Nursing care to transgender - Research Paper Example

?Nursing care to transgender: Current of knowledge Ten articles were reviewed since a review of literature in 2009 on nursing care to lesbian, gays, bi-sexual and transgender persons. The international and the American Nursing Association codes of ethics essentially prescribe that nursing care should provided to all people regardless of gender orientation. Several studies have been produced on the vulnerability and distinct health situation of lesbian, gays, bi-sexual and transgender person. This integrative review of literature attempts to describe the current state of knowledge of the nursing profession. The work believes that the Alegria (2011) currently provide a comprehensive set of guidelines on how to deal with LGBT from the standpoint of nursing care and also represent the current state of knowledge of nursing on the LGBT sector and in how to serve best the sector in advancing a nursing care that is sensitive to gender orientation. Nursing care to transgender: Current state of knowledge Both the National Center for Transgender Equality and the National Gay and Lesbian Task Force define transgender “broadly to include those who transition from one gender to another (transsexuals), and those who may not, including genderqueer people, cross-dressers, the androgynous, and those whose gender non-conformity is part of their identity” (NTDS, 2011, p. 12). Gender non-conformists include lesbians, gay, and bisexuals (NTDS, 2011, p. 12). Provision 1 of the Code of Ethics for Nurses of the American Nurses Association (2001) pointed out that “the nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.” The preamble of the Code of Ethics prescribed by the International Council of Nurses clearly and unequivocally pointed out that nursing care must be respectful and unrestricted by gender and gender orientation (ICN, 2006, p.1). In line with the codes of ethics mentioned, this review of literature seeks to find out the current state of knowledge in gender-orientation-sensitive health care. In particular, this review of literature seeks to find out what material can be considered as the material that can provide a basic reference for protocols and approach towards a gender-orientation-sensitive health care. This review covers materials from 2009 to 2012 and starts from a review of literature conducted on the subject in 2009. Thus, the inclusion criteria followed for the literature review are works written from 2009 to 2012, published in nursing or health journals, and must have the word transgender in the title of the material. The exclusion criteria included materials that are unpublished or non-journal articles, published earlier than 2009, and those that are only online materials. Other materials appear in the bibliography because they are relevant to be discussed in elaborating the points articulated in the selected materials. In a review of literature Addis et al. (2009, p. 647) pointed out that “member of various groups will have different needs, risks and expectations which impact on health, well-being and patterns of accessing health and social care services.” Primarily based on this point, the authors justified why a review of literature on social and health care are important among the lesbian, gay, bisexual and transgender older people. The focus of the authors’ integrative review of literature was to find out what research has indicated to be the appropriate guidelines or principles in health care among transgender people. Addis et al. (2009) pointed out that transgender people have been largely unknown, together with the gays, lesbians, and bisexuals. Based on their 2009 review of literature, Addis et al. observed that among the main themes that can be derived in the health care studies involving the social groups are isolation and their state of mental health. However, the research studies that were reviewed by Addis et al. (2009) have been criticized “for using small samples and for tending to exclude participants from the less affluent social backgrounds” (p. 647). Addis et al. (2009, p. 647) emphasized that although the condition of gays, lesbians, bisexuals and transgender persons have been unknown, the condition of bisexuals and the transgender people were the most unknown. The literature reviewed by the Addis et al. (2009) study included studies in which lesbians and gay persons were participants or research respondents but it is not clear however whether all types of transgender people were covered. Addis et al. (2009, p. 647-651) noted that in the literature they have reviewed, the gays and lesbians reported “marginalization in all aspects of social and political life,” experienced “negative feelings about being gay,” tended to overuse alcohol and many have not maintained positive relationships with their families of origin as family relationships often break down with disclosure of sexuality. The authors concluded that lesbians, gay, bisexuals and transgender people have experienced “discrimination” in the health and social care services (p. 647). Gays, lesbians