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In 2020, a healthcare worker couldn't get from home to work without seeing signs touting their hero status. Soon following were teachers (homeschooling is hard, y'all!) and other essential workers putting their health at risk to keep the country's infrastructure running. But how's all that gratitude, goodwill, and "we're in this together" coming along now? I've been hearing snippets here and there of not only patient and family verbal abuse, but the public in general being, well, just plain rude. Was all that hero talk just rhetoric? Are we all experiencing compassion fatigue? Mental health issues? A shared global trauma? Or maybe it's just me. Chime in on the poll. I'm very interested in what the rest of the country is experiencing at work with patient and family interactions.

Certainly a valid concern, and one that I'm not sure I'm qualified to answer. Changing social norms isn't my forte, but I think this demonstrates how challenging and multi-faceted it is to change any social norm. But here are a few thoughts as I do my best to engage. Members of a marginalized community may feel so unsafe and harbor so much suspicion that almost anything can be upsetting despite our best efforts to be sensitive and kind. We do not know what experiences patients have had before getting to us. So it remains important to try our best to be gender affirming. Maybe using language such as "I have some sensitive questions for you...." or some precursor to try to assuage a potentially upsetting situation, much like how we approach topics of sexual behaviors or economic status where it's important information, but uncomfortable to talk about. Being trauma informed is also helpful. Standardizing questions would also help so that we can say "we ask everyone this," like how we do for safety questions when it comes to abuse or domestic violence. All that being said, we can't read minds and we're just trying to do our best here. Mistakes happen. Hell, I've probably made mistakes in just this article and some of the responses to comments because I can't completely understand what it's like to be transgender or have gender dysphoria. As I try to navigate caring for people, I may say or do things that hurt others, but that's not my intent at all. I'm trying to learn how to be an ally. There will be growing pains. But I know how to apologize and can do so when I've inadvertently hurt someone. In the end, some people will be gracious with us and others won't. But we can be gracious with ourselves as we try our best.

Love that! This is an equally important topic in schools as well

I largely agree with the other commenters. Just remember, if you do become a nurse, there are days when you love it and there will be days that you hate it. It's OK to hate it once in awhile. doesn't mean don't do it. There are things you can do build resilience. There are a lot of avenues to pursue if something isn't working for you. Sometimes working with the right group of people makes it all worth it. At the end of the day, does it give you purpose? Is it fulfilling? Maybe not all of the time, but most of the time? Some good questions to ask yourself. Good Luck!

Totally go for it. You'd have to get those certifications within a certain amount of time anyway, and this would show you are serious about the position and want it more than others. I don't know of any managers (good ones, at least) who look down on getting certifications, like it's trying too hard. I've known nurses like that, but if managers are poo-pooing further education, you probably don't want to work for them anyway!

I was a school nurse for a brief time and any big ideas I had with wanting to promote change I felt I needed the backing of admin and teachers. Have you asked the staff what their take is? They might provide really good information and maybe already have something in the works. Or maybe there's nothing, but it seems a teacher or two would be interested in helping you out. As far as EBP, I know there are resources. I also worked as a community nurse serving those below the poverty line. A lot of our focus was helping families get their basic needs met, but the ultimate goal was for them to be self reliant. It was pretty hard. Only the most motivated people seemed to really be consistent in trying to improve. A couple of things I remember (but can't remember if they were evidence-based or not): Give opportunity to see or experience a richer life - like going to a museum or concert - something they couldn't normally afford. Teach critical thinking skills encourage education Help them find their "why" Motivational interviewing Improve mental health - it's hard to get out of a cycle if your thinking is always negative Find support / people who believe in you Also, I remember at a school nurse conference they told us that any ideas we had for the health of the students needed to be related back to outcomes of attendance and graduation rates. If we could prove that those would be bolstered, admin would be willing to give resource and support. That's all I got. Good Luck!

That is a really good question in a challenging situation. Honestly, I feel like I would have done the exact same thing. The private room seems to be the most appropriate option. Patients don't always get a choice when it comes to room placement and bed control can get complex with many moving parts and considerations, including safety for everyone involved. Most patients don't understand that and complaints crop up. In this case, I wonder if the initial placement in the room with a male companion was hurtful enough that it bled over into when she was placed in the private room? Like it was more of an isolation thing than a privacy thing? That's just one thought. And I'm definitely not the expert. Here's a link I found that addresses when patients object to transgender roommates, which isn't the case here, but it goes into hospital policy concerning transgender patients. Transgender Roommates It is good that you and your staff recognized the importance of privacy and HIPAA laws in regards to gender identification. If anyone else would like to chime in with thoughts or suggestions, feel free!

