Addressing Transgender Rights in Nursing Education By Brendan D . Shull , Jamela M . Martin , and Beth Tremblay
Modern atraumatic nursing and medical care is built upon a “ hypocritical ” oath proposed by Hippocrates in 275 AD . The Hippocratic Oath commands that no healthcare practitioner shall enact harm upon a patient .
But , put simply , we must admit that the medical and nursing community has failed to meet the needs of our transgender patients , who are subject to discrimination and poorer health outcomes due to ignorance and / or bias . Now is the time that we , as nurses , take action to meet the needs of this underserved population . Of the many textbooks assigned to the next generation of nurses , few mention healthcare that is specific to the transgender community . Of the many lectures that nursing students sit through , almost none formally and intentionally discusses how to address the healthcare needs of transgender individuals . This poses the question : Are nursing schools preparing the next generation of healthcare professionals to meet the needs of all their patients ?
Background Commonly mistaken for being synonymous with biological sex , gender is a collection of roles to which individuals are expected to adhere based on their external biological characteristics . For example . in the United States , an individual born with two X chromosomes and a vagina is typically expected to behave as a female and wear feminine attire ( Wade & Ferree , 2015 ). In this example , sex refers to the person ’ s biology whereas their exhibited traits ( for example , wearing dresses ) are expectations to which these individuals are often held . Transgender , or trans , individuals identify as a gender different from their assigned gender ; individuals may be born female but exhibit masculine traits or may learn they do not identify with either masculine or feminine traits ( these people often identify as non-binary ) ( Wade & Ferree , 2015 ). A mismatching gender identity may lead to severe distress , referred to as gender dysphoria indicated by a strong desire to be and be treated as another gender ( Diagnostic and Statistical Manual of Mental Disorders , 2017 ).
Transgender individuals are often subject to severe discrimination and prejudice which can have a negative impact on their physical , psychological , social , and economic health and prosperity ( Herman , et al ., 2019 ). Discrimination is often manifested in the form of refusal to provide gender transitions , denial of appropriate medical and mental health services , absent or lacking legal protections , and denied recognition of gender identity ( Adams & Vincent , 2019 ).
Transgender people are disproportionately homeless , at an increased risk for harassment and assault in school and work ( Anton , 2009 ), and are more susceptible to suicide . According to a 2016 study published in the Indian Journal of Psychological Medicine , bullying , violence , social rejection / isolation , harassment from peers , the public , and the police , and healthcare discrimination are major risk factors that contribute to the trans community ’ s 32-50 % suicide attempt rate ( Virupaksha , Muralidhar , & Ramakrishna , 2016 ).
Trans individuals are offered very little legal protection in the United States healthcare system , with 37 states not expressly prohibiting discrimination based on gender identity . In 2016 , the Department of Health and Human Services reinterpreted the prohibition of discrimination of sex to include gender identity ; however , this was enjoined from being implemented in Texas ( Human Rights Watch , 2018 ), and the order was completely rolled back by the Trump administration in 2020 ( Simmons-Duffin , 2020 )
Transgender Health Nursing Education Nurses play an integral part in providing care to transgender people . Madeleine Leininger , PhD , RN , FAAN , pioneered the theory of transcultural nursing , which focuses on reconciling the cultures , beliefs , and values of patients and nurses to promote health and well-being ( Leininger , 1974 ). Dr . Leininger ’ s theory necessitates that nurses are educated in the plight of transgender individuals , allowing them to provide high quality , empathetic care to trans identifying individuals . The American Nurses Association ( ANA ) Code of Ethics issues guidance for including lifestyle , values ,
22 NSNA IMPRINT • NOVEMBER / DECEMBER 2021 • www . nsna . org