Nursing In Practice Summer 2023 issue | Page 33

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others , as it may hurt someone and may have a negative impact on someone ’ s mental health and wellbeing . Healthcare professionals can also be reported to the NMC for behaviour that contravenes discrimination policy , and also to the police , and action can be taken against them . The Equality Act defines four different types of gender reassignment discrimination 6 : 1 . Direct discrimination : when someone treats another person unfairly because they are transgender . 2 . Absences from work : when a transgender person is treated differently due to taking leave of absence for reasons arising from gender reassignment . 3 . Indirect discrimination : when ways of working or workplace policies put transgender people at a disadvantage compared with others . 4 . Harassment : when someone makes a person feel degraded , ashamed or offended in relation to gender reassignment . This could include deliberately misgendering someone ( identifying their gender incorrectly by using an incorrect label or pronoun ).
Terminology
Here is some useful terminology to help you engage with and support transgender and nonbinary patients
Transgender / trans A gender a person has that does not match the gender they were assigned at birth
Transgender man ( trans man ) Assigned female at birth and now male
Transgender female ( trans female ) Assigned male at birth and now female
Non-binaryPeople who do not identify as male or female
Gender dysphoria Clinical term for discomfort experienced by a person due to the physical characteristics of their body
Gender pronouns ( he / him / she / her / they / them / ze / zir / xe / xir ) Words used to refer to a person in discussion . Stonewall has further information on pronouns , of which there are many 10
Dead name Someone ’ s birth name that they no longer wish to be associated with
Inclusive healthcare ‘ How can we be more inclusive for transgender patients ?’ is a common question I hear from many student and qualified nurses .
As part of my own research , I have spoken with trans people to gain a better understanding of what it means to be transgender , and how it affects them physically , mentally and socially – but most of all of how healthcare professionals can do better for them as our patients . Here are some suggestions for how best to achieve this :
• Ask the person about themselves . Every patient is different and may go by different pronouns or be going through different hormone treatment . So , if you don ’ t know , just ask ; they would rather you ask than make assumptions and get it wrong .
• Use of pronouns . Telling someone your pronouns and asking theirs can be an effective way to reassure someone from LGBTQIA + ( lesbian , gay , bisexual , transgender , queer / questioning , intersex , asexual ) communities that you are a safe person to talk to .
• Do not judge anyone for who they are . This is part of the NMC Code 7 , as well as that of the General Medical Council . We should always approach patients from a non-judgmental standpoint .
• Use the name they want you to use . The person ’ s birth name may be documented in the notes , but if they tell you they ’ ve changed their name with their gender , use that . Otherwise , you risk causing unnecessary distress .
• Be mindful when doing intimate examinations . Take your time , respect the person and be mindful that they may have different transgender undergarments , such as a binder for their chest .
• Listen to your patient . Listen to hear what they are telling you , rather than in order to reply .
• Have LGBTQIA + friendly posters or articles , and perhaps the Pride Progress flag , visible in your waiting room . The flag has 11 colours to represent a rainbow and inclusivity , and is a symbol of hope .
• Invite someone to your surgery or clinic to give a talk to and educate your team around trans patients .
• If a patient ’ s health issue doesn ’ t concern their genitals , don ’ t ask about them . We don ’ t need to know what someone ’ s genitals are if there is no problem in that area . Broaching the topic without good reason can trigger discomfort or distress .
• Don ’ t ask to see pictures of what the person looked like before . Doing so can also be triggering .
There are currently limited specific education and training resources on transgender . However , an e-learning package on Future Learn has been created by healthcare professionals at St George ’ s , University of London . 8 This is recommended to clinical colleagues who wish to gain more knowledge around transgender patients and the treatments and surgeries they may go through .
Transition processes Not all transgender people will go through hormone and surgical procedures , and each person ’ s journey is different . Equally , not every trans person will struggle with gender dysphoria , which is the discomfort experienced by someone who has a mismatch between their biologic sex and their gender identity .
People will go through different processes to transition from one gender to another .
The first thing people may initiate is a social transition , which includes but is not limited to :
• Change of name and pronouns .
• Change of social media profile to update others .
• Talking to their family and friends .