In recognition of Pride Month – Affirming and Inclusive Care of Transgender Patients

Recently, my 11-year-old son and I visited an Urgent Care about what I suspected was a urinary tract infection. The doctor asked my son basic questions related to his symptoms, including something about pain in his testicles. My son looked at me quizzically and I explained to the doctor that my son doesn't have testicles. He's transgender, born with female anatomy. To my great relief, the doctor nodded his acknowledgment and continued the conversation. My son, too, breathed a sigh of relief. We'd gotten through the tricky part. 

 Transgender people of all ages find medical visits of any kind stressful, so much so that 48% avoid regular care. Doctors, nurses, and other staff are often uncomfortable or don't know how to treat patients who identify as a gender different from the one assigned at birth based on a physical inspection of their anatomies. The potential anxiety, shame, fear, and indignity that trans patients can experience with well-meaning but uneducated or biased healthcare workers can actually be traumatizing – thus they avoid them. My family has been lucky, as my son transitioned at a very young age and I have been able to mostly shield him from embarrassing, uncomfortable, or painful situations. But I know many gender nonconforming (GNC) and transgender people who have not been so fortunate, and I'm grateful that there are so many nurses who want to do their very best for these patients.

How can you ensure that your trans and GNC patients don't experience trauma in your care? As a mother and advocate, I offer some ideas.

First and foremost, check your biases at the door. Personal beliefs about gender identity should never come into the treatment room, and if you are unable to treat every patient with respect and kindness regardless of their identity, please excuse yourself. The damage that can be done emotionally to a trans or non-binary patient by a biased caregiver is incalculable. You may be the last medical professional that patient sees if your actions show prejudice of any kind. If you must treat a patient whose gender identity you don't understand or feel comfortable with, do not share your ideas or opinions, or try to "educate" your patient as to what you think is right or wrong. I know that "First, do no harm" is intrinsic to the beliefs of nurses. Questioning any person's stated identity is harmful to them.

Educate yourself. Learn everything you can about the basics of gender differences, the gender spectrum, and the science behind gender identity. Read the literature, ask for training, and watch documentaries like Katie Couric's "Gender Revolution", currently available on Netflix. Make sure you have the requisite knowledge, skills, and awareness to treat transgender and GNC patients with competent and affirming care. The more you know, the less likely you'll be to experience anxiety of your own about treating GNC patients – and the safer and more comfortable your patients will feel. Don't expect to be educated by your trans patients – they come to you for care, not to teach. The less trans patients have to worry about your understanding and awareness, the better.

Ask questions. It is entirely acceptable to ask your patients what name and pronouns they would like you to use. Regardless of what it says in their paperwork, they may identify as he, she, or they. Use the correct pronouns! Same goes for name: ask what they prefer to be called, and use that name and that name only. Take them at their word regarding their name, pronouns, and identity. If you make a mistake, apologize and move on. Unfortunately, trans patients are used to being misgendered, but it's still always painful. If you can avoid mistakes, even better.

Do what you can to show support for your trans and GNC patients by making your treatment area affirming. Whether it's a rainbow pin or a sticker on a window, if you can show patients without even a word that they are in a safe place, they'll know they will be met with affirming care even before the conversation begins.

Trans and GNC children, especially, are at risk. The statistics around attempted suicide for our kids are shocking. Every message trans kids receive that there's something wrong or different about them contributes to depression, anxiety, and other mental health issues. It is critical that their medical care as children be affirming.

Regarding trans and GNC children, here's a sad truth: not all parents are supportive when a child asserts their true identity. If it's clear to you that a child identifies other than the way their parent or guardian presents them, do anything you can to support the child; find a way to affirm them. Try to create a space for the child to talk openly. Give them that rainbow sticker or flash a trans pin on your uniform. And if a parent leaves the door open at all, encourage them to learn more about the science of gender identity.

Supportive and affirming parents of trans children know that nurses are essential to our children's well-being – you honor their emotional and mental needs as well as care for them physically. You are often the people in the medical field with whom our kids feel safest and most accepted. Thank you for doing your part to treat them – and their adult counterparts – with the dignity and respect every patient deserves.

by Candice Chaplin, parent and advocate
This story was published in the April/May 2019 issue of the ARN Pulse.

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