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The Center of Excellence for Transgender Health (2013) defines the term transgender as persons who identify with the opposite sex or gender and express a gender identity that does not conform to their anatomically assigned birth gender. Approximately 0.3% or close to 1 million adults in the United States identify as transgender (Gates, 2011; Gates & Herman, 2014; Grant et al., 2011).
Transgender persons face healthcare challenges with major health disparities due to their gender identity. The National Transgender Discrimination Survey (Grant et al., 2011) provides extensive data on the difficulties transgender people experience as a result of significant social stigma and systematic discrimination. The study stated that due to transgender status 19% were denied access to care, 28% postponed care due to harassment and violence in a healthcare setting; 26% percent were physically assaulted, and 10% experienced sexual violence. High rates of depression and anxiety were common with 41% reporting attempted suicide compared to 1.6% of the general population. Human immunodeficiency virus (HIV) infection rates were four times (2.64%) the rate of the general population (0.6%) and over 25% misused drugs or alcohol to cope with mistreatment. With growing evidence of health disparities and negative health outcomes in transgender populations, DNP-prepared nurse leaders are ideally suited to initiate strategies that can aid health promotion and disease prevention in this vulnerable population.
Access to health care for transgender persons is critical to obtaining mental health services, psychosocial support and managing stressors (McCann, 2015). However, despite urgent healthcare needs, 50% of transgender respondents in a large study said they had to teach their medical providers about transgender care (Grant, et al., 2011). Transgender persons, as patient are not well understood by health care providers (Lutwak et al., 2014). Further, there are a lack of evidenced-based studies to guide care and assist healthcare providers gain greater knowledge and understanding of this population’s unique needs. There is also a significant lack of knowledge, skills, cultural competence, and awareness in providing transgender care. Research on nurse’s attitudes concerning transgender care consistently found negative attitudes, and physicians frequently reported that they witnessed derogatory comments and discriminatory care (Dorsen, 2012; Eliason, Dibble, & Robertson, 2011). A study by Carabez et. al (2015) found that practicing nurses rarely received education or training in transgender health and many were unaware of the needs of this population. In addition, health care providers were uncomfortable working with transgender patients.
Healthcare providers can play a critical role in reducing health disparities and unequal treatment in the transgender population (Snelgrove, Jasudavisius, Rowe, Head, & Bauer, 2012). Nursing as a profession values social justice and equality which are linked to fewer health disparities and more stable health indicators (Boutain, 2005). Nursing can ideally provide organizational leadership by developing a culture wherein stable, patient-centered relationships can develop and thrive. In support of the Institute of Medicine’s Report on the Future of Nursing (2011), graduate-level nurses are prepared to deliver safe and effective quality care. Furthermore, Doctor of Nurse Practice- (DNP)prepared nurses may initiate changes to promote more culturally competent, patient-centered transgender care.
DNP nurse leaders are trained in the essentials of healthcare policy advocacy which is central to nursing practice (American Association of Colleges of Nursing, 2006b). DNP nurses are prepared to provide transformational nursing leadership to facilitate the development of culturally competent, patient-centered initiatives to improve access and services for transgender persons.
The Quality and Safety Education in Nursing (QSEN) initiative identifies the competencies that graduate nurses need to provide safe, and effective quality care in all settings (American Association of Colleges of Nursing, 2012). The DNP nurse leader can effectively develop inter-professional teams to collaborate and perform transformational healthcare change by applying the QSEN competencies to create a needs assessment that identifies barriers, individual cultural characteristics and eliminate stereotypes that affect healthcare practices (Andrews & Boyle, 2008).
A DNP-led nursing initiative can provide a multi-dimensional approach to providing patient-centered transgender care. Development of system-wide competency training of nursing staffs and analyzing inherent features in the organization that pose barriers to patient-centered transgender care is a key component of the solution. Creating an organizational culture that is welcoming and developing partnerships with other community-based organizations that provide institutional care and support for transgender persons is also vital (Thornhill & Klein, 2010). These partnerships will be influential in the development of trusting, long-term relationships with transgender persons that over time will be transformational in preparing healthcare staff in delivering culturally-competent patient-centered care which empowers transgender patients.
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