Sex Change Generation: Implications for Nursing Practice

“This is not your mother’s Nursing anymore.” ~Carmen Kosicek

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No truer words could apply to the current state of the nursing profession. Things are changing at a rapid pace. Nurses are becoming entrepeneurs, leaving the bedside, becoming their own bosses, creating their own niche in the profession in order to be the nurses they want and dreamed of being.

The same could be said for our approach to patient care. What you learn in nursing school doesn’t necessarily remain relevant past your graduation date….and yet, there are other concepts and theories that are simply timeless…and forever relevant and critical to apply in every day practice.

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While watching a few reality TV shows revolving around the evolving sex change of a parent within a single parent household, several questions  came to mind: What are the implications for nurses who specialize in pediatrics? What are the implications for nurses who practice in the GYN setting? What are the implications of changing a gender identity or for those who struggle to figure this out in the realm of mental health nursing? Lastly, for nurses who DO NOT specialize in a specific area of nursing and choose to remain within the General Medical Surgical arena…..how does your approach to nursing care change? (It doesn’t necessarily have to, but you should be aware of its potential to impact a persons overall health and how to plan for that)

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I truly feel this is an area that must be talked about, explored, debated, and learned from. This is life. This is the real deal. These aren’t the typical clinical experiences we have in school… or that today’s students are likely to have “pre chosen” for them by their professors. But, think about it. A truly holistic approach to human care encompasses all areas of a person’s self perception, their place in this world….in order to provide best care—-the most therapeutic, healing, and compassionate experience a patient and family can walk away from—- shouldn’t we be finding out whether our patients are transgender—whether recently changed or remotely? Not because we want to pry, but because an identity change of this magnitude has an enormous impact on the rest of this person’s life (and their family–i.e. children).

If we were to do a nursing care plan that placed an individual such as this one at the center of it we might easily identify multiple potential nursing diagnoses that could be impacting the primary ones that brought a person in for healthcare to begin with. For example, lets explore a single parent family consisting of a father and a son. The father is actively transitioning into a female gender status while his teenaged son is going through the developmental processes of becoming a young man.

How is the teenager affected? There are certainly opportunities here to promote wellness from a pediatric standpoint by regularly engaging this family in wellness check ins to ensure that both father and son are transitioning in a healthy way so that the son achieves the necessary developmental milestones while making the adjustment to seeing his father transition into a different identity, and perhaps a different role. Certainly there is a grieving process to be considered for a child who is either losing a mother or a father that is transitioning to a different gender…..The first step? A nurse practitioner identifying this unique need during a standard wellness check up at regular intervals.

How is the father transitioning? His healthcare providers should also be monitoring the progression from a multitude of viewpoints, not just physically. The father could also get tips about developmental milestones from a child life nurse practitioner during this process so that he remains wary of the impact transitioning may have on the physical and mental well being of his child. Nurses can certainly play a pivotal role during this crucial time.

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Never before has the application of  nursing theory and a robust holistic approach to patient and family centered care been so important. In a family going through transitions there can be so much confusion and a multitude of feelings that can impede the father carrying out his role to the best of his ability while transitioning, and the healthy development of the teenage son who is himself trying to find his identity and his way in the world. How might sex education and the education regarding development of healthy, loving,  intimate relationships be approached here? Are there cultural and spiritual issues applicable to the transitioning family? (Just food for thought).

Look, I’m not saying we need to get into huge philosophical conversations with our patients. What I am saying is that we cannot ignore the ever changing terrain we practice in whether it be setting, or our patient populations. What I am saying is that we consider ALL– and plan to promote the health of ALL. Wellness is made up of the sum of how patients view themselves, feel about themselves, whether they value themselves or not, whether they take care of themselves or not, whether they have the information/resources they need to be their healthiest, and whether they are in a state of readiness to learn and be at their best—-all of these things impact the roles parents and children play within a family and how functional or dysfunctional the relationship or home environment is.

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There was a day that the single parent family was considered the “taboo situation” that no one liked addressing head on. In fact our children were…and still are…considered to be “at risk” for failing in society, not graduating, or developing in a healthy manner. Now, we have another type of family unit to consider. And to be the best healthcare providers, we should be doing just that.

Everyone in society deserves to thrive, no matter their SES or Gender Identity, especially our children. Nurses have the very real potential and ability to catch the small nuances that could lead to bigger problems later—preventable ones. It starts, and ends, with us. A social work referral here, an extra Nurse Practitioner wellness check there…the tiny things we do add up to healthy families that can weather the storms of life in whatever way they come.

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Where do we begin? By “thinking about thinking.” Nurses must first perform some introspection…figure out how they feel about these issues….and where their morals, values, and beliefs fit into a patient care scenario like this. Self exploration is important…because our quality of care can–at times–be affected by the biases we possess. It does happen—I saw it in the jails. I see it with morbidly obese people.  I was also pressured not to provide end of life care to a patient who had made death bed confessions the other nurses were disgusted by.

How we think of others and treat them (or fail to treat them) based on our own biases is not always ideal…but its the reality of being human. To be the best nurses we can be, its imperative that we have a strong sense of self awareness as the foundation from which we seek to care.

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As nurses, we choose whether our interactions with a patient and family are phenomenal— or poor….

The transgender patient and family is just one more evolving patient population we should strongly consider…and how we as nurses can make a positive difference in their lives too.

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