1
|
Brod T, Liebold J, Stoetzer C. [Transgender People in Emergency And Rescue Services]. Anasthesiol Intensivmed Notfallmed Schmerzther 2024; 59:599-608. [PMID: 39393396 DOI: 10.1055/a-1962-6390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2024]
Abstract
The treatment of transgender individuals presents a multifaceted challenge for those involved in emergency and rescue services, encompassing not only medical but also social aspects. Despite the increasing importance of healthcare for transgender individuals in Germany over recent years, there remains significant uncertainty among healthcare professionals in addressing the needs of this population. This uncertainty can result in transgender individuals delaying access to the healthcare system due to previous negative experiences, thereby increasing the risk of receiving suboptimal medical care.Ambiguities exist regarding gender-specific health issues and the appropriate use of pronouns and names. Surveyed participants have expressed a desire for more training opportunities in this area. Enhanced training of emergency services personnel is essential for fostering a better understanding of gender-specific health concerns. Additionally, there is a notable lack of specific guidelines for the treatment of transgender individuals within both emergency services and emergency rooms. Establishing specific treatment guidelines can enhance the safety of healthcare workers and consequently improve the medical care provided to transgender individuals.The objective of this CME article is to outline the key aspects of emergency medical care for transgender individuals, aiming to reduce uncertainties among emergency service personnel and enhance the quality of medical care for this group.
Collapse
|
2
|
Ingamells S, Steers D, Henry C, Hartley-Parsons T, Filoche SK. "I'm not getting paid to give you a TED talk on how my trans body works". Experiences of hysterectomy gender affirming surgery: A qualitative study. Int J Gynaecol Obstet 2024; 166:1304-1312. [PMID: 38546422 DOI: 10.1002/ijgo.15507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE To explore the experiences of care surrounding hysterectomy as part of gender affirming surgery. METHODS An in-depth reflexive thematic analysis from accounts by 10 out of 12 people was undertaken. Experiences were then mapped to the surgery journey as a template for developing system responsiveness. RESULTS No one person's experience of the procedure was affirmed across the entire surgery journey. Transgender health literacy was central to inclusive practice as it mediated bodily autonomy being upheld. The physical care environment influenced the experience, for example, the waiting room was marginalizing (intimidating), with a gendered clinic name and toilets. Some participants took a female support person/partner so that "people looking would assume that I was there supporting her, not the other way around." Communication misalignments were evident around information provided/understood about fertility and ovarian preservation. Participants were also placed in the position of both receiving care and providing education: "I also shouldn't have to be going in there for treatment, and then being expected to educate the medical professional that's meant to be helping me… I'm not getting paid to give you a TED talk on how my trans body works." The experiences mapped across the surgery journey highlighted multiple levels of service provision development needed to foster inclusive practice, for example, from workforce education to healthcare policy. CONCLUSION Healthcare for transgender people can be unsafe and inequitable. Increasing transgender health responsiveness across the surgery journey will facilitate better alignments in communication and uphold bodily autonomy, leading to safer and inclusive practice.
Collapse
Affiliation(s)
| | - Denise Steers
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Claire Henry
- Department of Obstetrics and Gynecology, University of Otago, Wellington, New Zealand
| | | | - Sara K Filoche
- Department of Obstetrics and Gynecology, University of Otago, Wellington, New Zealand
| |
Collapse
|
3
|
Logel SN, Maru J, Whitehead J, Brady C, Walch A, Lasarev M, Rehm JL, Millington K. Higher Rates of Certain Autoimmune Diseases in Transgender and Gender Diverse Youth. Transgend Health 2024; 9:197-204. [PMID: 39109261 PMCID: PMC11299103 DOI: 10.1089/trgh.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Purpose The objective of this study is to determine the prevalence of certain autoimmune diseases in transgender and gender diverse (TGD) youth. Methods A multicenter, retrospective analysis was conducted from January 2013 to January 2019 of youth ≤26 years of age with concurrent diagnoses of gender dysphoria (GD) and at least one of the studied autoimmune diseases. Prevalence rates were calculated and compared to previously reported rates. Statistical significance was determined using second generation p-values as pooled estimates of prevalence rates across study sites compared to a range of rates reported in the literature. Results During the study period, 128 of 3812 (3.4%) youth evaluated for GD had a concurrent diagnosis of at least one of the studied autoimmune diseases. Three autoimmune diseases had prevalence rates significantly higher than those previously documented in the literature (second generation p-value=0.000): type 1 diabetes mellitus (112.8/10,000, 95% confidence interval [CI]: 83.8-151.8), systemic lupus erythematosus (13.1/10,000, 95% CI: 5.5-31.5), and Graves' disease (12.3/10,000, 95% CI: 4.0-38.4). Conclusion There is an increased prevalence of certain autoimmune diseases in youth who identify as TGD presenting for subspecialty care. Limitations such as retrospective study design, selection bias, and reliance on electronic medical records make it difficult to draw wide-reaching conclusions about these findings. This study highlights the need for more research to delineate the impacts of unrecognized or untreated GD on autoimmune disease development and control.
