ArticlePDF Available

Abstract

As increasing numbers of transgender people access mental health services, so comes with this the requirement that mental health professionals are capable of providing inclusive and informed care. In Australia, mental health nurses play a key role in the mental health workforce, and are increasingly likely to engage with transgender people across a range of practice contexts. The research reported in this paper sought to explore the experience, knowledge, and attitudes of a sample of Australian mental health nurses in regards to working with transgender people. A total of 96 mental health nurses completed a survey that included an attitudinal measure and a measure of clinical knowledge. Findings indicate that a majority of the sample had worked with a transgender client before, but only a minority had undertaken training in working with transgender clients. Training was related to more positive attitudes, and both training and experience were related to greater clinical knowledge. Female and/or older participants had greater clinical knowledge, whilst more religious participants had less positive attitudes. The paper concludes by commenting on the dearth of competency and practice documents specific to mental health nurses working with transgender people, and outlines the Australian standards that would mandate their development.
Australian mental health nurses and transgender clients:
Attitudes and knowledge
Damien W. Riggs and Clare Bartholomaeus
Abstract
As increasing numbers of transgender people access mental health services, so comes with this the requirement
that mental health professionals are capable of providing inclusive and informed care. In Australia, mental
health nurses play a key role in the mental health workforce, and are increasingly likely to engage with
transgender people across a range of practice contexts. The research reported in this paper sought to explore the
experience, knowledge, and attitudes of a sample of Australian mental health nurses in regards to working with
transgender people. A total of 96 mental health nurses completed a survey that included an attitudinal measure
and a measure of clinical knowledge. Findings indicate that a majority of the sample had worked with a
transgender client before, but only a minority had undertaken training in working with transgender clients.
Training was related to more positive attitudes, and both training and experience were related to greater clinical
knowledge. Female and/or older participants had greater clinical knowledge, whilst more religious participants
had less positive attitudes. The paper concludes by commenting on the dearth of competency and practice
documents specific to mental health nurses working with transgender people, and outlines the Australian
standards that would mandate their development.
Keywords: transgender, attitudes, competencies, knowledge, mental health, nurses
This is an Author Accepted Version of a manuscript published in Journal of Research in Nursing.
Copyright Sage.
Introduction
Mental health nurses can play an important role in service provision to transgender people (i.e., people whose
gender differs from that normatively expected of their assigned sex). This role can include providing initial and
ongoing support related to gender identity, having a role in the assessment and referral of gender-affirming
medical procedures, as well as supporting families of transgender people (McCann, 2015). Yet despite the
importance of these roles, research findings continue to suggest that many transgender people have negative
experiences with mental health services generally (McNeil et al., 2012; Riggs et al., 2014; Shipherd et al.,
2010), with some mental health professional displaying a lack of knowledge and sensitivity. In regards to mental
health nurses specifically, it is noted that little attention has been paid to transgender clients and issues (Shattell
and Chin, 2014), and what attention has been paid in the literature summarised below suggests that nurses and
nursing students appear to be lacking in experience and training for working with transgender clients. Drawing
on an Australian study of mental health nurses’ knowledge about, and attitudes towards working with,
transgender clients, the present paper examines predictors of these two variables. Specifically, the survey sought
to examine the relationship between training specific to working with transgender clients, clinical experience in
this regard, and attitudes towards and knowledge about transgender people amongst a sample of mental health
nurses. The paper concludes with recommendations about the upskilling of the mental health nurse workforce so
as to better meet the needs of transgender people.
Literature Review
As noted above, little attention has been paid to transgender clients and issues in the academic literature on
nursing. Evidence for this claim appears in the work of Eliason, Dibble and DeJoseph (2010), who conducted
keyword searches for lesbian, gay, bisexual and transgender (LGBT) issues in the top ten nursing journals
ranked by impact score between 2005 and 2009. They found that five journals “had a complete silence about
LGBT issues” (Eliason et al, 2010: 212), and only 8 out of 4,941 articles mentioned LGBT issues, including just
one where transgender issues were mentioned. A broader review by Merryfeather and Bruce (2014) analysed the
content of 77 articles relating to transgender and transsexual issues in nursing literature between 1985 and 2011.
They found that transgender issues are often invisible or erased in nursing, evident in the lack of attention to
gender diversity in nursing education and textbooks, the slow implementation of policies about transgender
people and nursing, and the dearth of nursing research into transgender people’s lives. Similarly, Dorsen’s
(2012) integrative review of 17 articles published between 1990 and 2010 which focused on nurses’ attitudes
towards LGBT clients found that no studies discussed transgender people. As such, despite the use of the
acronym ‘LGBT’, research that claims to address the needs of all members of LGBT communities often ignores
transgender people, instead only focusing on sexual orientation and homophobia.
A small number of studies have, however, examined attitudes and knowledge amongst nurses and nursing
students attitudes in regards to to working with transgender clients. Importantly, only one previous study has
specifically examined the attitudes of mental health nurses towards transgender people. Kench’s (2015)
qualitative research exploring LGBT issues with 19 mental health nurses in Australia includes a significant
discussion of attitudes towards transgender people. Kench found that her participants generally spoke about their
experiences with transgender people differently to the ways in which they spoke about their experiences with
lesbian, gay, or bisexual people. Specifically, Kench’s participants stated that they knew little about transgender
people, and thus service provision could be ‘awkward’ and ‘uncomfortable’, affecting their ability to provide
culturally competent and inclusive care. This lack of knowledge was considered to arise from the fact that
participants infrequently (knowingly) came into contact with transgender people, and rarely provided nursing
services to transgender people.
Other research with nurses and nursing students more broadly has similarly found a lack of knowledge and
experience. Beagan et al. (2013) conducted semi-structured interviews with primary care nurses (n = 12) and
physicians (n = 9) in Canada and found that, with the exception of two nurses who had extensive experience
with transgender clients, nurses were aware of their own lack of knowledge for working with transgender
clients. While nurses sought to educate themselves, some of this learning was done on the job and from clients,
which may be an unfair demand upon clients. Similarly, a study in one area of the US by Levesque (2013)
examined nursing professionals’ knowledge, attitudes, and self-efficacy for working with transgender clients. Of
the 26 nursing professionals who completed surveys, most worked in primary care or acute care. While there
was a high level of overall acceptance of transgender clients, respondents reported low self-efficacy or
confidence for providing care, and no respondents had been taught about transgender clients in their nursing
education. Again in the US, Kline’s (2014) survey of 80 nursing practitioners who worked mostly in primary
care settings found that 80% agreed with the statement I need additional training to provide competent health
care to transgender patients.
Research with nursing students indicates similar findings in regards to attitudes towards transgender people.
Utilising pre- and post- measures focused on attitudes about LGBT client care, Carabez et al. (2015) report on
findings from a survey of 122 students enrolled in a community nursing course in an urban US university.
