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Nursing Attitudes toward Trans and Gender-Nonconforming Pediatric Patients

PICO Question

The improved cultural competence is essential to the improvement of nursing knowledge and attitudes on the transgender population. Nursing knowledge has guided nurses to interact with trans patients in multiple settings such as inpatient, outpatient, medical, and surgical. The PICO question developed for this evidence-based research aims to identify the trends in competent and culturally sensitive health care for transgender pediatric patients.

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The PICO question is as follows: Does nursing knowledge and attitudes toward trans and gender-nonconforming pediatric patients improve cultural competence and healthcare disparities?

Problem Background

Transgender describes people whose gender identity differs from the one assigned to them at birth. Gender nonconforming and transgender mainly encompass other terms like transsexual, genderqueer, crossdresser, and femme queen. Generally, children are designed a gender at birth depending on genital chromosomes. For most infants, there is a correlation between gender identity and designation. However, in some cases, the gender identity fails to correlate with the one that is designed. Such children are referred to as gender-diverse or transgender.

Transgender children and adolescents experience more challenges than adults because they depend on the parents care and financial support, which can be inadequate. According to Rafferty et al. (2018), most doctors become reluctant to provide medical care to such children. Based on experts broad consensus, appropriate care for transgender children may entail social transition, mental healthcare, and puberty blockers. Children and families identified as transgender have also been presenting themselves to pediatric providers to seek care, education, and referrals. Traditionally, the group has been treated as underserving, posing multiple health challenges and disparities. There has been a growing need for formal training and standardized therapy for such a population.

The transgender youth require a high degree of family acceptance. According to Cantor (2020), many cases reported on the juvenile justice system involve family abuse and rejection of transgender youth. Parents are expected to be supportive and readily aid their children through the transition period. The parent should seek gender affirmative doctors and counselors and connect them with their children. Based on Rafferty et al. (2018), many parents have joined organizations such as PLFAG, advocating for children’s rights. They should as well, develop positive reaction towards their transgender children. Cantor (2020) indicated that familial support towards transgender youth results in positive and desirable emotional, mental, and physical health outcomes. They inform supportive individuals and professionals like doctors to create and develop a support network for transgender children and adolescents because family acceptance and support results in increased self-esteem and general health status for such youth.

Collins, C. A. (2020). Pediatric nurse practitioners’ attitudes/beliefs and knowledge/perceived competence in caring for transgender and gender‐nonconforming youth. Journal for Specialists in Pediatric Nursing, 26(2), 1-7.

The study design selected was Non-experimental.

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The study is a cross-sectional descriptive study with a sample of 93 participants (pediatric nurse practitioners [PNPs]). Several Instruments for data collection were used in this study. The first one was the transgender attitudes and beliefs scale (TABS), which is “a 29‐item survey which aims to determine the attitudes and beliefs about people who are transgender” (Collins, 2020, p. 3) The second instrument was developed by the author and he named it transgender competence and knowledge survey (TRACKS). This instrument’s objective is to assess the level of knowledge and perceived competence among participants when taking care of transgender children. The sample used in this study was selected through non-probability sampling. The researcher used a convenience sample of PNPs drawn from eight states in the US.

Lindsay, S., Kolne, K., & Rezai, M. (2020). Challenges with providing gender-sensitive care: Exploring experiences within pediatric rehabilitation hospital. Disability and Rehabilitation, 1–9.

The study design was non-experimental qualitative study that was aimed to identify the challenges experienced by pediatric health practitioners when delivering gender-sensitive care. The methodology used for the study was needs assessment applying thematic analysis. The data were collected from the participants using the method of interview. With the help of purposive sampling, 23 pediatric rehabilitation healthcare providers were recruited. The results of the study indicated the persistence of gender stereotypes, complexity of gender identity, and the lack of proper training for health care professionals to meet the needs of pediatric patients.

Qureshi, R., Zha, P., & Porter, S. (2020). An assessment of lesbian, gay, bisexual, and transgender health competencies among bachelors-prepared registered nurses in graduate-level study. Academic Medicine, 95(12), 113-120.

The study used a quantitative cross-sectional design to identify the level of nurses’ health competencies when providing care to LGBT patients. Using survey to collect data from participants, answers were analyzed with the help of descriptive method to asses competencies. 116 registered nurses were sampled for participation. The study found that cultural and gender competencies of the majority of participants were limited with insufficient knowledge of prevalent conditions, health determinants, and gender-specific care.

Rider, G. N., McMorris, B. J., Gower, A. L., Coleman, E., Brown, C., & Eisenberg, M. E. (2019). Perspectives from nurses and physicians on training needs and comfort working with transgender and gender-diverse youth. Journal of Pediatric Health Care, 33(4), 379-385.

The study design used in the research was qualitative design. The method of thematic analysis was used to identify most common beliefs of nurses and physicians regarding the comfort of their work with transgender and gender-diverse adolescents. Data were collected with the help of semi-structured interviews conducted with purposively recruited sample of 14 nurses and physicians working with adolescents. The study results demonstrated that participants lacked specific training and resources and experienced discomfort providing care to transgender adolescents due to diminished skills.

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Traister, T. (2020). Improving LGBTQ cultural competence of RNs through education. The Journal of Continuing Education in Nursing, 51(8), 359-366.

The study used a mixed design, integrating both qualitative and quantitative approaches to measure the level of improvement of RN’s cultural competence in delivery of care to LGBT patients after training intervention. Pre- and post-intervention tests were conducted to collect data from the participants. The effectiveness of the educational intervention and the improvement of nurses’ knowledge were measured. Statistically significant results were obtained, indicating positive impact of training. Nurses demonstrated an increased demand for specialized LGBT cultural training for nursing practice.

Article with Best Solution

The article by Collins (2020) is the study that provides the best solution and helps answer the PICO question. Firstly, the research focuses on knowledge, attitude, and beliefs of nurses and other healthcare practitioners in the context of professional training. It provides evidence identifying the lack of proper transgender-specific education and establishes the need for improved awareness among specialists and families. Therefore, the article helps to answer the PICO question by stating that nursing knowledge and attitudes toward trans and gender-nonconforming pediatric patients improve cultural competence and healthcare disparities.

Implications for Nursing Practice

The answer to the PICO question and the reviewed literature might be a valuable contribution to nursing practice in the context of providing care to transgender youth. Firstly, the information might be used as the basis for the development of training programs for improved gender and cultural competencies of nurses working with transgender youth. Secondly, the data might be applied for raising public awareness about challenges of transgender pediatric patients. Finally, it might serve as a basis for the initiation and implementation of protocols for proper provision of care to transgender patients.

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