Transgender patient and a dilemma

Nurses General Nursing

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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.

From your article:

Any doctor who works with transgender children will absolutely know the difference between a "tomboy" and someone who has gender dysphoria.

And I would be willing to bet that most parents would be more likely to label their transgender child a tomboy rather than the other way around. Very few parents are quick to embrace the concept of their child being transgender.

Gender nonconformity is being conflated with gender dysphoria though.

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Specializes in Travel, Home Health, Med-Surg.
From your article:

Any doctor who works with transgender children will absolutely know the difference between a "tomboy" and someone who has gender dysphoria.

And I would be willing to bet that most parents would be more likely to label their transgender child a tomboy rather than the other way around. Very few parents are quick to embrace the concept of their child being transgender.

I agree with this!! M.D. and parents will work it out best for the child. Many of us have played as children in nontraditional ways, girls climbing trees etc. That alone doest make a diagnosis.

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I think a question to really think about is how many people get hurt when you treat people with respect and dignity by using the preferred pronouns and names of a transgender individual? And if people are getting hurt by using someone's preferred pronouns and gender, what is going on with that person that dignity causes them pain? In all honesty it should not cause anyone actual lasting pain to use a set of pronouns and a name, it can however cause damage by refusing to treat someone with dignity by using them. Your posts here are basically trying to rationalize your idea that its ok to treat people like dirt because you don't agree with their choices.

Who's it hurting you ask?

Dr. Jordan Peterson was affected by Bill C16 which is a new law in Canada that will get you a fine if you misgender someone even by accident.

I do not in any way try to justify treating people like dirt.

I suggest you go back and reread my posts.

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This thread is about how to properly and respectfully interface with transgender individuals in the course of nursing care, whether it be in the ER or on a general med surg floor or anywhere else where a nurse might incidentally come into contact with a transgender patient. It is not our role to attempt to convert the patient to our own beliefs about this issue. It's not our place to inform them that they are delusional and that we are not going to enable their delusions. It is not our place to refuse to use their requested pronouns. It is not our responsibility to engage in therapy or counseling or any such treatment of their disorder when they are getting their appendix out or have presented to the ER in psychological distress.

Treatment of transgender patients with hormone blockers or surgery is not the subject of this thread. Most of us here are RNs or LPNs and do not have the education or the expertise to address the appropriateness of these treatments, certainly as it relates to what we say to our patients and families. Research is still ongoing and these treatments are still controversial even among the "experts"-most of whom are not nurses.

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Guiding Families of Transgender Children

As with any patient who is in our care it is important to treat them in a caring and respectful manner no matter how you feel personally. As healthcare professionals it is indeed what we signed up for. There are mixed opinions on how to "treat" these individuals. If adults, then up to that individual adult, if a child then obviously more care is needed because biologically their brain is not complete so you would have concerns before doing any surgery etc. Either way, we as healthcare professionals, do not have to like, understand, agree with etc. We just need to be our caring selves while providing nonjudgemental care to all patients.

It's not a matter of how I feel. I'm simply questioning the approach on the subject. Are we not taught as health care providers to not play along with a patient's delusions? That is where I am coming from. And it seems that playing along with their delusions violates the ethic of "Do No Harm"

Dr. Leonard Sax in this interview voices his concerns over it.

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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.

You might want to reach out to Mount Sinai here in NYC to see if they can offer any insight. Over the past several years they've developed an extensive dedicated transgender healthcare service (IIRC the only one in NYC).

https://www.mountsinai.org/locations/center-transgender-medicine-surgery

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This thread is about how to properly and respectfully interface with transgender individuals in the course of nursing care, whether it be in the ER or on a general med surg floor or anywhere else where a nurse might incidentally come into contact with a transgender patient. It is not our role to attempt to convert the patient to our own beliefs about this issue. It's not our place to inform them that they are delusional and that we are not going to enable their delusions. It is not our place to refuse to use their requested pronouns. It is not our responsibility to engage in therapy or counseling or any such treatment of their disorder when they are getting their appendix out or have presented to the ER in psychological distress.

Treatment of transgender patients with hormone blockers or surgery is not the subject of this thread. Most of us here are RNs or LPNs and do not have the education or the expertise to address the appropriateness of these treatments, certainly as it relates to what we say to our patients and families. Research is still ongoing and these treatments are still controversial even among the "experts"-most of whom are not nurses.

Like Dr. Leonard Sax? He's against it the ideology that is transgenderism and he is certainly NOT a nurse!

Nobody is trying to convert the patient into someone else's beliefs.

Nobody said to inform them that they were delusional.

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Like Dr. Leonard Sax? He's against it the ideology that is transgenderism and he is certainly NOT a nurse!

Nobody is trying to convert the patient into someone else's beliefs.

Nobody said to inform them that they were delusional.

Great. You found one bigoted practitioner to support your position.

No one is confusing transgenderism with being a tomboy or tomgirl, its a false flag argument to delegitimize people.

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Specializes in Critical Care and ED.

The thing is darabow, that I'm just going to reject and dismiss all your resulting posts after your first one, because your first one says everything about you that I need to know. It was a thinly disguised and barely concealed message of intolerance and discrimination and explains every word you've written since. You can window dress it how you like, but it's painfully obvious that you're just searching for, and trying to hide behind, "science" in order to support your distasteful beliefs. Your sentence "...was really a man in drag which is what they call 'transitioning' now" gave the game away and no amount of backpedaling can make me believe that you have any kind of science to back up your assumptions. You let it slip there, buddy.

You see, I've met a thousand like you, and they all have the same modus operandi. Having dealt with bigots like you for all of my life, I can read you like a book. I suggest you find another career and never go near another patient again. You are a disgrace to the profession.

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Specializes in PMH.

I don't believe the DSM offers recommendations on treatment of disorders. The Diagnostic and Statistical Manual of Mental Disorders (DSM) offers a common language and standard criteria for the classification of mental disorders.

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Most definitely ask the patient his preference. He's 16, not a child. I'm surprised this was a dilemma. I'm curious, has this unit never had a trans person on it before?

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This is a propagation of illness. They should be treated as the Sex and Gender they were born as.

I worked at a Mental house and we had a trans client who claimed to be a woman (but was really a man in drag which is what they call 'transitioning' now).

He was bunked with the guys and not the women.

You have absolutely no business being in health care. Aside from your obvious pride in telegraphing your ignorance about the matters of human sexuality, gender and psychology, your language (using retarded as a pejorative) and gleeful insistence in using terms that are outdated, discriminatory and offensive reveals you to be ill suited to working with the public at large. I suspect you'll find you'll have a very volatile, short lived career in health care. Your "beliefs" fly in the face of science and you will be frustrated unable to reconcile your beliefs with reality. If you do stay in health care, do yourself and everyone you may be in a position to harm a favor, and keep your ignorance to yourself.

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