Thank you!

I know, right? It can be hard to adjust, but it's so important. I admire your efforts and hope that more nurses can follow. We don't need to wear the word "jaded" as a badge of honor!

I love that you are able to ask those questions and give a safe place! As an older nurse, I didn't even think to ask about gender for many years - it wasn't taught to us. And then it was just really uncomfortable for a long time. But it's super important to be able to ask questions and have conversations surrounding these issues, even if it's unknown territory. Like you said, it's the little things that are important!

Nurses are to care for every patient in their charge, regardless of gender, race, ethnicity, sexual orientation, socioeconomic status, religion, and so on. Nurses give compassionate and competent care every minute of every day to patients they would not be friends with outside of the patient-caregiver context. Indeed, nurses care for people they may strongly disagree with in politics, religion, or just overall beliefs. But nurses do it because that is their job. It is, in fact, what they signed up for. Marginalized communities have always had barriers to healthcare, and that is true for the LGBTQIA+ community. In particular, the transgender community faces unique struggles in accessing healthcare. The issues are distinct and go right to the core of who they are—their very identity. They deserve the same compassion and competence as every other person. The Williams Institute of UCLA School of Law published a study in June 2022 that indicates the number of youth who identify as transgender has risen sharply in the last five years. With an estimated 1.6 million transgender people over the age of 13 in the US, healthcare providers need to understand what issues they face and how to care for this marginalized population. The Issues Transgender people need the same basic and preventative healthcare as cisgender people. However, studies reveal that transgender people are less likely to seek care out of fear of discrimination. These fears are not unfounded. The LGBTQIA+ community has faced discrimination from everyone, from doctors and nurses to secretaries and insurance companies. Is it any wonder care is avoided or delayed? Besides basic care, transgender people face many of the same issues as other minorities due to minority stress. These issues include: Mental health problems such as depression and anxiety, often due to internalized stigma Self-harm and suicidal ideation Physical and sexual violence Substance misuse Sexually transmitted infections Inadequate and/or misinformed care from healthcare providers Increase tobacco use Obesity Transgender people who wish to transition face another level of healthcare barriers and issues. The aim of this article is not to address these issues specifically but rather to bring to light the disparities for this population. However, it is beneficial to understand just how many considerations, health and otherwise, a person who wishes to transition may face. These include: Legislation, including anti-trans legislation and variations from state to state Coming out to family, friends, schoolmates, co-workers, boss, etc. Parental consent Possible job loss Changing names and gender in legal documentation Pronoun use Presenting publicly, which may include changing clothing style and hairstyle or changing body contours to match gender identity (tucking, packing, binding) The medical side of transitioning includes things like: Hormone therapy; which can increase the risk of blood clots, strokes, heart disease, liver damage, and certain cancers Top and/or bottom surgery Speech therapy Hair removal Tracheal shave Lack of insurance coverage Discrimination in Healthcare Across the country, the healthcare needs of transgender people are misunderstood. Many consider changes "cosmetic.” Gender dysphoria, the distress felt when assigned gender at birth does not match gender identity, is not something that is the result of a choice. It is widely recognized by the medical community, including the American Medical Association, American Psychological Association, and the American Academy of Pediatrics, that gender-affirming treatments are critical, not cosmetic. A study published in the Journal of the American Medical Association shows that administering gender-affirming hormones significantly mitigates mental health issues such as depression and suicidal ideation. It saves lives. And yet many states are passing anti-trans bills that restrict access to things such as hormone therapy and puberty-blocking by barring insurance companies from covering these treatments ... or even defining them as child abuse. Nurses Can Provide a Safe Space for Transgender People By recognizing the mountain of difficulties the transgender community faces, nurses are in a position to lend a safe place for them. Thankfully, more research has been done, and therefore resources are available to help guide care. The evidence is starting to surface. One does not need to become an expert in this, but it is worth seeking out these resources to better understand the issues transgender people face and how care can be provided for them in a sensitive, gender-affirming way. Here are just a few resources and tools to help bone up on definitions, vocabulary, and knowledge so that care is administered in a sensitive way: NurseJournal.org: Nursing Care for Transgender Patients: Tips and Resources Gay & Lesbian Medical Association: Guidelines For care of Gay, Lesbian, Bisexual, and Transgender Patients AMA: Creating an LGBTQ-friendly practice AMA: To excel with LGBTQ+ patient care, avoid harmful assumptions Supporting Trans Youth Like many things involving inequalities and basic human rights, the issues of healthcare for the transgender population are fraught with politics, personal beliefs, social norms, and cultural traditions. Solutions come over time, piece by piece, and often with setbacks. Complicated problems require a multifaceted approach and collaboration from a variety of stakeholders. But in the end, the transgender community, along with the entire LGBTQIA+ population, deserve to lead happy, healthy lives, feel safe in their communities, and be confident in their healthcare team to do what is best for them. Definitions Gender Identity - an internal identification of one's gender, not always visible to others Gender Expression - includes mannerisms, styles, interests, and pronouns that reflect gender. This expression is steeped in cultural norms and heavily influenced by social constructs. Nonbinary - an umbrella term that includes experiencing gender identity outside of a male-female binary Genderqueer - falls outside the categories of man or woman Cisgender - identifying with gender assigned at birth Transgender - identifying with a gender other than that assigned at birth References/Resources Social Acceptance of LGBT People Ranked By State.pdf Poverty Rates by Sexual Orientation and Gender Identity.pdf Meeting the Health Care Needs of Transgender People Gay & Lesbian Medical Association: Guidelines For care of Gay, Lesbian, Bisexual, and Transgender Patients Gender Dysphobia Terminology surrounding Gender Identity and Expression Study estimates trans youth population has doubled in 5 years Supporting Trans Youth PROHIBITING GENDER-AFFIRMING MEDICAL CARE for Youth Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care Health concerns for transgender people What do I need to know about trans health care? Protect Trans Health: What Do We Want? LGBTQ Health National Center for Transgender Equality: Issues/Health & HIV What do I need to know about transitioning? Transition Roadmap The Williams Institute: Infographics