Collapse
Affiliation(s)
- Santhi N Logel
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Johsias Maru
- Division of Pediatric Endocrinology, Department of Pediatrics, Benioff Children's Hospitals, University of California San Francisco, San Francisco, California, USA
| | - Jax Whitehead
- Division of Endocrinology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cassandra Brady
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, Tennessee, USA
| | - Abby Walch
- Division of Pediatric Endocrinology, Department of Pediatrics, Benioff Children's Hospitals, University of California San Francisco, San Francisco, California, USA
| | - Michael Lasarev
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jennifer L Rehm
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kate Millington
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
4
|
von der Warth R, Horstmeier LM, Körner M, Farin-Glattacker E. Health Communication Preferences of Transgender and Gender-Diverse Individuals - Development and First Psychometric Evaluation of the CommTrans Questionnaire. JOURNAL OF HOMOSEXUALITY 2024:1-16. [PMID: 38421283 DOI: 10.1080/00918369.2024.2320246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Patient-doctor communication is an important component of patient-centered care and should be adapted to the target group. Adapting communication to transgender and gender-diverse individuals is particularly difficult, as little is known about the preferences of this group. Thus, the aim of the study was to develop a questionnaire to assess the communication preferences of the target group. Based on a qualitative study, an item pool was created, which was tested in a survey in September 2022. An item analysis was conducted and items with unacceptable characteristics were removed. The remaining item pool was examined with an explorative factor analysis. The sample consisted of N = 264 individuals. Of the initial k = 43 items, k = 9 items remained in the final factor analysis. The final two factor solution explained 60.7% of the variance. The factors describe the emotional resonance in communication (Cronbach's α = .74; e.g. "My medical doctors should be happy for me when my treatment progresses positively.") as well as gender-related communication (Cronbach's α = .85; e.g. "My medical doctors should introduce themselves with pronouns."). Overall, the questionnaire captures the communication preferences of transgender and gender-diverse individuals in medical conversations. It covers two important topics for the target group, but further validation is necessary.
Collapse
Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany
| | - Lukas M Horstmeier
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany
| |
Collapse
|
5
|
García-Acosta JM, Castro-Molina FJ, Fernández-Martínez AD, Delgado-Reyes A, Castellano-Fuenmayor MA. Best Nursing Practice: Safe and Inclusive Healthcare Environments for Transgender People: A Systematic Review. NURSING REPORTS 2024; 14:287-302. [PMID: 38391067 PMCID: PMC10885085 DOI: 10.3390/nursrep14010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: The aim of this study was to review the scope of the existing scientific literature on creating safe and inclusive healthcare environments for transgender people and provide an overview of the resources and nursing skills required to do so. (2) Methods: With the research question in mind, an exploratory search of six databases was conducted to identify all relevant primary studies. After screening and selection of articles based on the inclusion and exclusion criteria, a total of 41 articles were included and reviewed. (3) Results: The results were classified under four headings: the training of health professionals, the creation of safe spaces, the nurse as facilitator, and best care practice. Most of the evidence indicates that it is essential for nurses and other healthcare staff to be trained in specific skills to provide comprehensive, high-quality care to transgender people; however, there is a lack of material and human resources to do so. (4) Conclusions: The trans-inclusive care competent nurse should use neutral language that respects the person's preferred name and pronouns in a safe healthcare environment that offers and ensures warmth, respect, and inclusivity in the care provided. This study was registered with the Open Science Framework (OSF) on 9 January 2024 (osf.io/rpj6a).
