Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA.
Department of Nursing Practice, College of Nursing, University of Central Florida, Orlando, Florida, USA.
J Nurs Scholarsh. 2024 Jan;56(1):18-30. doi: 10.1111/jnu.12903. Epub 2023 May 3.
PURPOSE: Transgender and nonbinary (TGNB) patients experience many barriers when seeking quality healthcare services, including ineffective communication and negative relationships with their providers as well as a lack of provider competence (including knowledge, training, and experience) and humility (engagement in the process of self-reflection and self-critique) in treating TGNB individuals. The purpose of this qualitative study was to identify factors associated with cultural competence and humility that facilitate and impede effective relationships between TGNB young adults and their healthcare providers. METHODS: Data came from individual interviews with 60 young adults aged 18 to 24 from Florida who self-identified as transgender or nonbinary. We analyzed the data using inductive thematic approaches, and a feminist perspective, to identify themes associated with patient-provider relationships. CONCLUSIONS: We identified 4 themes related to patient-provider relationships: (1) Participants indicated effective patient-provider communication and relationships are facilitated by providers requesting and utilizing TGNB patients' correct names and personal pronouns. (2) Participant narratives conveyed their preferences that providers "follow their lead" in terms of how they described their own anatomy, reinforcing the utility of cultural humility as an approach for interactions with TGNB patients (3) Participants discussed the detrimental effects of TGNB patients having to educate their own providers about their identities and needs, suggesting clinicians' competence regarding gender diversity is paramount to fostering and maintaining patient comfort. (4) Finally, participants' responses indicated concerns regarding the confidentiality and privacy of the information they provided to their providers, suggesting a lack of trust detrimental to the process of building rapport between patients and their providers. CLINICAL RELEVANCE: Our findings indicate balancing the use of cultural humility and cultural competence during clinical encounters with TGNB young adults can enhance patients' experiences seeking healthcare. Nursing education is often devoid of focus on caring for transgender and nonbinary persons. Additional provider training and education on approaching clinical encounters with TGNB patients with cultural humility and competence should improve patient-provider communication and relationships, leading to a higher quality of patient care.
目的:跨性别和非二元性别(TGNB)患者在寻求高质量医疗保健服务时会遇到许多障碍,包括沟通不畅、与提供者关系紧张,以及提供者在治疗 TGNB 个体时缺乏能力(包括知识、培训和经验)和谦逊(参与自我反思和自我批评的过程)。本定性研究的目的是确定与文化能力和谦逊相关的因素,这些因素有助于促进和阻碍 TGNB 年轻成年人与其医疗保健提供者之间的有效关系。
方法:数据来自佛罗里达州 60 名年龄在 18 至 24 岁之间的自我认同为跨性别或非二元性别的年轻人的个人访谈。我们使用归纳主题方法和女性主义视角分析数据,以确定与患者-提供者关系相关的主题。
结论:我们确定了与患者-提供者关系相关的 4 个主题:(1)参与者表示,提供者请求并使用 TGNB 患者的正确姓名和个人代词,有助于促进有效的医患沟通和关系。(2)参与者的叙述传达了他们的偏好,即提供者在描述自己的解剖结构时“听从他们的引导”,这强化了文化谦逊作为与 TGNB 患者互动的一种方法的实用性。(3)参与者讨论了 TGNB 患者不得不向自己的提供者传授自己的身份和需求所带来的不利影响,这表明临床医生对性别多样性的掌握对于培养和维持患者的舒适感至关重要。(4)最后,参与者的反应表明,他们对向提供者提供的信息的保密性和隐私性表示担忧,这表明缺乏信任对建立患者与提供者之间的融洽关系的过程不利。
临床相关性:我们的研究结果表明,在与 TGNB 年轻成年人进行临床接触时,平衡使用文化谦逊和文化能力可以增强患者寻求医疗保健的体验。护理教育往往缺乏对照顾跨性别和非二元性别者的关注。增加提供者关于以文化谦逊和能力处理与 TGNB 患者接触的培训和教育,应能改善医患沟通和关系,从而提高患者护理质量。
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