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UCF and UConn Nursing Students Learn to Better Care for Transgender Patients

During clinical education, students in health care fields rarely have access to transgender people, who make up a tiny fraction of the general population. But in a world where transgender people are three times more likely to attempt suicide, twice as likely to be homeless, six to eight times more likely to suffer from depression, and twice as likely to be assaulted or victimized in some way – training clinicians in the appropriate what to treat them is essential.

“What if you identify as man, but you need an OB-GYN exam, your pap smear?” asks Desiree Diaz, assistant professor of nursing at UCF. “Imagine it: You’re a guy sitting in a roomful of pregnant women waiting to be seen by a doctor. How would you feel? Would you stay, or leave? Maybe you don’t go at all.”

Diaz partnered with former colleague Annette T. Maruca, an associate clinical professor at the University of Connecticut, to help address transgender care in nursing – because nurses are among the first-line health professionals who see transgender people. The two say that a time when transgender issues are seeing increased attention, it’s even more important to teach caregivers how to help this population that often shuns heath care.

Diaz and Maruca conducted a study with students on both UCF and UConn campuses to address how the attitudes of these future nurses would impact quality care for transgender patients. About 170 nursing students from both colleges participated in a simulation using “Taylor,” a transgender youth who identifies as male, but was born female. Taylor complains of anxiety, stress and migraines as his physical ailments. Each simulation runs about a half hour, with the transgender patient, Taylor, feeling anxious and becoming increasingly suspicious of the nursing staff. He listens to music on his headphones “to keep calm.” He’s nervous and paranoid: “Are you guys laughing at me?”  And, “No one is listening to me,” he pleads.

The instructors, who presented their findings at the International Nursing Association for Clinical Simulation and Learning conference and had an article published in BMJ Simulation & Technology Enhanced Learning online, learned that as a younger generation of students enters the nursing workforce, there are fewer biases against transgender people, but that doesn’t mean they are comfortable or knowledgeable about providing this population with quality care. With a mean age of 22, students in the study forgot sexual orientation and focused on quality of care; yet, some felt it was not their responsibility to be educated about transgender issues, and were uncomfortable discussing the topic with the patient.

“Some of them were like, ‘Why does this even matter?’” Diaz said. “But you have to think that this person needs multiple issues addressed: What room do we put him in? Are his physical symptoms related to his work stressors? Does he need mental health? Is he socially isolated and could that have an impact? What medications is he taking? Is that a factor?”

Haley Boyle, a graduating senior and president of the Student Nurses Association at UCF-Orlando says she “felt a little helpless for him. I felt like he had other things stressing him out. I wanted to ask more about his transition and how he was dealing with that.”

That’s exactly what Diaz and Maruca hope to teach the students.

“What were the social queues that were important? What questions made you realize what he was going through? What information should you eliminate as you’re treating Taylor?” Diaz said, explaining that the students need to think not only about his immediate symptoms but also his emotional, psychological and social stressors.

Senior Nancy Rupp says she feels better prepared by the simulation experience: “It’s important that we can act like nurses treating him so that if we make a mistake, it’s in a sim, not in the real world,” she said. “This is a situation we might not have the chance to experience in clinicals. It allows us to ask questions and hopefully find you’re prepared for a similar situation later.”

Unfortunately, during clinical education, students in health care fields rarely have access to transgender people, who make up a tiny fraction of the general population. And in most nursing programs, there are only about two hours of education on this specific population, although UCF and UConn now offer an enhanced curriculum with the added simulation hours.

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