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.
... Are you going to be able to cope with working with a co-worker who may be gay or TG?
... If you can't do that, then I think you'll have one tough row to hoe to be successful in this profession.
Actually, if OP remains in their local area and continues in their same social circles, it's perfectly reasonable to expect little to no future challenge to their thinking up to this point.
Yes, a lot of Christians there. Not all Christians are intolerant. Let's not throw out the baby with the bath water, now.
I loved your post.
Just the intolerance, I promise . I'll admit that religion in and of itself makes me uneasy. If faith is the basis of belief in something/someone instead of rational thinking, literally anything can be justified. And indeed, it has. The South has quite unashamedly used religion to justify racism, sexism, homophobia, and transphobia just in the last 50 years. Religion is the excuse for many deeply-held personal prejudices.
Despite that, I chose to live in the rural south. Cost of living is low, and there were many job opportunities for new grads. You can enjoy a very comfortable life as a nurse in south Georgia :).
I cannot say that my mindset is formed by living in the South. I came from overseas when I was little, lived in the North and the South and am looking to go overseas again. My convictions are my own, yes perhaps influenced by surroundings, but not decided from my surroundings.
Thanks for the advice. I might pause a little while to catch my breath!
Specializes in Oncology; medical specialty website.
Actually, if OP remains in their local area and continues in their same social circles, it's perfectly reasonable to expect little to no future challenge to their thinking up to this point.
Conformation* bias is real, ya'll.
*Intentionally misused
She doesn't have to conform, but she does have to have compassion. Unless her social circle owns a hospital, she's going to come in contact with people who have different values.
Actually, I do my best to obey the Bible and God's leading as a whole. Though it is not relevant to this topic, I do wear dresses. I do cover my head. I do wear makeup....sometimes. and I do not cut my hair....sometimes. :) In other words, I have not been selectively choosing what I want to follow and don't.
I thank you for what you wrote. What about a situation in where a transgender person may ask me what I think? Then if I told them that my views were different, I might be labeled an unfeeling, uncaring person no matter how well I cared for them. I know one thing, I would not just speak my mind and thoughts on my convictions unless I were asked.
Like I said earlier, I am learning more as I go through nursing school. Healthcare is an interesting field in that I will be in many different situations where I will have to think outside of the box and care for people whose backgrounds are very different from mine.
"I think that we are both here with the goal of your care, treatment, and to get you to your highest functional level."
And therein lies the problem. Your opinion of what constitutes a male or female in this regard is irrelevant. Because it's not about you! In any event, your beliefs are clearly offensive to others, including myself, and you might want to take a basic nursing equality and diversity class before you go any further in your career. Modern nursing has no place for extreme religious views. If I was a patient I would be horrified to have you as my nurse if I thought for a second you might prevent my partner from being treated equally at the bedside as my family member and included in my care as would be my wishes.
...Or your spouse, as many, many states are recognizing same sex marriages. Woo Hoo! About time....now back to regularly scheduled programming.....
I think at the end of the day nurses have a responsibility to treat every one with dignity, respect and provide the best care possible. I am a Christian and was raised to believe that God does not make mistakes. Therefore, I would never think it is okay for someone to change their sex or be transgender. However, I will treat with with the upmost respect, and give you quality care. You'd never know my thoughts or beliefs on your life choices.
Yet another who thinks being gay or trans is a "lifestyle choice".
I have to give credit where credit is due though - so thank you for saying you will remain professional and treat everyone with dignity regardless of your own personal beliefs.
And yet another who thinks being gay or trans is "innate".
Just because someone doesn't believe what you believe does not automatically make them closed minded or ignorant. I know a few people that are gay or bi that were not before. I'm not saying it's the same for everybody. Anyway I think everyone should be treated the same.
Just sayin' there's more research and evidence out there that supports same sex attraction as a biological and innate phenomena - in humans and other species, than to the contrary.
. I'll admit that religion in and of itself makes me uneasy. If faith is the basis of belief in something/someone instead of rational thinking, literally anything can be justified. And indeed, it has. The South has quite unashamedly used religion to justify racism, sexism, homophobia, and transphobia just in the last 50 years. Religion is the excuse for many deeply-held personal prejudices. 
Farawyn
12,646 Posts
Aliareza, whatchu got against the South, girl?
Yes, a lot of Christians there. Not all Christians are intolerant. Let's not throw out the baby with the bath water, now.
I loved your post.