The discrimination transgender people face in clinical settings creates negative repercussions for their overall health outcomes. Sometimes rather than engaging in overt harassment, clinicians may turn transgender people away because they believe transgender people require specialty care. About a third of transgender people report having been assaulted, harassed, or refused medical treatment at a doctor's office, according to a 2015 survey.
Now, a new survey presented at the Association of Nurses in AIDS Care conference in Portland, Oregon, finds that nurses who expressed interest in transgender care believe that transgender people have value and are ready and willing to care for transgender patients.
However, the survey also revealed that a small number of nurses would not be fully comfortable with transgender clients on an interpersonal level, and some had mixed beliefs about sex-gender paradigms.
Overall, the survey results indicated that a majority of nursing students pursuing an advanced degree had positive and medically appropriate beliefs about transgender people, yet a small minority held onto beliefs that may perpetuate stigma and reinforce existing structural barriers that impede a transgender person's access to care.
The research was presented by Joseph De Santis, Ph.D., ARNP, ACRN, FAAN, of the University of Miami School of Nursing and Health Studies. De Santis' colleague Mary McKay, DNP, ARNP, CNE, was the first author of the poster, titled "Pre-licensure BSN Students' Attitudes, Beliefs, and Willingness to Provide Nursing Care to Transgender Clients: A Pilot Study."
The purpose of the pilot survey was to understand prelicensure Bachelor of Science in Nursing (BSN) students' beliefs and attitudes about caring for transgender people. The survey was sent to 261 students in an adult nursing course.
The survey was conducted prior to a lecture on transgender care, in order to elucidate baseline attitudes and beliefs. Researchers used the Transgender Attitudes and Beliefs Scale (TABS), a three-part survey that ranks respondents along three criteria: interpersonal comfort, sex and gender beliefs, and human value.
The TABS survey asks respondents to rate statements in these three categories according to whether they strongly disagree, strongly agree, or fall somewhere in between, on a seven-point scale. Within the interpersonal comfort category, statements included, "I would feel comfortable having a transgender person into my home for a meal," or "If I knew someone was transgender, I would tend to avoid that person."
Within the sex/gender beliefs category, respondents are asked to rate statements like, "If you are born male, nothing you do will change that," or "a person who is not sure about being male or female is mentally ill."
And within the human value category, statements included, "Transgender individuals are valuable human beings regardless of how I feel about transgenderism," and "Transgender individuals are human beings with their own struggles, just like the rest of us."
Overall, 60 nursing students responded to the survey. On average, they were 26 years old, with an age range of 20 to 62. The vast majority (88%) were female, and a significant portion of the survey sample (22%) identified as LGBTQ. One participant identified as transgender.
When their scores were ranked along the TABS criteria, the results were promising. Twenty-one nursing students -- a full 35% of the cohort -- reported having previously cared for a transgender person.
Overall, a majority of respondents reported positive perceptions of transgender people, ranking highly along the TABS criteria of interpersonal comfort, sex/gender beliefs, and human value. However, the authors noted two statements within the interpersonal comfort criteria that were ranked lower than they had hoped, along with eight within the sex and gender criteria.
The human value criteria received consistent high marks. However, one student reported that they would be unwilling to conduct rectal examinations, enemas, dressing changes, or peri care (genital washing) on a transgender person.
The authors concluded that results should be interpreted with caution because of the small sample size of respondents. As well, the attitudes of prelicensure BSN students may not be consistent across other nursing communities.
Ultimately, they said more research should be conducted to determine whether prelicensure BSN students would report that they were competent and capable of caring for transgender patients.