Collapse
Affiliation(s)
- Jesús Manuel García-Acosta
- The Canary Islands Health Service, Tenerife, 38071 Canary Islands, Spain
- Nuestra Señora de la Candelaria School of Nursing, University of La Laguna, 38010 Canary Islands, Spain
| | - Francisco Javier Castro-Molina
- The Canary Islands Health Service, Tenerife, 38071 Canary Islands, Spain
- Nuestra Señora de la Candelaria School of Nursing, University of La Laguna, 38010 Canary Islands, Spain
| | - Alfredo David Fernández-Martínez
- Department of Education, Vocational Training, Physical Activity and Sport, Regional Government of the Canary Islands, Tenerife, 38010 Canary Islands, Spain
| | | | | |
Collapse
|
6
|
Derbyshire DW, Keay T. Nurses' implicit and explicit attitudes towards transgender people and the need for trans-affirming care. Heliyon 2023; 9:e20762. [PMID: 38106668 PMCID: PMC10722320 DOI: 10.1016/j.heliyon.2023.e20762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 12/19/2023] Open
Abstract
Background The primary objective of this study is to investigate the implicit and explicit attitudes of healthcare professionals - in particular nurses - towards transgender people. This is especially important in light of recent calls for improved trans-affirming care provision by healthcare professionals to generate quality healthcare access and outcomes for transgender people. Methods We use publicly available data from the transgender version of the Implicit Association Test from 2020 to 2022. We focus on differences between three subsets of participant: (1) non-healthcare professionals (N = 177,810), (2) non-nursing healthcare professionals (N = 22,443) and (3) nursing healthcare professionals (N = 11,996). We present the results of parametric statistical tests (t-tests) and an ordinary least squares regression, to analyse the robustness of our results when controlling for a host of sociodemographic characteristics. Results We find that non-healthcare professionals have significantly lower implicit bias towards transgender people compared to healthcare professionals. Further, within healthcare professionals, we find nurses have significantly higher implicit bias towards transgender people compared to non-nurses. We show how implicit bias and explicit attitudes are highly correlated. Further, we provide evidence that healthcare professionals - but in particular nurses - conflate sex and gender identity. Conclusion Whilst nurses continue to have higher levels of implicit and explicit bias towards transgender people there remains a need to globally establish additional enhanced trans-affirming care training provision for nursing and medical students.
Collapse
Affiliation(s)
- Daniel W. Derbyshire
- Research Fellow in Public Health Economics, European Centre for Environment and Human Health, University of Exeter, UK
| | - Tamsin Keay
- Assistant Professor in Nursing, Midwifery and Health Professions, Faculty of Health and Life Sciences, Coventry University, UK
| |
Collapse
|
7
|
Skuban-Eiseler T, Orzechowski M, Steger F. Why do transgender individuals experience discrimination in healthcare and thereby limited access to healthcare? An interview study exploring the perspective of German transgender individuals. Int J Equity Health 2023; 22:211. [PMID: 37817187 PMCID: PMC10566060 DOI: 10.1186/s12939-023-02023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Transgender individuals experience limited access to healthcare. This results not least from experiences of discrimination to which they are exposed in the health system. These contribute to transgender individuals having poorer health than cis individuals, i.e. individuals whose sex assigned at birth is in line with their gender identity. It is an ethical duty to take effective measures to minimize inequalities in medical care. At best, such measures should also be assessed as appropriate from the perspective of those affected in order to be accepted and thus effective. It is therefore important to know whether measures touch on the subjectively assumed reasons for experiences of discrimination. Hence, to be able to take appropriate measures, it is important to identify the reasons that transgender individuals see as causal for their experiences of discrimination in healthcare. METHODS We conducted semi-structured interviews with 14 German transgender individuals and asked them about their own experiences of discrimination in healthcare and their assumptions on the reasons for discrimination. We analyzed the responses using the method of structured qualitative content analysis. RESULTS 13 transgender individuals reported experiences of discrimination in healthcare. These emanated from different professional groups and took place in trans-specific as well as general medical settings. We were able to identify a total of 12 reasons that transgender individuals see as causal for their experiences of discrimination: (1) internalized trans-hostility and "protection" of cis individuals, (2) lack of knowledge/uncertainties regarding transition, (3) "protection" of a binary worldview, (4) binary worldview in medicine, (5) structural deficits, (6) asymmetric interactions with specialists, (7) current political debate, (8) view of transgender individuals as a "burden for society", (9) objectification, (10) homophobia, (11) misogyny/androcentrism and (12) discrimination as reaction to discrimination. CONCLUSIONS German transgender individuals have a very differentiated picture regarding their subjective reasons for experiencing discrimination in healthcare. Overall, disrespect regarding gender identity and a confrontation with foreignness seems to be seen as the decisive factor. Thus, it is not enough to focus only on measures that aim to remedy the information deficit on the part of medical providers. Measures must be taken that can create a granting and respectful attitude towards transgender individuals.