Participants completed a survey about comfort and knowledge in regards to working with LGBT clients before
undertaking a unit and assessment piece specifically focused on working with LGBT clients, and were surveyed
again after completion of the unit and assignment. The measure of knowledge suggested that participants were
statistically more likely to have developed increased knowledge about issues related to gender identity than they
were in regards to issues related to sexual orientation. Similarly, Strong and Folse (2015) examined the impact
of an education intervention at a US university for enhancing undergraduate nursing students’ knowledge of,
and attitudes towards, LGBT client care. Comparison of pre- and post-measures suggested that positive attitudes
towards transgender people increased more significantly than they did in regards to attitudes towards lesbians
and gay men.
Methodology
Procedure
Following ethics approval from the authors’ institution, participants were recruited primarily through an
advertisement placed in the Australian College of Mental Health Nurses’ eNewsletter, which appeared in
February 2015. Information about the survey had also previously been circulated via the first author’s existing
personal networks using Facebook and email. The survey was open from July 2014 to April 2015, and
administered via SurveyMonkey. All respondents gave their informed consent to complete the survey by reading
an information screen and selecting ‘yes’ to consent to proceed.
Participants
Current Australian figures suggest that there are 19, 626 nurses who work primarily in mental health settings
(AIHW, 2013). Only a relatively small proportion of this potential sample population, however, completed the
survey (n=96). Current figures also suggest that approximately one third of all nurses working in mental health
settings are male, as compared to only 10% of nurses in general being male. A similar gender ratio was
represented in the sample, with 72% being female and 28% being male. Finally, current figures suggest that the
average age of nurses who work primarily in mental health settings is 47. This was closely reflected in the
average sample age of 48.31 (SD=11.22). None of the participants identified as transgender.
In terms of practice settings, over three quarters of the sample worked in either a medical context (42.7%) or
community mental health (36.5%). The remainder of the sample worked in either private practice (9.4%), child
and family services (4.2%), education (4.2%) or correctional services (3.1%).
The sample were highly educated, with over a third having a masters degree (40.6%). The remainder of the
sample had either a diploma or certificate (18.7%), a bachelor degree (15.6%), or a doctorate (2.1%).
Importantly, for the purposes of the survey potential participants were invited to complete the survey if they
identified with the category ‘mental health nurse’ as their profession. In Australia, mental health nursing is not a
category of registration with the relevant licensing board (the Nursing and Midwifery Board of Australia).
Instead, registered nurses may undertake a specialist qualification in the form of a graduate diploma, after which
they are recognised as a credentialed mental health nurse by the Australian College of Mental Health Nurses.
The survey did not assess whether participants had undertaken such credentialing, and instead accepted self
designation as a mental health nurse as the primary criteria for participation.
Participants came from across six of the eight Australian states or territories. Almost a third of the sample lived
in New South Wales (32.3%). The remainder of the sample lived in South Australia (19.8%), Queensland
(18.8%), Victoria (15.6%), Western Australia (3.1%) or the Australian Capital Territory (6.3%).
In terms of primary client population, the majority of the sample (90.6%) worked primarily with adults. The
remaining participants worked either primarily with children/adolescents (3.1%) or equally with both adults and
children/adolescents (6.3%).
Survey Instruments
The survey utilised an adapted version of the Attitudes Towards Transgender Individuals Scale (ATTIS) (Walch
et al., 2012), which uses a 5-point Likert scale on 20 items. Adaptations to the scale primarily involved
substituting the word ‘people’ for ‘individuals’ as the former was considered less pathologising in tone (for
example, “Transgender people should not be allowed to work with children” rather than Transgender
individuals should not be allowed to work with children”). Two items were changed entirely as the wording was
considered to be unclear. The item “All transgender bars should be closed down” was changed to “Transgender
people should not be allowed in public spaces”. The item “Transgendered individuals should not be allowed to
cross dress in public” was changed to “Transgender people should not be allowed to present as their preferred
gender in public”.
When applied to the sample, no significant results were identified in regard to the ATTIS. It was hypothesised
that this may have been a product of the fact that the ATTIS, despite the amendments made, is relatively blunt.
In order to determine if any aspects of the ATTIS were useful for the present study, a factor analysis was
conducted with a Varimax (orthogonal) rotation. A three-factor solution was identified, however only one of
these factors explained a considerable proportion of the variance (48%). The eight items in this factor include
“Transgenderism is a sin”, “Transgenderism is immoral”, and “Transgenderism endangers the institution of the
family”. This factor displayed high reliability, a = .93. Higher scores on the measure equate to more positive
attitudes.
The second measure utilised was an adapted version of the Counselor Attitude Toward Transgender Scale
(CATTS) (Rehbein, 2012), which uses a 10-point Likert scale on 20 items. Similar to the ATTIS, adaptations to
the CATTS primarily involved substituting the word ‘people’ for the word ‘individuals’. Two items were
changed entirely because their meaning was unclear. “Offices should display both heterosexual and LGBTQ
books and pamphlets” was changed to “All mental health services should provide materials that are inclusive of
transgender people”. “Transgender individuals must choose to live as male or female in order to lead healthy
and productive lives” was changed to “Transgender people should live as their natally assigned sex”.
Similar to the ATTIS, the CATTS produced no significant results when applied to the sample. It was
hypothesised that this may be because the CATTS includes both items specifically about mental health practice
with transgender people, and items that are more general attitudinal questions about transgender people. A factor
analysis using a Varimax (orthogonal) rotation confirmed this hypothesis. A three-factor solution was identified,
with one of these factors including the five questions in the CATTS that specifically focus on mental health
practice (the other two factors included a mix of items that presented no logically coherent factors). This one
factor, which explained 45% of the variance, is utilised in the analysis presented below, and is referred to as
‘clinical knowledge for working with transgender clients’. Example items include “Transgender clients’
presenting issues always centre around or are linked to their gender expression”, “All mental health
professionals should receive mandatory training in working with transgender people”, and “Using an incorrect
pronoun when working with a transgender client is an acceptable mistake”. This factor displayed high
reliability, a = .89. Higher scores on the measure indicate higher levels of accurate clinical knowledge about
transgender clients.
In addition to these measures, participants were asked a series of demographic questions, including their gender,
age, degree of religiosity (not at all, somewhat, quite, very), highest level of education, primary workplace
setting, and primary client population. Participants were also asked which Australian state or territory they live
in, whether or not they had undertaken training in working with transgender clients, and whether they had
worked previously with transgender adult clientsand/or transgender child/adolescent clients.
Analytic Approach
Data were exported from SurveyMonkey into SPSS 21.0. Data were cleaned in two specific ways. First,
negatively scored items on the two scales were reversed. Second, composite scores were generated for the scales
outlined above. The minimum and maximum possible score for the two measures identified from the factor
analysis were attitudes (min 8, max 40) and clinical knowledge (min 5, max 50).