and transgender people also reported discrimination in retirement facilities. Addis et al. (2009, p. 650) reported that a survey among gay men concluded that the “prevalence of depression in men who have sex with men was 17.2% higher than in adult US men in general.” Gay/bisexual men have “higher prevalence of depression, panic attacks and psychological distress than heterosexual men” (Cochran et al., 2008, as cited in Addis et al., 2009). Based on the study of Cahill et al. (2001), older gay people are more likely to live alone than their heterosexual peers (Addis et al., 2009). Based on the study of Claes & Moore (2000), gay men are also most likely to delay entry into residential care (Addis et al., 2009). Bauer et al. (2009) investigated 85 transgender people through focused-group discussion and found that transgender persons worry on health concerns, lack of sensitivity or awareness of health professionals on the several kinds of transgender people, the ordeal of having to go through procedures appropriate for genders which they no longer assume, lack of protocols appropriate to their sexual orientation, and lack of consideration for their sexual orientation. The Bauer et al. (2009) focused-group discussions were semi-structured and were designed to elicit discussion about health, health care experiences, and efforts to maintain health, health education and resources. The focused-group discussions were in groups of 3 to 27 participants. The participants have low income, 12.3% reported they were unable to find work, 35.4% were partnered or married, and a 15.5% had children (Bauer et al., 2009). The Bauer et al. (2009) study transgender respondents described themselves as “woman, male-to-female, genderqueer, two-spirit, boy, and bi-gendered” (p. 351). Further, the transgender respondents “showed a range of sexual orientation including lesbian, gay, pansexual, bisexual, and heterosexual” (Bauer et al., 2009, p. 351). Meanwhile, based on their review of several studies from the 1990s to the 2000s, Bauer et al. (2009, p. 349) found that transgender people encounter obstacles to stable income and quality housing and experience “disproportionately high rates of violence, harassment, and discrimination in workplaces, schools, and child welfare systems.” Rondahl (2009) pointed out that non-heterosexuality was considered as sinful, criminal or pathological in Sweden: it was a criminal offense until 1979 when it was classified as a mental disorder. Rondahl (2009) added that many attitudes in the nursing and medical professions are based on the assumption that normal people are heterosexual and very little attention is given to sexuality in medical education programs and, often, not time at all is allocated to lesbian, gay, bisexual and transsexual issues. In response to the situation, Rondahl (2009) looked into the sources of knowledge on lesbian, gay, bisexual and transgender that medical and nursing students have accessed to among nursing and medical student. For the study, he used a sample of student nurses (n=90) and a sample of students in a physician program (n=77) in a university in central Sweden for a survey. For the study, Rondahl (2009) used an instrument developed by American researchers for an American population which the author modified for the Swedish population. The questionnaire included a test for assessing knowledge on lesbians, gays, bisexuals and transsexual. Based on the results of the survey, Rondahl (2009, p. 11) concluded that only 10% of the nursing students have “a passing level of care knowledge” for lesbians, gay, bisexuals and transgender people. Rondahl (2009, p. 11) also found that although both do not have “a passing grade,” non-religious persons “have a higher total LGBT knowledge and psychological knowledge than religious students.” In addition, Rondahl found that gender do not affect one’s state of knowledge on LGBT. LGBT refers to lesbian, gays, bisexuals, and transgender. Psychological knowledge on LGBT means the ability “to meet and communicate with LGBT patients and their relatives” (Rondahl, 2009, p. 10). Based on these, Rondahl (2009, p. 13) concluded that “the education system should address the knowledge deficit currently existing regarding LGBT among nursing and medical students.” Sanchez et al. (2009) reported the health care use, obstacles to health care, and situation on hormone use among male-to-female transgender persons based in three New York City community health care centers in 2007. The goal of Sanchez et al. (2009) study was to find out if the health care among the transgender persons has been in accord with the World Professional Association for Transgender Health as well as the goals of Healthy People 2010. Sanchez et al. (2009) found that more than a majority has seen a general practitioner and is covered by a health insurance. Sanchez (2009) reported that at least 25% of the respondents consider costs, access to health specialists, and lack of transgender friendly and transgender competent services as obstacles to health care among transgender persons. On the