Purpose: Research on nursing care of the transgender individual is emerging as reporting and incidence of this population has increased, however, a review of recent nursing literature found little to no research on parents’ experience of having a child undergo gender transition. Approximately 1.4 million adults, or 0.6% of the entire population in the United States, now identify as transgender (Flores, Herman, Gates, & Brown, 2016). In addition, a recent issue of The American Nurse (ANA, 2018) noted how ill prepared many nurses are while caring for this population. This qualitative study begins to explore the issue of transgender individuals from the parent’s perspective, and how, as nurses, we can support and treat the individual while also honoring the role that parents play in this transition process.
Several studies concluded that the process of transitioning is a family process, affecting all members (Alegria, 2018; Kuvalanka, Weiner, & Mahan, 2014). Additional studies reported parent’s feelings related to their child’s gender transition and new identity as a profound loss or ambiguous loss and an uncertainty (Coolhart, Ritenour & Grodzinski, 2018; Simons, Schrager, Clark, Belzer & Olson, 2013; Wahlig, 2015). Transgender individuals and families reported that when seeking health care they faced extraordinary levels of ill-treatment and scrutiny (James, et al., 2016; Kuvalanka, et al., 2014; Schimmel- Bristow, et al., 2018). According to the American Nurses Association (ANA, 2018) discrimination, denial of care, barriers accessing care and providers intolerance are associated with a lack of understanding and knowledge related to the needs of the transgender individual.
Methods: A qualitative phenomenological study was conducted from fall 2017 through summer 2018 using semi-structured interviews to explore the experience of parents whose children have transitioned. After University Human Subject Council approval, the researchers networked with parents through word of mouth and a local support group for recruitment. Criteria for sample eligibility included: (a) male or female, (b) parent of a transgender child who was 13-30 years of age and (c) English speaking.
The study was explained and an information sheet provided should the parent agree to participate. Participation in the interview signified consent in order to better establish anonymity. The interviews took place in person or over the phone. Interviews were audiotaped, transcribed and analyzed following naturalistic inquiry methodology.
Colaizzi’s (1978) method of data analysis was used to identify five overarching themes. The researchers reviewed transcripts individually, then met to conduct data analysis. Trustworthiness and credibility were achieved through prolonged engagement, peer debriefings, member checking and an audit trail. Member checking with two study participants provided validation of results.
Results: A purposive sample of 16 adult parents of transgender children between the ages of 13-30 years of age were interviewed. The majority (75%) were female. Data analysis resulted in the emergence of several themes related to “it rocks your world”; “dancing around in a way that doesn’t distance”; “your child is still your child”; “worrying about the future”; and “transformational, finally an answer.”
The participants spoke extensively about both the emotional as well as intellectual struggle that they experienced as they supported their child through this transition process. For many parents, the child’s initial depression, sadness, and anxiety was worse than the transition experience. As identified by Meleis, Sawyer, Im, Messias, & Schumacher (2000), transition includes the creation of new meanings and perceptions. As these parents grappled with the social and medical transition of their child, these new perceptions have overall led to the ability to “thrive again with the family intact”, as one participant commented.
Several research studies support the wide range of emotions expressed by the participants ranging from loss and grief, helplessness, fear about safety, and fear about the future (Coolhart, et al., 2018; Dierckx, Motmans, Mortelmans, & T’sjoen, 2016; Kuvalanka et al., 2014). One participant summed it up nicely as “it wasn’t the elephant in the room, it was the room” when describing the totality of the transition experience on the whole family.
Conclusion: The objective of this qualitative study was to begin to understand the experience of parents’ whose children undergo gender transition. The data analysis begins to shed light on the complex nature and struggles that parents face as they deal with the emotional and intellectual aspects of their child’s transition. Because parents are seeking accurate yet respectful information related to gender transition, schools, healthcare arenas and counselors have to be aware that the entire family is in transition. While the rights of the transgender teen must be respected, focusing only on their needs alienates other family members and loved ones who are now going through a transition of their own (Alegria, 2018).
Nurses care for individuals in the context of families and communities. Our notion of two genders is being challenged as we move forward in a healthcare environment that is diversifying definitions of gender identity. Thus, the emergence of transgender individuals seeking healthcare will only continue to increase. The need to understand the parent’s experience is critical to a positive transition for the individual, parent and family. The findings raise awareness of the parent’s perspective, provide a better understanding of the complex family issues that occur, provide nursing suggestions on how to continue to work to facilitate “healthy families”, and promote cultural sensitivity. Through an appreciation of the parent’s experience, nurses can work to improve the health of all. This presentation will discuss implications for policy, practice and education.