Collapse
Affiliation(s)
- Tobias Skuban-Eiseler
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany.
- kbo-Isar-Amper-Klinikum Region München, München-Haar, Germany.
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
| |
Collapse
|
8
|
Layton H, Tremayne P, Norton W. Supporting transgender patients with their personal hygiene. Nurs Stand 2023; 38:29-34. [PMID: 37599637 DOI: 10.7748/ns.2023.e12110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 08/22/2023]
Abstract
Attending to one's personal hygiene is a private and ritualistic act that is linked to self-expression and is important for one's well-being and self-esteem. Providing effective support with personal hygiene to patients can demonstrate thoughtfulness and sensitivity to their individual needs. Nurses in all fields of nursing may encounter patients who identify as transgender, but many nurses have expressed concerns about their lack of knowledge and confidence in that area of care. This article discusses the use of gender-affirming language and the factors to consider when supporting transgender patients with their personal hygiene as part of personalised, equitable and inclusive nursing care.
Collapse
Affiliation(s)
- Helen Layton
- The Leicester School of Nursing and Midwifery, De Montfort University Leicester, Leicester, England
| | - Penny Tremayne
- The Leicester School of Nursing and Midwifery, De Montfort University Leicester, Leicester, England
| | - Wendy Norton
- Faculty of Health and Life Sciences, De Montfort University Leicester, Leicester, England
| |
Collapse
|
9
|
von der Warth R, Metzner G, Körner M, Farin-Glattacker E. Exploring communication preferences of trans and gender diverse individuals-A qualitative study. PLoS One 2023; 18:e0284959. [PMID: 37611052 PMCID: PMC10446207 DOI: 10.1371/journal.pone.0284959] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/12/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Trans and gender-diverse individuals experience adverse health outcomes that might be due, in addition to other factors, to stigma and discrimination in the health care sector. At the same time, the concept of person-centred care acknowledges the role of patient-physician communication in health care outcomes. This study aims to explore patient-physician communication preferences in trans and gender-diverse individuals. METHOD A qualitative interview study was conducted, including N = 10 participants between February and March 2022. Participants were interviewed using a semi-structured interview guideline, based on previous knowledge in person-centred care and sample specific communication. Participants were asked about their experiences and wishes in patient-physician centeredness. Analyses were conducting using a qualitative content analysis strategy. RESULTS Mean age was 29.3 years; n = 6 participants identified themselves within the binary gender concept, while n = 4 identified themselves with a non-binary gender. Communication preferences for patient-physician communication were categorised into four themes: general communication aspects (e.g. active listening); the role of gender during appointments (e.g. appropriate/inappropriate addressing); gender-neutral language (e.g. experiences use of gender neutral language by physicians); own communication style (e.g. early outing and justification). Furthermore, possible contextual factors of patient-physician communication where found (e.g. trusting relationship). CONCLUSION Adding knowledge to communication preferences of trans and gender-diverse individuals, this study was able to identify preferences that are specific to the sample as well as preferences that differ from the cis-gendered population. However, it remains unclear how the patient-physician communication preferences affects health care utilization and outcomes. TRIAL REGISTRATION German Clinical Trial Register (DRKS00026249).
Collapse
Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg; Germany
| | - Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg; Germany
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg; Germany
| |
Collapse
|
10
|
Comeau D, Johnson C, Bouhamdani N. Review of current 2SLGBTQIA+ inequities in the Canadian health care system. Front Public Health 2023; 11:1183284. [PMID: 37533535 PMCID: PMC10392841 DOI: 10.3389/fpubh.2023.1183284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
Gender identity and sexual orientation are determinants of health that can contribute to health inequities. In the 2SLGBTQIA+ community, belonging to a sexual and/or gender minority group leads to a higher risk of negative health outcomes such as depression, anxiety, and cancer, as well as maladaptive behaviors leading to poorer health outcomes such as substance abuse and risky sexual behavior. Empirical evidence suggests that inequities in terms of accessibility to health care, quality of care, inclusivity, and satisfaction of care, are pervasive and entrenched in the health care system. A better understanding of the current Canadian health care context for individuals of the 2SLGBTQIA+ community is imperative to inform public policy and develop sensitive public health interventions to make meaningful headway in reducing inequity. Our search strategy was Canadian-centric and aimed at highlighting the current state of 2SLGBTQIA+ health inequities in Canada. Discrimination, patient care and access to care, education and training of health care professionals, and crucial changes at the systemic and infrastructure levels have been identified as main themes in the literature. Furthermore, we describe health care-related disparities in the 2SLGBTQIA+ community, and present available resources and guidelines that can guide healthcare providers in narrowing the gap in inequities. Herein, the lack of training for both clinical and non-clinical staff has been identified as the most critical issue influencing health care systems. Researchers, educators, and practitioners should invest in health care professional training and future research should evaluate the effectiveness of interventions on staff attitudinal changes toward the 2SLGBTQIA+ community and the impact on patient outcomes.
