跨性别者和非二元性别者寻求住院精神科护理的社会生态障碍与促进因素：一项定性描述性研究。
Social-ecological barriers and facilitators to seeking inpatient psychiatric care among transgender and nonbinary people: A qualitative descriptive study.
作者信息
Boutilier Ava J, Clark Kristen D, Bosse Jordon D, Jackman Kasey B, Jewell Jaylyn, Dawson-Rose Carol
机构信息
School of Medicine, Queens University, Kingston, Ontario, Canada.
College of Liberal Arts, University of new Hampshire, Durham, New Hampshire, USA.
出版信息
J Adv Nurs. 2025 Apr;81(4):1937-1952. doi: 10.1111/jan.16393. Epub 2024 Aug 29.
AIM(S): To assess barriers and facilitators to seeking inpatient psychiatric treatment among transgender and nonbinary people.
DESIGN
Qualitative interview study.
METHODS
Semi-structured interviews were conducted from March 2019 to June 2022 with transgender and nonbinary people admitted to an inpatient psychiatric hospital in the United States during the past 5 years. Data were analysed using thematic analysis and constructed within a modified social-ecological model of stigma. Standards for Reporting Qualitative Research were used for this study.
RESULTS
Participants (N = 15) described barriers and facilitators across all three social-ecological levels. i) Individual themes included distrust of the mental healthcare system, feeling unsafe, loss of autonomy, minimizing one's own mental health needs, and feelings of accountability to others. ii) Interpersonal themes included: lack of support for transgender/nonbinary identity, limited transgender/nonbinary knowledge among mental healthcare professionals, and allyship. iii) Structural themes included: carceral setting, financial costs, and availability of non-profit treatment options.
CONCLUSION
Multi-level themes were identified as barriers and facilitators to seeking inpatient psychiatric care for transgender and nonbinary people, providing opportunities among inpatient settings to improve care delivery and engagement. Greater health equity can be achieved by addressing barriers to care.
IMPLICATIONS
Incorporating inclusive and affirming practices in inpatient psychiatric services presents an opportunity to reduce barriers to seeking care.
IMPACT
The present study describes the experiences of transgender and nonbinary people as they determine whether to voluntarily seek inpatient psychiatric treatment. This perspective allows nurses, health systems, and policymakers to integrate transgender and nonbinary people's needs to improve healthcare delivery.
PATIENT/PUBLIC CONTRIBUTION: Transgender and nonbinary participants were recruited in collaboration with community organizations. Members of the transgender and nonbinary community participated in study design development and analysis and were part of the study team.
目的
评估跨性别者和非二元性别者寻求住院精神科治疗的障碍和促进因素。
设计
定性访谈研究。
方法
2019年3月至2022年6月，对过去5年在美国一家住院精神科医院住院的跨性别者和非二元性别者进行了半结构化访谈。采用主题分析法对数据进行分析，并在修正的耻辱感社会生态模型中构建。本研究使用了定性研究报告标准。
结果
参与者（N = 15）描述了所有三个社会生态层面的障碍和促进因素。i）个人层面的主题包括对精神卫生保健系统的不信任、感到不安全、失去自主权、低估自己的精神健康需求以及对他人的责任感。ii）人际层面的主题包括：对跨性别/非二元性别身份缺乏支持、精神卫生保健专业人员对跨性别/非二元性别知识有限以及盟友关系。iii）结构层面的主题包括：监禁环境、经济成本以及非营利性治疗选择的可用性。
结论
多层次主题被确定为跨性别者和非二元性别者寻求住院精神科护理的障碍和促进因素，为改善住院环境中的护理提供和参与度提供了机会。通过消除护理障碍可以实现更大的健康公平。
启示
在住院精神科服务中纳入包容性和肯定性做法为减少寻求护理的障碍提供了机会。
影响
本研究描述了跨性别者和非二元性别者在决定是否自愿寻求住院精神科治疗时的经历。这种观点使护士、卫生系统和政策制定者能够整合跨性别者和非二元性别者的需求，以改善医疗服务。
患者/公众贡献：跨性别者和非二元性别参与者是与社区组织合作招募的。跨性别者和非二元性别社区的成员参与了研究设计、开发和分析，并成为研究团队的一部分。
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