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'I had no idea how to speak without distressing the individual'

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Student nurse Rebecca reflects on her placement providing therapeutic psychiatric nursing care to a transgender experiencing dysphoria and how the experience changed her

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Rebecca Baird

Throughout my placement experiences in psychiatric nursing settings, I hadn’t ever come across a transgendered individual experiencing gender identity issues or dysphoria. Although I had nursed individuals who fall within the LGBTQ+ community, I had never experienced nursing care tailored to individuals undergoing their gender reassignment journey.

Transgender is an umbrella term for individuals experiencing dysphoria towards their birth assigned gender, expressing that they may be of the opposite gender or may lie within the 58 known established genders of 2017. Some of the main known genders are cisgender, transgender, non-binary, neutrios and intersex. It is known that worldwide there are 0.2-0.3% or 25 million transgender individuals using healthcare services (Thomas et al, 2017). 

My first second-year placement involved providing community psychiatric nursing care in a desolate rural town. I had to look after individuals aged 18-65 experiencing a range of mental health disorders or issues. Through social interactions with the townspeople, I picked up on their lack of education about and slight prejudice towards mental illness and specifically towards transgendered individuals and the LGBTQ+ community. 

My mentor had assigned me a small caseload of patients to see individually and provide therapeutic psychiatric nursing intervention. Through therapeutic relationship building, I began to get to know and nurse an individual with a schizophrenic illness who also identified as a transgendered woman. I believe, this considerably changed and shaped my nursing practice, attitudes, and values, and challenged my preconceived ideas about transgenders.

Before meeting and guiding this individual through their recovery and transition, I had never even met anyone who identified as transgender. Consequently, I had no idea what to expect and how to speak to the individual without distressing them or causing dysphoria. However, allowing the individual to express themselves on an individual level with myself, purely free from judgement, allowed me to develop an effective rapport and encouraged the individual to be their “true self” more often within their community and without CPN support. 

However, almost every day this individual experienced prejudice in the community and within friend and family settings for being transgender. This, at first, would frustrate me as this would also deteriorate the individual’s mental state, and because personally I believe it to be a dehumanising act. However, the individual had learned to ignore this type of behaviour and was able to mentalise others’ minds and why they would act this way. The individual also experienced health inequalities due to lack of resources within the local transgender health service. It is known that within the local gender identity clinic, a transgender must live authentically (meaning as one’s true gender) for a year to be able to receive hormonal treatment and to be put on a waiting list to be assessed for this, which can also take up to a year. 

As nurses, we all aim to ensure that an individual’s needs are holistically met. This individual’s spiritual and emotional needs were not met due to their sexual dysphoria. I believe sensitivity when dealing with transgenders is lacking within healthcare. Although we are ethically practising effective care (non-judgement, empathy), it is the financial and educational resources that are lacking within the NHS. 

This experience opened to me new aspects of care and improved my own knowledge within this area. I hold this experience close to my heart and hope that individuals within the LGBTQ+ community receive equal opportunities in all areas, including healthcare, the same as individuals who are not. 

Rebecca Baird is currently in her second year studying mental health nursing at Robert Gordon University in Scotland

Reference 

Thomas R et al (2017) Ensuring an inclusive global health agenda for transgender people. Bull World Health Organ; 95: 154-156.

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