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The purpose of the study was to provide a transgender narrative on healthcare interactions to increase visibility and awareness of transgender-identified issues in accessing care. This study aimed to: (a) examine how transgender individuals perceive and experience interactions with trained healthcare professionals, such as nurses, physicians, and mental health professionals, (b) identify common issues related to transgender individuals' barriers to care, and (c) identify how these barriers affect a transgender individual's ability to access health care.
A phenomenological approach was used.
The nine transgender-identified participants received a demographic questionnaire followed by a virtual semi-structured interview. Thematic analysis was used to analyze the interview data.
The themes that emerged from the data were (a) challenges with accessing health care, (b) inconsistent healthcare information, and (c) disenfranchised versus empowered experiences.
The results of this study not only provided an opportunity for the transgender participants to share their experiences, but also provides educational information for healthcare providers to improve their future interactions with transgender patients.
Identifying the transgender patient with the correct name and pronoun, providing a welcoming and open healthcare environment, and knowing where to locate transgender health resources will improve the transgender patient's healthcare experience.
To explore trans men's access and use of healthcare services in Chile, based on the experiences of the trans men themselves, as well as of healthcare professionals.
A qualitative study with an ethnographic approach was carried out with 30 participants: 14 trans men and 16 healthcare professionals. Semi-structured one-on-one interviews with open-ended questions were used to collect the data. A thematic analysis was carried out with the NVivo Software.
Three main themes were identified: (1) failures in the recognition of trans identity, (2) challenges with patient-centered care, and (3) use of other (“non-trans”) health services.
The results suggest that not all transition processes are the same, individuals seek different ways; therefore, it is necessary to consider different body types and identities when planning programs and care for men in transition. Moreover, the accompaniment provided during the gender transition process should contemplate emotional and mental support.
The study outlines the need for all healthcare professionals to have training and knowledge about the transgender population, regardless of whether they are part of the teams supporting gender transition processes. The role of nurses and the contributions that can be made from nursing discipline in this research field are fundamental.
Transgender and nonbinary (TGNB) patients experience many barriers when seeking quality healthcare services, including ineffective communication and negative relationships with their providers as well as a lack of provider competence (including knowledge, training, and experience) and humility (engagement in the process of self-reflection and self-critique) in treating TGNB individuals. The purpose of this qualitative study was to identify factors associated with cultural competence and humility that facilitate and impede effective relationships between TGNB young adults and their healthcare providers.
Data came from individual interviews with 60 young adults aged 18 to 24 from Florida who self-identified as transgender or nonbinary. We analyzed the data using inductive thematic approaches, and a feminist perspective, to identify themes associated with patient-provider relationships.
We identified 4 themes related to patient-provider relationships: (1) Participants indicated effective patient-provider communication and relationships are facilitated by providers requesting and utilizing TGNB patients' correct names and personal pronouns. (2) Participant narratives conveyed their preferences that providers “follow their lead” in terms of how they described their own anatomy, reinforcing the utility of cultural humility as an approach for interactions with TGNB patients (3) Participants discussed the detrimental effects of TGNB patients having to educate their own providers about their identities and needs, suggesting clinicians' competence regarding gender diversity is paramount to fostering and maintaining patient comfort. (4) Finally, participants' responses indicated concerns regarding the confidentiality and privacy of the information they provided to their providers, suggesting a lack of trust detrimental to the process of building rapport between patients and their providers.
Our findings indicate balancing the use of cultural humility and cultural competence during clinical encounters with TGNB young adults can enhance patients' experiences seeking healthcare. Nursing education is often devoid of focus on caring for transgender and nonbinary persons. Additional provider training and education on approaching clinical encounters with TGNB patients with cultural humility and competence should improve patient-provider communication and relationships, leading to a higher quality of patient care.
The purpose of this study was to identify coping strategies, resources, and strengths that predict well-being in a community-based sample of youth with varying levels of adversity.
Grounded in the resilience portfolio model, we used a mixed methods approach with data from a cross-sectional sample of 231 youth ages 8–17.
Data were collected using a survey, participant-generated timeline activity, and brief interview. Measures included assessments of coping and appraisal, resilience resources and assets, and subjective well-being and depression.
Active and passive coping strategies predicted subjective well-being and depression. Controlling for demographics and coping, meaning making strengths and supportive relationships were significant predictors of subjective well-being and lower depression, and decreased the impact of adversity on these outcomes.
The results of this study provide support for the resilience portfolio model in a community-based sample of youth, with relationships as predicted for subjective well-being and symptoms of depression. For both outcomes, family relationships held the strongest associations with positive well-being and lower symptoms of depression. Supportive relationships with peers, meaning making strengths, interpersonal strengths, less passive coping, and fewer adverse life events were also associated with better outcomes.
These findings underscore the need to assess youth resources and strengths and to design interventions that target these protective factors for all youth, regardless of exposure to adversity.
