Trans* Health in Practice: Simple ways to be welcoming, supporting, and caring with the non-binary community

Co-authored by Candace W. Burton, PhD, RN, AFN-BC, AGN-BC, FNAP assistant professor at Virginia Commonwealth University, and Monica McLemore, PhD, MPH, RN, assistant professor at the University of California San Francisco.

This week the United State Supreme Court hears arguments in Obergfell v. Hodges, a case that could determine the fate of hundreds of same sex marriages across the country. Even as our attention is drawn to that high-stakes process, it’s critical to consider how we can create an inclusive space in our own lives, work, and communities. One means of doing so is to recognize and attend to the needs of trans* and non-binary gender individuals in health care practice. As three nurses who work in mental health, reproductive health, and emergency care, we encounter people all along the gender spectrum and strive to provide safe, effective, and nonjudgmental care. We also understand that institutional-level change occurs about as fast as you can swim through peanut butter, but there are some simple things each of us can do on a daily basis. Small changes can make a difference in how your practice welcomes trans* and non-binary people, so here are a few suggestions.

The first thing is to understand what is meant by “trans*” and “non-binary.” The asterisk after trans* indicates that what comes after could be a variety of things: transman, transwoman, transgender—it’s a way to indicate that you aren’t just referring to one group within the trans* population. Non-binary means someone whose gender isn’t completely defined by the terms man or woman. We could try to explain that in greater detail, but non-binary means non-binary so we’re not going to try to label it more than that! You may also see “gender non-conforming” used, but that term suggests that there is some ideal of gender to which to conform—this can have very negative and shaming connotations.

Next, realize that the “T” in LGBTQI isn’t silent but is often silenced. Trans* individuals have a plethora of reasons to distrust health care providers, and “coming out” may be complicated and risky, especially if a provider isn’t routinely demonstrating gender-inclusive behaviors. So, for example, though you may be perfectly well aware that Jane Smith likes feminine pronouns and forms of address, make sure sure this is confirmed at each visit. This demonstrates that you recognize it could change and that your practice can and will support any answer.

Third, recognize that there are times that sex or gender is relevant and times when it’s not. Some of the authors of this piece have practices related to reproductive health, often called “women’s health” — but we’re aware that not all people who need gynecologic or obstetric care are women. Hormone therapy, contraception, and other concerns in this area make it important for us to know each client’s history—but if we’re treating someone for a sinus infection, there’s a lot less to consider.

Fourth, understand that cisnormativity is insidious. Cis is the opposite of trans, and means that someone’s external appearance and internal experience of sex and gender are the same. Cisnormativity is the social expectation that this is true for everyone. Trans* folks are often misgendered as a result, such as when Jane Smith is called from the waiting room as “Mr. Smith” because records identify her as a male. In such a case, Jane may leave without being seen, rather than be outed to everyone present. Consider using just last names to identify clients, and make sure there are gender-neutral restrooms available.

Finally, know your gender-neutral pronouns and use them consistently. Ze or xe are commonly used if an individual’s gender preference isn’t known (ze, zir, and zir’s; xe, xyr, and xyr’s). Some non-binary folks also use they or them, but this can sound distancing if used without thought, such as when referring to “them” or “those people”. If you model these, and make clear that inclusive language is important in your practice, others will as well. Such language may not apply to every person in your practice, but it demonstrates a culture of inclusivity that can benefit more than just trans* and non-binary individuals.

Some of these suggestions are easier to implement than others, obviously, and some may take a good deal of training and effort. Recognize, however, that for trans* and non-binary individuals, these “changes” are about making life and experience visible and valued. Doing so creates a culture of inclusivity, welcome, and support for some of the most vulnerable folks we care for. Today could be the day that someone you encounter realizes you can be trusted to be supportive, thoughtful, and nonjudgmental in your care.

Check out these links for more information that can shape good practice habits around gender with your clients:

http://itspronouncedmetrosexual.com/2012/05/what-does-the-asterisk-in-trans-stand-for/

http://transequality.org/about-transgender

http://www.lambdalegal.org/sites/default/files/publications/downloads/whcic-insert_transgender-and-gender-nonconforming-people.pdf

http://transhealth.ucsf.edu/trans?page=lib-00-02

About monashattell

Mona Shattell is Associate Dean for Research and Faculty Development in the College of Science and Health, and Professor in the School of Nursing at DePaul University. The College of Science and Health at DePaul University is comprised of 8 departments (health sciences, psychology, STEM studies, biology, chemistry, physics, environmental science, and mathematics), 1 school (nursing), and 4 centers (STEM Center, Quantitative Reasoning Center, Center for Family and Community Services, and the Center for Community Research). The college currently has 150 full-time faculty members, 2700 undergraduate students and 725 graduate students, and $15 million in research funding. In her role as Associate Dean for Research, Dr. Shattell promotes research in all departments, schools, and centers in the college; she enhances the culture and capacity of the college to support scientific inquiry, supports and mentors tenure-track and non-tenure-track faculty, and promotes student research. In addition to her position as Associate Dean, she also serves as the PI of mental health services research teams and as board member for several community non-profit mental health advocacy organizations. She is Associate Editor of Advances in Nursing Science and Issues in Mental Health Nursing, a regular blogger for the Huffington Post, and the author of more than 100 journal articles and book chapters. She has participated in several fellowship programs: she is a former Public Voices Fellow with the OpEd Project, which is a media fellowship program that develops thought leaders from traditionally underrepresented groups; she participated in the Sigma Theta Tau International Mentored Leadership Development Program, and post-doctoral K30 Clinical Research Training Program through NHLBI. She is active in a number of professional organizations and is a Fellow of the American Academy of Nursing. She is also a member of the American Nurses Association, the American Psychiatric Nurses Association, the Southern Nursing Research Society, Midwest Nursing Research Society, Sigma Theta Tau International, and the International Academy of Nursing Editors. She serves on numerous community boards of mental health-related service and advocacy organizations. Prior to joining the faculty at DePaul University, she was tenured Associate Professor at the University of North Carolina at Greensboro, Assistant Professor at the University of Alabama at Birmingham, and Lecturer at the University of North Carolina at Charlotte. She received a PhD in nursing from the University of Tennessee Knoxville, a Master of Science degree in nursing from Syracuse University, and a Bachelor of Science degree in nursing, also from Syracuse University.
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4 Responses to Trans* Health in Practice: Simple ways to be welcoming, supporting, and caring with the non-binary community

  1. peggychinn says:

    Very informative! thank you so much for contributing this to LavenderHealth!

  2. Pingback: Since Last We Spoke 5-4-15 : Forensic Healthcare Online

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