As a nurse working in a hospital or clinic, it’s part of their bedside manner to want the patient to feel as comfortable as possible and to respect their decisions. Nurses don't want to miss a beat when caring for their patients. Learn what things to consider and how to avoid common misunderstandings with transgender patients.
The goal is to provide the best care while being sensitive and respectful to all patients. in an interview with MedPage Today, Jennifer Flynn, CPHRM, risk manager with the Nurses Service Organization (NSO), talked in great detail about how to proceed when presented with transgender patients. The following tips and pointers were taken from her interview:
When it comes to treating transgender or genderqueer individuals, the most important part is determining whether they are, in fact, transgender. After all, transgender is not a choice; people are born in the wrong body and they undergo surgery to correct the mistake that nature made. Transgender patients seldom go around exclaiming that they are transgender, just like regular men or women go around screaming they are male or female. Luckily, depending on the role of the nurse, it may not even be necessary to know the patient’s gender.
For instance, if the patient is being treated for an upper respiratory issue, there isn't a need to know their gender, or much less, to conduct an examination of their genitals. In the patient’s sheet, the nurse can frequently find the patient’s gender, as well as their preferred name.
However, the information in their healthcare record could be incomplete or out of date, especially if the patient made the decision to transition recently. If this is the case, and the nurse is unsure of how to refer to a patient’s gender or name, or their preference in how they wish to be addressed, it is not considered impolite to ask how they like to be called or referred to. A nurse can always ask something along the lines of “How do you prefer to be addressed?”, or “What is your preferred name?”
In order to maintain a good patient-nurse relationship, it’s very important to never make assumptions about the patient, whether about their beliefs, gender, identity, sexual orientation, or any other concerns that they may have. The interest in their preferred ways to be addressed usually helps to establish a positive rapport with the patient and to create a healthy relationship to ensure the proper fulfillment of their treatment.
Another important point when treating transgender patients is to find out the actual gender that they identify as, as well as the pronouns they prefer to be used when referring to them. In an ideal situation, the patient should have two important fields in their patient intake and registration forms. The first is the gender that the patient was assigned at birth, and the second is the patient’s current gender at the moment of ingress. However, while patients may have many answers to these questions, it is of vital importance that they answer truthfully, as this will allow the healthcare center to dispense the best possible service for the patient.
By asking questions in their registration forms about things like gender identity and sexual orientation communicates to patients that the center has an interest in providing the best care for their needs, and to recognize them for how they see themselves and not for how others might want them to be. In the spirit of maintaining a positive relationship, the patient’s name, current gender, and preferred pronouns must be properly documented in their paperwork. This paperwork must be kept alongside their healthcare records, which is protected under the Health Insurance Portability and Accountability Act (HIPAA) privacy laws.
The information contained in this paperwork must never be disclosed to non-essential personnel, and must only be shared on a need-to-know basis. In other words, if the person is not vital to the patient’s care, then the nurse must use discretion and refrain from revealing information to them. For the sake of transparency, the patient must always be kept apprised of the people who are aware of their current condition.
In terms of treating genderqueer or transgender patients, the same level of care and standards of quality must be dispensed, without discrimination. The only difference with gender-specific patients is in the pronouns that must be used to refer to them, even if the patient decides to abide by the non-gender-specific pronoun “they.”
According to Flynn, the biggest challenges of treating transgender and gender-nonconforming people don’t come from dispensing treatment at all. Instead, these individuals usually suffer complications when they refrain from seeking treatment for their conditions, due to the fear of being discriminated against, humiliated, or misunderstood. Other important issues that arise when treating these patients revolve around mental health concerns, such as depression, anxiety, substance abuse, and gender dysphoria, among others, all of which can be caused by the distress from being transgender.
Sexual health history is also an issue for these patients; it must never be assumed that they partake in heterosexual relationships according to their current gender, and the topic of contraception must always be approached with caution. The nurse must always focus on behaviors and associated risks of any active sexuality, like STIs and HIV.
Lastly, transgender individuals have been known to suffer more from violence and victimization than gender-specific or gender-conforming patients. Healthcare specialists must always screen their patients for these issues, as well as dispense the appropriate health screenings for both their birth and current genders, such as mammograms, Pap smears, and prostate cancer screenings, among others.
As a registered nurse working in both private and public health centers, it is of utmost importance that they remain culturally sensitive to all types of patients. Regardless of their differences, a nurse must always remain respectful of diversity and administer appropriate care to the patient. The first step will always be to remain aware of any potential bias that may interfere with the provisioning of quality care. In order to improve their bedside manner, especially when treating patients in a culturally sensitive manner, nurses are encouraged to expand their knowledge about sexual identity and orientation.
They are also encouraged to communicate efficiently with transgender patients and to research on what the terms mean. Lastly, they must also strive to create a welcoming environment for all patients, regardless of gender-conforming, non-gender-conforming, or transgender status. To this end, the nurse must always use gender-neutral and inclusive language, as well as convey proper respect at all times.