A theory-informed understanding of resources and strengths that predict youth well-being is essential to inform strengths-based interventions for pediatric research and practice. The resilience portfolio model is a useful framework for understanding predictors of youth well-being.
International evidence shows that nurses' work environments affect patient outcomes, including their care experiences. In Chile, several factors negatively affect the work environment, but they have not been addressed in prior research. The aim of this study was to measure the quality of the nurse work environment in Chilean hospitals and its association with patient experience.
A cross-sectional study of 40 adult general high-complexity hospitals across Chile.
Participants included bedside nurses (n = 1632) and patients (n = 2017) in medical or surgical wards, who responded to a survey. The work environment was measured through the Practice Environment Scale of the Nursing Work Index. Hospitals were categorized as having a good or poor work environment. A set of patient experience outcomes were measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Adjusted logistic regression models were used to test associations between the environment and patient experiences.
For all outcomes, the percentage of patients satisfied was higher in hospitals with good as compared to poor work environments. In good environment hospitals patients had significantly higher odds of being satisfied with communication with nurses (OR 1.46, 95% CI: 1.10–1.94, p = 0.010), with pain control (OR 1.52, 95% CI: 1.14–2.02, p = 0.004), and with nurses' timely responses in helping them to go to the bathroom (OR 2.17, 95% CI: 1.49–3.16, p < 0.0001).
Hospitals with good environments outperform hospitals with poor environments in most patient care experience indicators. Efforts to improve nurses' work environment hold promise for improving patient experiences in Chilean hospitals.
Hospital administrators and nurse managers should value, especially in the context of financial constraints and understaffing, the implementation of strategies to improve the quality of nurses´ work environments so that they can provide patients with a better care experience.
Childhood abuse could potentially cause negative health consequences later in life, where they influence individuals' physiological, psychological, and behavioral health. Screening for ACEs is not widely incorporated during routine primary healthcare. The information about past childhood abuse screening among adult patients is elusive. The aim of the study was to investigate healthcare providers (HCPs) practices, skills, attitudes, and perceived barriers related to past childhood abuse screening among adult patients in Saudi Arabia.
Cross-sectional study.
Data were collected from healthcare facilities in the Riyadh and Madinah regions of Saudi Arabia using a self-reported questionnaire.
A total of 126 HCPs completed the survey. Less than one-third of the HCPs reported routinely (usually or always) screening for childhood abuse. HCPs were more concerned that they would offend their patients by examining history of adversities. HCP practice location, the extent to which they think it is part of their responsibilities to screen for history of adversities, and their self-reported of adverse childhood experiences were significantly associated with screening practices for childhood abuse. Four perceived barriers were significantly associated with HCP screening.
Screening for past adversities is vital for identifying childhood trauma among the public; therefore, we might participate in reducing childhood trauma and further controlling consequences in the future. Developing a screening form for childhood abuse or adversities and providing this form in healthcare settings are appropriate at this stage.
Early screening for ACEs is recommended, which prioritizes health promotion and disease prevention. It is highly needed to increase HCP awareness toward childhood abuse, screening for it, and reflection on it.
To explore the impact of 12 American Nurses Association recognized standardized nursing terminologies (SNTs) on patient and organizational outcomes.
Previous studies reported an effect of SNTs on outcomes, but no previous frameworks nor meta-analyses were found.
Systematic review and meta-analyses.
PubMed, Scopus, CINAHL, and OpenGrey databases were last consulted in July 2021. All abstracts and full texts were screened independently by two researchers. The review included primary quantitative studies that reported an association between recognized SNTs and outcomes. Two reviewers independently assessed the risk of bias and certainty of evidence for each meta-analyzed outcome using the “Grading of Recommendations, Assessment, Development and Evaluation” (GRADE) approach.
Fifty-three reports were included. NANDA-NIC-NOC and Omaha System were the most frequently reported SNTs used in the studies. Risk of bias in randomized controlled trials and not-randomized controlled trials ranged from high to unclear, this risk was low in cross-sectional studies. The number of nursing diagnoses NANDA-I moderately correlated with the intensive care unit length of stay (r = 0.38; 95% CI = 0.31–0.44). Using the Omaha System nurse-led transitional care program showed a large increase in both knowledge (d = 1.21; 95% CI = 0.97–1.44) and self-efficacy (d = 1.23; 95% CI = 0.97–1.48), while a reduction on the readmission rate (OR = 0.46; 95% CI = 0.09–0.83). Nursing diagnoses were found to be useful predictors for organizational (length of stay) and patients' outcomes (mortality, quality of life). The GRADE indicated that the certainty of evidence was rated from very low to low.
Studies using SNTs demonstrated significant improvement and prediction power in several patients' and organizational outcomes. Further high-quality research is required to increase the certainty of evidence of these relationships.
SNTs should be considered by healthcare policymakers to improve nursing care and as essential reporting data about patient's nursing complexity to guide reimbursement criteria.
In response to the aging population, the Department for Professional Development in the Nursing Division at the Israeli Ministry of Health has invested significant resources in training registered nurses for post-basic certification in the field of geriatrics. However, little is known about how the nurses implement the scope of practice in the field and how they maximize their full potential following the training.
