Transgender Health Care for Nurses: An Innovative Approach to Diversifying Nursing Curricula to Address Health Inequities

Methods of Teaching Transgender Health in Undergraduate Nursing Programs: A Narrative Review

BACKGROUND

Transgender populations experience disproportionately higher rates of mental and physical health issues such as suicidality and heart disease than their cisgender counterparts. Education of health professions students and providers is recognized as an effective method in mitigating transgender health disparities.

PURPOSE

This narrative review investigated the methods in which transgender health is taught in undergraduate nursing programs. Suggestions for optimizing transgender health education are presented.

METHOD

This review critically appraised and synthesized 28 articles that met these inclusion criteria: articles in English describing teaching strategies used in transgender health education with samples that include undergraduate nursing students.

RESULTS

Didactic lecture is the most widely used method, followed by role-play simulation, use of film and video, guest presentation, and high-fidelity and standardized patient simulation.

CONCLUSION

Lectures remain the dominant method of delivering transgender health content. Improvements in students' knowledge and attitude related to transgender care were noted posteducation.

Nurses' implicit and explicit attitudes towards transgender people and the need for trans-affirming care

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.

A Review of Patient Experiences and Provider Education to Improve Transgender Health Inequities in the USA

Transgender individuals are an underserved, vulnerable population. They face many inequities including barriers in both accessing and receiving adequate healthcare. These inequities are proposed here to be rooted in a lack of education about transgender people and their experiences. We begin by exploring the existing transgender healthcare research carried out in the USA, examining client experiences, provider education and attitudes, and the barriers transgender people face to obtaining proper healthcare. Secondly, we look at the previous research on educational interventions implemented with medical students and practitioners in the USA to enhance knowledge about transgender people, and increase sensitivity and awareness, while also increasing the level of comfort in working with these clients. The limitations in these fields of study are discussed in order to understand how to better serve transgender clients in the USA. We will do this through a narrative review to determine evidence-based best practices for educational intervention, uncovering gaps in the literature and highlighting where to focus in future work for researchers and practitioners.

Nurse Educators' Perceptions of Teaching Patient-Centered LGBTQ+ Gender-Affirming Care to Undergraduate Students

ABSTRACT

Nurse educators are uniquely positioned to equip students with the knowledge, skills, and attitudes to provide LGBTQ+ persons with culturally congruent inclusive care. Using Quality and Safety Education for Nurses' patient-centered care competency as a framework, this study used a qualitative exploratory-descriptive design to investigate nine undergraduate nurse educators' perceptions of teaching LGBTQ+ gender-affirming care. Three themes emerged from the interviews denoting challenges: importance of patient-centered care, limited knowledge, and barriers to curricular integration. Incorporating LGBTQ+ topics across the undergraduate nursing curriculum is necessary to support the delivery of person-centered care.

Educating "Helping" Professional Students to "Help" Trans People Navigate Their Health Care Needs: A Review of Recent Literature

In the 2015 United States Trans Survey, trans people overwhelmingly indicated that training health-care providers about trans health is an urgent policy priority within the US. This literature review examines the types of educational training interventions health professional schools have developed from 2015-2020 focused on trans health. This review revealed that the fields of medicine and interprofessional education have created the majority of interventions, which tend to increase students' knowledge, comfort, and confidence working with trans patients. Schools of counseling, social work, and public health are not adequately developing curriculum and interventions that prepare students in health professional schools to work with trans people. Recommendations include schools of medicine developing more faculty expertise in trans medicine, professional organizations requiring trans content on licensure exams, state licensure boards requiring continuing education in trans health, and health professional schools increasing the use of trans standardized patients and trans panels.

Pedagogical strategies of LGBTQIA+ education in pre-licensure nursing: An integrative review

OBJECTIVES

Previous research suggests that information about providing culturally sensitive care to patients of the LGBTQIA+ population has been lacking among pre-licensure nursing programs. This is due, in part, to a lack of faculty preparation and knowledge regarding LGBTQIA+ issues. The purpose of this integrative review is to examine pedagogical strategies of LGBTQIA+ content integration in pre-licensure nursing programs in the United States.

DATA SOURCES

The literature search was conducted by searching CINAHL, the Cochrane Database, PubMed, MEDLINE, Google Scholar, and PsychINFO for peer-reviewed articles that were written in the English language and completed in an educational setting.

