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March 16, 2017

Nursing Care For Transgender Patients

Laverne Cox. Caitlyn Jenner. Amazon’s series Transparent.

Transgender issues are becoming more visible in pop culture, and in real life and healthcare, too.

The New York Times reported that the number of people who identify as transgender has doubled since 2011.

Those numbers are already showing up in healthcare facilities nationwide.

So don’t be surprised if a transgender male seeks an appointment for his annual pap smear. 

As healthcare providers, a recent challenge is providing equal and unbiased care to transgender patients.

Historically, that hasn’t happened.

As a nurse, how will you handle your next patient’s mammogram if she was born a man?

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The Transgender Dilemma 

Transgender patients often avoid care.

The fear of discrimination, lower quality of care, and lack of insurance access can be paralyzing. 

Just entering your doors takes courage. 

Ask yourself how you could reward that courage with an open and nonjudgmental attitude.

Act like you’ve been here before, even if you haven’t. Make the patient believe this is an everyday occurrence for you and nothing to be ashamed about. 

We go more in-depth in a recent article about caring for LGBTQ individuals. But first and foremost, remember that:

1. The transgender patient is a person with a health concern. 

2. Our job as nursing professionals is to provide equitable care 

Nurses who are firmly grounded in these two tenets are on their way to providing quality care for these patients.

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Create a Supportive Environment

To a transgender patient, how they identify is more important than their sexual equipment. 

Use the pronoun the person prefers. He or she: know which one s/he prefers before using one.

If all else fails, “you” and “your” work great. 

On that subject, ask the patient the name s/he prefers. A patient’s legal name may be Michael, but she prefers Debra. 

But verbal language is not the only kind of communication.

Does the healthcare space offer symbols of inclusivity? A rainbow flag or poster about World AIDS Day can go a long way. 

Ensure that forms cater to transgender individuals. There should be a section for preferred name, sexual orientation, gender identity, and “partner” information.

Rework assessment questions with hetero-preferential word choices. Even LGBTQ members on your team can set the stage for open interaction.

Need more advice? Read 10 Tips For Caring for LGBTQ Patients.

Setting the Pace for Self-Disclosure: Let the Transgender Patient Lead

The transgender patient may be slow to reveal much about themselves. Negative experiences can do that to a person.

Cultivate patience. Over time, the individual will feel assured that the environment is safe for self-disclosure.

Gender Transitions Happen Slowly 

Transgender identity is a process. Individuals may fall at different points along the transition spectrum. 

A transgender man is a person assigned female at birth but who identifies as male. A transgender male patient may have taken hormones and/or had breast reduction surgery, but may or may not have female genitalia. 

A transgender woman is a person assigned male at birth but who identifies as female. A transgender woman may have a female voice and breasts, and also the male genitalia that genetics gave her. 

Don’t assume she will use a bedpan. Instead, ask “Is there anything else you need for your physical comfort?

Put Yourself In His High Heels

Transgender individuals often avoid or postpone preventive screenings.

Many can’t endure the thought of a repeat of a past experience. And, some fear the looks when others assess that they are walking into the “wrong” type of clinic.

A transgender male may be stressed by having to sit in a mammography waiting room with women. 

He has a right to be there, though. His residual female breast tissue warrants a mammogram.  

Likewise, a transgender woman still has a prostate needing an annual check. 

Nonetheless, quality care includes good information to help patients protect their health and life through early screening and detection.

Get familiar with recommended screenings for transgender men and women. Be ready with the correct information and protocol. 

Don’t act surprised or flustered. This heightens tension and can shut down any chances you had at having an open discussion.  

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Tap Your Community For Help

Consult with your organization’s social work or patient navigation department. Familiarize yourself with local and national community resources.  

But don’t just rely on organizations. Ask your nurse friends from other units or facilities about their most awkward situations and how they handled them.

Their triumphs and mistakes can make your next encounter with a transgender patient a smooth one. 

Beyond that, stay abreast of health concerns and risks. Know the appropriate terminology, and any additions to the LGBTQ spectrum. People are not defined by acronyms.

Lastly, don’t be afraid to ask the tough, awkward questions in a non-judgmental fashion. 

  • Can you give information about your sexual preferences?
  • With whom are a few of your supportive relationships?
  • Are you engaged in high-risk behaviors?
  • Anything else I should know that could impact your health?

Sensitivity is key when administering care to your transgender patient. But, don’t shy away from  relevant information that can protect and prolong his or her health. 

Your patient will thank you in the long run, and so will his or her loved ones.

Next Up: Guaranteed Moments of Happiness In Hospital Corridors

Sources:

1. Judge rules doctors can refuse trans patients and women who have had abortions. Marie Solis, Mic.com. mic.com/articles/164234/judge-rules-doctors-can-refuse-trans-patients-and-women-who-have-had-abortions (accessed March 3, 2017).

2. Estimate of US Transgender Population Doubles to 1.4 Million Adults. Jan Hoffman, New York Times. www.nytimes.com/2016/07/01/health/transgender-population.html?_r=0 (accessed March 3, 2017).

3. About LGBT Health. Centers for Disease Control and Prevention, www.cdc.gov/lgbthealth/about.htm (accessed February 11, 2017)

4. Gay and Lesbian Medical Association. Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients. www.outforhealth.org/files/all/glma_guidelines_providers.pdf (accessed February 11, 2017)

5. Gay and lesbian Medical Association. Ten Things Transgender Persons Should Discuss with Their Healthcare Care Provider. www.glma.org/index.cfm?fuseaction=Page.viewPage&pageID=692 (accessed February 11, 2017).

6. Green J, et al. Lesbian, Gay, Bisexual, and Transgender Health Disparities, and President Obama’s Commitment for Change in Health Care. Race, Gender & Class: Vol. 17 No. 3-4, 2010 (272-287).

7. More Than Pink: LGBTQ Breast Health – LGBTQ Health Care Experiences in Western Washington. Susan G. Komen, Puget Sound: http://komenpugetsound.org/wp-content/uploads/2016/11/More-Than-Pink-LGBTQ-Breast-Health_web.pdf (accessed February 11, 2017)

8. The Joint Commission. Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community – A Field Guide. 2011. www.jointcommission.org/assets/1/18/LGBTFieldGuide.pdf (accessed February 11, 2017)

9. Women’sHealth.gov: www.womenshealth.gov/publications/our-publications/fact-sheet/lesbian-bisexual-health.html (accessed February 11, 2017).

 

 

 

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