Results
Experience and training in working with transgender clients
Of the sample overall, 72.9% had worked with an adult transgender clientbefore, but only 11.5% had worked
with a child or adolescent transgender client. In terms of differences amongst the sample in regards to working
with transgender clients, those who worked in child and family services were statistically less likely to have
worked with a transgender client than would be expected in an even distribution, whilst those who worked in a
medical context were statistically more likely to have worked with a transgender client, χ² = 22.59, p< .001.
In terms of previous training in working with transgender clients, only a quarter of the sample (19.8%) had
undertaken such training. Similar to experiences in working with transgender clients, those who worked in child
and family services were statistically less likely to have undertaken training in working with transgender
clientsthan would be expected in an even distribution, whilst those who worked in an educational context were
statistically more likely to have undertaken training, χ² = 12.25, p< .05.
Attitudes towards transgender people
The average score for attitudes was 32.11 (SD=4.69), meaning that in general the sample had positive attitudes
towards transgender people.
A one-way between groups ANOVA was conducted to determine whether attitudes towards transgender people
differed between practice contexts. A statistically significant difference emerged, F(6, 78) = 4.018, p<.001. Post
hoc comparisons using the Bonferroni test indicated that the mean score for participants who worked in child
and family services was lower than the mean scores for all other practice contexts.
Participants who had previously undertaken training in working with transgender clients reported more positive
attitudes towards transgender people (M=33.61, SD=5.98) than did participants who had not (M=28.30,
SD=2.32), t=2.904, p< .05, d = 1.17.
There was a strong positive correlation between attitudes towards transgender people and clinical knowledge
about working with transgender people, r = .703, p < .001. Participants with higher levels of clinical knowledge
had more positive attitudes. There was a modest negative correlation between attitudes towards transgender
people and religiosity, r= -.330, p< .05. Those who were more religious had less positive attitudes.
Clinical knowledge related to working with transgender clients
The average score for clinical knowledge was 41.11 (SD=9.02), meaning that in general the sample had a
relatively high level of clinical knowledge.
A one-way between groups ANOVA was conducted to determine whether clinical knowledge about working
with transgender clients differed between practice contexts. A statistically significant difference emerged, F(6,
93) = 10.444, p<.001. Post hoc comparisons using the Bonferroni test indicated that the mean score for
participants who worked in child and family services was lower than the mean scores for all other practice
contexts.
Female participants reported higher levels of clinical knowledge about working with transgender clients
(M=44.15, SD=8.35) than did male participants (M=36.72, SD= 10.39), t= 3.049, p < .05, d = 0.78. Participants
who had previously worked with transgender clients reported higher levels of clinical knowledge (M=43.36,
SD=7.5) than did participants who had not (M=37.84, SD=7.40), t=3.904, p< .05, d = 0.74. Participants who had
previously undertaken training in working with transgender clients reported higher levels of clinical knowledge
(M=42.84, SD=5.71) than did participants who had not (M=36.36, SD=7.81), t=3.2314, p< .01, d = 0.94.
There was a strong positive correlation between age and clinical knowledge about working with transgender
people, r = .455, p < .001. Participants who were older had higher levels of clinical knowledge.
Discussion
The findings reported above suggest that both training and clinical experience are related to more positive
attitudes and greater clinical knowledge. In terms of other significant predictor variables, practice context
accounted for statistical differences in terms of both attitudes and clinical knowledge, religion specifically
accounted for differences in terms of attitudes, and both age and gender accounted for differences in terms of
clinical knowledge. These findings largely mirror previous research on mental health professionals working
with transgender people (Bowers et al., 2015; Claman, 2005; Rehbein, 2012). In order to elaborate on the
implications of these findings, and having first acknowledged the limitations of the research, in the conclusion
to this paper we outline something of the policy and professional contexts in which Australian mental health
nurses currently operate, before then suggesting some potential changes required to further upskill the mental
health nurse workforce.
Limitations
Despite a concerted recruitment strategy that involved social media, emails, and correspondence with the
relevant professional organisation, the research reported in this paper is based on a relatively small sample.
Nonetheless, and without per se making claims to generalizability, the sample reported in this paper is
representative of general trends within mental health nursing in Australia in terms of gender differences and age.
The findings reported in this paper are potentially also limited by the reliance upon a factor analysis to identity a
sub-set of items from each of the measures. Whilst this is not per se an unusual analytic approach, and whilst the
alpha values for each identified factor were high, it will be important that future research assesses the
applicability of these measures with other cohorts of mental health nurses. Finally, whilst not a limitation, it is
notable that the lowest levels of clinical knowledge and least positive attitudes were amongst those who worked
in child and family services. This was potentially because those who worked in this sector were the least likely
to have worked with transgender clients or undertaken training in working with transgender people. Further
research, potentially of a qualitative nature, is required to unpack any potential differences between the
experiences that differing cohorts of mental health nurses bring to their practice with transgender people.
Conclusion
While there are a number of resources that focus on competencies for working with transgender clients amongst
mental health professionals more broadly (see, for example, American Psychological Association, 2015;
ALGBTIC, 2009; Australian Psychological Society, 2013), there has to date been no such resources developed
for mental health nurses or nurses in general. In lieu of this, the primary document referred to in the nursing
literature is the Standards of Care produced by the World Professional Association for Transgender Health
(2011), although this is seldom used in the nursing field by nursing practitioners (Kline, 2014) or in nursing
programs (Walsh and Hendrickson, 2015). In addition to an absence of resources focused on competencies for
working with transgender clients, there is also an absence of guidelines for mental health nurses working with
transgender clients (Kench, 2014; Zunner and Grace, 2012), although some recent documents produced in the
UK by the Royal College of Nursing do include information about transgender clients (e.g., Evans, 2015;
RCNPHE, 2015). Furthermore, the Royal College of Nursing has endorsed the document ‘Good practice
guidelines for the assessment and treatment of adults with gender dysphoria’ by the Royal College of
Psychiatrists (2013), which includes several mentions of nurses. None of these documents, however, specifically
target mental health nurses.
Despite this lack of resources and guidelines related to competencies specific to working with transgender
people, there are nonetheless sources from which a mandate for the development of such documentation can be
derived. In the Australian context, where the research reported in this paper took place, Standard 3 of the
National Practice Standard for the Mental Health Workforce (Department of Health, 2013) states that clinicians
should understand the importance of ‘meeting diverse needs’, which includes understanding about gender
diversity. Similarly, Standard 6 of the Standards of Practice for Australian Mental Health Nurses (ACMHN,
2010) states that mental health nurses should work to reduce stigma and promote social inclusion. Together,
these documents indicate that coverage of issues specific to transgender people is both warranted and important.
Whilst it is beyond the scope of the present paper to outline in detail the contents of potential training materials
and documents specific to mental health nurses working with transgender people, the following should serve as
a guide to the types of issues typically addressed in similar documents. First and foremost, other mental health
professional organisations have voiced opposition to discrimination against transgender people. This includes
public and private discrimination based on actual or perceived gender identity or expression, including legal
discrimination and its impact upon transgender people’s lives (ALGBTIC, 2009; Association of American
Medical Colleges, 2014). Vocalising such opposition is thus a core agenda for mental health nurses, and in
Australia would clearly meet the requirements of Standard 6 outlined above.