side, the Sanchez et al. (2009) study provided evidence that physician care is associated reduction in high risk behavior, abandonment of smoking habits and obtaining needles from a physician. Further, physician’s care has been associated with obtaining hormone therapy from a licensed physician. The key finding of Sanchez et al. (2009) is that health care has been failing to adhere to the standards recommended by the World Professional Association for Transgender Health and Healthy People 2010. Based on the prescriptions of the World Professional Association for Transgender Health, the overarching goal for care for transgender persons is personal comfort with his or her choice of gender identity as well as the maximization of overall psychologically well-being and self-fulfillment (Sanchez et al., 2009). US national data suggest, however, that only 30 to 40% of transgender persons use regular medical care (Sanchez et al., 2009). Thus, data from the 3 New York City community centers suggest that the New York City health care data are on the high side when compared to the national figures. Further, Sanchez et al. (2009, p. 713) mentioned that Healthy People 2010 reported the US health care system has still to address “biases against gender identity differences” to promote access to quality health care and associated services. Around 32% of respondents to the Sanchez et al. (2009) study reported that “access to provider knowledgeable about transgender health issues” is the most important obstacle to transgender-friendly health services, followed by transgender-friendly care provider (30%), availability of specialists (28%), physical accessibility (18%), and language (13%). Keiswetter & Brotemarkle (2010, p. 272) articulated an important logic: HIV infection rates among transgender persons are high and the social group are stigmatized and suffers greatly from discrimination, implying that ultimately they will be requiring in-patient care at some point in their lives. Keiswetter & Brotemarkle (2010) identified specific guideposts on how “culturally competent care for HIV-infected transgender persons in the inpatient hospital setting” can be providing, focusing on the role of the clinical nurse leader. The guideposts appear to be the prescription of Keiswetter & Brotemarkle based on their experiences as nurses and also based on the literature the authors have cited in their work. Based on the authors’ interpretation of agency data, prevalence of HIV infection in transgender “exceed estimates in men who have sex with men population” (2010, p. 272). Additional factors contributing to higher rates of HIV infection among transgender include “high rates of mental health issues, physical/sexual abuse, social isolation, economic marginalization, incarceration, inadequate health care, and perception of low HIV risks status” (Keiswetter & Brotemarkle, 2010, citing Herbst et al., 2008). According to Keiswetter & Brotemarkle (2010, p. 272), the clinical nurse leader “could provide transgender patients an ideally positioned to advocate, instill, and coordinate consistent and culturally competent care at the bedside and beyond.” For the Keiswetter (2010), the clinical nurse leader acts also as an educator and advocate in direct patient care. The clinical nurse leader “can be instrumental in shaping the inpatient experience for the transgender patient while working to maximize to continuity of care to improve patient outcomes” (Keiswetter & Brotemarkle, 2010, p. 272). Keiswetter & Brotemarkle (2010, p. 273) recognized that “although some hospital have units devoted to infectious disease and staff with expertise in HIV care, many nurses and health care staff have limited knowledge or understanding of transgender people.” Keiswetter & Brotemarkle (2010, p. 273) prescribed that it is also important for nurses and the health care staff “to make a positive impression so as to facilitate care in patients who distrust health care systems.” This is because, according to Keiswetter & Brotemarkle (2010, p. 273), “patients views of health care workers as ignorant and insensitive concerning transgender issues can act as a serious barriers to care, both in acute care and outpatient setting.” At the same time, “the lack of clinical and cultural competency can lead to misunderstandings, inappropriate care, and undiagnosed health problems” (Keiswetter& Brotemarkle, 2010, p. 273). In other words, what Keiswetter & Brotemarkle (2010) are saying is that the clinical nurse should be competent but this is not sufficient because she or he must also be viewed as competent by their patients. For Keiswetter& Brotemarkle (2010, p. 274), the role of the clinical nurse leader cover more than direct health care must include leadership, client and community advocacy, education and information management, risk anticipation, management and use of client-care and information technology, and lateral integration of care. As educators, CNLs are also focused on education regarding HIV transmission, HIV-prevention, and promotion of the appropriate protocols regarding use of