Health Care Giving on Transgender Patients Nursing Analysis Paper “Transgender is a term used to describe people whose gender identity differs from the sex

Health Care Giving on Transgender Patients Nursing Analysis Paper “Transgender is a term used to describe people whose gender identity differs from the sex they were assigned at birth. Gender identity is a person’s internal, personal sense of being a man or a woman (or boy or girl.) For some people, their gender identity does not fit neatly into those two choices. For transgender people, the sex they were assigned at birth and their own internal gender identity do not match. People in the transgender community may describe themselves using one (or more) of a wide variety of terms, including (but not limited to) transgender, transsexual, and non-binary. Always use the term used by the person” (Gay & Lesbian Alliance Against Defamation, 2020, “Transgender FAQ” section).

Transgender individuals experience a high degree of discrimination, homelessness, violence, abuse, and hate crimes (James et al., 2016). Trans men and women who experience physical victimization continue to have worse mental health outcomes compared to those who do not and are oftentimes targeted for violence on the basis of their gender identity or expression (Barboza, Dominguez, & Chance, 2016). In a 2015 survey, 29% of the respondents were living in poverty and 40% had attempted suicide in their lifetime, nearly nine times the rate in the U.S. population. More than 77% who had a job in the past year took steps to avoid mistreatment in the workplace, such as hiding or delaying their gender transition or quitting their job (James et al., 2016).

Consider the following case study: Samantha White is a 23 yr old, white, male-to-female transgender patient who had an appendectomy yesterday. She hasn’t yet had gender-reassignment surgery but says she is considering having it done in the next couple of years. Samantha has type 2 diabetes, a possible consequence of starting estrogen therapy several months ago. She buys estrogen on the streets, she says, “Because it’s just too hard to find a good doctor who will work with me on my hormones.” Now, along with the usual postoperative interventions, the care team has been trying to help Samantha control her blood glucose level. She doesn’t pay attention to her diet, and frequently misses doses of her oral hypoglycemic drug.

Susan, a relatively new nurse on the unit, receives change-of-shift report from another nurse who warns her that Samantha White is “rude” and doesn’t listen. “He’s kind of a strange one,” the nurse says. “His cross-dressing is purely attention-seeking behavior.”

Susan notices that the physicians making their morning rounds have gathered outside of the patient’s room. The senior resident, Dr. Harmes, says quite loudly, “This is a 23-year old male, two days post appendectomy, with uncontrolled type 2 diabetes. His surgical site is clean; it’s been healing well.” He adds, “Oh, and she prefers the name Samantha.” The other physicians and residents giggle quietly.

Transgender individuals battle extensive healthcare disparities, but aligning the treatment of transgender patients with the ethical principles you learned this semester can help us understand these disparities.

1) a. Please state and expound on at least three ethical principles that apply in Samantha’s case.

b. What is the best way to address a patient whose preferred name doesn’t match the name on the medical record?

c. If Samantha has health insurance coverage, what problems, if any, might be expected when trying

to obtain reimbursement?

2) a. How can we provide good clinical care to this patient? What specific issues are important to address?

b. Are there any changes you would make to the care plan if Samantha were a person of color?

c. How could Susan’s manager work with staff to inform others who criticize or harass transgender

patients?