In terms of specific skills for working with transgender clients, existing guidelines state the importance of using
the preferred language of the client, such as in relation to pronouns and name (ALGBTIC, 2009; Association of
American Medical Colleges, 2014; British Psychological Society, 2012; World Professional Association for
Transgender Health, 2011). In addition, professionals are advised to be sensitive to ethical issues and challenges
related to providing multiple psychological services, such as both treatment and assessment (Australian
Psychological Society, 2013). Developing an adequate skill set requires developing an accompanying
knowledge set. At its most basic, mental health nurses must be aware that being transgender is not indicative of
a mental disorder (British Psychological Society, 2012), despite the diagnosis of ‘gender dysphoria’ appearing
in the DSM5. Professionals are advised to understand the current socio-political context (ALGBTIC, 2009) and
how this informs their own attitudes about transgender issues, as well as how this context may more generally
place clients at risk (British Psychological Society, 2012). It is also recommended that professionals be
knowledgeable about the diversity of transgender people’s identities and experiences, and avoid assumptions
about their clients’ decisions about medical interventions, including that they may or may not choose particular
surgeries (Australian Psychological Society, 2013). Importantly, in order for changes such as these to occur,
there needs to be a shift beyond that of the individual professional being responsible for acquiring additional
knowledge, and towards one where the requirement for upskilling is mandated by the registering body.
Nursing education provides a clear opportunity for training in regards to working with transgender clients. In
Australia, the Australian Nursing and Midwifery Accreditation Council (ANMAC) is the accreditation authority
responsible for accrediting education providers and programs of study for the nursing and midwifery profession.
The Nurse Practitioner Accreditation Standards were revised in 2015 after public consultations (ANMAC,
2015), yet whilst there are several mentions to ‘diversity’ in terms of culture, there is no mention of gender
diversity or working with transgender people. There would, however, be scope to include transgender issues
under, for example, ‘Standard 2 Curriculum Framework’, ‘Standard 3 Program Development and Structure’
and/or ‘Standard 4: Program content’. In relation to mental health nurses specifically, the Australian College of
Mental Health Nurses has an important role to play in ensuring the inclusion of knowledge and competency
around transgender issues. Given that mental health nurses are already required to engage in continued
professional development, mandating for this to include training in working with transgender clients would
seem important.
In conclusion, it is important that any attempts at upskilling the mental health nurse workforce to better meet the
needs of transgender clients should include consultation with transgender people themselves, so as to be sure to
identify what currently works well in practice, in addition to what needs improving. Whilst an increasing body
of research has been conducted on mental health professionals in general in terms of working with transgender
clients and the experiences of clients themselves, the experiences of mental health nurses and the clients they
work with has to date received little attention. Continued research that allows for the development of both
evidence based education and practice in the field is thus very much warranted.
Key Points
1) Mental health nurses with more training are more knowledgeable about transgender issues,
2) There are potential differences across cohorts of mental health nurses that warrant closer attention in
regards to the impact of these differences upon competent service provision,
3) Training is not currently mandated nor widely available to mental health nurses in regards to
transgender issues,
4) Guidelines and resources should be developed that mandate the upskilling of the mental health nurse
workforce in terms of engaging with transgender clients, and
5) Continued research is needed that considers the voices of both mental health nurses and transgender
clients.
References
American Psychological Association (2015) Guidelines for psychological practice with transgender and gender
nonconforming people. Available at: www.apa.org/practice/guidelines/transgender.pdf (accessed 10
August 2015).
Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling (ALGBTIC) (2009)
Competencies for counseling with transgender clients. Alexandria, VA: ALGBTIC.
Association of American Medical Colleges (2014) Implementing curricular and institutional climate changes to
improve health care for individuals who are LGBT, gender nonconforming, or born with DSD: A
resource for medical educators. Washington, DC: AAMC.
Australian College of Mental Health Nurses (ACMHN) (2010) Standards of practice for Australian mental
health nurses. Canberra: ACMHN.
Australian Institute of Health and Welfare (AIHW) (2013) Mental health nursing workforce. Available at:
mhsa.aihw.gov.au/resources/workforce/mental-health-nursing-workforce/ (accessed 17 August 2015).
Australian Nursing & Midwifery Accreditation Council (ANMAC) (2015) Nurse Practitioner Accreditation
Standards 2015, Canberra: ANMAC.
Australian Psychological Society (2013) Guidelines on working with sex and/or gender diverse clients.
Available at: www.psychology.org.au/Assets/Files/EG-Sex-gender-diverse-clients.pdf (accessed
August 18, 2015).
Beagan, BL, Chiasson, A, Fiske, CA, Forseth, SD, Hosein, AC, Myers, MR and Stang, JE (2013) Working with
transgender clients: Learning from physicians and nurses to improve occupational therapy practice.
Canadian Journal of Occupational Therapy 80(2): 82-91.
Bowers, S, Lewandowski, J, Savage, TA and Woitaszewski, SA (2015) School psychologists’ attitudes toward
transgender students. Journal of LGBT Youth 12(1): 1-18.
British Psychological Society (2012) Guidelines and literature review for psychologists working therapeutically
with sexual and gender minority clients. Leicester: British Psychological Society.
Carabez, R, Pellegrini, M, Mankovitz, A, Eliason, MJ and Dariotis, WM (2015) Nursing students' perceptions of
their knowledge of lesbian, gay, bisexual, and transgender issues: Effectiveness of a multi-purpose
assignment in a public health nursing class. Journal of Nursing Education 54(1): 50-53.
Claman, EE (2005) Construction and validation of a "Counselor Knowledge of and Attitudes Towards
Transgender Issues" scale. Master’s Thesis, Ohio State University, Columbus OH, US.
Department of Health (2013) National practice standards for the mental health workforce. Victoria: Department
of Health.
Dorsen, C (2012) An integrative review of nurse attitudes towards lesbian, gay, bisexual, and transgender
patients. Canadian Journal of Nursing Research 44(3): 18-43.
Eliason, MJ, Dibble, S and DeJoseph, J (2010) Nursing’s silence on lesbian, gay, bisexual, and transgender
issues: The need for emancipatory efforts. Advances in Nursing Science 33(3): 206-218.
Evans, DT (2015) Proud: Lesbian, gay, bisexual or trans clients or patients: Guidance for nurses and health
care support workers on next of kin issues. London: Royal College of Nursing.
Kench, T (2015) Towards sustainable equity in mental health services for LGBT people: A rhizomatic
contribution from nurses constituted at n 1. PhD Thesis, University of Canberra, Canberra, Australia.
Kench, T (2014) L.G.B.T. and mental-health nursing care: A qualitative research project. Polare, 93.
Kline, LI (2014) Health care provision to transgender individuals; understanding clinician attitudes and
knowledge acquisition. Master’s Thesis, University of Vermont, Burlington, VT, US.
