Enhancing Student Nurse Practitioner Cultural Competence Caring for Transgender Individuals

Regardless of societal advances such as marriage equality and the repeal of “don’t ask, don’t tell” legislation lesbian, gay, bisexual, and transgender (LGBT) people continue to face significant health disparities. Transgender people are particularly vulnerable to discrimination and violence which are associated with increased rates of mental illness and substance use.  As many as 41 percent of transgender people have attempted suicide, a rate 25 times greater than that of the general population. Despite the health care concerns of transgender people, many hesitate to seek care due to fear of maltreatment by health care providers. Nineteen percent of transgender people report being refused care because of their gender non-conforming status, some have experienced actual violence in the doctor's office. Studies have demonstrated that nurses hold negative attitudes towards LGBT people.  Nursing curricular content related to LGBT issues is lacking in most programs; incorporating such content may facilitate cultural competence and thereby improve attitudes toward LGBT people. A  transgender health unit was incorporated into a primary care nurse practitioner course at a large, northeastern, university-based school of nursing.  An online learning module was developed and included assigned readings and a video to introduce topics and promote respectful dialog during a subsequent panel discussion.  Three transgender people participated in a facilitated panel discussion with the class, sharing their stories of life, transition, and experiences in the health care system.  An ungraded assignment required students to define common terms and gender models, describe the subjective themes of transgender people depicted in the video, and to reflect on their areas of greatest learning.  The student reflections suggested a shift in their attitudes, an understanding of the importance of providing patient-centered care that respects the uniqueness of each person, and a sense of advocacy to remove the barriers that promote health disparities among transgender people.