|Type of paper:||Essay|
Transgender identity is one of the most important issues in the health care system since it touches on access to quality, adequate, patient-centered, and efficient care by individuals who are transsexual. Transgender people are those whose gender identities, behaviors, and expressions are different from, and do not conform to, the sex they were biologically assigned at birth. Transgender patients experience a myriad of challenges in accessing quality, efficient, and cost-effective care in the healthcare system partly because their identities affect their healthcare needs in different ways. For instance, according to Safer et al. (2016), transgender people face obstacles such as exclusion, marginalization, discrimination, stigma, violence, socioeconomic barriers, and lack of cultural competency among health care providers to understand transgender needs. Hence, due to these challenges and their unique healthcare needs or preferences, transgender patients often require adaptations in care. This paper examines the issue of transgender identity in the healthcare setting by looking at how a transgender patient's healthcare is affected and the required adaptions in care to meet their needs. It also discusses policies by healthcare facilities for identifying patients' gender, and strategies to prevent discrimination in the healthcare setting.
Due to the sexual orientation or expression of transgender people coupled with their unique healthcare needs and preferences, a transgender patient's healthcare is affected in various ways. To begin with, the access to adequate health care by transgender patients is affected by various obstacles and challenges, such as discriminatory practices in healthcare, stigmatization, societal intolerance, and insensitivity to transgender issues or needs by health care providers (Gupta, Path, Imborek, & Krasowski, 2016). Furthermore, according to Gupta et al. (2016), transgender people are faced with challenges such as problems associated with sharing of rooms in inpatient units, the lack of enough unisex restrooms in outpatient settings, the lack of familiarity among medical professionals with the terminologies and needs of transgender patients, and the lack of flexibility of electronic medical records in gender identity documentation. Also, in most cases, misgendering of transgender patients results because gender designations beyond the assigned sex are not recognized by laboratory information systems (LISs) and electronic medical records (ERMs) (Gupta et al., 2016).
Additionally, according to Safer et al. (2016), even though medical intervention such as hormone surgery and therapy are often required by transgender patients, such safe care is sometimes lacking due to financial barriers such as lack of income or insurance, inappropriate clinical facilities, lab references, and electronic records, and discrimination. This lack of adequate access to transition-related care by transgender people together with other obstacles thus affects transgender patients' healthcare. Besides, a transgender patient's healthcare is affected by the fact that the healthcare system as a whole has not fully adapted to their unique healthcare needs. For example, some healthcare facilities still do not have in place policies on how to identify, record, and safely store patients' gender identities. Due to this shortcoming, most healthcare facilities are not able to provide patient-centered care to transgender patients.
Hence, as a result of the numerous challenges faced by transgender people in accessing quality, cost-effective, patient-centered care for transgender patients require adaptations and modifications in care to cater for and suit their healthcare needs. One of the adaptations that should be implemented by healthcare facilities to meet the healthcare needs of transgender patients is a modification of their clinical facilities to conform to the needs of transgender people. For instance, clinical laboratories, inpatient units, and restrooms should be structured or built in such a way that they conform to and accommodate the special care needs of transgender patients. Moreover, adaptations should be made to the EMRs used by healthcare facilities such as hospitals so as to make it possible and easy to identify transgender patients with the right names, gender, and pronouns. Further, to meet and accommodate the healthcare needs of transgender people, there must be adaptions in terms of increasing or enhancing the cultural competence, skill, and knowledge of healthcare professionals so that they can offer patient-centered care to Trans patients.
Transgender patients also require adaptations in care so as to ensure the provision of transgender-inclusive healthcare services. These adaptations are necessary since they will help improve the understanding of nurses and other professionals regarding the special treatment needs of transgender patients. They will also ensure that health care facilities are designed and structured in such a way that they can easily accommodate transgender people. The overall impact of such adaptions is that they will translate into improved healthcare outcomes for patients with transgender identity issues.
Healthcare facilities are legally mandated by State health regulations pertaining to clinical records to come up with policies for identifying patients' gender on their healthcare record. Such records must be systematically organized, complete, readily accessible, and accurately documented. Examples of healthcare facilities' policies for identifying a patient's gender on their healthcare record include the Presbyterian/St. Luke's Medical Center's transgender patients' identification policy, the Scott & White Hospital's patient identification policy, and the Johns Hopkins patient identification policy.
