Role-play simulation to teach nursing students how to provide culturally sensitive care to transgender patients

ObjectiveIncrease student knowledge and comfort with caring for a transgender individual and confronting colleagues when exhibiting poor cultural intelligence.BackgroundTransgender patients often experience health care inequities, including heteronormative microaggressions in communication and policies. Simulation has been a successful means of providing students with the education, tools, and experience necessary to combat systemic injustice in health care. Simulation is an interactive pedagogy that allows nursing students to practice assessment, patient care, and difficult conversations in a controlled, risk-free environment.Design/ MethodsPrelicensure nursing students role-played a simulation created as an interactive learning strategy to promote culturally sensitive assessment of a transgender patient and their caregiver, including assessing for pronouns and providing patient-centered care. The simulation included preforming a difficult conversation between nurses to cultivate an environment of being an upstander. The simulation demonstrated holistic methods of assessing and supporting unique patient needs for the patient who is transgender.ResultsNursing students reported they felt that their comfort with advocacy and ability to communicate with transgender patients, as well as with their families, and health care team members was enhanced after completing the simulation.ConclusionSimulation has the ability to reduce discomfort and discrimination in health care for transgender patients by equipping students with culturally sensitive and inclusive communication tools and providing them with risk-free environment where they can learn to provide care for this vulnerable population in preparation for successful future encounters.     

Bridging the Gap of Mental Health Inequalities in the Transgender Population: The Role of Nursing Education

The transgender population experience mental health disparities as a result of numerous environmental, sociocultural and personal factors. Health care-related discrimination plays an unfortunate role in these disparities. The institutional and informational erasure of transgender individuals in health care actively contributes to this discrimination. The lack of preparation of health care professionals to care for this population is a significant factor. There is an absence of education on transgender topics in nursing school and a lack of nursing research on this population. An awareness through education of culturally competent transgender terminology is crucial to ensure a transinclusive environment is created. The creation of a transinclusive environment in the mental health care setting will ultimately lead to improved patient outcomes.     

Integration of transgender health: A multi-modal approach

The lesbian, gay, bisexual, transgender, queer, and intersexed (LGBTQI+) community can benefit from access to evidence-based health care, social services, justice, and equality. A significant challenge that nurses and educators have is a lack of knowledge, enlightenment, and clinical experience necessary to provide equitable and evidenced based healthcare, specifically to transgender and gender diverse individuals. As this population continues to flourish, Associates Degree (ADN) prepared nurses will be called upon to render care frequently, so curricula must be adjusted. The objective of this quality improvement project was to emphasize how a multimodal education approach can expand knowledge and ease in caring for this community. The methodology included one in-class presentation and a Success Coaching Event that presented a didactic education module, a lived experience speaker, a film depicting bad versus good communication during a clinical encounter, and a post didactic discussion panel. The quasi-experimental design supported the success of the intervention, evaluated by comparing pre- and post-test survey scores as well as results from a final exam. This new curricular framework can be implemented in all ADN programs where nurses learn basics communication and assessment.     

Emergency Care Considerations for the Transgender Patient: Complications of Gender-Affirming Treatments

The transgender population presents a unique challenge for the emergency nurse. There are types of surgeries, medications, complications, and differences in laboratory testing that are unique to transgender people. In addition, emergency nurses are increasingly encountering more transgender patients in the emergency department for care, referrals, and education. Yet, many emergency nurses lack the formal training to care for transgender patients and their families. A complete understanding of the terminology, gender-transforming surgeries, hormonal suppression and augmentation of sexual characteristics, adverse effects, complications of surgeries, and ongoing health risks owing to the altered hormonal milieu and potential risk for acquiring sexually transmitted diseases is important to provide the necessary emergency care for this emerging population.     

