Transgender patient and a dilemma

[CBlover]

So my coworkers and I encountered a bit of a dilemma with a transgender pt. 16 y.o. born female transitioning to male. The pt preferred to be called he so I will refer to them as he. He was a 16 year old who definitely appeared as a female outside of a small amount of chin hair, male haircut and clothes. He was a psychiatric pt who needed a shower. We always send our pts to shower with a chaperone since we are not a psychiatric unit, we are an ER who holds overflows from time to time, and we don't have a shower on unit obviously. With females we send a female security staff member, with males we send a male staff member. We encountered a dilemma here. Obviously the pt was a minor first off. Then we all just looked at each other in confusion as to what gender to send as a chaperone. Do we send the male or the female security?? I mean for the pt's safety and the security staff safety, this was a tough call. The pt could have brought accusations against the staff untruthfully AND who knows anymore the security could have assaulted him! It's like what do you do?? What do yall think? Have yall encountered similar situations? I just feel like we in healthcare are going to be encountering things like this more and more and it could get a bit sticky.

[Kooky Korky, BSN, RN]

Send a male security escort. "He" wants to be treated like a male, so treat him like a male. End of discussion.

I tend to see it your way. But I would want to have inquired of the pt for his preference, although asking would possibly have gotten me in trouble for asking.

[LibraSunCNM, BSN, MSN, CNM]

I tend to see it your way. But I would want to have inquired of the pt for his preference, although asking would possibly have gotten me in trouble for asking.

Why would asking the patient their preference get you in trouble?

[klone, MSN, RN]

I tend to see it your way. But I would want to have inquired of the pt for his preference, although asking would possibly have gotten me in trouble for asking.

I think asking the patient his preference is the absolutely BEST way to handle the situation. Why would that get you in trouble?

[FolksBtrippin, BSN, RN]

The patient decides which gender. When you are concerned about potential allegations you have one staff member watch pt and one staff member watch the other staff member.

Easy. Next problem.

[JBudd, MSN]

He is a minor, so should have a parent or caregiver (if not with the family) there until admit to psych ward. That should cover it. All our minors have to be escorted by a responsible adult. You could even have waited on the shower until one was there.

[peachtreednurse, RN]

if bath area is private with patient accessible call in reach, sexual identity should not be of any significance; rather the psychiatric care risks and concerns..

Security * Actual police officers

[heron, ASN, RN]

Let's not oversimplify, here. A previous poster made a good point when he pointed out that, as a minor, the patient's parents have some legal standing here, too. I assume that, since the pt has already started transitioning, that his parents are at least somewhat supportive, but that's by no means a given. The goal is to provide care in a way that lets the pt feel emotionally safe, the parents are reasonably comfortable and staff are protected from unfounded accusations. Asking the patient what he prefers is a good starting point, but isn't the end of the discussion. Since the pt is in a short-term ED holding pattern, the safest most efficient solution seems to be 2 staff or staff plus a family member.

[broughden]

Strange how most posters assume the parents are involved in this child's life.

Where as, as a former police officer in NY, I naturally assume the transitioning, dirty (ie needs a shower), psych hold minor is most likely a run away and will refuse to tell the staff how to contact next of kin. Because in NY we saw this all the time.

[Daisy4RN]

Strange how most posters assume the parents are involved in this child's life.

Where as, as a former police officer in NY, I naturally assume the transitioning, dirty (ie needs a shower), psych hold minor is most likely a run away and will refuse to tell the staff how to contact next of kin. Because in NY we saw this all the time.

Good point! And if that is the case then you have a whole other set of problems, who is the legal guardian, find the parents, court appointed, what is the psych condition, can the patient make own decisions r/t psych issue, etc etc, ...just let him take a bed bath until transferred to psych where they hopefully are equipped to deal with this.

[CBlover, BSN, RN]

I think I'm going to with asking his mom to come along. She does support him and sometimes visits. He comes frequently for self mutilation and it's pitful actually. So I also agree that we may need to be extra careful even when we let him shower with the door closed. Lots of good points brought out here! thanks everyone

[Julius Seizure]

hmmmm

[Julius Seizure]

Send a male security escort. "He" wants to be treated like a male, so treat him like a male. End of discussion.

This is a relatively good answer. But without the quotations around "He".

Really though, is there a reason why staff can't just ask what gender he would prefer to be escorted by?

Ultimately, I suspect that one of the most important qualities in the person assigned to this young psychiatric patient's care, is not thinking of him as a "he" in quotation marks.