To assess whether nurses' full potential is maximized in geriatric acute and long-term geriatric care, and community settings in Israel.
A quantitative, cross-sectional study.
The study population is a convenience sample of registered nurses who completed post-basic certification in geriatric care (n = 287). The participants completed a self-administered questionnaire addressing socio-demographic and occupational characteristics, implementation of the scope of practice, and a professional satisfaction questionnaire.
Baseline demographic variables were summarized using means and counts, with frequency counts and percentages used for the scope of practice. A one-way ANOVA was utilized to examine the differences between the workplace and the scope of practice. Chi-square was used to examine practice types and the workplace.
Nurses in all surveyed geriatric settings reported average to high overall performance in independent decision-making activities and delegated duties. The majority (66%) reported very high satisfaction with the completion of the post basic certification education However overall performance differed significantly between the different geriatric settings.
Most of the nurses with a post-basic geriatric certification are satisfied with their scope of practice, feel valued by colleagues and managers, and are able to practice independently within their professional scope. This can have a positive impact on the care of the older adult population.
Administrators should ensure that nurses with a post-basic geriatric certification are able to maximize their scope of practice. Specifically, we recommend nurse managers to leverage the results of this study and advocate for nurses to fulfill their full potential in their scope of practice.
To investigate the mediating role of general self-efficacy (i.e., belief in one's competence to cope with a broad range of stressful or challenging demands) in the relationship between adverse childhood experiences (ACEs) and psychological distress (i.e., symptoms of stress, anxiety and depression) in gender minority individuals, which include people with a gender identity that is not aligned with their sex assigned at birth.
The study sample included gender minority participants who participated in Waves 4 and 5 of Project AFFIRM, a multi-site longitudinal study of gender minority health. ACEs, general self-efficacy, and psychological distress were measured using the Behavior Risk Factor Surveillance System ACE Module at Wave 4, the PROMIS General self-efficacy measure at Wave 4, and the Brief Symptoms Inventory Global Severity Index (GSI) at Wave 5, respectively. After adjustment for covariates, including age, race, sex assigned at birth, and income, multivariable linear regression analyses were conducted to assess each component of the proposed mediation model. Next, mediation analyses were used to determine whether general self-efficacy mediated the association between ACEs and psychological distress.
The sample for this study consisted of 166 gender minority adults with a mean age of 38.6 ± 12.2 years. Most were non-Hispanic White (46.4%) and female assigned at birth (59.6%). Mean ACEs score was 3.2 ± 2.1 (range 0–8), mean general self-efficacy score was 13.9 ± 3.6 (range 4–20), and mean raw-score GSI was 17.3 ± 13.7 (range 0–64). Participants who reported experiencing more ACEs had greater psychological distress (B 1.60; 95% CI = 0.66, 2.54) and lower general self-efficacy (B −0.41; 95% CI = −0.67, −0.15). In addition, lower general self-efficacy was associated with higher psychological distress (B −1.06; 95% CI = −1.61, −0.51). Bootstrap estimation of the indirect effect was significant (95% CI = 0.14, 0.90) and explained 27.1% (95% CI = 7.76, 69.76) of the total effect of ACEs on psychological distress in gender minority adults.
Our findings suggest that general self-efficacy partially mediated the positive association between ACEs and psychological distress in gender minority adults. Interventions that aim to improve general self-efficacy may be beneficial in alleviating psychological distress in gender minority adults.
Nurses can play an important role in reducing the health risks associated with ACEs by screening gender minority individuals using a trauma-informed approach to care and offering resources and referrals, as appropriate.
Gender diverse older adults often endure health disparities, encounter discrimination in healthcare settings, and experience lack of access to healthcare. However, members of this population also have assets that help to mitigate these healthcare challenges. A systematic integrative review was performed to synthesize recent studies of the healthcare needs and assets of gender diverse older adults living in the United States.
A search of PubMed, CINAHL, Web of Science, PsycINFO, and Google Scholar was conducted. Findings from selected studies were organized by theme and subtheme.
Thirty-five articles met inclusion criteria. Seven themes were identified: (1) Inclusivity and acceptance, (2) Antidiscrimination protections, (3) Community, (4) Care of mind, body, and spirit, (5) End of life preparations, (6) Financial security, and (7) Intersectionality. These themes were further divided into 20 healthcare needs and 9 healthcare assets.
The findings call for increased training for healthcare providers to provide safe, gender-inclusive care environments; policy to combat discrimination across all healthcare settings; supportive community resources and healthcare advocacy; empowerment of gender diverse older adults through acknowledgment of their healthcare assets; and more research to discern the role of intersectionality in the applicability of the identified themes to gender diverse older adults of various sociodemographic backgrounds.
This review benefits clinicians by suggesting practice changes to address healthcare needs of gender diverse older adults while describing healthcare assets of this population for integration into health promotion initiatives.
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