REVIEW METHODS

The search was conducted by a single independent reviewer. Inclusion and exclusion criteria were applied to articles identified by the databases. Eighteen articles met all identified criteria. Articles were appraised using resources from the Joanna Briggs Institute and one article was excluded from further consideration after appraisal. Seventeen articles were analyzed for themes.

RESULTS

Three themes emerged from the review: lecture and dialogue, experiential learning, and reading and writing.

CONCLUSIONS

Based on the review of the literature, there is a myriad of evidence-based pedagogies to incorporate LGBTQIA+ content into pre-licensure nursing programs. Students were successful in achieving learning outcomes and interventions were well-received. The studies in this review may assist in mitigating a lack of faculty preparedness in teaching LGBTQIA+ content by providing examples of pedagogical strategies that can be adapted to fit their particular course or program.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

The Binary Order of Things: A Discursive Study of Nursing Students' Talk on Providing, and Learning About, LGBT Patient Care

Against the backdrop of the healthcare inequities and maltreatment facing LGBT patients, recommendations have been made for the inclusion of LGBT health topics in nursing curricula. Based on data collected in focus group discussions with South African nursing students, we complicate the assumption that training focused on health-specific knowledge will effectively reform providers' prejudicial practices. Findings reveal ambivalence: silence and discrimination versus inclusive humanism. Participants drew on discourses of ignorance, religion, and egalitarian treatment to justify their inadequacy regarding LGBT patients; while doing so, however, they deployed othering discourses in which homophobic and transphobic disregard is rendered acceptable, and "scientifically" supported through binary, deterministic views of sexuality and gender. Such "expert" views accord with Foucault's notion of "grotesque discourse." We conclude with a discussion of the findings' implications for nursing education; we call for the recognition and teaching of binary ideology as a form of discursive violence over LGBT lives.

Identifying Gaps in LGBTQ Health Education in Baccalaureate Undergraduate Nursing Programs

BACKGROUND

The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) population historically has faced stigma and discrimination, including in health care. Although discrimination in health care generally has improved, barriers to culturally congruent care remain. Education for nurses and other health care workers is key to addressing these barriers; however, little is known about the status of LGBTQ health education in nursing schools.

METHOD

A survey on LGBTQ health education provided to undergraduate nursing students was sent to all Commission on Collegiate Nursing Education-accredited schools.

RESULTS

Nearly two-thirds of responding schools indicated their graduates were not adequately prepared to care for this population, and 38% of schools agreed their faculty had the knowledge needed to adequately teach this content. Barriers included time constraints and lack of faculty knowledge.

CONCLUSION

In addition to a need for expanded LGBTQ health education for students, there is a need for faculty education about LGBTQ content. [J Nurs Educ. 2021;60(10):552-558.].

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.

Transgender and gender diverse health education for future nurses: Students' knowledge and attitudes

BACKGROUND

Compared to cisgender peers, transgender and gender diverse (TGD) people experience significant health disparities associated with discrimination and limited access to appropriate care in healthcare settings. Nurses represent the largest segment of the United States (US) healthcare workforce; however, US nursing programs only dedicate approximately 2.12 h to Lesbian, Gay, Bisexual, and TGD (LGBT)-related content.

OBJECTIVES/DESIGN/SETTING/PARTICIPANTS

To fill the gap in TGD-related nursing education, the Transgender Curriculum Integration Project (TCIP) developed and integrated an evidence-based curriculum specific to TGD health into the pre-licensure accelerated Bachelor's in Nursing Science (BSN) program at Johns Hopkins School of Nursing. The purpose of this study was to assess the preliminary efficacy and feasibility (i.e., attrition, engagement, acceptability) of the TCIP in improving the TGD-related health knowledge and attitudes among a sample of pre-licensure nursing students.

METHODS

TCIP utilized a self-administered online survey to assess students' knowledge and attitudes about TGD health prior to (time point 1) and following (time points 2 and 3) the integration of TGD-specific content into five nursing pre-licensure courses. Rank-based nonparametric testing using Kruskal-Wallis H and Mann-Whitney U were conducted to determine if there were statistically significant differences in responses between the three time points. Thematic content analysis was used to determine themes present among short answers.

