Supporting the Health and Well-Being of Transgender Students

Measuring the prevalence and impact of adverse childhood experiences in the lives of LGBTQ individuals: A much-needed expansion

BACKGROUND

Numerous studies indicate that LGBTQ people have extensive experiences with adverse childhood experiences (ACEs), more so than their heterosexual and cisgender counterparts. Research also shows that LGBTQ youth endure traumatic experiences with victimization, including bullying, harassment, and violence, based on their non-hetero-cis-normative genders and/or sexual identities. Yet, most ACE measurement strategies fail to: (1) explicitly link the risk of ACE exposure to the discrimination and stigmatization of LGBTQ people, and (2) account for the breadth of potential ACE exposure in LGBTQ populations.

OBJECTIVE

In the current article, we develop and present a more comprehensive ACE measurement strategy for understanding the cumulative and deleterious impacts of ACEs in the lives of LGBTQ individuals.

METHODS

Here, we offer three expansions to the current ACE framework: (1) the inclusion of an LGBTQ-specific ACE in addition to the standard ACE measures, (2) the addition of LGBTQ qualifiers for current ACE items (when applicable), and (3) the expansion of ACE measures to capture the unique ACE experiences of LGBTQ individuals in family life, schools, and faith communities.

CONCLUSIONS

The implementation of a more comprehensive ACE measurement strategy will assist scholars and policymakers in better understanding the impacts of ACEs in the lives of LGBTQ individuals. In all, ACE measurement strategies that capture the breath of exposure of ACEs in the lives of LGBTQ individuals will assist in ACE screening, public health policy, and clinical intervention efforts.

Policy attitudes toward adolescents transitioning gender

Anti-transgender policies and state legislative initiatives that focus on school bathroom use and hormone use have emerged in recent years. These policies are generally written by and voted on by cisgender people, and as such, it is crucial to understand influences on nonaffirming attitudes toward policies that can impact trans youth. The present study aimed to extend research on transphobic attitudes in general to attitudes toward policies that impact youth undergoing transition. Latent variable covariances and structural equation modeling were used to test the relations between transphobia, genderism, homophobia, need for closure, sexual orientation, social dominance orientation, attitudes toward sexual minorities, beliefs about gender roles, aggression, religious fundamentalism, and contact with sexual and gender minority individuals, as they are related to attitudes toward hormone use and bathroom use for trans youth. Analyses of data from a sample of 248 cisgender adults indicated that genderism and transphobia was associated with attitudes toward gender-affirming hormone use and bathroom use for trans youth; need for closure was associated with gender-affirming attitudes toward bathroom use, but was not associated with hormone use. Sexual orientation was linked to attitudes toward gender-affirming policies, such that nonheterosexual participants had more affirming attitudes toward trans youths' bathroom use, but not hormone use. Implications for future research, advocacy efforts to promote rights for trans youth, and clinical work with trans youth and/or parents/guardians of trans youth are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sensitivity Toward Gender and Sexually Diverse Populations: Development of a Scale

BACKGROUND

Individuals who are lesbian, gay, bisexual, transgender, queer, intersex, asexual, or nonbinary (LGBTQIA+) experience inequitable access to and utilization of health care services. Nurses' lack of awareness and sensitivity may contribute to this phenomenon.

PURPOSE

This article describes the development and validation of the Gender and Sexual Diversity Sensitivity Scale (GSDSS). A sample of 210 undergraduate nursing students from a large research-intensive university completed the scale online. An exploratory factor analysis was conducted.

RESULTS

Factor analysis illustrated a three-factor construct of the scale (i.e., General Education Experience, Cognitive Awareness, and Comfort With Interactions); Cronbach's alpha coefficients ranged from .66 to .91, and the total scale alpha coefficient was .782.

CONCLUSION

The GSDSS has evidence of construct validity and reliability, and can be used in studies that include nursing and other health professional students. [J Nurs Educ. 2022;61(7):383-389.].

Trans-affirming care: An integrative review and concept analysis

BACKGROUND

Contemporary healthcare exists within a cisnormative landscape which underpins the erasure of trans persons in healthcare, health research, and health education, and results in negative experiences and poorer outcomes. Further, nurses report feeling inadequately prepared to provide affirming care to trans patients, with little guidance available to inform their practice.