Isn't it scary how people trust Google more than a doc or other healthcare profesh? I really like the 2 questions you ask at the end to make a good decision. This can be used for more than just healthcare decisions - even something as simple as purchasing something. Thanks for your article!

Thank you for your article! I've used TikTok mostly for entertainment purposes as well, but I found some pretty cool mental health stuff there as well. If I question anything, I turn to more reliable sources, but you're right in that it can kind of spur a person to take action. Nice work!

Such a good idea. Irritation is good indicator for me as well. ?

Simpler Times Have you ever heard that old song “Video Killed the Radio Star” by the Buggles? It came out in 1979. An oldie, but a goodie. The lyrics of this poppy song deal with how new technology has put to rest an old way of life as TV and music videos made their debut in the 20th century. Though innovation with its many advantages is inevitable, there is something to be missed from bygone days when things were simply . . . simpler. Social media has got to be one of the most influential innovations in the 21st century. And, just like the advent of TV and music videos, social media has put by the wayside an older way of creating and consuming content. When it came to health information, the old way was pretty straightforward. Ask your doc, or a nurse, pharmacist, or other healthcare professional. Home remedies were passed down, friends and family could be solicited for advice, and there were always books for hardcore seekers of knowledge. Of course, that didn’t mean that health information was always reliable. Aunt Betty’s homemade cure for the common cold was surely more of a placebo than anything. But that cure probably stayed within Betty’s circle of family, friends, and neighbors. Good or Bad? Now there’s social media, and with it, the ability to spread an idea faster than the Omicron variant. When I asked my daughters, ages 13 and 16, if social media makes people stop thinking, they both answered unhesitatingly, “Yes!” The 13-year-old barely let me finish the sentence before she had shared her certain verdict. The 16-year-old admitted that sometimes she will withhold her opinion on something—a book, a movie, a TikTok—until she’s read what others think. I was about to get all judgy when I realized I’ve done pretty much the same thing, giving a book a 5-star rating and then second-guessing myself after seeing negative comments and critiques on social media. There is no question that social media has enormous sway in people's lives. Decades ago, when the internet was starting to burst forth and connect the world, there was a lot of positive talk about how it could open up dialogue between people. As a global community, we could travel the world virtually, learn about other’s lives, their cultures, their perspectives, and understanding and empathy would inevitably follow. If only. Don’t get me wrong. On days when I’m less cynical, I can picture that glorious ideal of sharing and seeking out ideas and people coming together with good intentions and correct information to make a difference. But let’s not be naive. The internet ends up being a giant echo chamber, algorithmically tailored to tell people exactly what they want to hear and confirming all their preconceived notions, beliefs, ideas, and dreams, while also stoking fears and misunderstanding. It’s both. Both things can be true about this vast online community. And many times, things fall in the middle of that spectrum. Healthcare is not immune. It falls prey to the whims of social media with its clever one-liners, ever-changing trends, and punchy ads. I can't even begin to fathom the number of health-related industries out there all competing for loyal customers. Everything from vast healthcare systems conducting research to hospitals and universities all the way to the local apothecary or online scammer disguised as a legit business. And they all have ways of getting information to the public, whether it’s blogs, social media campaigns, or email lists. The reach extends far beyond Aunt Betty’s circle. Misinformation, Confusion, Distrust Obviously, misinformation isn’t trite when it comes to healthcare decisions. It can have life changing consequences. One would think people would be extremely careful about the source of their information. But the fact is, most people don’t check a website’s “about page” to see what entity lies behind the information, who produces the content, or where their funding comes from, all of which are incredibly important. Neglecting to put on the Sherlock Holmes hat and do a bit of