Experiences of Transgender People in the Healthcare System: A Complex Analysis
Article Sidebar
Published:
May 7, 2018
Keywords:
Transgender, Nursing, Health Disparities, Inequity, Barriers, Gender, Equity, Health, Research, Literature, Review, Analysis, Canada
Main Article Content
Abstract
A nursing perspective following McIntyre and McDonald’s framework was used to unpack the complex issue of challenges faced by transgender people in the Canadian healthcare system, considering historical, ethical, legal, social, cultural, political, and economic perspectives. Transgender people have unique healthcare needs which are often misunderstood or unaddressed by healthcare professionals, leading to poorer outcomes and inequities. Issues concerning transgender people are becoming a focus and a higher priority for society. This literature review reveals the complexity of this issue as the roots in historical, ethical, legal, social, cultural, political, and economic contexts are explored. A variety of barriers and facilitators exist to addressing and resolving this issue, including transgender people avoiding healthcare, intolerance, lack of knowledge and understanding, lack of healthcare provider training, media representation, and economic costs. The analysis of this issue can be used to inform resolution strategies to utilize facilitators and overcome barriers, including increasing awareness and knowledge, improving education and healthcare provider competency, and utilizing nurse leaders as advocates, role models, and agents of change. Improving care of transgender people is a nursing leadership priority. By implementing the suggested resolution strategies, the healthcare system can begin to move towards a more inclusive, understanding, and holistic model of care to improve healthcare access and outcomes for transgender people.
Article Details
Section
Review & Clinical Practice
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References
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2. McIntyre M, McDonald C. Nursing issues: A call to political action. In: McIntyre M, McDonald C, eds. Realities of Canadian Nursing: Professional, Practice and Power Issues. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2014. 3-16 p.
3. Addis S, Davies M, Greene G, MacBride-Stewart S, Shepherd M. The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: A review of the literature. Health and Social Care in the Community 2009;17(6):647–658.
4. Davis S, Berlinger N. Moral progress in the public safety net: Access for transgender and LGB patients. LGBT Bioethics: Visibility, Disparities, and Dialogue 2014;44(5):45-47.
5. Hein L, Levitt N. Caring for transgender patients. Nursing Made Incredibly Easy 2014:29-36.
6. Lim F, Brown D, Kim S. Addressing health care disparities in the lesbian, gay, bisexual, and transgender population: A review of best practices. American Journal of Nursing 2014;114(6):24-34.
7. Bogart LM, Revenson TA, Whitfield KE, France CR. Introduction to the special section on lesbian, gay, bisexual, and transgender (LGBT) health disparities: Where we are and where we're going. The Society of Behavioral Medicine 2014;47:1-4.
8. Redfern J, Sinclair B. Improving health care encounters and communication with transgender patients. Journal of Communication in Healthcare 2014;7(1):25-40.
9. Dorsen C. An integrative review of nurse attitudes towards lesbian, gay, bisexual, and transgender patients. Canadian Journal of Nursing Research 2012;44(3):18-43.
10. Koh J. The history of the concept of gender identity disorder. Seishin Shinkeigaku Zasshi 2011;114(6):673-80.
11. Drescher J. Out of DSM: Depathologizing homosexuality. Behavioural Sciences 2015;5:565-575.
12. Carroll S. State Sponsored Homophobia 2016: A world survey of sexual orientation laws: criminalization, protection and recognition. 11th ed. Geneva: International Lesbian, Gay, Bisexual, Trans and Intersex Association; 2016.
13. Cohen-Kettenis PT, Pfafflin F. The DSM diagnostic criteria for gender identity disorder in Adolescents and Adults. Archives of Sexual Behavior 2009;39(2):499-513.
14. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
15. Canadian Nurses Association. Code of Ethics for Registered Nurses [Internet]. Ottawa (ON): Canadian Nurses Association; 2008 Jun [cited 2016 Aug 5]. Available from: https://www.cna-aiic.ca/~/media/cna/files/en/codeofethics.pdf.
16. Unger C. Care of the transgender patient: A survey of gynecologists’ current knowledge and practice. Journal of Women’s Health 2015;24(2):114-118.
17. Canadian Human Rights Commission. 17/05/2016 - “Transgender people have the same right to respect and dignity as everyone else in Canada,” Canadian Human Rights Commission welcomes new bill [Internet]. Ottawa (ON): Canadian Human Rights Commission; 2016 May 17 [cited 2016 Aug 5]. Available from: http://www.chrc-ccdp.gc.ca/eng/content/transgender-people-have-same-right-respect-and-dignity-everyone-else-canada-canadian-human.