RESULTS

Findings indicate TGD-specific content improved student's gender sensitivity overtime, with improvements in self-reported skills in providing care for TGD people and knowledge of additional TGD-specific resources. However, gender sensitivity remains low among student's and students requested more TGD content suggesting room for further improvement.

CONCLUSIONS

Findings support the efficacy of TCIP and highlight complexities of curricular change that can guide future curricular integration and evaluation in nursing programs nation-wide.

Transgender and gender-expansive youth: Assisting the nurse in providing culturally competent care for our clients and their families

TOPIC

Society's blue and pink concept of gender has been under a dramatic and controversial shift over the last 10 years. While the general population has been given some latitude in slowly coming to terms with this new understanding, health care providers, specifically nurses, have been under the microscope to demonstrate a perfect blend of competency and compassion when caring for clients who present outside the gender binary.

PURPOSE

To clarify the areas of potential impact in the nurse's role and to discuss ways in which they can better equip themselves to promote effective communication and culturally competent care. Thus, we envision heightened empowerment for the nurse to take a more active role in decreasing risks for negative health outcomes such as psychological stress, depression, self-harm, and suicidal ideation in our transgender and gender-expansive youth.

SOURCES USED

Utilizing PubMed, nationally recognized websites, and current textbooks/pamphlets, a literature review was conducted to ascertain pertinent information related to transgender, gender-expansive youth, and nursing education. Included references were from 2012 to the present.

CONCLUSIONS

Nurses have a unique and dynamic opportunity to provide support and education for our transgender youth and their families, yet often play a minimal role due to inexperience or lack of resources.

The integral role of nurses in primary care for transgender people: A qualitative descriptive study

AIM

To understand nursing activities, training and key supports needed to provide primary care to transgender individuals.

BACKGROUND

Discrimination, limited practitioner knowledge and a deficiency of services contribute to health care barriers for transgender individuals. Literature demonstrating how primary care services are delivered, and more specially the role of nurses in this care, is lacking.

METHODS

Qualitative description methodology and interviews were used to describe this phenomenon. Participants included nurse practitioners, registered nurses and registered practical nurses.

RESULTS

Nurses are important in providing primary care to transgender individuals. While NPs worked to full scope of practice, RNs' and RPNs' roles could be optimized. A key challenge was lack of education; however, mentorship and collaboration contributed to competency development. Ensuring the workplace provided gender-affirming care was key to a safe and inclusive environment.

CONCLUSIONS

Supporting nurses to develop capacity and work to full scope of practice can improve access to care. Ongoing opportunities for mentorship and ensuring an inclusive workplace will aid in the provision of care for this vulnerable population.

IMPLICATIONS FOR NURSING MANAGEMENT

Development of organisational policies, staff training and appropriate supports, for role optimization and team collaboration, can eliminate barriers experienced by transgender individuals.

Homeless experiences and support needs of transgender people: A systematic review of the international evidence

AIM

To examine the experiences and support needs of homeless transgender people by synthesizing the existing evidence.

BACKGROUND

Transgender people face many challenges in society in terms of people's knowledge, understanding and acceptance of a person's gender identity. Evidence regarding the homelessness experiences and available supports to transgender people remains sparse.

METHODS

A systematic review was undertaken and included qualitative and quantitative studies. A total of twelve papers were included in the review, utilizing the PRISMA method. Methodological quality was evaluated using the Mixed Methods Assessment Tool (MMAT).

RESULTS

Following analysis, the themes that emerged were (a) pathways into homelessness, (b) experiences whilst homeless and (c) routes out of homelessness.

CONCLUSION

It has become increasingly clear that the distinct needs of this group are complex and multifaceted. In order to adequately address the issues and concerns comprehensively, coordinated and effective collaborations need to be in place.

IMPLICATIONS FOR NURSING MANAGEMENT

Clinical nurses need to recognize and respond to the distinct needs of trans homeless people. Nurse managers need to provide leadership to promote the needs of homeless trans people and ensure that policies and procedures are in place that are responsive to issues and concerns.

