The role of the Nurse involved with clients & patients with Gender Dysphoria & Transsexualism

Maxine Rathbone (RGN) & Krystyna Haywood
2nd September 2001

INTRODUCTION

This document was twofold; although originally aimed at providing a funding proposal to Community Health Sheffield, it also aims to introduce much needed debate for community nursing guidelines for the pre and post-operative care of patients considered transsexual, and/or diagnosed as Gender Dysphoric, and for which a range of treatments can lead anywhere up to, and beyond, sex reassignment surgery.

WHO SHOULD DO IT?

A qualified nurse with preferable community experience, it is also desired that the nurse will have an interest in Gender Dysphoria and Transsexualism.

WHAT IS THE ROLE?

The role is to offer support and care to pre and post-operative patients with Gender Dysphoria and Transsexualism. The role of this nurse calls for the person to train to such a high standard that they can be called on as a 'Specialist Nurse'. Within their remit they should be aware of their capabilities and realise their limitations.

ACCOUNTABILTY

Nurses are accountable to their code of professional conduct, to the patient that is being cared for, to other members of the 'Gender Clinic Panel' and their remaining family & friends that provide clear support to the patient.

1) HOW CAN THE COMMUNITY NURSE HELP A PRE-OPERATIVE PERSON WITH GENDER DYSPHORIA & TRANSSEXUALISM?

a) To understand health issues: - Preparation for surgery smoking, overweight, other medical histories-asthma, heart diseases, discontinuation hormone treatment, diet and referral to DHSS for advice on claiming benefits (if not already doing so) alternative health advice as appropriate. Knowledge of the surgery itself, even if this may only be to explain the 'Admissions Procedure' and basics of the surgery day including the operation and recovery.

b) Liaising with other Health Care Disciplines: - General Practitioner, Social Services, local District Nursing Team.

c) Stock: - ensuring that they have a supply of equipment needed post-op e.g. dilation related paraphernalia, aids and adaptations.

d) Electrolysis: - advice regarding where and how treatment can be performed and costs.

e) Hormones: - ensure that once prescribed hormone treatment, they are taking correct dosage, not obtaining from other sources! Blood tests are taken on a regular basis and that any changes in dosage are prescribed.

f) A 'Buddying' system could be given especially to the patient who is awaiting to be seen and admitted onto the Gender Clinic list.

2) HOW CAN THE INVOLVEMENT OF THE COMMUNITY NURSE HELP A POSTOPERATIVE PERSON WITH GENDER DYSPHORIA & TRANSSEXUALISM?

a) Monitoring general health, making aware of post op complications e.g. Deep Vein Thrombosis, Chest Infections, Wound Infections

b) Monitor healing progress, checking sutures if still in-situ and removing as and when needed, if not to be removed at hospital. Ensuring that they are passing urine without problems, (they may have had an indwelling catheter sent home with due to post-op complications) and bowels are opened without straining. Advice on diet may need to be given to help with the healing process, within their budget.

c) Give advice regarding personal hygiene and ensuring that they are aware of keeping the wound clean. Advice on dilation and how this is to be performed, and when. If the person has physical disabilities then they will need physical help with this procedure.

d ) Reassurance and support is very important and may go on for many, many, months post -op. Answer any "stupid "questions that may be asked and if answers not easy to come by then knowing where answers may be obtained. It is important for the nurse to be very "open minded' and not easily shocked by any discussions. Teaching about the new anatomy and how it works, including personal questions about sex and new sexual relationships.

e ) Liaison with other disciplines including Surgeon, Gender Clinic, GP and Social Services. Liaising with various agencies regarding transport for hospital appointments.

f ) Being there! Remember that this person has had to make many sacrifices. One of them may be having lost family and friends along the way, to live the life that they have finally chosen. The Nurse may be their only contact with the outside world!!!!

3) WHAT TRAINING IS NEEDED FOR THE COMMUNITY NURSE TO BE ABLE TO OFFER SUPPORT FOR PEOPLE WITH GENDER DYSPHORIA & TRANSSEXUALISM?

a) To be aware of what Gender Dysphoria & Transsexualism is and what it means for the sufferer?

b) An understanding of hormones, regimes and complications. Aware of the effects on the person having the hormones and how it puts them through a "second puberty".

c) Awareness of the Gender Clinic policies and procedures, also aware of surgical procedures especially as these may differ on whom the person has as surgeon to do the reassignment procedure.

d) Working/Shadowing with various people involved with the care overall; gender clinic and surgical ward.

e) A basic level of counselling.

4) WHAT RESOURCES ARE NEEDED IN THE TRAINING FOR NURSES?

a) Access to relevant literature, especially up to date (could be obtained by accessing the Internet).

b) Monies need to be made available to, regarding training, salaries, equipment etc.

c) Wide range of experiences of nursing and life.

d) Easy access to surgeons and psychiatrists.

e) Access to post-op people who are willing to share information and life experiences.

5) SHOULD THE PROJECT BE UNDERTAKEN AT A LOCAL OR NATIONAL LEVEL, DEPENDING ON FUNDING, OR AT THE USE OF LOCAL ACTIVIST?

a) If this means more widespread use of Community Nurses then it would regional as it may mean in some areas that there maybe a lack of patient numbers. Areas such as large cities as London may need more than one Specialist Nurse due to large contact numbers.

b) Recognised training throughout the country would ensure that care and support would be consistent, with no postcode preferences.

c) Monies need to share equally to all Gender Clinics and not the majority to Charing Cross.

6) WHO WOULD BE INVOLVED IN THE TRAINING OF THE COMMUNITY NURSES?

a) Local Gender Clinics

b) People with Gender Dysphoria, and transsexual people themselves, especially post-op people.

c) Nurses on the hospital wards that care for these patients postoperatively.