Introduction to Rivera’s Gender Affirming Nursing Care Model: A Middle-Range Theory

Abstract

Purpose: Currently, standards for transgender care guide surgical, hormonal, cosmetic and psychological care, yet do not include the domain of nursing care and nursing sensitive care outcomes. In response, the purpose of this project was to create a middle-range nursing theory to guide transgender nursing care. Methods: Rivera’s Gender Affirming Nursing Care (GANC) Model was developed using a community informed iterative process, combining and modifying two existing theories. Each theory was evaluated, construct templates were created, modified, and expanded to create the proposed gender transcendent model. Face validity was established through expert and community review. Findings: Concepts identified include: Relationship (Join With), Knowledge (Learn With) and Engagement (Partner With). Action within the model is propelled by drivers, including ongoing learning, ongoing research, ongoing self-assessment, and leadership. The model operates within the recognized domains of nursing, to support gender affirming nursing care. Conclusions: The middle-range theory was tested and found to stimulate gender neutral thinking; however, the model would benefit from additional testing to determine impact on nursing and patient outcomes. The model allows the nurse, through self-reflection and other internal growth mechanisms, to identify personal implicit and explicit bias. It is through these actions and shifting paradigms that nurses develop a personal gender affirming nursing practice.

Interpersonal Transphobia Within Nursing

“…Consider ciswomen who express their gender in a more masculine way or cismen with low testosterone who require additional testosterone. Consistent with the gender-affirming nursing care model,50 this means that nurses cannot assume anyone's gender identity (or anatomy or sexuality). To act with gender-affirming care principles, nurses ask everyone their chosen name, pronouns, and gender identity, and respect clients’ rights to privacy and confidentiality of their identity 49,50.…”

“…Consistent with the gender-affirming nursing care model,50 this means that nurses cannot assume anyone's gender identity (or anatomy or sexuality). To act with gender-affirming care principles, nurses ask everyone their chosen name, pronouns, and gender identity, and respect clients’ rights to privacy and confidentiality of their identity 49,50. Gender-affirming care includes neutralizing clinical language by doing an organ inventory and screening bioanatomy 49.…”

“…To act with gender-affirming care principles, nurses ask everyone their chosen name, pronouns, and gender identity, and respect clients' rights to privacy and confidentiality of their identity. 49,50 Gender-affirming care includes neutralizing clinical language by doing an organ inventory and screening bioanatomy. 49 Gender-affirming care also includes having familiarity with medical and surgical options for trans * clients (see The World Professional Association for Transgender Health, 4 Standards of Care, version 8), including knowing where to look for coverage of these modes of care by province, territory, and noninsured health benefits for First Nations and Inuit people.…”

Gender-affirming care in undergraduate nursing education: a scoping review protocol

“…This dearth of gender-affirming integration in curricula is partly due to faculty-reported barriers such as lack of time, knowledge and competence, and uncertainty for where to include the content in the curriculum 17–20. While there are increasingly more nursing-based resources for faculty to draw from, such as the tool for assessing ‘LGBTQI+’ health training,21 Rivera et al ’s middle range gender-affirming nursing care model,22 or the sexual orientation and gender identity nursing eLearning toolkit,23 there have not been unified efforts to consolidate and disseminate resources, and many remain widely unknown 20. The provision of gender-affirming education to faculty (and faculty teaching students) improves attitudes toward TGD people and a greater sense of the importance of learning gender-affirming care 20 24.…”