Five steps to better care for trans patients
Nursing scientist Annekathrin Hempel researched the care of trans people in nursing in her master's thesis at the UW/H.
The number of gender reassignment surgeries in Germany has risen from 883 in 2012 to 2598 in 2021. This development reflects the growing visibility and recognition of trans people in society. However, the master's thesis by nursing scientist Annekathrin Hempel at the UW/H shows that there is a need to catch up in the care and treatment of trans patients. She analysed the experiences of nurses in dealing with patients after gender reassignment surgery in hospital and derived five recommendations for action for nurses.
Numerous knowledge gaps and uncertainties among carers
Hempel conducted five guided interviews with carers. All interviewees had been working in the department for at least two years. The results show that carers are not sufficiently trained in dealing with trans people, for example during their training:
- The interviewees stated that they were afraid of misbehaving when they started working in the department - for example, when using patients' pronouns correctly. According to their own statements, carers often lacked the background knowledge that they had to generate from direct conversations with patients.
- A central point in the care of patients undergoing gender reassignment surgery is the frequently blurred boundaries between closeness and distance, for example due to dressing changes in the genital area every two hours. Carers were often required to maintain a professional distance here.
- The carers said that changing dressings for newly constructed genitalia requires a high level of expertise and is very time-consuming. Knowledge of wound care, wound observation and wound documentation was essential. Close professional dialogue with doctors was very important to ensure optimal care.
- Due to high levels of suffering, experiences of discrimination and fear of the operations, it often happened that carers had to explain post-operative care more intensively than usual.
Recommendations for the care of trans people
1. adapt training
Gender reassignment surgery is currently only touched on superficially in nursing training. In order to do justice to this and better prepare future nurses for the specific needs of trans people, training content should be updated and expanded.
2. expand further and advanced training
The lack of specialised further training and clear instructions makes day-to-day care more difficult. There is a need for targeted training, e.g. in dialogue management or psychological stress, in order to strengthen skills in dealing with trans patients.
3. promote specialisation
With the increase in gender reassignment surgery, the need for specialised nursing staff is growing. Annekathrin Hempel suggests introducing special roles such as a "trans nurse" or integrating "advanced practice nurses" for qualified care on wards.
4 Integrate psychological support
The successful integration of psychologists into oncology teams shows how valuable psychological support is. A similar integration into the care of trans patients could significantly improve their psychological well-being.
5. update care concepts
Care concepts, such as Krohwinkel (1993), are based on a binary view of gender and gender identity. This does not take into account the gender identity of many patients. Existing concepts need to be revised and adapted to changing gender identities.
Conclusion
The proposed measures reflect an urgent need for action in the care of trans people. It is not only about expanding knowledge and skills, but also about fundamentally rethinking and adapting structures and concepts.