needles (Keiswetter, 2010, p. 274-275). Further, CNLs must act as agents of continuity (Keiwswetter, 2010, p. 275). Unfortunately, Keiswetter & Brotemarkle (2010) failed to clarify what cultural competence in caring for transgender patients mean. In addition, Keiswetter & Brotemarkle (2010) also failed to point what role the CNL can fulfill vis-a-vis the family members or significant others of transgender whenever these are available or even what role the CNL can undertake in addressing depression and low spirits and morale that transgender patients may have while under their care. Garnero (2010) summarized key concepts in culturally-sensitive diabetes care for LGBT Americans. Garnero (2010) emphasized that there are certain ailments in which the LGBT population are most affected. For example, Garner (2010) pointed out that lesbians have the highest rate of polycystic ovarian syndrome (PCOS) and this is “a fact that is not mentioned about PCOS on two leading diabetes Web sites” (Garnero, 2010, p. 179). The LGBT population “have unique health characteristics, disparities, and barriers that increase their risk for diabetes or its complications” (Garnero, 2010, p. 179). For example, some of the distinct characteristics of the American LGBT population: cigarette smoking is highest in the LGBT community, PCOS is highest among lesbians (38% versus 14% among heterosexual women), diabetes rates are highest among LGB African-American adults, overweight and obesity rates are higher among lesbians, risk for type 2 diabetes is higher among transgender women who are on hormone therapy, uninsured rates and difficulty obtaining medical care occur most frequently among lesbians thereby making detection more difficult, depression and suicide attempts are highest among LGB individuals, homeless adolescent include up to 40% LGBT individuals and other data or claims on data were among those cited by Garnero (2010) to support her assertion on the vulnerability of the LGBT population to diabetes. Unfortunately, the concept of cultural sensitive diabetes care was not really elaborated in Garnero (2010). At most, Garnero (2010) are claims on why the LGBT population is vulnerable to diabetes and the so-called cultural dimensions may not really be cultural dimensions at all but only lifestyles that may have made the LGBT community more vulnerable to diabetes. Nothing in this discussion should be taken to mean that discrimination against LGBT and the marginalization of the latter do not exist. It is clear that discrimination against LGBT exist as LGBT lifestyles are considered non-normal by the larger heterosexual population, especially by that part of the heterosexual population that is homophobic. Because of that discrimination, marginalization of the LGBT in healthcare exists. Nevertheless, familiarity on the realities of LGBT lifestyles need not be considered as cultural competence but simply as gender sensitivity as nursing care and the nursing profession must be gender-sensitive to be more competent in nursing care. In an ethnographic qualitative study Melander et al. (2010) explored the needs of transgender people of color in San Francisco (N=43) and found that “transgender youth and adults make decisions out of necessity” and when needs are unmet “resort to options that are available at the time” (p. 218). Some of the transgender individuals “arrive in San Francisco with little or no resources, looking for opportunities to live openly as transgender individuals and connect with others to whom they can relate” (Melander et al., 2010, p. 218). Further, the “transgender individuals, particularly transgender youth in San Francisco, are socially vulnerable and need support through programs designed specifically for them” (Melander et al., 2010, p. 218). For Melander and her colleagues, “more resources are needed for transgender youth and adults to socialize, receive services, organize events, mobilize outreach activities, and, more importantly, to live like everyone else without societal judgment or abuse” (Melander et al., 2010, p. 218). The more health care related findings and recommendations of Melander et al. (2010) are as follows. First, health care providers must be open and sensitive to the needs of the transgender youth and adults and facilitate health-care seeking behaviors. Second, resources for harm reduction and health care targeted for HIV and sexually transmitted disease must be made available. Third, health care providers must be prepared to make referrals among the transgender individuals to facilitate their transition to the preferred gender. Fourth, health care providers should be sensitive for transgender specific problems. Finally and fifth, ethnicity should also be considered in any intervention program among the transgender individuals. At first glance, the concerns raised by Melander et al. (2010) may not be ethnicity-related but it is also possible to argue that because of it is the people of color LGBT who are the most vulnerable in the San Francisco, ethnicity is a valid variable to consider in assessing what social group