Fair care for everyone

Student nurse Brooke and her partner Dan are sharing their own experiences to speak up for transgender patients

During my first year studying nursing at Derby University I went to a lecture about protected characteristics. Some students had questions about treating transgender patients and, while my lecturer is fantastic and offered the best answers he could, he hadn’t actually had any transgender patients so lacked real-life experience.
 
After the lecture I spoke to him about my partner Dan, who at that point was two years into his transition. I suggested that Dan’s lived experiences could be beneficial for my cohort to learn from. My lecturer was really enthusiastic about this and we set a date for our first ever talk about transgender patient care.
 
I knew straight away how important and useful it was that we were sharing our experiences and advice. Everyone was so receptive and we really felt like we’d been able to make a difference.

Since then we have gone on to do talks at many universities, senior schools, hospitals and RCN Congress 2019 and hope to continue to do them.

A topic for everyone

Talking about LGBTQ+ rights (whether you fit in to this group or not) is important. The world has changed a lot from when daily prejudice was experienced back in the 50s, however discrimination is still very much an issue.
 
Stonewall, a charity that campaigns for the equality of LGBTQ+ people across the UK, reported that two in five transgender people have suffered a hate crime due to their gender identity in the last year alone. Unfortunately, Dan and some close friends are part of this statistic.
 
The world of health care is no different and unfortunately there is still a lot of discrimination within the NHS. Dan and I have heard countless stories of staff misgendering patients (using the wrong pronouns) and refusing or making treatment difficult. 

A question of health

Being with Dan has shown me how hard some people have to fight to be heard and accepted for who they truly are. And we have learned together that navigating the NHS when you are transgender can be really difficult.

Early on in his transition Dan was advised by his clinician at the gender clinic that he would need to become a “professional patient”. This means having an understanding of the hormones he takes, his bloods and the range they should fall in, etc. This is because he can’t necessarily always rely on every health care professional to be fully knowledgeable about this.

Outside of treatment related to transitioning, transgender patients – like any patient – may also need to access health care for any number of reasons. And there may be extra sensitivities surrounding these.
 
For example, transgender men may never be invited for cervical screenings, and similarly transgender women may never have had a prostrate exam. These examinations can be lifesaving but are often overlooked.
 
When transgender patients do undergo such exams, this can cause quite dysphoric thoughts and can have an effect on mental health so an understanding of this and a sensitive approach is vital. 

If transgender patients feel as though they are being judged or discriminated against when they access health care then they will be put off seeking help when they need it. 

We should always speak up to help promote inclusivity and patient-centred wellbeing

Opening up the conversation

Giving talks with Dan on transgender care has shown me how open my fellow health care professionals are to learn and that by simply sharing our experiences, we have the potential to improve care for many people. It has also helped me recognise that my voice is important and my experience can empower other staff members.
 
I was recently on a shift and overheard two experienced nurses discussing transgender people and expressing some common misconceptions. Instead of being the nervous student nurse and hiding away as I might once have done, I pulled up a chair and joined the conversation. We discussed the discrimination transgender people still face today and how we could better improve all of our practice to be allies of the LGBTQ+ community.

One of the most amazing things about nursing is that we never stop learning and we’re constantly challenged to grow and rethink our perceptions. As student nurses, we are a crucial part of the conversation and should always speak up to help promote inclusivity and patient-centred wellbeing for every patient.

Brooke's advice

As nurses we base our practice around the six Cs, and these should be used when approaching and planning care for every patient.

Care

Although your patient may have been given the advice to become a “professional patient” they will likely still have worries and concerns. Take the time to explain and allow for questions that may arise due to their gender identity. 

Compassion

Transitioning can take years, so have compassion and understand that your patient may be going through an emotional roller-coaster.

Competence

I would urge you to only initiate conversations that you feel competent to take part in. It is OK to say that you don’t know about something and need to learn more. 

Communication

We need to take the time to talk and listen to our patients. Although someone's preferred pronoun may not align with what you consider “normal” for a specific gender, they must be self-defined and respected.

Courage

It takes courage to be an advocate for your transgender patient. This can range from ensuring people use the correct language (pronouns etc.) to creating a safe space and potentially challenging others’ negative preconceptions. 

Commitment

By commiting to being a LGBTQ+ ally, you can make a huge difference. Your voice as a respected health professional can help change people’s perspectives more widely.

Want to improve care for trans people?

The RCN has published Fair Care for Trans People guidance  to help nursing staff provide fair care for trans people. It provides information about gender dysphoria, an overview of hormone therapy and surgical procedures and gives advice on supporting trans people to live healthy lives.

Pictures by Steve Baker

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