Providing Culturally Sensitive Care to Women Who Are in the Sexual Minority or Are Gender Nonconforming

Women who are in the sexual minority or are gender nonconforming experience more physical and mental health disparities compared with those in the sexual majority. Individuals in the minority have reported a fear of being judged or a feeling of being invisible to health care providers. Many nurses believe that they treat all patients the same, but they may be unaware of the special cultural needs of individuals in the minority. In this article, we describe health disparities experienced by lesbian, gay, bisexual, transgender, questioning/queer, and intersex (LGBTQI) populations; explain definitions and terms to improve communication; and discuss best practices to provide inclusive environments for these individuals. We also discuss the process of coming out and how nurses can best meet the needs of individuals in the different stages of coming out.     

Barriers to quality health care for the transgender population

The transgender community is arguably the most marginalized and underserved population in medicine. A special issue focusing on men's health would be incomplete without mention of this vulnerable population, which includes those transitioning to and from the male gender. Transgender patients face many barriers in their access to healthcare including historical stigmatization, both structural and financial barriers, and even a lack of healthcare provider experience in treating this unique population. Historical stigmatization fosters a reluctance to disclose gender identity, which can have dire consequences for long-term outcomes due to a lack of appropriate medical history including transition-related care. Even if a patient is willing to disclose their gender identity and transition history, structural barriers in current healthcare settings lack the mechanisms necessary to collect and track this information. Moreover, healthcare providers acknowledge that information is lacking regarding the unique needs and long-term outcomes for transgender patients, which contributes to the inability to provide appropriate care. All of these barriers must be recognized and addressed in order to elevate the quality of healthcare delivered to the transgender community to a level commensurate with the general population. Overcoming these barriers will require redefinition of our current system such that the care a patient receives is not exclusively linked to their sex but also considers gender identity.     

Development of a family liaison model during operative procedures.

The essence of family-centered care is the provision, by all health professionals, of psychosocially supportive care that fosters family integrity and functioning. Data from a hospital-based satisfaction survey at The Children's Hospital of Philadelphia (CHOP) indicated that the primary reason for parents being "less than completely satisfied" was lack of communication. A search of recent literature suggests also that breakdown in family-centered care in intensive care units is neither new nor unique. The purpose of this article is to describe how efforts to improve communication with parents and families led to the development of a family liaison program and an expanded role for staff nurses in the Cardiac Intensive Care Unit (CICU). The goals of this family liaison program were three-fold: to facilitate establishment of a relationship between CICU nursing staff, parents, and families at the earliest possible point in time; to ensure communication with parents and families at regular intervals during their child's surgery; and to promote practice that incorporates principles of family-centered care within the CICU. The design and implementation of such a program presented nurses in the CICU with both a challenge and an opportunity to take an innovative approach to meeting the fundamental need for information reported by parents and families, and echoed throughout nursing literature. This family liaison program serves to educate parents and families, communicate updates, provide physical and emotional support, and establish continuity of care for the patient and family. Additionally, nurses involved in the program have given positive feedback regarding their expanded role in this family-centered care model.     

Preconception,Pregnancy, Birthing,and Lactation Needs of Transgender Men

Planned and unplanned pregnancies are occurring among transgender men. Although the literature highlights the fact that many transgender men retain their reproductive pelvic organs and desire pregnancy, there is a dearth of information on best practices and standards of care guiding perinatal care for this population. A literature review was conducted to explore the reproductive health needs of transgender men related to reproductive desires, contraception, family planning, fertility preservation, pregnancy, birth, and lactation. Findings show that pregnant and birthing transgender men are reporting feelings of invisibility, isolation, and loneliness in highly gendered perinatal care environments. A lack of gender-affirming perinatal environments and experienced providers is contributing to the avoidance of care by transgender men and further discrimination in an already marginalized population. More research attention is needed to understand the reproductive health needs of pregnant and birthing transgender men and to optimize the care they receive.     

