Received: 28/10/2015 Accepted: 05/11/ 2015 Published: 12/11/ 2015
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Do you know a transgender person? Odds are you don’t. Only 16% of Americans say they personally know someone who is transgender . This personal disconnect fosters a knowledge gap and leaves popular culture as the main information source about the transgender population . Research suggests that transgender individuals face health disparities often linked with discrimination, social stigmas, and denial of civil and human rights . Historically, information about transgender persons has been learned from several unreliable sources that promoted stereotypes, rumors, and myths rather than factual information . Only recently do we see a slightly more positive depiction with the attention paid to Caitlyn Jenner and other transgender individuals on American television programs such as Orange is the New Black and Transparent. Many people – including nurses – have limited knowledge of, and experience in working with transgender individuals. Unfortunately, the health care needs of transgender individuals may be overlooked or undertreated due to gaps in knowledge about this unique population . It is imperative that nurses and other health care professionals are prepared to provide care for transgender individuals to eliminate health disparities among this population.
The U.S. Department of Health and Human Services’ Healthy People 2020 report identified a major healthcare discrepancy in the care and treatment of transgender individuals, a complex and widely-discriminated-against minority group . Health care providers’ lack of preparation in caring for transgender individuals contributes to the populations’ increased risk of violence, discrimination, harassment, and increased risks for substance abuse, STI/HIV exposure, suicidality, and poor medical management [2,3]. While improvements to insurance coverage and access to care contained in the United States Affordable Care Act and the currently proposed Health & Human Services regulatory changes are beneficial, the reality for many patients in far too many places is this: up to 71% of transgender patients have experienced discrimination from a health care provider [2,4,5,]; 50% had to teach their provider about transgender-related health matters; 19% were denied care because of their gender identity; and 28% postponed needed treatment out of fear of discrimination [6,7]. The Journal of Emergency Nursing recently published a case study reporting an unfavorable patient encounter of a transgender individual seeking care in an emergency department . The authors reported the intentional misgendering of the patient, refusing to use his preferred name and pronouns, and creating a generally unwelcoming environment for the patient by the emergency department staff; violating the Joint Commission’s guidance on providing proper care for transgender patients . Nurses have the opportunity to make a positive impact on the care provided to transgender patients by applying the following transgender-specific concepts (Table 1):
|Two Basic Concepts for Providing Care for Transgender Individuals|
|Honor the patient’s preferred gender identity, using pronouns and terminology based on patient preference or request.||A transgender patient may have traits or characteristics that do not conform to their gender identity. Keep in mind that their anatomy does not define them.|
|Strategies for Delivering Culturally Competent Care for Transgender Individuals|
|Do not assume gender identity based on appearance or voice||Ask patients their preferred name and pronoun|
|Ask patients how they identify themselves, to avoid making assumptions about their gender identity||Provide debriefing and education to other nurses about the transgender patient during shift handoff communications|
|Examine evidence-based literature about communication, treatment, and nursing care for transgender individuals||Ask clinically relevant questions|
Table 1: Basic and concepts and clinical strategies for integrating transgender-specific health care [10,11].
In the 21st century, nurses across all health care settings must provide culturally-competent, patient-centered care to ever more diverse patient populations. Consistent with the American Nurses Association’s Code of Ethics, nurses must engage in gaining knowledge of, and insight into the diverse patient populations we serve. Our educational institutions, both academic and clinical, must provide the opportunities for such learning. For transgender patients, there is much room for improvement. Only recently are transgender health issues being included nursing school curricula and current major nursing textbooks [3,12]. The lack of knowledge among health care providers about how to provide health care for this population is evident, contributing to poor patient outcomes . Fortunately, we have begun to acknowledge this problem and take the initial steps to address systemic limitations and promote strategies to provide welcoming, competent care to transgender patients.
Transgender health issues and factual information about the reality of transgender lives must be infused throughout nursing education [3,12]. Entry-level practice programs, advanced practice programs, and nursing staff education programs must include information aimed at closing a knowledge gap that is, arguably, harming our patients. Nurses can learn a great deal about transgender health directly from their transgender patients. Simple strategies like partnering with the community, teaching proper terminology and communication skills, and including transgender patients/exemplars in general learning scenarios and simulations can go a long way towards addressing the problem. Most importantly, the world is rapidly changing and it is imperative that our nursing education institutions stay abreast of these changed to meet the needs of our changing patient populations.