18. Merryfeather L, Bruce A. The invisibility of gender diversity: Understanding transgender and transsexuality in nursing
literature. Nursing Forum 2014;49(2):110-123.
19. Russell ST, Fish JN. Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annual Review of Clinical Psychology 2016;12:465-487.
20. Fredriksen-Goldsen KI, Simoni JM, Hyun-Jun Kim H, Lehavot K, Walters KL, Yang J, et al. The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. American Journal of Orthopsychiatry 2014;84(6):653–663.
21. Pelton-Sweet L, Sherry A. Coming out through art: A review of art therapy with LGBT clients. Art Therapy: Journal of the American Art Therapy Association 2008;25(4):170-176.
22. Pride Calgary Planning Committee. Calgary Pride Parade 2016 [Internet]. Calgary (AB): Calgary Pride; c2018 [cited 2016 Aug 5]. Available from: http://www.calgarypride.ca/events/parade-2016/.
23. Goodyear S. Transgender bathroom debate has students wondering 'what the big deal is' [Internet]. CBC/Radio-Canada; 2016 May 24 [cited 2016 Aug 5]. Available from: http://www.cbc.ca/news/canada/transgender-school-policies-bathrooms-student-voices-1.3589717.
24. O’Neil L. Transgender girls now officially welcome to become Girl Guides in Canada [Internet]. CBC/Radio-Canada; 2015 Oct 15, c2018 [cited 2016 Aug 5]. Available from: http://www.cbc.ca/news/trending/transgender-girls-now-officially-welcome-to-become-girl-guides-in-canada-1.3273129.
25. The Canadian Press. Degrassi returns with first transgender character [Internet]. CTV News; 2010 July 19, c2018 [cited 2016 Aug 5]. Available from: https://www.ctvnews.ca/degrassi-returns-with-first-transgender-character-1.533964.Lindsay D. Wentworth Prison star Socratis Otto discusses playing transgender
26. Maxine and the Caitlyn Jenner effect. [Internet] Available from: http://metro.co.uk
/2015/07/22/exclusive-wentworth-prison-star-socratis-otto-discusses-playing-transgender-maxine-and-the-caitlyn-jenner-effect-5306346/
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30. Alberta Health Care. Bulletin: Alberta Health Care Insurance Plan [Internet]. Alberta (CA): Government of Alberta; 2012 [updated 2015; cited 2016 Aug 5]. Available from: http://www.health.alberta.ca/documents/AHCIP-Bulletin-Med-166A-2012.pdf.
31. Alberta Trans. Medical transition in Alberta [Internet]. c2015 [cited 2016 Aug 5]. Available from: http://albertatrans.org/transition.html.
32. Sevelius JM, Patouhas E, Keatley JG, Johnson MO. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Annals of Behavioral Medicine 2014:47(1):5-16.
33. Wood S, Vanhook P, Philipsen N. Health disparities among lesbian, gay, bisexual, and transgender (LGBT) individuals. Maryland Nurse 2016:17(3):10-12.
34. Jan JT, Edmiston EK, Ehrenfeld JM. Important considerations for addressing LGBT health care competency. American Journal of Public Health 2015:105(11):8.
35. Travers R, Guta A, Flicker S, Larking J, Lo C, McCardell S, et al. Service provider views on issues and needs for lesbian, gay, bisexual, and transgender youth. The Canadian Journal of Human Sexuality 2010;19(4):191-198.
36. Kotter JP, Cohen DS. The Heart of Change: Real-Life Stories of How People Change Their Organizations. Boston: Harvard Business Review Press; 2002 Aug 1.
37. Bradford J, Reisner S, Honnold J, Xavier J. Experiences of transgender-related discrimination and implications for health: Results from the Virginia transgender health initiative study. American Journal of Public Health 2013;103(10):1820-1829.
38. Roller CG, Sedlak C, Burke Draucker C. Navigating the system: How transgender individuals engage in health care services. Journal of Nursing Scholarship 2015;47(5):417-424.
39. Hartzell S. The transformational leader [Internet]. Study.com;c2003-2008 [cited 2016 Aug 5]. Available from: http://study.com/academy/lesson/the-transformational-leader.html#transcriptHeader.