Perspectives From Nurses and Physicians on Training Needs and Comfort Working With Transgender and Gender-Diverse Youth

Abstract

Introduction: Nurses and physicians receive minimal training about providing competent care to transgender and gender diverse (TGD) patients, and training specific to TGD youth is particularly lacking. This qualitative study examined healthcare providers' experiences and attitudes about working with TGD youth to identify specific training needs.Method: Semi-structured interviews were conducted with 14 nurses and physicians who work with adolescents. Thematic analysis was used to characterize participants' responses.Results: Five themes summarized participants' responses to interview questions: 1) training regarding gender diversity, 2) discomfort with gender-related topics, 3) reasons for not asking about gender, 4) talking about gender with patients, and 5) need for resources.Discussion: Findings highlight multiple opportunities to improve provider education and care experiences of TGD youth. Specific training is needed to assist providers with managing discomfort with gender-related topics while simultaneously developing their knowledge and skills to discuss gender issues.

LGBT + young people’s perceptions of barriers to accessing mental health services in Ireland

“…At present, however, nursing curricula lack emphasis on the health care needs of LGBT + individuals. As a result, many nurses lack training, knowledge and comfort in providing care to LGBT + individuals (Carabez et al., 2016; Dorsen & Van Devanter, 2016; Rider et al., 2019). Services can begin to address these deficits by introducing LGBT + affirmative policies, procedures and referral networks, as well as cultural competency training to promote LGBT + inclusivity.…”

“…Significant disparities also exist between transgender and gender‐diverse (TGD) youth and cisgender youth, with higher rates of depression, self‐harm, suicidality, eating disorders and substance use disorders, and a greater exposure to bullying and harassment among the former (Dowshen et al., 2016; Eisenberg et al., 2020; Price‐Feeney et al., 2020). Despite evidence of increased risk of mental health issues among LGBT + young people, studies indicate less health care utilization and higher unmet treatment needs among LGBT + youth as compared to the non‐LGBT population (Dunbar et al., 2017; Sefolosha et al., 2019; Williams & Chapman, 2011), which some posit may be associated with the difficulties they may experience accessing health care (Rider et al., 2019; Sefolosha et al., 2019).…”

“It’s kind of hard to go to the doctor’s office if you’re hated there.” A call for gender‐affirming care from transgender and gender diverse adolescents in the United States

“…We conducted interviews in person (42%) or via phone or video conferencing (58%) at the discretion of the participant; interviews took 40 min on average (range: 27–50 min). The semi‐structured interview guide included questions about experiences with healthcare (general and gender‐related), recommendations for healthcare providers, and a brief description of themes noted by healthcare providers in our previous work (Rider et al, ) with a request for feedback. Examples of interview questions are shown in Box , and include how previous qualitative themes from healthcare provider interviews were framed to elicit responses from the young people.…”

“…However, healthcare providers typically express a lack of comfort working with TGD patients and a desire for information, materials and treatment guidelines (Lurie, ; Rider et al, ; Vance, Halpern‐Felsher, & Rosenthal, ). Indeed, healthcare professionals’ training for working with lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) youth is notably lacking (Barrett et al, ; Carabez et al, ; Davidge‐Pitts, Nippoldt, Danoff, Radziejewski, & Natt, ; Obedin‐Maliver et al, ; Vance et al, ; White et al, ).…”

“…In conjunction with this study, we previously conducted interviews with 14 nurses and physicians serving adolescents to learn about their experiences and attitudes with regard to working with TGD youth to identify specific training needs (Rider et al, ). That work identified five themes, three of which were included in this study with youth: (a) providers’ discomfort with gender‐related topics, (b) reasons for not asking about gender in clinical interactions, and (c) their previous training regarding gender diversity.…”