Nursing Care for Transgender Patients: Tips and Resources
Ensuring inclusive and affirming healthcare environments is crucial for all patients, including transgender individuals. In this guide, discover how nurses can establish welcoming spaces and collaborate effectively with transgender patients.
Challenges in Healthcare for Transgender Patients
1. Transgender individuals and those with gender nonconforming identities often encounter obstacles and prejudice within healthcare settings. It is the responsibility of healthcare providers, including nurses, to cultivate an environment that is nonjudgmental and welcoming for every patient.
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2. Nurses play a significant role in creating a supportive atmosphere for transgender people. Many patients confide in nurses, perceiving them as more trustworthy than physicians. In fact, nursing has consistently ranked as the most honest and ethical profession in Gallup polls over the past two decades.
3. Numerous nurses aspire to provide comfort for all patients, including transgender and gender nonconforming individuals. However, for nurses with limited experience caring for this community, this endeavor can be challenging due to inadequate educational resources.
4. The goal of this guide is to enhance nurses’ understanding of the transgender and gender nonconforming community, address potential barriers they face in healthcare, and offer practical steps to effectively collaborate with these patients.
Barriers to Healthcare for Transgender Patients
1. For many transgender patients, healthcare can be an intimidating and sometimes inaccessible realm.
2. Transgender individuals are more likely to lack health insurance compared to cisgender patients (those whose gender identity matches the one assigned at birth). This limited access to healthcare is often due to high costs. A Kaiser Family Fund analysis revealed that 19% of transgender adults reported being uninsured, in contrast to 12% of cisgender individuals. Similarly, 19% of transgender adults reported encountering cost-related barriers to receiving care, while only 13% of cisgender adults faced such barriers.
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3. Emotional barriers also hinder access to healthcare for many transgender and gender nonconforming individuals. Ash Dasuqi, a midwife and critical care nurse, explains that healthcare providers often fail to respect or acknowledge their gender identity. Instances of misgendering (using incorrect pronouns) and misnaming can cause significant distress for these patients. Such communication mishaps can inadvertently expose transgender patients to potential harm by revealing their gender identity to family and friends.
4. Beyond emotional and financial challenges, outdated policies designed with heterosexual and cisgender patients in mind can also negatively impact transgender individuals’ healthcare experiences. These distressing encounters can lead to transgender patients postponing necessary medical appointments and procedures.
5. “Past negative experiences when seeking care can cause transgender patients to delay treatment,” states Desiree Díaz, Ph.D., an associate professor at the University of Central Florida’s College of Nursing.
Healthcare Bias and Discrimination
1. Healthcare providers often do not intentionally misgender patients or make them feel alienated. Rather, these issues stem from broader systemic problems. Some nurses and healthcare professionals may have been socialized or educated to hold biases against transgender or gender nonconforming individuals. This bias might manifest as reluctance to treat or support these patients.
2. Systemic issues within healthcare disproportionately affect transgender and gender nonconforming patients due to biases, stigmatization, and outdated policies. Even well-intentioned providers may lack the training required to adequately care for transgender patients.
3. Moreover, general hostility and discrimination can discourage transgender and gender nonconforming individuals from pursuing nursing careers, which would bring valuable lived experiences to the field. These systemic challenges have also resulted in a scarcity of research focusing on transgender patients in healthcare.
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4. Kristie Overstreet, Ph.D., a clinical sexologist, psychotherapist, and LGBTQIA+ healthcare expert, highlights that while many nurses and providers wish to provide affirming care, they often lack the organizational support needed for proper training.
5. Addressing these issues necessitates better education and training for healthcare professionals working with transgender and gender nonconforming patients. Another crucial step is acknowledging and actively mitigating biases to reduce their potential harm.
6. For instance, internal biases can lead to assumptions that result in mistakes regarding medical transitioning or conflating sex and gender. Some transgender individuals experience outright discrimination, with providers refusing treatment or using legal names that differ from their chosen names due to personal beliefs.
Creating a Supportive Environment
1. Once nurses become aware of their biases and deepen their understanding of transgender and gender nonconforming individuals, they can take meaningful steps to establish affirming healthcare spaces. Keep in mind that each person’s situation is unique, so consider these recommendations as general guidelines.
2. Respecting Body Privacy
3. Avoid asking invasive questions about a patient’s genitals, gender-affirming surgeries, hormone therapy, or other personal details related to medical or nonmedical transitions. If these details are pertinent to a patient’s care, approach the topic with care and sensitivity. Share this information only with relevant healthcare staff when medically necessary.
4. Patients should be informed in advance if sharing information about their bodies is required for medical treatment. “Healthcare staff should assume this information is very personal and should inform patients ahead of time when it will be necessary to share information about their body to other healthcare providers for the purpose of medical treatment,” says Dasuqi.
5. Sensitive Communication
6. When communicating with patients, use open-ended questions, being both direct and sensitive. For example, inquire about a person’s gender, but exercise care when discussing their sex. “More direct questions that are relevant are often more appropriate,” advises Dasuqi. She recommends questions like, “Can you provide more details about your symptoms and the kind of genitalia you have?”
7. When uncertain about a person’s gender, ask for clarification rather than making assumptions.
8. Pronoun Usage
9. Respect and use the pronouns that patients employ to refer to themselves and their partners. Patients may use he/him/his, she/her/hers, they/them/theirs, or other pronouns that reflect their identity. Introduce yourself with your own pronouns to create a comfortable environment for transgender and gender nonconforming patients.
