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The Role of Nurses in Overcoming Health Disparities and Barriers to Healthcare for Transgender Individuals

Transgender individuals often face numerous barriers to receiving quality, affirmative healthcare. They need care that fully recognizes and acknowledges their journey to live the healthiest possible life. While overcoming health disparities and barriers is a substantial undertaking that involves systemic changes, there are small steps that nurses can take each day to address discriminatory behavior toward transgender individuals.

The following are specific action items that healthcare professionals, particularly nurse educators, who want to make a more inclusive healthcare environment for transgender people:

#1: Identify and explore implicit bias

Often nurses do not intentionally or maliciously make transgender patients feel alienated. Instead, the problem stems from broader “implicit bias” and unintentional actions or language that are harmful to transgender people. An implicit bias is an “attitude or stereotype that affect[s] our understanding, actions, and decisions in an unconscious manner.” This bias often stems from societal and environmental beliefs that transgender people are wrong, and many people have limited exposure to transgender people, limiting their knowledge about the subject. As a result, nurses may unconsciously treat trans patients differently.

Being aware of your background and potential implicit bias is the first step toward providing inclusive care. Consider participating in implicit bias training to learn how your biases might be impacting patient care. Seek out resources to better understand healthcare problems that trans people face and how you can adjust your perspective and language to make them feel accepted.

Action for Nurse Educators. Help nurses self-assess when they feel uncomfortable, anxious or fearful in caring for transgender patients and find available resources to address unconscious prejudice.

#2: Make a note of the patient’s pronouns and preferred name

Transgender people can feel disrespected or devalued when someone assumes their gender. One way to establish a therapeutic nursing relationship is to avoid “misgendering” or assuming someone else’s gender. First, ask patients their preferred pronouns and name. Data shows that one in four transgender youth uses pronouns or pronoun combinations that fall outside of the binary construction of gender. Also, inquire about partner relationships with a question like, “How would your partner identify themselves in terms of gender?”

Action for Nurse Educators. Role model for nurses how to introduce themselves with their pronouns to help transgender patients feel more comfortable. For example, they can say, “Hi, my name is Kate, and my pronouns are she/her. How may I refer to you?”

#3: Communicate directly with patients using open-ended questions

Open-ended questions and conversations are essential for good communication, especially when talking to transgender patients about gender and sexual anatomical parts. Examples might include:

  • “Do you have preferred terms to refer to your sexual parts?” or
  • “Tell me about any hormone therapy now or in the past or surgical procedures.”

Not all transgender patients use exact words or names to talk about their bodies. Being direct is vital for effective communications. Be aware that these questions may trigger extreme discomfort or body dysmorphia (their bodies do not always reflect their self-image) in patients, and try to remain empathetic.

Action for Nurse Educators. Practice open-communication language and discuss how best to communicate with transgender patients considering how it might impact their mental health.

#4: Be sensitive to issues involving transgender minors

Relationships and communication between a guardian and a transgender minor can be tricky. Consider the following situation.

Your 16-year-old patient identifies as FTM (female to male), but his mom believes it is just a phase. How would you approach this as a nurse? Will you respect the patient’s pronouns or side with the parent, who is legally in charge?

This disparity can cause conflict for giving your patient the care he needs. Anticipate these situations by identifying multidisciplinary team experts and creating guidelines for handling similar cases.

Action for Nurse Educators. Create challenging care scenarios for nurses to discuss as a group, like ethical case study discussions. Develop a list of resources for the care of a transgender minor, especially when they do not have supportive guardians.

#5: Open a dialogue with administrators and leaders

Many employers and organizations are ensuring inclusivity for all, including gender identity. Show your support for these initiatives by joining committees, sharing your feedback with leadership and being enthusiastic about cultural competent sensitivity training. Look for resources about transgender terminology, potential cultural conflicts, handling difficult situations and care disparity. Be aware of the care disparities in transgender patients, such as higher substance abuse rates and mental health issues. For example, one study that polled transgender participants found that more than half of transgender male teens and 30% of female transgender teens have attempted suicide in their lifetime.

Action for Nurse Educators. Suggest topics for sensitivity training and offer to coordinate or create education for all employees.

Every transgender patient’s journey will be different; some may choose gender affirmation procedures or hormones, while others may not. Nurses need education and training on letting the patient guide the conversations and language, and nurses should work to recognize implicit bias and implement measures to overcome prejudices. Nurse educators have a critical role in educating student nurses and practicing nurses to help overcome barriers to ensure that trans individuals receive the highest quality, gender-affirming care.

Learn about The University of Texas at Arlington’s online Master of Science in Nursing (MSN) Nursing Education program.

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