Political involvement in nursing--education and empowerment

Political apathy in the nursing profession can be attributed to numerous factors, including a lack of knowledge of the political process and public policy formation, feelings of powerlessness, and a perceived ethical conflict between professional values and political involvement. Nursing as a profession has arrived at a prestigious point in development where the word "nurse" now is synonymous with the words "patient advocate," thus giving the specialty an important image to fulfill. The public, however, will not recognize nurses as patient advocates until they begin to champion public health and social issues at the Institutional, community, and national levels. Numerous changes in health care delivery methods, together with politicians' increased involvement in health care development, have left nurses in a precarious position even though nurses are the largest group of health care workers in the United States. In this article, the first of a two-part series, the lack of knowledge of the political process and feelings of powerlessness in the nursing profession will be examined, along with their effects on political involvement among nurses.     

Improving communication in a pediatric intensive care unit using daily patient goal sheets

PURPOSE: The aim of the study was to determine if a pediatric intensive care unit (PICU) daily patient goal sheet would improve communication between health care providers and decrease length of stay (LOS). MATERIALS AND METHODS: We evaluated a daily patient goal sheet's impact on questionnaire-based measures of effectiveness of communication, nurses' knowledge of physicians in charge, and on LOS in the PICU. RESULTS: Four hundred nineteen questionnaires were completed by nurses and physicians before goal sheet implementation and 387 after implementation. Nurses and physicians perceived an improved understanding of patient care goals (P < .001), reported increased comfort in explaining patient care goals to parents (P < .001), and listed a higher number of patient care goals after goal sheet implementation (P < .01). Nurses identified the patient's attending physician and fellow with increased accuracy after goal sheet implementation (P < .001). Median PICU LOS was unchanged; however, mean LOS trended toward a reduction after goal sheet implementation (4.1 vs 3.7 days, P = .36). Seventy-six percent of respondents found the goal sheets helpful. CONCLUSIONS: Using a PICU daily patient goal sheet can improve communication between health care providers, help nurses identify the in-charge physicians, and be helpful for patient care. By explicitly documenting patient care goals, there is enhanced clarity of patient care plans between health care providers.     

Dare to be different: transformational leadership may hold the key to reducing the nursing shortage

Health care leadership continues to run under a transactional style that may be causing nurses to leave the system. Nurses no longer wish to stay in the profession perhaps because they struggle ideologically with the system in which they work. However, nurses may hold the key to transforming health care and dragging it into the 21st century in terms of work practices and reform. This is because nurses are visionary, creative, involved in decision making at patient level and have gender based qualities, and communication strategies that the health care sector needs. In contrast to transaction leadership, transformational leadership and team development has a positive affect on communication and team building. The later style is ideologically suited to nurses and may ensure the future of nurses and nursing in the health care sector. The case study described in this paper was an actual working environment and one that I came across all too often as a registered nurse and clinical educator.     

Negotiation of parental roles within family-centred care: a review of the research

Aims and objectives. To review research published in the past 15 years about how children's nurses’ negotiate with parents in relation to family‐centred care. Background. Family‐centred care is a basic tenet of children's nursing and requires a process of negotiation between health professionals and the family, which results in shared decision‐making about what the child's care will be and who will provide this. The literature highlights inconsistencies in the degree to which nurses are willing to negotiate with parents and allow them to participate in decisions regarding care of their child. There is need to explore further the extent to which nurses communicate and negotiate shared care with children and their parents. Conclusions. Three themes emerged from this review of the literature relating to whether role negotiation occurred in practice, parental expectations of participation in their child's care and issues relating to power and control. Parents wanted to be involved in their child's care but found that nurses’ lack of communication and limited negotiation meant that this did not always occur. Nurses appeared to have clear ideas about what nursing care parents could be involved with and did not routinely negotiate with parents in this context. Relevance to clinical practice. For family‐centred care to be a reality nurses need to negotiate and communicate with children and their families effectively. Parents need to be able to negotiate with health staff what this participation will involve and to negotiate new roles for themselves in sharing care of their sick child. Parents should be involved in the decision‐making process. However, research suggests that a lack of effective communication, professional expectations and issues of power and control often inhibit open and mutual negotiation between families and nurses.     