10. Sensible Form Completion
11. Filling out forms that inquire about sex can be distressing for transgender and gender nonconforming patients. Nurses should be prepared to offer support and understanding in such situations. When verifying a patient’s identification, avoid asking about their “real” or given name. Instead, ask for the name on their insurance and confirm their date of birth and address. Continue addressing patients by the name they initially provided.
12. Update Intake Forms
13. Update patient intake forms to include options for transgender and gender nonconforming individuals. The National LGBT Health Education Center offers guidance and templates for this purpose.
14. Holistic Care
15. As Kristie Overstreet emphasizes, patients’ gender identities are just one aspect of their overall being. Provide care that considers their cultural, emotional, physical, and psychological dimensions. Desiree Díaz adds that cultural congruence is vital when caring for LGBTQ+ populations, stressing the importance of understanding the intersection between gender identity and cultural context.
16. Patient Advocacy
17. Speak out against colleagues who misgender patients or make transphobic remarks. Advocate for patients on matters like gender confirmation surgery and fertility treatments.
Essential Concepts and Terms
1. When interacting with LGBTQ+ individuals, including transgender patients, keep the following key terms and concepts in mind. This list, curated by Kristie Overstreet, offers a foundation for understanding, although terms may vary across communities and cultures.
2. Cisgender: Individuals whose gender identity aligns with the sex assigned at birth.
3. Transgender: Individuals whose gender identity differs from their sex assigned at birth.
4. Nonbinary: Individuals who don’t exclusively identify as male or female, embody a mix of genders, or have no gender; this identity defies gender norms.
5. Crossdresser: Individuals who wear clothing typically associated with a different gender.
6. Drag king or queen: Entertainers who perform with gender as part of their act (may or may not identify as transgender).
7. Agender or genderless: Individuals without a gender identity or expression (sometimes interchangeable with gender-neutral).
8. Genderqueer: Individuals who reject the gender binary and don’t identify within it.
9. Bigender: Individuals who possess two gender identities or expressions, either simultaneously, at different times, or in different contexts.
10. Intersex: A broad term encompassing individuals born with sexual characteristics that don’t conform to binary male or female bodies.
11. Lesbian: A female individual of any gender identity who is romantically, emotionally, or sexually attracted to other females.
12. Gay: A person emotionally, romantically, or sexually attracted to individuals of the same gender identity or expression (e.g., a gay male).
13. Bisexual: Individuals emotionally, romantically, or sexually attracted to multiple genders.
14. Queer: A multifaceted term that encompasses sexual and gender identities other than heterosexual and cisgender.
15. Asexual: Individuals lacking sexual attraction or desire for others (may experience romantic attraction).
16. Pansexual: Individuals capable of emotional, romantic, or sexual attraction to individuals of any gender identity or expression.
17. Gender Dysphoria: Emotional distress arising from the incongruity between a person’s gender identity and the sex assigned at birth.
Promoting Equitable and Affirming Care in Nursing
1. According to Desiree Díaz, the foundation of equitable healthcare is to provide safe care for everyone, regardless of sexual orientation, gender preference, or identity. Ensuring equity in healthcare involves creating a safe and nonthreatening environment for all patients, including transgender individuals. The ultimate aim, as Ash Dasuqi points out, is to establish a healthcare system where transgender patients are treated without the need for special considerations.
2. The goal is to shift societal systems and norms to recognize and embrace the transgender and gender nonconforming experience as part of the norm, rather than viewing it as an exception. This transformation is essential to fostering true inclusivity in healthcare.
Resources for Nurses
1. National LGBTQIA+ Health Education Center
Providing Affirmative Care for Patients with Non-binary Gender Identities is a comprehensive guide by the National LGBTQIA+ Health Education Center. This resource offers practical advice for healthcare professionals on providing care for nonbinary patients. It includes insights into understanding nonbinary gender identities, using correct names and pronouns, and features scenarios for healthcare practitioners to learn how to interact with patients in an affirming manner.
2. Centers for Disease Control and Prevention
Patient-Centered Care for Transgender People: Recommended Practices for Health Care Settings, published by the CDC, serves as an online resource to help healthcare workers understand the healthcare needs of transgender individuals. This guide addresses issues like stigma, discrimination, and barriers to care, and provides patient-centered strategies for healthcare. It also identifies outdated or offensive terms to avoid.
3. National Clinician Consultation Center
This center offers expert materials and consultation specifically related to HIV/AIDS and conditions such as hepatitis C. Healthcare professionals seeking clinical consultation or education on these topics can access the center’s resources at no charge. The center also provides easy-to-access clinical resources online.
4. University of California, San Francisco – Transgender Care
UCSF Transgender is a division of the UCSF Medical Center comprising experts in transgender medicine. Their Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People provides advice on creating safe and welcoming spaces for these individuals. The guide also delves into topics like hormone therapy, managing menses in transgender men, and fertility options for transgender individuals. These guidelines are thoroughly researched and available online for free.
5. GLMA – Health Professionals Advancing LGBTQ Equality
GLMA’s mission centers on ensuring health equity for LGBTQ+ individuals and promoting equality for LGBTQ+ healthcare professionals. The organization offers multiple transgender health resources, including information about transgender individuals’ health, guidelines, and learning modules for healthcare providers.
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