Measures to improve the care of trans patients

What is the situation regarding the care of trans people in nursing? What experiences have nurses had in dealing with patients after gender reassignment surgery in hospital? Nursing scientist Annekathrin Hempel researched these questions in her master's thesis at the University of Witten/Herdecke (UW/H) and derived five recommendations for action for carers.

The number of gender reassignment surgeries in Germany has risen from 883 in 2012 to 2598 in 2021. This development reflects the growing visibility and recognition of trans people in society. However, care is lagging behind and urgently needs to catch up when it comes to dealing with and caring for trans patients, the master's thesis shows.

Numerous knowledge gaps and uncertainties among carers

Hempel conducted five guided interviews with carers for her thesis. All interviewees had been working in their respective specialism for at least two years. The results show that carers are not sufficiently trained in dealing with trans people, for example as part of their training:

• The respondents stated that they were afraid of behaving incorrectly when they started working in the speciality - for example, when using patients' pronouns correctly. According to their own statements, carers often lacked the background knowledge that they had to generate from direct conversations with patients.
• A central point in the care of patients undergoing gender reassignment surgery is the frequently blurred boundaries between closeness and distance, for example due to dressing changes in the genital area every two hours. Carers were often required to maintain a professional distance here.
• The carers said that changing dressings for newly constructed genitalia requires a high level of expertise and is very time-consuming. Knowledge of wound care, wound observation and wound documentation was essential. Close professional dialogue with doctors was very important to ensure optimal care.

• Due to high levels of suffering, experiences of discrimination and fear of the operations, it often happened that carers had to explain post-operative care more intensively than usual.

Recommendations for the care of trans people

1. adapt training

Currently, gender reassignment surgery is only touched on superficially in nursing training. In order to do justice to this and better prepare future carers for the specific needs of trans people, training content should be updated and expanded.

2. expand further and advanced training

The lack of specialised further training and clear instructions makes day-to-day care more difficult. There is a need for targeted training, e.g. in dialogue management or psychological stress, in order to strengthen skills in dealing with trans patients.

3. promote specialisation

With the increase in gender reassignment surgery, the need for specialised nursing staff is growing. Annekathrin Hempel suggests introducing special roles such as a "trans nurse" or integrating "advanced practice nurses" for qualified care on wards.

4 Integrate psychological support

The successful integration of psychologists into oncology teams shows how valuable psychological support is. A similar integration into the care of trans patients could significantly improve their psychological well-being.

5. update care concepts

Care concepts, such as Krohwinkel (1993), are based on a binary view of gender and gender identity. This does not take into account the gender identity of many patients. Existing concepts need to be revised and adapted to changing gender identities.

Conclusion

The proposed measures reflect an urgent need for action in the care of trans people. It is not only about expanding knowledge and skills, but also about fundamentally rethinking and adapting structures and concepts.

Further information: The Master's degree programme in Nursing Science (M. Sc.) at Witten/Herdecke University qualifies nursing experts for leading positions in research and practice.