Trans Patient

[Neo Soldier, BSN, RN]

We had a patient who wished to be identified as a female. She recently started hormone treatments and she looked female. She hadn't gotten the reassignment surgery. The day shift decided to let her sleep in the female room the entire shift without incident.

The night shift came in and asked that she stay in the general day room or the male room. This made the patient very upset.

This became an interesting discussion. We agreed she is male and so couldn't be in the female room. It would have been uncomfortable for the other women. But she couldn't be in the male room because she chose to identify as female and also looks like a woman; it wouldn't be safe anyway. This was in the emergency room where there were no assigned beds and the general area had pull out chairs that patients could sleep in.

The dilemma is, how would that work on a patient unit where women and men are separated?

[deza, MSN, NP]

In inpatient behavioral health we try our best to place males on one side of the unit and females on the other side. Usually if a patient identifies as LGBTQ ect. they get a blocked room. Each of our rooms have 2 beds. In the future I think each room will have one bed.

[pixierose, BSN, RN]

I don't blame her for being upset.

If the patient identifies as female, she is assigned to a woman's room. And vice versa.

It's not the business of the other patient.

We give the option for a private room.

This is our policy at the freestanding inpatient psychiatric hospital that I work at. It works very well, and we've had no issues. FWIW, I work on a 50+ year old plus unit and patients have been very tolerant. I say this because I'm sure this thread will bring out a lot of naysayers (they usually do); if our "Geri" psych patients are tolerant and open minded, we certainly can be.

[KelRN215, BSN, RN]

If the patient self-identifies as female she should be treated as female, regardless of whether or not she has a member. I don't understand why the presence of a transgender woman would make other women uncomfortable. Why would the other women even need to know that she's transgender? Are these women showering together?

[babyNP., APRN]

Where do you put people who are intersex?

[traumaRUs, MSN, APRN]

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[offlabel]

If the patient self-identifies as female she should be treated as female, regardless of whether or not she has a member. I don't understand why the presence of a transgender woman would make other women uncomfortable. Why would the other women even need to know that she's transgender? Are these women showering together?

I could see severe psychic trauma to a female room mate of a transgendered woman that began, for example, masturbating in front of her. The sexual trauma women bring to in patient psychiatric facilities is profound and risking exposure of a woman to another traumatic event in the interests of "accommodation" is unconscionable.

Get an empty room.

[cayenne06, MSN, CNM]

This became an interesting discussion. We agreed she is male and so couldn't be in the female room.

No no, she is a woman. She is not male. She belongs in the female section. There is NO reason for the status of her genitals to even be an issue here. Trans people are at HIGH risk of sexual assault and general discrimination/harrassment. Give her a private room if available, or a privacy curtain thing, for HER comfort- not the other patients.

I know psych is different than dealing with the general population, but her right to a safe and therapeutic environment is more important than catering to the patients who are uncomfortable with trans people. I mean jeez.

And anyway, that initial discomfort usually fades pretty darn quick, unless someone is transphobic. Trans people are just the same as everyone else.

[heron, ASN, RN]

I could see severe psychic trauma to a female room mate of a transgendered woman that began, for example, masturbating in front of her. The sexual trauma women bring to in patient psychiatric facilities is profound and risking exposure of a woman to another traumatic event in the interests of "accommodation" is unconscionable.

Get an empty room.

I agree, get an empty room.

Meanwhile, do I understand you to be saying that the trauma experienced by cis-gendered women is legitimate, whereas the experience of trans women is "trauma" that is merely "accommodated"?

[NuggetsHuman, BSN, RN]

I could see severe psychic trauma to a female room mate of a transgendered woman that began, for example, masturbating in front of her. The sexual trauma women bring to in patient psychiatric facilities is profound and risking exposure of a woman to another traumatic event in the interests of "accommodation" is unconscionable.

Get an empty room.

Wow.

The assumption that a transwoman would masturbate in front of a ciswoman is rife with inherent bias and, I hope you hear this kindly, a lot of ignorance about being trans.

Simply because someone is transgendered does NOT make them any more or less likely to have paraphilias or inappropriate sexual behavior.

Conversely, transfolk are at exceptionally high risk for violence done to them by others, both physical and sexual. To assume that only ciswomen are at risk of being traumatized by the POTENTIAL for a transwoman's inappropriate sexual behavior is to completely ignore that the transwoman is MORE likely to be at risk for psychological and emotional abuse, if not also physical harm, because your facility is treating her differently.

Please, please, please educate yourself more and get your manager to bring in quality training about supporting trans, nonbinary, and gender non-conforming individuals.

Psych hospitals need to be safe and accessible for ALL people.

[cayenne06, MSN, CNM]

I could see severe psychic trauma to a female room mate of a transgendered woman that began, for example, masturbating in front of her. The sexual trauma women bring to in patient psychiatric facilities is profound and risking exposure of a woman to another traumatic event in the interests of "accommodation" is unconscionable.

Get an empty room.

WHAT?! Why is this a trans-specific issue? WHY IN THE WORLD would a trans person be more likely to whip out their junk than anyone else?? Patients prone to sexual misconduct should be managed appropriately. I don't understand why you would single out trans people like that.

The sexual trauma TRANS women bring to in patient psychiatric facilities is profound, and risking exposure of a TRANSwoman to another traumatic event is unconscionable. Imagine how threatening it would feel for a trans woman to be the only female in a roomful of men.

Nothing wrong with a private room (on the women's unit), if available and desired by the patient- which it probably is. Who doesn't want a private room. But she can also just, you know, be treated the same as everyone else. Nobody has any business knowing what is or is not under her clothes- hopefully nobody is seeing anyone elses' genitals at ALL.

EDITED TO ADD: would your opinion be the same if this was a trans man? Would you place him on the female ward?

[deza, MSN, NP]

Offlabel never said that a trans woman is more likely to masturbate in front of someone. Offlabel only gave an example of what could be a bad situation. It is not the most unusual thing to see in psych anyway. Although I think a trans person is less likely to pull out their genitals.

In my state we cannot prevent male and female patients from socializing with the opposite sex, so we do not have male and female "wards".