Practicing inclusive care in the perioperative environment: a personal and professional perspective.

Abstract

There is an increasing number of people self-reporting as being transgender (trans); 1% of the general population, and higher in younger people. However, there is a lack of hospital, state, federal, and international guidelines in this space, and many perioperative nurses and clinicians may have limited experience caring for trans patients.

“Transition” covers a range of facets for trans people, both social and medical, and trans patients may present with a variety of different appearances and expressions, at different stages of transition. Many of the common operations/procedures trans people undergo have the potential to influence their perioperative care (particularly management of patients’ airways and management of perioperative medications).

Additionally, many trans people have traumatic experiences which can impact care. Trans people in Australia have a much higher rate of being victims of violent crime, abuse, have higher lifetime incidences of depression (73%) and anxiety (67%), overall leading to a lifetime risk of suicide of 43%. Trauma may also be experienced in healthcare settings, including refusal of care, being physically attacked and being sexually assaulted. The literature, however, also shows that having avenues of support improves physical and mental outcomes. Healthcare professionals can be avenues of support. This leads to recommendations of clinical and non-clinical care, based on literature regarding trans care more generally, perioperative care, and non-clinical care. Particular recommendations include: facilitating a supportive environment through posters, stickers, badges, and similar, diversity officers and training, and individual level efforts to respect names, pronouns, and someone’s gender.