According to the Scott & White Hospital, Texas policy for identifying patients' identity on their healthcare record, all patients have the right to have the confidentiality and personal privacy of their medical information to be respected. The policy also provides that it is the duty of members of the medical staff to ensure that all patients have a complete and legible medical record. Additionally, according to the hospital's patient identification policy, a patient's medical record shall contain data on the patient's identity, therapeutic and diagnostic orders, documentation of hospital-acquired infections or complications, consent forms, patient assessment forms and reports, admission diagnosis, treatment plans, and the patient's social or family history. Moreover, such a policy for identifying patient's identity on the healthcare record should normally include the patient's medical record number, date of birth, correct gender, full names, age, location, and ward.
Through such patient identification policies, healthcare facilities can easily identify all patients including those with transgender identity issues so as to ensure that they are provided with care that caters to their needs. According to Deutsch and Buchholz (2015), because the preferred names of transgender people differ from their legal identifications and those assigned at birth, they often suffer assault, ridicule, and distress in the healthcare or clinical setting and may at times be referred to using the wrong names and pronouns. Hence, according to these authors, it is imperative for healthcare facilities to use the electronic medical records appropriately to aid in correctly identifying transgender patients. They should include as part of the demographic variables the pronoun preferences, gender identity, and the preferred names. Hospitals also need to maintain an inventory of the medical transition history of transgender patients, permit the seamless transition from one listed name or identity to the other, and train healthcare professionals on the correct use of EHRs to identify patient's identity to avoid confusions.
As stated earlier, one of the main challenges patients with transgender identity issues face in the healthcare system is discrimination on the basis of sex or gender identity, hence limiting their access to adequate and quality care. In light of this, there is a need for healthcare providers and organizations to come up with appropriate strategies for preventing discrimination in the healthcare setting. One strategy that can be used to prevent discrimination in healthcare setting particularly that targeting transgender people is training and education of healthcare professionals. To stop discrimination in clinical settings, there is a need to create or raise awareness among nurses and physicians on what is considered discriminatory, the effects of discrimination, and ways of avoiding discrimination in the healthcare setting. The education and training framework should also include cultural sensitivity programs that impact the necessary competency and knowledge in medical professionals that enable them to interact positively with transgender patients. Diversity training for healthcare professionals such as nurses will also prevent discrimination by ensuring that medical staff refer to transgender patients respectfully in accordance with their gender identities and provide patient-centered care (Collier, 2015). Healthcare workforce should be educated on the need to value equal treatment, equity, and diversity in healthcare settings.
Another strategy for preventing discrimination in the healthcare setting is by formulating and implementing new rules, regulations, laws, and policies that prohibit discrimination. According to Collier (2015), the legal framework should create an enabling, non-oppressive, and conducive environment that respects transgender patients' unique needs. For instance, ensuring the presence of gender-neutral facilities such as washrooms in healthcare facilities can help create an environment in which transgender patients feel wanted and cared for. With renewed regulatory vigilance, healthcare facilities will be compelled or required to come up with relevant anti-discrimination policies, such as zero-tolerance policies. Further, to prevent discrimination, healthcare facilities should develop improved data and quality monitoring systems that will ensure that all patients are provided with quality care.
In summary, a transgender patient's healthcare is mainly affected by the health care system's inability to fully cater for their unique care needs and the structural, cultural, institutional, and socioeconomic barriers to access to a patient-centered care. Therefore, such patients require adaptations in care through modifications in healthcare facilities or procedures in a manner that is accommodative of their healthcare needs. Discrimination in healthcare setting which is one of the barriers to transgender people's access to care can be prevented through diversity training and education of medical staff and via an effective legal framework.
Collier, R. (2015). Addressing transgender discrimination in health. CMAJ, 187(17), 493-494
Deutsch, M.B., & Buchholz, D. (2015). Electronic health records and transgender patients - Practical recommendations for the collection of gender identity data. Journal of General Internal Medicine, 30 (6), 843-847
Gupta, S., Path, F.R.C., Imborek, K.L., & Krasowski, M.D. (2016). Challenges in transgender healthcare: The pathology perspective. Laboratory Medicine, 47(3), 180-188
Safer, J.D., Coleman, E., Fieldman, J., Gerofalo, R., Hembree, W., Redix, A., & Sevelius, J.(2016). Barriers to health care for transgender individuals. Current Opinion inEndocrinology, Diabetes and Obesity, 23(2), 168-171
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