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.
Specializes in OR, Nursing Professional Development.
I know a few people that are gay or bi that were not before.
Or, they were in denial. Or, they were still in the closet because of the attitudes towards them. Or, they were trying to conform to "social norms". In other words, they were gay or bi; they just didn't tell you.
Rocknurse -- honest question. There are people who have a lot of hostility toward Christians. Not merely who disagree, and maybe they don't go around fire bombing churches, but do have hostility in their hearts. Or perhaps it comes across as mockery, if not as anger.
Should these people stay out of nursing? Because those are very intolerant thoughts to have, no? Or is it possible that they are able to make nursing care about nursing and not about their own feelings?
One other quick side note, off topic of the thread, but since it was brought up: the Bible and slavery. There are passages that acknowledge the reality of slavery/war captivity/indentured servitude of the time, and sets certain rules of engagement.
However, regarding the practice of enslaving one ethnic group under another, as was the practice in the US, UK, etc.? There is not so much as a verse that supports that. I've heard many times that religion was a justification for slavery in the US, but nobody has ever been able to show me the passages--professing Christians making that assertion included. They're not in there.
I also have a little story to tell you guys. I was in a nursing home caring for a patient that only had a few days left to live. The patient's family was all there, and I had very little time for other things. One of my favorite residents in the nursing home came up to talk me, and his story was so deep and personal, I stayed to hear the whole damn thing.
He was raised Amish, which is probably one of the strictest cultures out there. He was raised to believe in God and the Bible. But he knew he was gay from the time he was 16 years old. He didn't tell anyone. He married a woman in the hopes that he could "cure" himself. After THIRTY-SEVEN YEARS of marriage, he got a divorce. Not because he'd found another person, but because he just didn't feel like pretending anymore. He's now in a nursing home, all alone. He chose to be alone after all that time. Nobody chooses to be alone just for the hell of it. These people don't choose to be ostracized. Some of them even wish they were dead--I've met a gay person who told me himself that he wished he was dead because he didn't feel accepted. Why would anyone choose that? (Hint: it's not a choice). The main reason I do not believe people choose this is because there isn't a benefit to "choosing" this. It's hard.
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.
It is awesome that you understand yourself well enough to have these questions. I'm not Trans myself, but have friends who are, and friends who are Asexual and it's interesting to watch how hard it can be for them. I personally do not tend to have the urge to lust at the "attractive" people. Just don't care about physical appearance. When I tried to explain this to someone they tried to tell me that I just hadn't meet the right person yet. I'm 34, in a wonderful relationship with someone I care for deeply. What does it matter if I love him because he's intelligent and makes me feel like I have someone to talk to? My sexuality is my own. Just like a Trans person's gender is their own. As nurses, the only thing we should care about is if they are on conversion therapy, how it is affecting their body, and what interventions to we need to make. Calling them by their preferred name is just one part of how we make sure our care plan is relevant to them. Patients are more likely to follow through of the care provided is tailored to their wants and needs.
Do MD's views as a group generally parallel those of nurses on this issue? As in are they as divided?
I don't know of any research that explicitly looks at physicians and their opinions, but the research that looks at patients and their experience suggests physicians have as much trouble treating transgender patients with respect as anyone else.
Regarding psychiatry, while being gay was removed as a mental illness decades ago, "gender dysphoria" is still in the DSM-5. There are those who use this to say that transgender people are clearly mentally ill, and there are those (like me) who recognize that generally transgender patients require medical treatment in order to transition, and you can't bill insurance without a diagnosis. So, it's an unfortunate feature of our healthcare system that necessitates us treating them as mentally ill in order to help them. Except that the treatment is confirming their gender identity, rather than trying to convince them that they're wrong.
It is interesting to see what things are allowed today under the guise of scientific explanations. I wonder what other issues will be scientifically approved in a couple of years. Scary.
Rocknurse -- honest question. There are people who have a lot of hostility toward Christians. Not merely who disagree, and maybe they don't go around fire bombing churches, but do have hostility in their hearts. Or perhaps it comes across as mockery, if not as anger.
Should these people stay out of nursing? Because those are very intolerant thoughts to have, no? Or is it possible that they are able to make nursing care about nursing and not about their own feelings?
Personally I don't care what anyone's thoughts are. You can think whatever you like. But if you act in a way that explicitly disrespects patients - for whatever reason - then yes, you should either avoid the field or find a niche that doesn't require patient interaction. I've seen nurses treat murderers and rapists without being rude, it shouldn't require an act of Congress to respect someone's choice of pronoun.
I treat all patients the same regardless of their characteristics. That said I do not give up who I am when I put on my scrubs and walk into work. I don't do the religion thing but anyone who knows me personally knows my strong political beliefs on which I will not compromise. If you google my name you can see my political contributions and there is a 50/50 chance you will disagree with me.
I will call you by your preferred name (first name, nickname, Mr/Mrs/Ms etc) and will treat you with respect as long as you are under my care.
I will always treat my colleagues with respect concerning their beliefs as well. To say someone who has a different belief than you shouldn't be a nurse makes you as closed minded and intolerant as they are. Sorry "little snowflakes" you are not morally superior to the person you are attacking for their Christian beliefs because your beliefs are different.
The ethical debates about these situations are far more complex than what is studied in nursing. Nursing school ethics focuses on the patient's rights while giving less emphasis to the rights of the caregiver and community. This is only a small slice of ethics as a whole.
If you really want to have to defend your beliefs have a debate with someone with a degree in ethics who likes to play devil's advocate. There are enough ethical frameworks they can throw at you that you will be wrong no matter which choice you make.
It is interesting to see what things are allowed today under the guise of scientific explanations. I wonder what other issues will be scientifically approved in a couple of years. Scary.
Personally, I don't find it scary, but I think we're looking at this through different lenses. I'm with the Dalai Lama (the head of Tibetan Buddhism), who said, "If scientific analysis were conclusively to demonstrate certain claims in Buddhism to be false, then we must accept the findings of science and abandon those claims."
I don't think that the justification for transgender not being a choice works. There are other choices in life that also have risks and it does not mean that the person was what the chose from the start. To make it clearer, this is a very unrelated example, but it backs my point. In a number of places, when a Muslim turns from Islam and becomes a believer in the LORD Jesus Christ, they risk losing their friends, family, possessions, and even their lives. Does the outcome of their decision mean that they were Christians from birth? No. They were brought up believing Islam and were Muslims until they made that decision.
Please don't use this to go off topic. I used this illustration, which I have actually seen, to say that making a high-risk decision does not mean that a person is only releasing what they have meant to do all along. It would not be much of a decision then, would it? Just some food for thought......
Libby1987
3,726 Posts
Do MD's views as a group generally parallel those of nurses on this issue? As in are they as divided?