Levesque, PJ (2013) Nurse practitioners knowledge, attitudes, and self-efficacy for working with transgender
patients. Clinical Nursing Studies 1(4): 93-100.
McCann, E (2015) People who are transgender: Mental health concerns. Journal of Psychiatric and Mental
Health Nursing 22(1): 76-81.
McNeil, J, Bailey, L, Ellis, S, Morton, J and Regan, M (2012) Trans mental health study 2012. Edinburgh: The
Scottish Transgender Alliance.
Merryfeather, L and Bruce, A (2014) The invisibility of gender diversity: Understanding transgender and
transsexuality in nursing literature. Nursing Forum 49(2): 110-123.
Riggs, DW, Coleman, K and Due, C (2014) Healthcare experiences of gender diverse Australians: A mixed-
methods, self-report survey. BMC Public Health, 14.
Rehbein, RN (2012) Transition in conceptualizing the transgender experience: A measure of counselor
attitudes. Master’s Thesis, Eastern Illinois University, Charleston, IL, US.""""
Royal College of Nursing and Public Health England (2015) Preventing suicide among trans young people: A
toolkit for nurses. London: Royal College of Nursing and Public Health England.
Royal College of Psychiatrists (2013) Good practice guidelines for the assessment and treatment of adults with
gender dysphoria. London: Royal College of Psychiatrists.
Shattell, MM and Chinn, PL (2014) Nursing silent on LGBTQ health: Rebel nurses provide hope. Archives of
Psychiatric Nursing 28(1): 76-77.
Shipherd, JC, Green, KE and Abramovitz, S (2010) Transgender clients: Identifying and minimizing barriers to
mental health treatment. Journal of Gay & Lesbian Mental Health 14(2): 94-108.
Strong, KL and Folse, VN (2015) Assessing undergraduate nursing students’ knowledge, attitudes, and cultural
competence in caring for lesbian, gay, bisexual, and transgender patients. Journal of Nursing Education
54(1): 45-49.
Walch, SE, Ngamake, ST, Francisco, J, Stitt, RL and Shingler, KA (2012) The Attitudes Toward Transgendered
Individuals Scale: Psychometric properties. Archives of Sexual Behavior 41(5): 1283-1291.
Walsh, D and Hendrickson, SG (2015) Focusing on the “T” in LGBT: An online survey of related content in
Texas nursing programs. Journal of Nursing Education 54(6): 347-351.
World Professional Association for Transgender Health (2011) Standards of care for the health of transsexual,
transgender, and gender nonconforming people (7th ed.).
Zunner, BP and Grace, PJ (2012) The ethical nursing care of transgender patients. American Journal of Nursing
112(12): 61-64.
"
... Nurses have a significant share in the provision of health services. According to the results of studies from different countries investigating the attitudes of nurses towards LGBT individuals, it has been shown that nurses have negative attitudes towards these individuals [13][14][15][16][17][18][19][20][21]. However, in Turkey, there are several review articles on the health of LGBT individuals. ...
... It is stated that there is a relationship between traditional values and negative attitudes towards LGBT individuals [5]. In previous studies, nurses who defined themselves as religious have been shown to have a negative attitude towards LGBT individuals [20,21]. In our study, it was found that nurses who defined themselves as 'traditional' were more homophobic than those who defined 'not traditional'. ...
... In this study, it was found that nurses who have no LGBT acquaintance were more homophobic than ones have LGBT acquaintance (p<0.015). Different studies are similar to our findings [14,15,20,21]. Having an LGBT acquaintance can create an opportunity for the individual to get to know LGBT individuals, empathy with them, have knowledge about sexual orientations and gender identities. ...
Article
Full-text available
Purpose: The aim of this study was to determine the attitudes of a group of nurses towards lesbian, gay, bisexual and transgender individuals. Materials and methods: This cross-sectional study was carried out with 358 nurses working in a hospital in the northern region of Turkey between December 2016- February 2017. The data were collected using the personal information form and the Hudson and Ricketts Homophobia Scale. Kruskal Wallis, Mann Whitney U test, Single Factor Variance Analysis, ttest and correlation were used in the analysis of the data. Ethical approval was obtained from the Clinical Research Ethics Committee of an university. Results: The mean score of the scale of the nurses was found as 111.5±20.7. Nurses who stated that they did not want to communicate with lesbian, gay, bisexual and transgender people were found to be more homophobic than the nurses who stated that they wanted to communicate with them. It was also found that the nurses who define themselves as ‘traditional’ were more homophobic than those who define themselves as ‘not traditional’ (p <0.05).The relationship between the nurses' knowledge towards lesbian, gay, bisexual and transsexual individuals and their attitudes towards these individuals was found to be significant similar to the previous international studies. Conclusions: The findings of this study indicate that the level of education, the level of acquaintance with LGBT individuals and the knowledge of LGBT individuals has an effect on the homophobic attitude
... These quality guidelines were selected because the authors pull together criteria for both quantitative and qualitative research, both of which are necessary for the articles included in the present systematic review. Overall, these four studies reported that more 'competent' clinicians appeared to be those that were generally more experienced (Dispenza & O'Hara, 2016), and those that were specifically more experienced working with gender diverse clients (Riggs and Bartholomaeus, 2016a;2016b ...
... Two of the research articles included in this review were conducted in Australia (Riggs and Bartholomaeus, 2016a;2016b), and the rest were conducted in the USA. ...
Article
Full-text available
Gender diverse people experience significantly high levels of mental health difficulties, face significant barriers accessing mental healthcare, and often report negative experiences with mental health professionals. At the same time, healthcare professionals describe feeling deskilled when providing care for gender diverse adults. This paper aims to systematically review research into mental health professionals’ experiences of providing care for gender diverse individuals, and the kind of research methods employed in these investigations. PubMed, SCOPUS, psycARTICLES, and psychINFO were searched, as well citation and reference lists of relevant articles. From 268 search results, 12 articles were deemed relevant to be included in the review. The studies used quantitative, qualitative and mixed methods approaches. Each article was evaluated against established quality guidelines. All studies were likely to have been affected by social desirability bias, and had limited exploration of participants’ contexts, or social discourse. The quality of the articles varied. Clinicians reported having minimal training about gender diversity, and they tended to be less competent working with gender diverse clients compared to LGB clients. Participants described uncertainty working with gender diverse clients, and all the studies identified the need for improved training for mental health professionals working with gender diverse adults.
... Rejection, abandonment and ejection from family homes by parents can have detrimental effects on the health outcomes of LGBT adolescents (Ryan et al., 2010). Negative attitudes by healthcare professionals towards gender and sexual minorities remain a significant barrier to reducing health disparities and providing acceptable and effective care to the LGBT communities (Bockting et al., 2020;Dominguez, 2017;Jackson, 2000;Riggs & Bartholomaeus, 2016). ...
