5 Needs for Transgender-Competent Periop Care

In celebration of diversity month in April, AORN is shining a spotlight on those who are advancing diversity, equity, and inclusion in perioperative nursing.

Transgender patients face a heightened risk of adverse outcomes and missed diagnoses. They are often on hormonal medications and may lack a comprehensive understanding of the potential side effects, says J.D. Buchert, MSN, M.Ed., MS, RN, a Workforce Safety Manager for Quality and Safety Operations at Parkland Health in Dallas, Texas.

They may also have unfamiliar surgical histories that could jeopardize their safety in the OR.

For example, transgender women may have completed a laryngoplasty and/or chondroplasty to alter their voice pitch. These procedures could risk vocal cord damage, reduce the tracheal lumen, or cause stenosis, dysphagia, or tracheal perforation that affects intraoperative airway management.

If a transgender patient has undergone gender-confirming surgery involving the urethra, such as vaginoplasty, phalloplasty, or metoidioplasty with urethral lengthening, “this can impact the placement of a urinary catheter and may necessitate using a smaller catheter with or without balloon,” Buchert cautioned.

What Nurses Need to Know to Protect Transgender Patients

Unfortunately, nurses often lack the necessary knowledge to care for this uniquely vulnerable patient population for surgery. To address this gap, Buchert recently presented an education session at AORN Global Surgical Conference on “Transgender Care: A Door-to-Door Experience with Keen Focus on the Perioperative Setting.”

Here are five important lessons he shared to help nurses gain the confidence to provide transgender-competent care:

1. Start with Conversation

If you are unsure about which name or pronoun(s) to use, just ask. Then make sure to consistently use their chosen name(s) and pronoun(s). With your patient’s consent, update this information in their chart so they aren’t forced to explain multiple times. Typically, a patient’s preferred name is listed in parentheses after their legal name in their electronic health record.

“Remember that identity may be linked to government ID, which could be a significant barrier to legally changing their name and gender on official documents. This can lead to confusion, repetitive questions, incorrect pronouns, and names, or even ‘outing’ someone to others in the healthcare setting.”

2. Be Clear About Why Their “Dead Name” Appears in Formal Medical Documentation

State and federal requirements call for two patient identifiers for things such as surgical procedures, treatments, and prescription dispensing. The identifiers usually include name and birthdate. However, for a transgender patient, they may consider their legal name as their “dead name” and wonder why they are seeing it on medical documentation.  If this happens, explain: “state or federal laws require this action, but please know we will address you using your preferred name.” Once this process is explained to the patient, they tend to understand and will abide by the law or governance that guides this regulation.

3. Don’t Over-Ask About Previous Procedures and Medications

If it is not relevant to their presenting complaint, do not ask about gender surgeries, because “this can be dehumanizing and embarrassing.” Additionally, avoid invasive physical examinations if possible. “A vulnerable and visible gender-variant person might already feel like a ‘spectacle,’ and it is important to avoid further marginalizing them.”

During preoperative care, nurses can take these actions to help their transgender patient feel more at ease with their surgical care:

• Be open and honest about what tests need to be done and why
• Explain the procedure involved
• Address their concerns
• Outline the safety standards adhered to by your facility

4. Provide Appropriate Confidentiality and Ensure Privacy

Transgender patients are vulnerable to assault and harassment, making safety and confidentiality imperative. To safeguard your transgender patient:

• Find a private space for discussion
• Ask permission to disclose information to other providers
• Be mindful about what name someone is called in public spaces

Physical privacy is also important for transgender patients in surgical care. That’s why efforts should be made to reduce traffic and staff rotation in the operating room, especially if the surgical procedure involves exposure of genitalia or the chest area.

5. Create a Welcoming Environment

Displaying outward signs of acceptance signals to your patients they are in a safe space, which can significantly impact their experience. These can include:

• Signage
• Rainbow stickers
• Pronoun pins

“These are all important ways to let patients know that we will care for them, and they can trust us,” Buchert stressed.

At a higher level, Buchert encouraged his nurse colleagues to be advocates for integrating transgender-inclusive best practices into organization practices, including gender-affirming education in staff development programs. “Transgender patients don’t expect you to know everything—ask and be open to being educated,” he said.

Join AORN in advancing diversity, equity, and inclusion in perioperative nursing and access valuable resources for your practice. Visit our DEI page.