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Topics About 'Transgender'.

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  1. South Dakota’s House of Representatives approved a bill, on February 29th, that would criminalize physicians who treat transgender children with hormones and sex reassignment surgeries. The Vulnerable Child Protection Act will now be sent to the state’s Senate for a committee hearing. Rep. Fred Deutsch, the bill’s primary sponsor, explains the legislation will protect vulnerable children who “are being chemically castrated, sterilized and surgical mutilated. South Dakota’s House of Representatives is the first state to pass a bill to restrict medical treatment for trangender teens. However, more than half a dozen state houses are considering similar bills. House Bill 1057 Under the bill, it would be a Class 1 misdemeanor for a physician to prescribe hormone replacement therapy or perform sex reassignment surgery to youth under the age of 16. This includes: Performing a mastectomy Gender affirming surgery (vasectomy, penectomy, vaginoplasty and others) Prescribing, dispensing or administering puberty blocking medication, supraphysiologic doses of testosterone to females and supraphysiologic doses of estrogen to males Removing any healthy or non-diseased body part or tissue. The penalty would be a maximum of 1 year in jail and a fine of $2,000. Nurses would be exempt from prosecution. The Debate Republicans and Democrats debate represent a larger culture war with conflicting values, beliefs and practices. The debate is bigger than just the medical issues and extends into parenting and the role of physicians. Opposition to the Bill Parents, many members of the medical community and advocates of transgender youths make the following arguments (although there are many more) in opposition to House Bill 1057: The bill is a form of discrimination that would withhold life saving treatment The bill is unconstitutional and the decision about gender expression should be between the youth, parent and doctor. Sex assignment surgeries and are rarely performed on youth Puberty blockers, requiring parental consent and extensive counseling, are reversible Libby Skarin, policy director for the American Civil Liberties Union of South Dakota, issued a statement after the vote, stating “By blocking medical care supported by every major medical association, the legislature is compromising the health of trans youth in dangerous and potentially life-threatening ways.” A conservative Christian organization, Liberty Counsel, has offered legal counsel to defend bill, at no cost to state taxpayers. Proponents of the Bill Lawmakers supporting the bill make debate these points (among others): Need to protect youth from making life altering changes until they are old enough to consider all available options Too young to understand the potential consequences Sex-reassigment surgery and administration in youth are harmful, abusive and criminal acts The website https://hb1057.com/, promotes Deutsch’s bill and features resources and videos from the Heritage Foundation, the Minnesota Family Council, a Christian organization. For Thought In 2018, the American Nurses Association released a position statement, Nursing Advocacy for LGBTQ+ Populations and applied the nursing code of ethics to this population. ANA Position Statement: Nursing Advocacy for LGBTQ+ Populations How do you think this ethical duty of nursing fits into the debate around limiting transgender healthcare for youth? Let us hear from you!
  2. General Hospital, the iconic soap opera on ABC for the past 55 years has a new story line that the nursing community may find interesting. This program has been on the air for 55 years and is an innovator for presenting real social issues. Besides the #metoomovement and #Ghtoo hashtag there is another story developing with a real transgender actress. History in The Making For those of you who are avid GH watchers or just curious about this groundbreaking soap, there is a new character worth watching. The character of Dr. Terry Randolph as portrayed by real transgender actress Cassandra James is fictional RN Liz Weber's (Rebecca Herbst) childhood best friend. Before we see Terry, Liz makes a point of saying, he was the boy who kissed her first when they were teenagers. This is the first real transgender person to portray a transgender character on a soap opera and therefore, this is historic news. In addition, this is forecast not to be a minor blip in the story. Rather, this is supposed to become a huge story line. This role will be Ms. James' first important role on television. A little background on this actress is in order. Cassandra James, is a 25 years old Canadian-American actress. She has a grounding in theatre. She came to Los Angeles where GH is taped a year ago. Big leap from unknown to soap opera actress in one year! According to an interview in the Vancouver Sun, she started her transition from male to female 2 years ago, in 2016. The Mystery Deepens The jury is still out on what will happen to this character and whose lives she will intersect. We do know that Liz Weber is engaged to Franco Baldwin. He has a shady past to say the least and was just treated as a long-time survivor of sexual abuse. We do not know if Terry's specialty is psychiatry, she leaves Liz's house saying she has a consult at GH. Transgender Characters in the News The world of the transgender person is entering the mainstream. Bruce Jenner aka Caitlyn, and Chaz Bono (Chastity) now the son of Cher and the late Sonny helped open the doors to this world. Recently, actress Scarlett Johansson made news for deciding to portray a transgender role. She was cast in a film called Rub & Tug and was supposed to have a role as transgender mobster Dante "Tex" Gill. She did receive criticism for tackling the role as a cisgender actress. Cisgender refers to remaining the sex you are born with. In other words, Johansson was born female and remains female. The actress decided against going forward in the role. Cassandra James on the Controversy Cassandra James, of GH, had this to say about the casting decision. Not shy around the press, James has made her support of transgender actors known in interviews. "I have faith in people's ability to learn from their mistakes. It's really important for people who are having their eyes opened to what's happening within our community to commit to making this a learning moment for themselves and also using their cis privilege to lift up trans voices. That's imperative moving forward." Another Groundbreaking Drama Other TV dramas are branching out into the transgender world. The FX drama Pose, created by prolific producer/director Ryan Murphy (Nip Tuck, The Assassination of Gianni Versace), has the most trans actors in TV history. Five trans female actresses have continuing roles in the show. The popularity of ballroom dancing is now featured in Pose from a historical point of view. This show revolves around the world of ballroom dancing and what transpired in Manhattan in that world in the 1980s. Even Donald Trump's Manhattan is a theme of the show. He is not seen but mentioned as a presence in the city and one of the characters works for his organization. The LGBTQ era which coincided with HIV awareness is also a story line in this groundbreaking show. Hospital Culture is Changing Society, which includes the worlds of nursing and medicine is evolving. GH has a hospital backdrop as the setting of this transgender story line. This is one soap opera that will continue to make headlines and one that will continue to use the fast-paced hospital as its' primary setting. REFERENCES 1. General Hospital News: Introducing Cassandra James!General Hospital News: Introducing Cassandra James! | Soap Opera News Published June 18, 2018. Accessed August 6, 2018. 2. Vancouver transgender actress makes history on General Hospital with castingVancouver transgender actress makes history on General Hospital with casting | Vancouver Sun Published July 12, 2018. Accessed August 6, 2018. 3. 21 Transgender Stars, Creators Sound Off on Hollywood: "I Want to Portray These Characters, and I'm Ready" Gardner, C., Sun, R., Weinberg, L., Goldstein, J., White, B. July 17, 2018 21 Transgender Stars on Hollywood, Scarlett Johansson, Representation | Hollywood Reporter -The Hollywood Reporter. Accessed August 6, 2018. 4. Ryan Murphy Says 'Pose' Could Have Never Happened Without Trans Talent Evan Real June 1, 2018 Ryan Murphy on 'Pose,' Hiring Transgender Talent | Hollywood Reporter -The Hollywood Reporter. Accessed August 6, 2018.
  3. 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. Jessica S. Quigley RN, DNP

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