OBJECTIVE

To explore the conceptual understanding of trans-affirming care as it pertains to nursing, and to provide recommendations for trans-affirming nursing care at the systemic, organizational, and individual level.

METHODS

A systematic search of the literature was completed using standard review processes. Two reviewers independently applied a two-step study selection procedure to identify eligible citations. Walker and Avant's concept analysis method was used to analyze the extracted data to determine antecedents, defining attributes, empirical referents, and consequences.

RESULTS

Of the 5914 studies, 136 met criteria, representing a variety of clinical settings. The antecedents identified were depathologization of gender variance and cultural humility. The defining attributes were patient-led care, trans-affirming culture, and trans-competent providers. The consequences were improved psychological and physical health outcomes.

CONCLUSIONS

Trans persons and communities are becoming more visible in society, as are their testimonials about their substandard treatment within healthcare systems. Nurses need to respond to these health inequities with self-reflection, advocacy, and education. At the center of this work is the concept of trans-affirming care, which is a philosophy of care specific to trans persons. Tweetable abstract: This article offers an evidence-informed definition of trans-affirming care and recommendations for how it can be operationalized by nurses.

Pediatric nurse practitioners' attitudes/beliefs and knowledge/perceived competence in caring for transgender and gender-nonconforming youth

PURPOSE

There is a growing number of youth and their parents seeking assistance from care providers related to gender dysphoria and transitional care for transgender and gender-nonconforming (TGNC) youth. The purpose of this study was to determine pediatric nurse practitioners' (PNP) attitudes/beliefs and knowledge/competence in caring for TGNC youth.

DESIGN AND METHODS

This cross-sectional descriptive study surveyed PNPs (N = 93) from eight states using two survey instruments to measure attitudes and beliefs and knowledge and perceived competence related to caring for TGNC youth.

RESULTS

Eighty-one percent of PNPs reported caring for TGNC youth in their practice. Despite this, only 15% of the PNPs received education related to transgender patients during their advanced practice education. Results showed that attending continuing education offerings related to caring for TGNC patients increases PNP perceived competence as well as knowledge. Attitudes and behaviors towards the transgender population were also more positive if the PNP had attended continuing nursing education offerings. Three themes emerged from a qualitative portion of the survey, asking the participant to share thoughts related to caring for transgender youth: lack of education for healthcare providers, the need to refer patients to comprehensive gender services, and the need for support for transgender patients and their families.

PRACTICE IMPLICATIONS

Education plays an important part in nurses' attitudes, beliefs, and perceived competence in caring for transgender patients. Because the PNP is likely to be exposed to patients with TGNC, it is imperative they seek out opportunities to learn about transgender issues and caring for transgender patients.

The Intersection of Gender Identity and Violence: Victimization Experienced by Transgender College Students

College students disproportionately experience victimization, stalking, and relationship violence when compared with other groups. Few studies explore victimization by the gender identity of college students, including those who identify as transgender. The purpose of this study is to explore the rates of violence experienced by transgender students compared with male and female college students. This study utilized the National College Health Assessment-II (NCHA-II) and included data from students (n = 82,538) across fall 2011, 2012, and 2013. Bivariate statistics and binary logistic regression were conducted to test the relationships between gender identity and victimization. Transgender students (n = 204) were compared with male (n = 27,322) and female (n = 55,012) students. After adjusting for individual factors, transgender students had higher odds of experiencing all nine types of violence when compared with males and higher odds of experiencing eight types of violence than females. Transgender students experienced the highest odds in crimes involving sexual victimization, including attempted sexual penetration (adjusted odds ratio [aOR]: 9.49, 95% confidence interval [CI] = [6.17, 14.59], d = 1.00), sexual penetration without consent (aOR: 9.06, 95% CI = [5.64, 14.53], d = 0.94), and being in a sexually abusive relationship (aOR: 6.48, 95% CI = [4.01, 10.49], d = 0.48), than did male students. Findings reveal increased odds of victimization among transgender students when compared with male and female students. Results demonstrate the need for more comprehensive violence prevention efforts in college settings.

Creating inclusive health care environments: Health care stories from the trans population

BACKGROUND

Transgender people face a multitude of health care access barriers that create wide disparities in health. Transgender people have more untreated acute and chronic conditions than the cisgender population.

PURPOSE

The purpose of this study was to describe positive and negative experiences of transgender people when accessing health care.

METHODOLOGICAL ORIENTATION

Qualitative methods including semi-structured interviews and content analysis for identification of themes.