Transgender women's satisfaction with healthcare services: A mixed-methods pilot study

BACKGROUND

Many transgender women are dissatisfied with healthcare services PURPOSE: (a) To describe satisfaction/dissatisfaction with healthcare services; and (b) to describe barriers/facilitators of satisfaction with healthcare services among a sample of transgender women.

DESIGN AND METHODS

A mixed methods design collected quantitative data (n = 50) and qualitative data (n = 25) from transgender women.

FINDINGS

Quantitatively, satisfaction with healthcare services was high among the participants, with lower areas related to healthcare systems issues. Qualitatively, participants identified barriers and facilitators of healthcare satisfaction.

IMPLICATIONS

This study provides clinical, research, educational, and policy implications for improving healthcare satisfaction among transgender women.

A sexual health course for advanced practice registered nurses: Effect on preparedness, comfort, and confidence in delivering comprehensive care

BACKGROUND

Sexual healthcare is a critical component of well-being. Sexual health disparities persist nationally. Nurses and advanced practice nurses are well positioned to provide sexual healthcare to diverse patient populations. However, many nurses do not feel prepared to provide comprehensive care and sexual health curricula vary widely across schools of nursing.

OBJECTIVES

We aimed to evaluate the effectiveness of a new sexual health course for graduate students in improving nurses' knowledge, preparedness, comfort, and confidence in delivering comprehensive, culturally informed sexual healthcare.

DESIGN

A pre-post-intervention survey study design was utilized to assess course effectiveness.

SETTING

Medium-sized, private university.

PARTICIPANTS

Graduate nursing students enrolled in the course (intervention group, n = 30) were recruited. Graduate students enrolled at the institution but not enrolled in the course served as controls (n = 64).

METHODS

Descriptive statistics and multivariate analysis were used to evaluate pre- to post-course changes in knowledge, preparedness, comfort, and confidence in the intervention group and differences between the intervention and control group at baseline.

RESULTS

At baseline, all participants (n = 94) exhibited high objective clinical sexual health knowledge. The intervention group had significantly increased overall preparedness, comfort, and confidence in providing sexual healthcare to diverse patient populations. In particular, participants in the intervention group had statistically significant increases associated with care for marginalized minority populations (sexual minorities, gender minorities, sex workers, and persons with a history of sexual trauma).

CONCLUSIONS

The graduate-level course on sexual health and sexual health disparities effectively increased perceived preparedness, comfort, and confidence in delivering comprehensive and culturally informed care to diverse populations. Nursing programs should evaluate their curricula to determine whether graduates are optimally prepared.

Registered Nurses as Optimizers of Gender-Affirming Care Within a Transgender and Intersex Specialty Care Clinic

An estimated 1.4 million transgender adults live in the United States; this equates to approximately 0.6% of the U.S. population (Lane et al., 2018). Clinical focus on gender dysphoria has significantly increased over the past 30 years (MacCarthy, Reisner, Nunn, Perez-Brumer, & Operario, 2015), with burgeoning evidence from across disciplines documenting the positive outcomes associated with gender-affirming interventions. The purpose of this article is to illustrate how RNs optimize psychosocial, hormonal, and surgical gender-affirming care through performing comprehensive assessments, coordinating care, and providing education and health coaching.

Strategies for inclusion of lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) education throughout pharmacy school curricula

Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others (LGBTQIA+) patients face stigma and barriers to health care, including a lack of health care professionals' knowledge and confidence in treating this patient population. Pharmacists are in prime position to decrease this health disparity. United States pharmacy schools have limited LGBTQIA+ content, continuing the concern of recent graduates without knowledge and confidence. This commentary discusses potential barriers to introducing LGBTQIA+ content into school of pharmacy curricula and presents five strategies currently in use by nursing, medical, and pharmacy schools. Schools of Pharmacy should consider proactive incorporation of this content to graduate practitioners able to provide quality care to LGBTQIA+ patients.

Incorporating LGBTQ health into the curriculum: Assessment of student pharmacists' knowledge and comfort level in caring for transgender patients

BACKGROUND AND PURPOSE

This study aimed to measure the effects of instruction regarding transgender health in second-year student pharmacists and provide qualitative insight regarding their impressions of the educational experience.