Collapse
Affiliation(s)
- Dominique Comeau
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
| | - Claire Johnson
- School of Public Policy Studies, Université de Moncton, Moncton, NB, Canada
| | - Nadia Bouhamdani
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
- Medicine and Health Sciences Faculty, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Moncton, Moncton, NB, Canada
| |
Collapse
|
11
|
Chaudhary S, Ray R, Glass BD. “I don't know much about providing pharmaceutical care to people who are transgender”: A qualitative study of experiences and attitudes of pharmacists. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100254. [PMID: 37095891 PMCID: PMC10121476 DOI: 10.1016/j.rcsop.2023.100254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Background Globally, with the increased visibility, the number of transgender people accessing healthcare services has risen in the last decade. Although pharmacists are required to provide equitable and respectful care to all patients, their experiences interacting with trans and gender-diverse (TGD) people and attitudes towards the provision of care are largely unknown. Objectives This study aimed to determine the experiences and attitudes of pharmacists providing care to TGD people in Queensland, Australia. Methods Within a transformative paradigm, this study used semi-structured interviews conducted in person, over the phone, or through the Zoom app. Data were transcribed and analyzed by applying the constructs of the Theoretical Framework of Accessibility (TFA). Results A total of 20 participants were interviewed. Analysis revealed all seven constructs across interview data, with affective attitude and self-efficacy being the most frequently coded constructs, followed by burden and perceived effectiveness. The least coded constructs included ethicality, intervention coherence, and opportunity cost. Pharmacists had positive attitudes towards providing care and interacting professionally with TGD people. Prime challenges in delivering care were being unaware of inclusive language and terminology, difficulty building trusted relationships, privacy and confidentiality at the pharmacy, inability to locate appropriate resources, and lack of training in TGD health. Pharmacists felt rewarded when they established rapport and created safe spaces. However, they requested communication training and education to improve their confidence in delivering care to TGD people. Conclusion Pharmacists demonstrated a clear need for further education on gender-affirming therapies and training in communication with TGD people. Including TGD care in pharmacy curricula and continuous professional development activities is seen as an essential step towards pharmacists improving health outcomes for TGD people.
Collapse
|
12
|
Tamrat J. "Trans-forming" dental practice norms: Exploring transgender identity and oral health implications. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2022; 56:131-139. [PMID: 36451990 PMCID: PMC9674002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This narrative review explores current research to broaden understanding and awareness of the transgender experience while identifying oral health needs and proposing strategies of inclusivity to optimize oral health outcomes. METHODS A comprehensive electronic literature search was conducted in the following online databases: PubMed, Google Scholar, CINAHL, and Education Source. The search yielded 35 articles with a wide range of study designs and methodologies. RESULTS & DISCUSSION Several themes emerged from the literature, including psychosocial oral health implications, barriers to oral health care, inclusive dental practice strategies, and cultural competence of oral health providers. CONCLUSION The transgender population experiences many social and health disparities that stem from discrimination. Systemic inequalities, coupled with other barriers to care, have significant oral health implications for this population. Implementing inclusivity strategies and gaining awareness of the transgender experience will contribute to better oral health outcomes in this community.
Collapse
Affiliation(s)
- Jessica Tamrat
- Alumna, Dental Hygiene Degree Program, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada. This literature review was written in partial fulfillment of the requirements for the BDSc(DH) program at the University of British Columbia.