... Dorson and Devanter (2016) suggest the more recent generation of nurses are considered to be more comfortable discussing issues around sexual orientation and gender identity, compared to more experienced nurses who were trained in a conservative era and are generally less comfortable discussing these issues. Health professionals often lack the knowledge and understanding around the current barriers to accessing mental health and are often unaware of the sensitivity of transgender people's issues (Hughto et al., 2018;Nuttbrock et al., 2015;Riggs & Bartholomaeus, 2016). ...
Article
Accessible summary What is known on the subject? • There is evidence that the LGBT communities experience greater health disparities, particularly in relation to their mental health needs. • The LGBT communities are often faced with stigma and discrimination within mental health services. What the paper adds to existing knowledge? • People within the LGBT communities have identified that their experiences of mental health services reinforce stigma and lack an understanding of their specific needs. • Their needs can be addressed by mental health services that challenge heteronormative assumptions and promote self‐acceptance and equity. What are the implications for practice? • The existing heteronormative culture in mental health nursing practice needs to be challenged. • Practice needs to demonstrate self-awareness of personal and societal LGBT biases, prejudices, and stigma. • Practice needs to demonstrate knowledge of important LGBT health care and psychosocial issues. • Practice needs to reflect LGBT clinical skills grounded in professional ethics, guidelines, and standards of care. Abstract Introduction The lesbian, gay, bisexual and transgender (LGBT) communities are a minority population that experience a range of health disparities, including mental health. Because these groups have higher rates of mental disorder than the general population it is, therefore, pertinent to identify their specific mental health needs and their experiences when accessing mental health care. Aim To identify the mental health needs of the LGBT communities and their experiences of accessing mental health care. Methods An integrative review of qualitative studies was conducted. Results A total of fourteen studies were selected for this review. The studies identified that participants’ experiences of accessing mental health care were related to (a) experiencing stigma and (b) staff's lack of knowledge and understanding of LGBT people's needs. They identified a need for mental health care that promotes the principles of equity, inclusion and respect for diversity. Discussion The LGBT communities while not a homogenous group, face unique challenges when dealing with their mental health needs. Services that promote health equity and self‐acceptance are important for this group. Implications for practice It is vital that mental health nursing education incorporate models that promote equity, inclusion and respect for diversity regarding this group of people.
... However, poor knowledge of LGBT-related terminologies reported by some studies was also observed in our study population.(339,340) Healthcare professionals have been noted to lack sufficient knowledge and preparation in dealing with transgender patients which sometimes manifests as confusion about terms, lack of comfort and discriminatory acts during encounters.(215,341) Poor LGBT health-related knowledge has been documented among physicians with a positive attitude,(305) which is similar to that reported in this study. ...
... Among our sample, experiences of cisgenderism and transphobia were particularly prominent in 'general' health settings. While this finding may be somewhat unsurprising given the lack of transgender-specific training provided through medical education in Australia [78][79][80][81], it is troubling given that general practice clinics were by far the most commonly attended sites for sexual health care in our sample. Although eliminating cisgenderism and transphobia in all health settings is essential, we echo conclusions from other research that general practitioners must be a priority in terms of transpositive professional development [6,82,83]. ...
Article
Full-text available
Transgender and gender diverse people have unique risks and needs in the context of sexual health, but little is known about sexual health care for this population. In 2018, a national, online survey of sexual health and well-being was conducted with trans and gender diverse people in Australia (n = 1,613). Data from this survey were analysed to describe uptake of sexual health care and experiences of interpersonal and structural cisgenderism and transphobia. Experiences of cisgenderism and transphobia in sexual health care were assessed using a new, four-item scale of 'gender insensitivity', which produced scores ranging from 0 (highly gender sensitive) to 4 (highly gender insensitive). Logistic and linear regression analyses were conducted to determine if experiences of gender insensitivity in sexual health care were associated with uptake and frequency of HIV/STI testing in the 12 months prior to participation. Trans and gender diverse participants primarily accessed sexual health care from general practice clinics (86.8%), followed by publicly funded sexual health clinics (45.6%), community-based services (22.3%), and general hospitals (14.9%). Experiences of gender insensitivity were common overall (73.2% of participants reported ≥2 negative experiences) but most common in hospitals (M = 2.9, SD = 1.3) and least common in community-based services (M = 1.3, SD = 1.4; p
... Although there is some evidence that understanding of language around LGBT identities may be improving 24 , poor knowledge of LGBT-related terminologies remains an issue in the USA 25,26 Transgender patients are particularly vulnerable to the impact of poor understanding and perceptions from healthcare professionals, which sometimes manifests as confusion about terms, lack of comfort and discriminatory acts during encounters. 27,28 Poor LGBT health-related knowledge has even been documented among physicians with a positive attitude, 4 which was explored in more depth in this study uncovering the nding that many participants were keen to know more in order to better support their patients. ...
Preprint
Full-text available
Background: The highest quality of appropriate care is required to achieve the UN’s Sustainable Development Goals and improve the health of the LGBT population in the global south. This study assessed the training, knowledge, beliefs, attitudes and practice of Nigerian healthcare students and faculty living, working and learning within the constraints of religious, legal and cultural barriers for LGBT people. Methods: This study was carried out among all the tutors in the faculty of clinical sciences, year five medical and nursing students in the College of Medicine, University of Lagos. The sequential mixed methods study design was guided by the socio-ecological model of health. Quantitative data were collected with an adapted questionnaire. The results were used to generate prompts for the qualitative component consisting of In-depth interviews with 21 of the respondents. Transcripts were analysed using thematic analysis. The quantitative and qualitative data were subsequently integrated and, using the socio-ecological model, synthesized. Results: The response rate was 88.2% (medical students), 66.2% (nursing students) and 60.7% (tutors). Themes uncovered were: knowledge of LGBT terminologies; teaching and learning about LGBT health topics; ethics, professionalism and personal beliefs. A fifth of tutors reported teaching related topics or using LGBT examples in class. Students were more knowledgeable of LGBT terminologies than tutors. Facilitators and barriers to LGBT inclusion in healthcare education settings were identified within the following socio-ecological domains: globalization, policy, community, institution, intrapersonal and individual. Conclusion: Ongoing advocacy with policy makers and educational leaders on the right to health for all citizens was recommended. A multilevel intervention by non LGBT and LGBT individuals is required for inclusion of LGBT health in educational curriculum of healthcare students and professionals.
... There is evidence that professionals who have received specific training on working with TGD clients exhibit more positive attitudes, and -when combined with experiencedemonstrate a higher level of clinical competency (Riggs and Bartholomaeus, 2016). More generally, mental health providers can also overcome these barriers through using the correct name and pronouns for a client, even if this name is not recognised on legal documents, including the provision of using both sex assigned at birth and gender (Dolan et al., 2020;Samuels et al., 2018;Vance and Mesheriakova, 2017). ...