District continence nurses’ experiences of their continence service in primary health care

hägglund d . (2009) Journal of Nursing Management  18, 225–233
District continence nurses’ experiences of their continence service in primary health care Aim The aim of the present study was to describe district continence nurses’ experiences of providing continence services in primary care. Background It has been stated that there is too little research on the experiences of district care nurses who provide continence services. Method Twenty-two district continence nurses answered a written questionnaire containing three open-ended main questions. A qualitative content analysis method was used to analyse the texts. Results The district continence nurses’ feelings of maintaining their professionalism were promoted by scheduled patient encounters, patients who participate in assessment of urinary incontinence (UI) and functioning teamwork. The opposite situation, nurses’ feelings of having a lesser degree of professionalism, was associated with not having scheduled patient appointments, patients not participating in assessment of UI and lack of teamwork. Conclusions The district continence nurses lacked the authority to start nurse-led continence clinics because of the lack of collaborative teamwork, an organization that did not enable nurse-led scheduled appointments and nurses’ limited view of their own profession. Implications for nursing management Primary health care managers and policy-makers need to provide an environment that enables interprofessional collaboration so that nurses’ skills can be used to advance patient services; such initiatives could enable district continence nurses to reach their full potential.     

A brief intervention to standardize postanesthetic clinical handoff

This naturalistic, pre‐ and post‐design study explored the feasibility and acceptability of a brief patient safety intervention to introduce a tool to standardize interdisciplinary communication processes at patient handoff between anesthetists and postanesthesia nurses in the postanesthetic care unit. Observation and interview data were collected pre‐ and post‐intervention from a convenience sample of 27 nurses and 23 anesthetists in a large tertiary hospital in Melbourne, Australia. Following the intervention, significant improvement was observed in nurses' performance of several patient safety behaviors, but trends in nurses' interdisciplinary communication behaviors such as asking questions and escalation of care were nonsignificant. This research provides evidence that tools to standardize clinical handoff communication may empower nurses to perform desired patient safety behaviors during interprofessional handoff. It underpins future research to explore strategies to empower nurses to advocate for patient safety during interdisciplinary communication, and provides a foundation for patient handoff improvement, education, and further research.     

Preconditions needed for establishing a trusting relationship during health counselling - an interview study

Aim. To examine the preconditions needed by district nurses to build a trusting relationship during health counselling of patients with hypertension. Background. Trust has been found to be an important aspect of the patient–nurse relationship. Little research has focused on how trust is formed in patient–nurse relationships or the conditions the development process requires when working with health counselling; in particular not in relation to hypertension. Design. Qualitative study. Method. Qualitative data were collected through open‐ended interviews with all (10) district nurses from three primary health care districts of western Sweden. All interviewees work with the health counselling of patients with hypertension. A latent content analysis was performed with thematic coding of the content of the interviews. Results. The first theme that emerged from the analysis, the nurses’ competence, describes the nurses’ consciousness of their method of expression, both oral and non‐verbal, as well as their pedagogical competence and their ability to be reliable in their profession. The second theme, the patient meeting, describes the continuity in the patient meeting and creating respectful communication. Conclusion. The results show an awareness of preconditions influencing building a trusting relationship. When creating a trusting relationship the communication and pedagogical competences of district nurses have considerable importance. Despite this awareness they state that it is easy to fall into a routinised way of working. Relevance to clinical practice. The implications of this study might be used as support and guidance for district nurses when developing their competence in health counselling in relations to patients with hypertension. This knowledge is also important when planning for nurse‐led clinics for this patient group.     

Developing a Virtual Nurses’ Station for Community-Based Nurses

Nurses who work throughout the community need a nurses' station, just as nurses who work in a hospital. The nurses' station is the area where communication, information sharing, and documentation occur. This article describes how a virtual nurses' station was created using Blackboard technology to meet the needs of nurses who are scattered throughout a geographic area. These nurses work in several urban neighborhoods to conduct the outreach services offered through an academic nurse-managed wellness center to community-dwelling older adults. Results have been positive as the virtual nurses' station provides the nurses an area to exchange data and information, print patient health care information, and access nursing policies. Satisfaction surveys from the nurses give valuable input on the design and use of the virtual nurses' station.