ENA highlights need for transgender patient care awareness

A new article about a transgender patient's "freak show" experience in a U.S. emergency department, published online in the Journal of Emergency Nursing, is prompting the country's largest professional organization of emergency nurses to encourage transgender patient care awareness.

The study comes during the Emergency Nurses Association's (ENA) annual conference, Emergency Nursing 2015, September 28 to October 3 at Orlando's Orange County Convention Center.

The JEN article chronicles the experience of transgender patient Brandon James (a pseudonym) in an American emergency department. According to the case study, the patient's ED visit was filled with situations that a transgender person might experience wit healthcare providers who are unfamiliar with treating transgender patients. James, a masculine transgender man who transitioned using hormone replacement therapy five years before his ED experience in 2011, presented his driver's license which identified him as a female. His electronic medical records from previous medical visits also included female gender markers.

James said his emergency department check-in process was humiliating, with staff pulling in 2-3 additional people and debating his gender aloud. "It wasn't business-like at all. I was a spectacle. I was a freak show at the circus," said James. "It was definitely to draw attention to the fact that my outward appearance didn't match (my identification)."

After waiting several hours to be treated, a nurse who listened to James' friend recount the check-in experience listened, apologized and validated their experience.

"This patient's story identifies new implications for emergency nursing practice when treating a transgender patient. Emergency nurses are on the front lines of treating more and more transgender patients. All patients must be treated with dignity and respect. We want nurses and their ED colleagues to understand how to give these patients the care and respect they deserve," said ENA president Matthew F. Powers, MS, BSN, RN, MICP, CEN. "ENA fully supports the best practices outlined in this article and supports further research around transgender emergency care."

Takeaways from this study for emergency nurses treating a transgender patient include:

• 1) Ask the person how they would like to be addressed?. In the case of Brandon James, many insensitivities might have been avoided if the ED staff member would have asked the patient how he would like to be addressed.

  2) Use the proper pronoun. ?When speaking to a transgender patient, nurses should use the pronoun that matches the gender to which they currently identify.

  3) Keep conversation clinical. ?Emergency nurses should only ask clinically relevant questions during their examination of a transgender patient.

  4) Be sensitive to shared spaces.?When taking a transgender patient into an area of the ED where they might share a space with another patient, keep the gender to which they identify top of mind.

  5) Lead by example. ?Because nurses are on the front lines of patient care in the ED they should take a leadership role in showing respect to transgender patients and step in to help defuse any sensitive situations they observe.

James' story is told in the article, "I Was a Spectacle...A Freak Show at the Circus: A Transgender Person's ED Experience and Implications for Nursing Practice", to prevent similar events from happening in emergency departments across the country.