are most vulnerable other than being part of the LGBT population. Rawling (2012) presented a set of definition of LGBT, gay, lesbians, bisexuals and transgender people which “task forces” in the United States also have a definition and use a case study to highlight a problem that can face a person in the LGBT community: those closest to him or her may not be accepted by relatives and may be deprived of visit rights and even the right of helping the person who is ill. The Rawling (2002) case situation also presented the diagnosis of an illness can be delayed if sexual orientation is not disclosed at the outset of a medical examinations because risks to certain illnesses and conditions are not immediately identified. Alegria (2011, p. 175) basically argued that transgender identity is an important information because it has implications for vulnerability or “implications for psychosocial and physical evaluation.” The declared objective of Alegria (2011), however, is “to educate nurse practitioners (NPs) regarding: (a) the definition and range of transgenderism, (b) social influences on transgender persons, and (c) health care for transgender persons” (p. 175). Alegria (2011) is a very important document because it identifies the questions to ask, the recommended physical examination to do, and the laboratory analysis to request when confronted with a patient who revealed an LGBT identity. Alegria (2011) highlights the importance for health practitioners for gender orientation sensitivity and the need for health practitioners to elicit this important datum from patients. Alegria (2011) emphasizes, however, that getting the data on sexual orientation is not always easy because of the stigma and discrimination associated with the identity and, thus, gender and gender-orientation sensitivity in health care require that health practitioners behave and execute protocols consistent with that fact. It is possible that in the years to come, Alegria (2011) will become an important document that defines what gender orientation-sensitivity in health care is all about. Mollon (2012) merely echoed the concerns that were already raised by earlier materials and re-expressed concerns on deprivation and the marginalization of transgender. Thus, Alegria (2011) provides a comprehensive set of guidelines and protocols on the importance of getting information on gender orientation and what it means to have a gender-orientation-sensitive health care. Mollon (2012), however, reminds us health disparities with the LGBT as the “minorities” continue and there is a need for continuing reforms in our practice of health care. It is possible to summarize some of the discussions in this review through Tables 1 and 2 which follow. Table 1. Works reviewed, methodology/framework and results Author & Year Purpose Methodology and/or Framework Sample Measures Treatment and/or processing of data Results Findings Addis et al. (2009) Identify key issues and map research Meta-narrative using expert knowledge to conceptually define the research area Utilized an inclusion criteria based on scholarship, original contribution to research, and having been cited as material that made a seminal contribution Materials with “lesbian,” “transgender,” “bisexual,” and “older people” None but the materials covered in the review were assessed for relevance Further quality criteria were adopted through which research were evaluated Synthesis of the literature 187 materials were reviewed and 20 primary research papers were evaluated, summarized, and key findings from the research studies were identified Health needs of transgender persons have largely been disregarded. Current health practices “marginalize” transgender persons. Bauer et al. (2009) Develop a framework for studying transgender health concerns Developing a conceptual tool of erasure as a framework for studying transgender health concerns 85 respondents in focused discussion groups of 3 to 27 participants Themes elicited through focused group discussion Identification of themes expressed in the focused group discussions Conceptual framework of “erasure” as a tool for interpreting and analyzing health concerns of transgender people The analytical framework “erasure” is useful for understanding, for example, “the negative experiences trans people face in the health care system” because this causes “some to hide their trans identity when accessing HIV services” and can result into some people not wanting to know or disclose their HIV status Rondahl (2009) Three concerns: 1) knowledge of nursing and medical students on LGBT persons; 2) differences between gender on LGBT knowledge; 3) difference between religious and non-religious students in LGBT knowledge Survey n=71 for nursing students and n=53 for medical students The samples were from a Swedish university Knowledge exam on LGBT developed by Harris, Nightingale, and Owen (1995) (cited in Yarber, Bausermann, Scheer, & Davis The role of gender and religiosity on LGBT knowledge was explored Data processing was assisted by SPSS Version 14 Overall response rate of 92% Scores