick and choose random parts to follow, others not so much.....
Specializes in MENTAL HEALTH, EDUCATION,ADMINISTRATION.
Agreed .. But unfortunately it happened all too often. Is it possible that sometimes it is unintentional or an oversight? Sure, but as professionals we are supposed to be on a higher level of awareness than the average citizen.
Farawyn
12,646 Posts
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.
Middlesex: A Novel (Oprah's Book Club): Jeffrey Eugenides: 9780312427733: Amazon.com: Books