Article
Objective: Trans and gender diverse young people experience mental health difficulties self-harm and suicidality at markedly higher rates than the general population, yet they often feel isolated from mental health services. There is little qualitative research on the experiences of trans and gender diverse young people accessing mental health support in Australia. The objective of this study was to comprehensively explore the experiences of trans and gender diverse young people in Australia who have sought mental health support from therapists, counsellors, psychiatrists and/or inpatient care providers. Methods: We report on findings from the Trans Pathways study, which was a mixed-methods study to evaluate the experiences of trans and gender diverse young people accessing mental health services: specifically, therapy and counselling services, psychiatric services and mental health inpatient services. Results: A total of 859 trans and gender diverse young people aged 14–25 years across Australia completed an anonymous online questionnaire. Therapy and/or counselling services (64.4%) were most frequently sought by trans and gender diverse young people in this study, followed by psychiatric services (43.0%) and mental health inpatient services (12.3%). The findings demonstrated that many mental health professionals lacked expertise in gender diversity, and that trans and gender diverse young people found it difficult to locate mental health professionals who were able to meet their needs in a timely manner. Conclusion: These findings indicate that training is necessary for all mental health professionals to improve their knowledge of gender diversity, enhance the support provided to trans and gender diverse young people and help to address the high rates of poor mental health. The findings outlined here provide insight into the areas in which clinicians could optimise their care of trans and gender diverse young people.
... Our study found that the health professionals who had no familiarity with LGBTQ+ people were more homophobic, like other studies in the literature (Hou et al., 2006;Riggs & Bartholomaeus, 2016;Yen et al., 2007). Smith et al. (2009) This study determined that the health care professionals who cared for LGBTQ+ people and were willing to do so had less homophobic and discriminatory attitudes. ...
Article
Aim: To determine the homophobic and discriminatory attitudes of healthcare professionals and associated factors in the private sector. Background: Examining possible homophobic and discriminatory attitudes of healthcare professionals is very important to eliminate barriers such as access to and use of health services. Method: This descriptive, and cross-sectional study included 626 health professionals in 20 private hospitals throughout Turkey. The data were collected in May 2020 using an online questionnaire containing the Hudson and Ricketts Homophobia Scale, and the Discriminatory Attitudes Scale. Results: Most of the health professionals (64.4%) said that they did not know any LGBTQ+ people, almost half (44.2%) had cared LGBTQ+ people before, and most (95.4%) said that they would be willing to care them. The health professionals' homophobia score was 3.60 (SD=1.23), and their discrimination score was 2.10 (SD=.71). A positive relationship was found between their homophobia and discrimination scores(r=.642). Significant differences in their scale scores were found to be related to their personal and professional characteristics. Conclusions: The homophobic attitudes of health professionals were above average and had a positive relationship with discriminatory attitudes. Implications for nursing management: Private hospital administrators should plan initiatives and training programs to improve healthcare professionals' attitudes towards LGBTQ+ people.
... The Problem People who are transgender or gender diverse frequently experience significant health disparities in comparison with their cisgender counterparts (Riggs et al. 2015;Winter et al. 2016). These health disparities often emanate from substandard interactions with health providers both in terms of specific issues around transition but also discriminatory treatment in person, offensive and inappropriate comments or even refusal of care (Riggs et al. 2014;Ellis et al. 2015;Riggs and Bartholomaeus 2016;Riggs and Sion 2017). ...
Article
Full-text available
Educating trainee healthcare practitioners about transgender healthcare has been neglected globally, and nationally in Aotearoa New Zealand. Reasons for this oversight are only just beginning to come clear. Recent research reveals that healthcare practitioners often have a strong interest in learning about transgender healthcare but lack the knowledge and confidence to be able to teach this topic and cultivate the associated values of healthcare practitioners. There is also a lack of research about the most effective ways to teach trainee healthcare practitioners about relevant aspects of transgender healthcare. This issue is pressing, because transgender people frequently endure unmet mental and physical health needs directly related to a lack of access to welcoming, effective healthcare, even where unrelated to processes of gender transition. Aotearoa New Zealand thus seems at a critical juncture in increasing teacher education and student learning about the routine and specific healthcare needs of transgender people. We need to address this persistent educational gap, even out inequalities in health outcomes for transgender people and, in Aotearoa New Zealand, we can potentially lead the way in this field. We can: (1) commit specific curriculum space to transgender health issues; (2) research effective, specific teaching practice on this topic; (3) develop teacher practice around knowledge, confidence and values to deliver the best teaching for trainee healthcare practitioners. Teachers of healthcare practitioners need to set high standards for transgender healthcare education, and further research is needed to establish the best approach for such provision.
... Australian trans women experience significant mental health issues, often due to systematic discrimination and violence (Pitts et al. 2009;Hyde et al. 2013;Riggs et al. 2015;De Cuypere and Winter 2016;Winter et al. 2016;McCann and Brown 2017). Although these can be managed by competent, well-trained staff (Riggs and Bartholomaeus 2016), several studies indicate that GAHT plays a crucial role in reducing trans women's psychological distress and improving their quality of life (Murad et al. 2010). ...
Article
Full-text available
Despite the increased visibility and knowledge in the area of transgender health, the sexual health and experiences of transgender women undergoing Gender-Affirming Hormone Therapy (GAHT) are still under-researched; often, the effects of GAHT on trans women’s sexuality are broadly miscategorised as ‘erectile dysfunction’. This study aimed to provide an exploration of trans women’s negotiation of the psycho- and physiosexual shifts which result from GAHT. Twelve participants (including one pilot) took part in hour-long semi-structured interviews, with two providing a secondary interview for further data triangulation. These interviews were manually transcribed, coded, and final themes were identified and titled from participants’ own words. The interviewer also maintained a journal that was used to provide further depth, reflection, and insight to the emerging themes. The final analysis identified four themes: overall experiences, physiological changes, psychological changes, and shifts in experiences of orgasm. Most participants had positive and/or affirming experiences of sexuality while medically transitioning. One important, and significantly under-researched, experience described by participants was the development of new erogenous zones; for many, their source of sexual pleasure and climax had shifted partially if not entirely away from their genitals and towards nipples, legs, backs, or other body parts. These findings highlight the dearth of medical knowledge in the area of sexual function and pleasure for trans women undergoing GAHT and provide an impetus for a systematic reimagining of how clinical practitioners might negotiate their treatment of a transgender client.
Article
Full-text available
The Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria is a publication of the Intercollegiate Committee of the Royal College of Psychiatrists. The overall goal of the Good Practice Guidelines is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynaecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counselling, psychotherapy), and hormonal and surgical treatments. The Good Practice Guidelines are based on the best available science and expert professional consensus. The Good Practice Guidelines articulate standards of care while acknowledging the role of making informed choices and the value of harm reduction approaches. In addition, the Good Practice Guidelines recognizes that treatment for gender dysphoria i.e., discomfort or distress that is caused by a discrepancy between persons gender identity and that persons sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) has become more individualized. Some individuals who present for care will have made significant self-directed progress towards gender role changes or other resolutions regarding their gender identity or gender dysphoria. Other individuals will require more intensive services. Health professionals can use the Good Practice Guidelines to help patients consider the full range of health services open to them, in accordance with their clinical needs and goals for gender expression.