on knowledge on LGBT disaggregated by study program, gender, and religiosity Nursing and medical students have very poor knowledge on LGBT care Gender differences is not a factor for differences in LGBT knowledge but religiosity may be a factor although both religious and non-religious respondents score poorly on LGBT knowledge Sanchez et al., (2009) Assess if health care are in-line with WPTH and HP 2010 Case study Transgender persons in 3 community centers of New York City (N=101) Simple frequency counts and percentages Statistical correlations The role of access to physician services in presence or absence of high-risk behaviors Among respondents, 77% reported having health insurance, 81% reported having seen a physician in the past year, over 25% identified certain factors as obstacles to health care for transgender persons Physician care associated reduction in low risk behavior and cessation of smoking Health care in the case is not yet fully in-line with the goals of the WPTH but their health figures are better compared to the US national data Access to physician services is associated with lower high risk behavior Keiswetter & Brotemarkle (2010) Identify the roles of a Clinical Nursing Leader for transgender patients Reference to literature and assertion of what the tasks of Clinical Nursing Leader should be on transgender patients Not applicable None Not applicable A set of recommendations or assertions on what a Clinical Nursing should leader should do It is probably inappropriate to identify a set of findings because the authors provided simply outline what roles a Clinical Nursing Leader should do in caring for their transgender patients Garnero (2010) Summarize key concepts in providing culturally sensitive diabetes care for LGBT Deriving key points from literature and identifying key points from one stock of knowledge on a subject matter Not applicable Not applicable Not applicable Identification of key points on why LGBT individuals are highly vulnerable to diabetes Key point on why there is a need for culturally sensitive health care for diabetes/on why there is a need for gender-sensitive health care orientation There is no summary at all of the key concepts for providing culturally sensitive diabetes care for LGBT but the author identified the factors which makes the LGBT population vulnerable to diabetes Melander et al. (2010) Identify the needs of transgender people of color in San Francisco Qualitative ethnographic LGBT people of color in San Francisco (N=43) None None Description of LGBT population among people of color in San Francisco Identification of specific sources of vulnerability and a set of recommendations for LGBT/ethnicity sensitive health intervention Rawlings (2012) Highlight an end-of-life scenario that can happen to an LGBT individual Definition of terms and presentation of a case and identification of end-of-life problems that can face an LGBT individual and presentation of LGBT as a factor that determine one’s end-of-life situation Non-random, case presentation Not applicable Not applicable Identification of a possible end-of-life scenario for an LGBT individual Gender orientation is an important datum to obtain in diagnosis and health care, especially in end-of-life situations Alegria (2011) Educate nurse practitioners on the range of transgenderism, social influences on a transgender persons, and health care for transgender persons Definition of key terms and provision of guidelines for health care among transgender individuals Not applicable Not applicable Not applicable Not applicable Not applicable Mollon (2012) Presentation of data on the state of disparity of health care with LGBT as “minorities” Presentation of data Not applicable Not applicable Not applicable Not applicable The LGBT communities continues to be underserved in the general population Table 2. Works reviewed and findings Author & Year Findings Addis et al. (2009) Health needs of transgender persons have largely been disregarded. Current health practices “marginalize” transgender persons. Bauer et al. (2009) The analytical framework “erasure” is useful for understanding, for example, “the negative experiences trans people face in the health care system” because this causes “some to hide their trans identity when accessing HIV services” and can result into some people not wanting to know or disclose their HIV status Rondahl (2009) Nursing and medical students have very poor knowledge on LGBT care. Gender differences is not a factor for differences in LGBT knowledge but religiosity may be a factor although both religious and non-religious respondents score poorly on LGBT knowledge Sanchez et al., (2009) Health care in the case is not yet fully in-line with the goals of the WPTH but their health figures are better compared to the US national data Access to physician services is associated with lower high risk behavior Keiswetter & Brotemarkle (2010) It is probably inappropriate to identify a set of findings because the authors provided simply outline what roles a Clinical Nursing Leader should do in caring for