SAMPLE

Nine transgender people ranging in age from 20 to 35 years who currently reside in a metropolitan area of the Southwestern United States.

CONCLUSIONS

The interviews contained candid stories about the participants' health care experiences and included perspectives about provider knowledge, provider communication, and provider office interactions. Findings identified health care disparities among transgender people related, in part, to negative experiences in the health care environment. Some of these negative experiences arose from the uncertainty of providers' transgender-specific health care knowledge and anxiety about dysphoria-triggering communication in the health care environment.

IMPLICATIONS FOR PRACTICE

These findings enhance practice by offering insight into how health care providers and personnel interactions influence the experience of transgender patients and help health care providers and personnel understand situations that create anxiety and dysphoria in transgender patients.

Is Research on Transgender Children What It Seems? Comments on Recent Research on Transgender Children with High Levels of Parental Support

Recent research on transgender children who have had support from their parents for their transitioning has concluded that their mental health is virtually no different than that of nontransgender children. Such research has been extensively cited, over 370 times in the past three years. Most of the hundreds of reviews received the stated results of the studies with little caution. However, the research featured numerous statistical errors and omissions, the implications of which would likely lead neutral observers to conclude that the mental health of transgender children, even when supported by their parents, was poorer than that of the groups of control children. In particular, levels of anxiety as reported by both parents and their transgender children appear to be significantly higher, and the transgender children's reports of self-worth appear to be significantly lower. Although reports regarding depression are not as significantly different, the effect sizes were generally in a similar direction as the other outcomes, being less favorable for the transgender children. Such issues highlight the need for careful examination of statistical research, even when published in highly regarded medical journals. As with other research, findings from the early stages of controversial research may often be premature. Further research is needed to explore factors underlying these results.

Summary

Some scholars have believed that if transgender children were supported by their parents before the children reached puberty, the generally higher rates of mental illness experienced by many transgender persons might be prevented or alleviated. Dr. Kristina Olson of the Department of Psychology at the University of Seattle was the first scholar to have studied groups of transgender children who were being supported by their parents and to have compared them to a control group of children and to siblings of the same transgender children. Her conclusion was that there were minimal, if any, differences in anxiety, depression, and self-worth among the groups of children; her research has since been cited extensively as having found just that. We reanalyzed her raw data and found that, to the contrary, the transgender children, even when supported by their parents, had significantly lower average scores on anxiety and self-worth. Often, a significantly higher percentage of transgender children, compared to controls, featured preclinical or clinical levels of anxiety. Parental support of transgender children may temporarily reduce levels of poor mental health for some transgender children, but it does not appear to eliminate those problems for all transgender children. Our findings should serve as a warning against accepting research at a surface level, which can lead to acceptance of invalid information and pursuit of ineffective interventions.

Fostering sexual and gender minority status disclosure in patients

Members of the sexual and gender minority (SGM) community face complex barriers to accessing quality healthcare. NPs have a responsibility to create welcoming care settings where patients can share a trusting provider-patient relationship to disclose their SGM status, an event shown to improve patient outcomes.

Transgender Students: Advocacy, Care, and Support Opportunities for School Nurses

Transgender individuals are disproportionately affected by negative mental and sexual health outcomes. School nurses have prime opportunities to combat these outcomes through affirming nursing care, especially when transgender students are socially transitioning. Examples of affirming practice include recognizing students' gender-affirming names, using their pronouns, ensuring safe locker rooms, advocating for student's clothing choices, stopping bullying and harassment, and refraining from making assumptions about their transgender students' sexual orientation. Through inclusive care directly provided to transgender children, school nurses can also be instrumental in ushering an affirming environment for all.

Clinical research with adolescents: barriers and how to overcome them

PURPOSE OF REVIEW

This review aims to emphasize the importance of including adolescents in research, outline current standards and evaluate barriers that prevent adolescent research. We also hope to provide some guidance and call for much needed additional direction in the field.

RECENT FINDINGS

The absolute necessity for including adolescents in research has been an area of focus within the community of adolescent providers and care takers. Recent policy and support from major organizations has emphasized the importance of including this population in research but also pointed out many of the complexities.

SUMMARY

Adolescent research is imperative to guiding policy and promoting evidence-based care. Current standards provide both guidance and barriers, yet more research is needed to further guide conduct of ethical research in this population.