Technical Report
Full-text available
These toolkits aim to: •develop skills and knowledge and recognise the wider context of mental health in relation to trans* sexual orientation and gender identity. •provide a general outline for health professionals looking to increase their skills and knowledge around suicide prevention strategies with trans* young people
Article
Full-text available
Background Gender identity disorder and the process of transitioning involve both mental and physical health, yet there is virtually no discussion of transgender health care in occupational therapy. Purpose This study draws on interviews with primary-care nurses and physicians about their experience with transgender health care, extending the insights gleaned there to make suggestions for occupational therapy practice with this population. Method Semi-structured interviews were conducted with 12 primary care nurses and 9 physicians who had clinical experience with lesbian, gay, and bisexual patients. Findings Participants felt uncertain about transgender care, wanting more specialized knowledge. Collaborating with patients, acknowledging stigma, ensuring inclusive systems and procedures, navigating health care, and providing holistic care emerged as key elements for best practice. Advocacy was a crucial part of care provision. Implications Suggestions are provided for therapists to ensure that space and interactions are welcoming to transgender clients as well as suggestions for occupational therapy intervention in the transitioning process.
Article
Full-text available
Nurses work with diverse populations, but the nursing literature lacks research, theoretical frameworks, or practice guidelines regarding lesbian, gay, bisexual, and transgender (LGBT) health. Through diverse teaching strategies, students explored issues related to LGBT patients, families, and nurses using a cultural humility lens. Diverse teaching strategies included readings, a 2-hour presentation on LGBT health issues, and an assignment to conduct a scripted interview with two nurse key informants, based on the Health Care Equality Index (HEI). Students completed an online LGBT awareness preinterview survey, completed interviews, and completed a postinterview survey. Students showed a significant increase in knowledge about sexual orientation and gender identity and research and interview methods from pretest to posttest. The diverse teaching strategies involved in this assignment can enhance student knowledge, attitudes, and skills related to LGBT health care needs and increase appreciation of nursing research. [J Nurs Educ. 2015;54(x):xxx-xxx.]. Copyright 2014, SLACK Incorporated.
Article
Government policy makers are becoming increasingly interested in the views and experiences of people who utilize mental health services to inform rights-based and socially inclusive health and social care initiatives. However, very little information exists in the available literature about transgender people in this regard. The current research was part of a larger mixed methods study that used surveys and in-depth semi-structured interviews. This paper reports on the findings from the interview data that relate to the unique mental health experiences of the people whom identified as transgender (n = 4). The data were subject to thematic analysis, and the main themes that emerged included service experiences, treatment issues, other supports, and hopes and aspirations. Participants identified challenges and opportunities for enhancing mental health service provision for transgender people and their families. Some of the highlighted concerns related to practitioner attributes and relevant psychosocial sup- ports. Mental health nurses are well placed to use their knowledge and therapeutic skills to support people who identify as transgender and significant people in their lives.
Article
As nurses, we advocate for the most vulnerable and underserved, who, within the lesbian, gay, bisexual, and transgender (LGBT) community, are transgender individuals. Yet, the existence of LGBT education in nursing schools has not been examined. After approval by the university institutional review board, 113 nursing programs in Texas were surveyed between November 2013 and January 2014, with a 12-question, Web-based questionnaire. A Verisign certificate and 128-bit encryption program supported compliance with the Health Insurance Portability and Accountability Act of 1996. Nineteen percent of the surveys were returned. Ten (47.62%) of 21 respondents addressed transgender or transsexual individuals. Fifteen (71.43%) of 21 answered a free-text question to estimate the number of hours spent addressing LGBT content, reporting an average of 1.6 hours. Our study suggests that, in Texas, nursing students may not be receiving sufficient content, nor do they understand transgender health needs or how to best deliver competent, compassionate care to this population. [J Nurs Educ. 2015;54(6):347-351.]. Copyright 2015, SLACK Incorporated.
Article
Lesbian, gay, bisexual, and transgender (LGBT) people experience distinct health disparities and are one of the largest underserved populations in any nursing setting. Transgender health has been the subject of relatively little health research, particularly within the nursing community. Studies investigating nursing’s knowledge and attitudes towards LGBT persons suggest a gap that can affect the access and quality of care for transgender patients. The purpose of this pilot descriptive study was to explore nurse practitioner knowledge, attitudes and self-efficacy in caring for transgender persons; those whose gender identity and/or gender expression does not fit their gender assigned at birth (natal gender). Bandura’s theory of self-efficacy was used as the theoretical framework. Using a sample of nurse practitioners (n=416) that provided email addresses to a nurse practitioner association questionnaires were delivered electronically which were designed to measure knowledge, attitude and self-efficacy for providing transgender health care. Twenty-six completed surveys were returned. The results indicated that the majority of the respondents’ state “full respect” and “acceptance” towards transgender patients while also reporting low self-efficacy for providing care. All respondents report no transgender content during their nurse practitioner education. Implications from this study suggest that nurse practitioners hold attitudes that promote culturally competent care while knowledge and self-efficacy are potential areas of need. Further clinical research is needed investigating nurse practitioner knowledge, attitude and self-efficacy on a larger scale while also investigating gender and sexual minority content in nursing educational programs.
Article
The purpose of this study was to gain a better understanding of the current attitudes and beliefs held by practicing school psychologists toward individuals who identify as transgender. A review of literature revealed a lack of information about the needs of transgender students in schools. The authors of this study created a ten-question survey that was distributed to practicing school psychologists across the United States. The authors found that school psychologists with more experience working with transgender students are more comfortable addressing the needs of those students; that persons who are more confident in their ability to work with transgender students have more positive attitudes toward this population; and that the majority of school psychologists who participated in this study were willing or more than willing to work with transgender students. The implications of these results are discussed in relation to school psychology graduate education and the needs for future research.
Article
Lesbian, gay, bisexual, and transgender (LGBT) patients experience barriers to health care that include fear of discrimination, as well as insensitivity and lack of knowledge about LGBT-specific health needs among providers. This study examined the effectiveness of an educational intervention designed to improve knowledge and attitudes of baccalaureate nursing students regarding LGBT patient care. Education focused on key terminology, health disparities, medical needs of transgender patients, and culturally sensitive communication skills for competent LGBT patient care. Knowledge level and attitudes were evaluated before and after the intervention using a survey based on a modified Attitudes Toward Lesbians and Gay Men Scale and two assessment tools developed for this study. A statistically significant increase in positive attitudes and knowledge level was found immediately after the intervention. Findings from this study support the inclusion of education related to LGBT patient health care in undergraduate nursing curricula to promote cultural competence and sensitivity. [J Nurs Educ. 2015;54(x):xxx-xxx.]. Copyright 2014, SLACK Incorporated.