detective work can result in a person coming away convinced the wrong information is right. In addition, healthcare is complicated and many times controversial. It is intertwined with politics, technology, religion, and culture. And then there’s the actual science of the human body. There’s a reason it takes years of schooling and experience to become an expert on the human body or even just one system of the human body. It is incredibly complex! I’m reminded of this anytime I delve into a branch of nursing that isn’t my forte. And then figuring in all the medications, interventions, treatments, surgical procedures, and technology orbiting this intricate web—no wonder people come away more confused than ever! Distrust is another challenge when it comes to health information on social media. Take the recent obvious example, COVID. Changes came fast and furious during the pandemic, and misinformation abounded. As new discoveries were made, recommendations changed and evolved, often seemingly contradicting each other. The general public became understandably frustrated, and distrust of the scientific and medical community grew. Now, could this have been avoided? Who’s to say? Hindsight is 20/20, and hopefully, there has been a lot of knowledge gained about the importance social media plays in effective and clear communication. When people are confused about what they’ve read or have an inkling they may have come across inaccuracies, do they verify information with their doctors? One study published in the Journal of Medical Internet Research found that during the COVID pandemic, only 36% of people fact-checked something they had read in social media with their doctor. Educate, Understand, Inspire Perhaps social media has lessened some older outlets of dispersing information, like pamphlets, books, or even just talking to a healthcare professional. And those older ways were less fraught with potential disasters. But that doesn’t mean social media has to kill common sense. Used in the right way, it can encourage a person to think, to research, and to seek answers. Technology often runs faster than our ability to keep up. Education is critical for using technology wisely, and this is true of social media. When people learn how social media works and the impact it has on their thinking, they are suddenly armed against accepting the opinion or “facts” coming from any fool with a keyboard and a platform. No one wants to be duped. If people are educated to have a high level of skepticism and curiosity, they are less likely to be taken for a ride. All the better if they are educated at a young age. Nursing remains one of the most trusted professions. We can be proactive in sharing reliable websites with our patients and their families. Precious few have adequate time to educate their patients thoroughly, but sometimes just a few words can go a long way. Here are a few ideas: “A great website for getting good information is . . .” “I really like [insert website here]. It makes things so easy to understand.” “You do need to be careful about where you get online information. There are a lot of bad websites out there.” “You should always check with your doctor if you read something online that you have questions about.” “facebook and Twitter aren’t the best places to get medical answers.” “Diabetes.org [or other website] has a lot of information about your chronic illness.” I’m not above glancing at pages like Joe Mama’s Guide to DIY Remedies (not a real website, but it should be). But I’d never make that suggestion to a patient. My favorite outlets for health information are: The Cleveland Clinic The Mayo Clinic Centers for Disease Control and Prevention Harvard Health National Institutes of Health Pubmed Various non-profit foundations, institutes, and societies, such as: American Cancer Society Asthma and Allergy Foundation National Organization for Rare Disorders Healthcare professionals have a tremendous opportunity to engage and inspire others by taking advantage of social media. It can be leveraged to direct readers to credible sources of information. It has amazing power to promote awareness and motivate. And it has the ability to connect people with the same goals to promote healthy practices, discourage misinformation, and form communities to help each other—just what the internet was meant to do in the first place! In the meantime, I’ll encourage my daughters and my patients to check their sources, be both skeptical and curious, and to think for themselves. And I’ll make sure I do the same. References The Buggles - Video Killed The Radio Star (Official Music Video) Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study