EDUCATIONAL ACTIVITY AND SETTING

Students completed a pre- and post-survey assessing knowledge regarding transgender therapeutics, the pharmacist's role, level of comfort providing care, and impression of exposure to the topic. McNemar's test and paired t-tests compared respondent data before and after the activity. The post-survey evaluated the learning activity, with an opportunity to leave open comments that were then analyzed using content analysis.

FINDINGS

Eighty-five of 107 (79.4%) students completed both surveys and were included in the analysis. Transgender therapeutics knowledge, participant understanding of pharmacist's role, comfort level, and assessment of adequateness of exposure improved significantly (p < 0.001). A majority (82.4%) affirmed that more than one exposure to issues regarding care of transgender patients is needed in the curriculum. Fifty-five open comments offered by 23 students were coded and categorized into two overall themes with four and two subthemes, respectively. Strengths of the activity were topic importance, exposure appreciation, presentation style, and knowledge foundation. Opportunities for improvement included providing more information and different types of information.

SUMMARY

The activity increased student pharmacists' knowledge regarding transgender therapeutics, the pharmacist's role, and comfort level in caring for this patient population. Respondents found the content valuable and desired more. Colleges of pharmacy should consider increasing exposure to specific patient populations, such as transgender patients, to prepare students for practice.

Inequities in cancer care among transgender people: Recommendations for change

Owing to a shift in social attitudes and human rights standards, health inequities experienced by gender minorities are gaining an increasing spotlight globally. Transgender (trans) is an umbrella term used to describe individuals who have a dissimilar sex, gender identity and/or gender expression than what was designated at birth. Recently, studies have sought to identify health disparities and barriers to care among this population. While oncology-focused research remains limited, the social determinants of trans health elicits a significant impact on transgender people across the cancer continuum and, thus, requires further examination. The purpose of this paper is to explore the issue of trans health inequity in the context of Canadian cancer care highlighting current clinical practice, as well as gaps in research, provider education and health care policy. The paper will conclude with recommendations for policy development and a reflection on the oncology nurse's role in advocating for change.

Inégalités des soins aux personnes transgenres atteintes du cancer : Recommandations en faveur de changements

Avec l'évolution des attitudes sociales et des normes relatives aux droits de la personne, les inégalités que connaissent les minorités de genre en matière de santé attirent de plus en plus l'attention, partout dans le monde. L'appellation transgenre (ou trans) est un terme générique servant à décrire les individus qui adoptent un sexe, une identité ou une expression de genre différent de celui qui leur avait été attribué à la naissance. Récemment, des études ont cherché à identifier les disparités et les obstacles liés aux soins de santé chez cette population. La recherche en oncologie demeure limitée, et puisque les déterminants sociaux de la santé des personnes transgenres touchent assez fortement cette population tout au long du continuum du cancer, la question doit être approfondie. Cet article a pour but d'explorer la question des inégalités en santé vécues par les personnes transgenres dans le contexte de soins du cancer au Canada. Il traite de la pratique clinique actuelle, des lacunes en recherche, de l'éducation des fournisseurs et des politiques de soins de santé. L'article se termine sur des recommandations en faveur du développement des politiques et propose une réflexion sur le rôle de l'infirmière en oncologie dans la promotion du changement.

Psychiatric Epidemiology of Transgender and Nonbinary Adult Patients at an Urban Health Center

PURPOSE

Transgender and nonbinary people have an increased burden of psychiatric problems compared with the general population. Data are needed to understand factors associated with psychiatric diagnoses, acuity in terms of suicide attempts and level-of-care escalation, and outpatient engagement among transgender and nonbinary adults.

METHODS

We conducted a retrospective review of records from 201 transgender and nonbinary adults who presented for primary care at a health center. Regression models were fit to examine factors associated with psychiatric diagnoses, substance use disorders (SUDs), acuity, and outpatient behavioral health engagement.

RESULTS

Male sex assignment at birth was associated with decreased odds of a psychiatric diagnosis (odds ratio [OR] 0.40, 95% confidence interval [CI]: 0.20-0.81). Increased odds of SUDs were associated with later hormone initiation (OR 1.04, 95% CI: 1.01-1.08) and suicide attempt (OR 5.79, 95% CI: 2.08-16.15). Increased odds of higher acuity were associated with alcohol use disorder (OR 31.54, 95% CI: 5.73-173.51), post-traumatic stress disorder (OR 18.14, 95% CI: 2.62-125.71), major depressive disorder (MDD) (OR 6.62, 95% CI: 1.72-25.44), and absence of psychiatrist integration into primary medical care (OR 4.52, 95% CI: 1.26-16.22). Increased odds of outpatient behavioral health engagement were associated with case management utilization (OR 10.73, 95% CI: 1.32-87.53), anxiety disorders (OR 15.84, 95% CI: 2.00-125.72), and MDD (OR 10.45, 95% CI: 2.28-47.98).

