There is a growing recognition today among health care providers and researchers that patients’ transgenderism may become a factor in their care (Chapman, Watkins, Zappia, Nicol, & Shields, 2012). Therefore, it should be taken into consideration when organizing and managing the way care is provided. Nursing care plays a particularly significant role in this area because nursing care providers are responsible for a large portion of interactions and activities in which difficulties associated with patients’ transgenderism may be manifested. Three aspects of health care management for transgender patients can be approached: the understanding of stigma, the standards of care, and the education for care providers.
First of all, it should be acknowledged on the institutional level that transgender people experience stigma and discrimination, which affects health care services that they receive (Poteat, German, & Kerrigan, 2013). It has been confirmed that stigma and discrimination are causes of health disparities; moreover, stigma can be found to be incorporated in care thus affecting various aspects of treatment and deteriorating results. In the study conducted by Poteat et al. (2013), transgender people were interviewed on the subject of their relations with care providers, and the results showed that interviewees mostly expected that care providers would not be able to meet transgender patients’ needs due to uncertainty and ambivalence in the provider-patient relationship. Transgenderism is mostly eliminated from nursing care management considerations. The first step to addressing this problem is including transgenderism issues in guidelines for care.
A way to include these issues in guidelines for care is to create and encourage the adoption of standards of care for the addressed group of patients. Coleman et al. (2012) propose such standards, and the authors’ major point is that the care system should recognize the role of gender dysphoria, i.e. discomfort or distress caused by the difference between gender identity and assigned sex, which can be manifested in accepted gender role behaviors. The purpose of standards of care is to “help patients consider the full range of health services open to them, in accordance with their clinical needs and goals for gender expression” (Coleman et al., 2012, p. 165), which is why it is recommended to providers to employ these standards.
Finally, nursing management should also consider that the needs of transgender people should not only be recognized in actual clinical situations but also on the stage of educating health care providers. According to Poteat et al. (2013), care for transgender people are excluded from medical training ‘due to the social and institutional stigma against [them]” (p. 22). To address this problem, it has been suggested to design educational programs with a wider range of patient diversity considerations. A particular aspect proposed by Chapman et al. (2012) is eliminating “prejudicial attitudes among student health professionals [to] prevent discriminatory practices” (p. 938). It was found that attitudes among students are connected to their political and religious beliefs and personal experience, and proper education is argued to be the right way to address the existing prejudice.
In an attempt to organize better nursing health management for transgender patients, first of all, the role of social and institutional stigma should be recognized and understood. Second, care providers should adopt standards of care for transgender people. Finally, transgender patients’ needs should be explained in educational programs for future providers. Combined, these efforts are expected to ensure better care through adequate and comprehensive health management.
References
Chapman, R., Watkins, R., Zappia, T., Nicol, P., & Shields, L. (2012). Nursing and medical students’ attitude, knowledge and beliefs regarding lesbian, gay, bisexual and transgender parents seeking health care for their children. Journal of Clinical Nursing, 21(7), 938-945.
Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J.,…Monstrey, S. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people. International Journal of Transgenderism, 13(4), 165-232.
Poteat, T., German, D., & Kerrigan, D. (2013). Managing uncertainty: A grounded theory of stigma in transgender health care encounters. Social Science & Medicine, 84(1), 22-29.