| |
Collapse
|
13
|
Padilha MI, Caravaca-Morera JA, Gentil AGB, Dal Vesco SNP, Bellaguarda MLDR, Silva A. Transgender people in the nursing discourse: An integrative review. J Adv Nurs 2022; 78:2731-2746. [PMID: 35748098 DOI: 10.1111/jan.15318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/09/2022] [Accepted: 05/15/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To integrate and analyse the literature produced by nurses in terms of care, education and understanding of the reality of transgender (trans) people. DESIGN An integrative review methodology guided by the framework proposed by Whittemore and Knafl. DATA SOURCES The search strategy was applied in the following databases: Medline, Embase, Scopus, Web of Science and CINAHL, as well as in Biblioteca Virtual de Saúde, during February and March 2021, with no time frame. REVIEW METHODS The references found were assessed according to the eligibility criteria established. The information of the articles included was extracted, and a thematic analysis was performed to synthesize the review findings. RESULTS The searches in the databases yielded 2859 articles; 985 after removing duplicates, and 33 articles were included in this review. Three major themes were identified: (1) Understanding the trans universe through the trans perspective; (2) Understanding health and nursing care for trans people; and (3) Trans women as the focus of health and nursing care. The themes evidenced in the lens of nurses and clients the importance of nursing training at all levels to prepare professionals on how to provide culturally competent nursing care for this population and reduce healthcare inequities. CONCLUSION Nurses must work to provide a space for convergence and enhancement of the rights of trans people and cease to be a verticalized care model. To such end, it is necessary to devise places and possibilities to teach and learn, to construct and reconstruct a culturally competent nursing care. IMPACT This review highlighted the current knowledge and identified gaps in the understanding of nurses, health professionals and students about the experience lived by trans people, resulting from the lack of training and continuing education of these professionals.
Collapse
|
14
|
Norris M, Borneskog C. The Cisnormative Blindspot Explained: Healthcare Experiences of Trans Men and Non-Binary Persons and the accessibility to inclusive sexual & reproductive Healthcare, an integrative review. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 32:100733. [PMID: 35576736 DOI: 10.1016/j.srhc.2022.100733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/15/2022] [Accepted: 04/27/2022] [Indexed: 01/11/2023]
Abstract
Trans men and non-binary persons assigned female at birth (AFAB) often encounter resistance and reluctance pertaining to their healthcare needs. As a result of patriarchal-based decision-making and cis-heteronormative ideologies, the trans and gender diverse (TGD) population is routinely left out of representation in research, education, and healthcare. The aim of this integrative literature review is to describe the experiences of trans men and non-binary persons AFAB in healthcare interactions and their sexual and reproductive healthcare needs. A total of 32 articles were analyzed, synthesized, and reconceptualized through joint inductive and deductive analysis with a transfeminist and intersectional lens. From these papers, two broader concepts emerged with five sub-concepts that portrayed underlying barriers to care (primed with fear, onus of self-advocacy, and call for competence) and internalized ideologies (pregnancy incompatibility and presumptive care). A multidisciplinary approach is essential to employ in implementation efforts involving improved standards of care and in achieving desired family planning. As this is not as linear as addressing a knowledge gap, but one of deeper set intrinsic ideologies, instruction on the necessary impact of continued education and peer learning within the context of in-group dynamics can help the efficiency of designated change agents within the healthcare systems themselves.
Collapse
Affiliation(s)
- Megan Norris
- Dalarna University, School of Health and Welfare, Högskolegatan 2, 791 31 Falun, Sweden.
| | - Catrin Borneskog
- Dalarna University, School of Health and Welfare, Högskolegatan 2, 791 31 Falun, Sweden.
| |
Collapse
|
15
|
Shamsikhani S, Ahmadi F, Kazemnejad A, Vaismoradi M. Meaning of Respect for Older People in Family Relationships. Geriatrics (Basel) 2022; 7:geriatrics7030057. [PMID: 35645280 PMCID: PMC9149946 DOI: 10.3390/geriatrics7030057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Older people have various physical and mental health needs and often receive help from their family members to perform their daily life activities. This research aimed to explore the meaning of respect for older people in family relationships. Methods: A qualitative study using a content analysis approach was conducted. Semi-structured interviews were performed with sixteen older people and four family members. Results: Three main categories were developed: “respect for personal interests”, “kind and sincere respect” and “respect for autonomy”. Understanding of the meaning of respect for older people was influenced by special expectations from family members in terms of meeting personal needs, consideration of preferences and interests and empowerment and support to help preserve older people’s independence and autonomy. Conclusions: Family members should be informed and educated with regard to their expected roles in family relationships, and should consider respect as an important factor affecting older people’s well-being.
Collapse
Affiliation(s)
- Soheila Shamsikhani
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14155-4838, Iran;
| | - Fazlollah Ahmadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14155-4838, Iran;
- Correspondence: ; Tel.: +98-21-8288-3553
| | - Anoshirvan Kazemnejad
- Biostatistics Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14155-4838, Iran;
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway;
| |
Collapse
|