CONCLUSION

Psychiatric disorders were highly prevalent among transgender and nonbinary adult patients. Novel findings include associations of lack of psychiatrist integration into primary care with acuity and of case management utilization with outpatient behavioral health engagement.

Examination of Lesbian, Gay, Bisexual, and Transgender Health Care Content in North Carolina Schools of Nursing

BACKGROUND

Nursing students require academic and clinical training in preparation for the increased demand for culturally competent care. One group that is in need of culturally knowledgeable health care providers is lesbian, gay, bisexual, and transgender (LGBT) individuals. The purpose of this study was to examine how LGBT health care content is integrated into North Carolina schools of nursing curricula and to examine the existence of specific LGBT policies.

METHOD

A survey was mailed to 70 deans and directors of RN programs in North Carolina.

RESULTS

Over 90% of the schools indicated that LGBT health care issues were taught in the curricula. The majority of the content was taught as an "other" course (37%). More than two thirds of the schools devoted less than 5 hours teaching LGBT content.

CONCLUSION

LGBT health care content is being taught, yet the presence of specific LGBT practice policies is basically nonexistent. [J Nurs Educ. 2017;56(4):223-226.].

Systematic Review of Sexual and Reproductive Health Care Content in Nursing Curricula

OBJECTIVE

To examine whether and to what extent pre-licensure nursing programs include sexual and reproductive health (SRH) content in their curricula.

DATA SOURCES

Electronic databases, including CINAHL, MEDLINE, PubMed, Web of Science, Science Direct, Google Scholar, ProQuest, and CAB Direct were searched for relevant literature. We also reviewed the reference lists of all studies, nursing organization Web sites, and the personal files of the authors.

STUDY SELECTION

Inclusion criteria were studies focused on SRH content in pre-licensure nursing education, written in English, and published between January 1990 and November 2016. We identified 632 articles, and of these, 22 met the inclusion criteria. Duplicates were discarded, and 13 articles were reviewed (9 quantitative descriptive, 2 modified Delphi, 2 mixed methods).

DATA EXTRACTION

Data extraction and subsequent analysis were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted and organized under the following headings: author and year to establish a historical timeline, study purpose and design, sample size, data collection methods, main study findings, and limitations.

DATA SYNTHESIS

We found the following: (a) most studies focused on baccalaureate education; if associated degree programs were reviewed, findings were not reported separately; (b) definitions were not consistent, which affected the scope of study results; (c) the SRH topics taught were similar; (d) there is a recent interest in sexual orientation and gender identity curriculum; (e) barriers to including content were time constraints, competing demands with other curriculum priorities, and a need for creative curriculum tools.

CONCLUSION

Documentation of SRH content in pre-licensure nursing education is limited. Faculty should conduct ongoing evaluation of their curricular strategies and clinical experiences and publish results in the literature.

The impact on relationships following disclosure of transgenderism: a wife's tale

WHAT IS KNOWN ON THE SUBJECT?: The experiences of transgender people are becoming increasingly more visible in popular culture, biographical literature and the media. The topic has received little attention within the psychiatric and mental health nursing literature. There is a paucity of literature exploring the impact on relationships following a disclosure of transgenderism. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: A narrative account of the consequences for the wife of one transwoman and their relationships with friends and family following the disclosure of transgenderism. The article identifies a range of issues that require further attention in relation to healthcare provision. These include the mental health needs of partners and spouses; attitudes of healthcare professionals towards transgender issues; and the adequacy of the formal support offered to partners and spouses of transgender people. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a need for healthcare practitioners to explore their understanding of transgender issues and how these may impact on the mental health of partners and spouses. It is important that healthcare professionals provide a hopeful and supportive environment to enable couples to explore their relationships following disclosure of transgenderism.