their transgender patients Garnero (2010) There is no summary at all of the key concepts for providing culturally sensitive diabetes care for LGBT but the author identified the factors which makes the LGBT population vulnerable to diabetes Melander et al. (2010) Identification of specific sources of vulnerability and a set of recommendations for LGBT/ethnicity sensitive health intervention Rawlings (2012) Gender orientation is an important datum to obtain in diagnosis and health care, especially in end-of-life situations Alegria (2011) Not applicable but the document provide the standard questions to raise and the laboratory tests to prescribe for transgender patients Mollon (2012) The LGBT communities continues to be underserved in the general population The articles chosen in this integrative review of literature are all scientifically meritorious because all of the materials are peer-reviewed articles. Of course, when a study involve the use of a sample, the generalizations formulated by the researchers should be considered as valid only for the population on which the sample was taken, provided the sample is a random sample. Thus, questions of external validity need not be raised provided the generalization is done only for the population covered by the sample. In the studies covered by this integrative research, the researchers have been careful enough to qualify their conclusions based on their sampling procedures and the population they have chosen. However, some of the studies covered by integrative review of literature may have to review their use of the term “culturally-sensitive nursing care for transgender” when the appropriate term may be “gender-orientation-sensitive nursing care.” In the view of this work, on this matter, there can be questions of internal validity in some of the studies. Meanwhile, Alegria (2011) can still be improved but the material appears to be the best material at the moment on “gender-orientation-sensitive nursing care” for transgender people. The recommendation that this integrative study can make at the moment is that for at least some or all of the assumptions of Alegria (2011) to be empirically validated by future studies even as Alegria (2011) can be the tentative core material for a “gender-orientation-sensitive nursing care” for transgender persons. References Addis, S., Davies, M., Greene, G., MacBride-Stewart, S. & Shepherd, M. (2009). The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: A review of the literature. Health and Social Care in the Community, 17 (6), 647-658. Alegria, C. (2011). Transgender identity and health care: Implications for psychosocial and physical evaluation. Journal of the American Academy of Nurse Practitioners, 23, 175-182. ANA. (2001). Code of ethics for nurses with interpretive statements. American Nurses Association (ANA): Nursing World. Accessed 30 July 2012 from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Tools-You-Need/Code-of-Ethics.pdf Bauer, G., Hammon, R., Travers, R., Kaay, M., Hohenadel, K., & Boyce, M. (2009). “I don’t think this is theoretical; This is our lives”: How erasure impacts health care for transgender people. Journal of the Association of Nurses in AIDS Care, 20 (5), 348-361. Cahill, S., South, K., & Spade J. (2001). Outing age. Public policy issues affecting gay, lesbian, bisexual and transgender elders. National Gay and Lesbian Task Force Foundation, New York. Claes, J. & Moore, W. (2000). Issues confronting lesbian and gay elders: The challenge for health and human services providers. Journal of Health and Human Services Administration, 23, 181-202. Cochran, S., Sulian, J., & Mays, V. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71, 53-61. Garnero, T. (2010). Providing culturally sensitive diabetes care and education for the lesbian, gay, bisexual, and transgender (LGBT) Community. Diabetes Spectrum, 23 (3), 178-182. Herbst, J., Jacobs, E, Finlayson, T., McKleroy, V., Neumann, M., & Crepaz, N. (2008). Estimating HIV/AIDS prevalence and risk behaviors of transgender persons in the United States: A systematic review. AIDS and Behavior, 12 (1), 1-17. ICN. (2006). The ICN code of ethics. Geneva: The International Council of Nurses (ICN). Keiswetter, S. & Brotemarkle, B. (2010). Culturally-competent care for HIV-infected transgender persons in the inpatient hospital setting: The role of the clinical nurse leader. Journal of the Association of Nurses in AIDs care, 21 (3), 272-277. Melander, P., Bhupendra, S., Sheth, L., Bermudez, C., Drone, J., Wood, W., & S. (2010). Understanding sociocultural and psychological factors affecting transgender people of color in San Francisco. Journal of the Association of Nurses in AIDS Care, 21 (3), 207-220. Mollon, L. (2012). The forgotten minorities: Health disparities of the lesbian, gay, bisexual, and transgendered communities. Journal of Health Care for the Poor and Underserved, 23 (1), 1-6. NTDS. (2011). Injustice at every turn. A Report of the National Transgender Discrimination (NTDS) Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force. Rawlings, D. (2012). End-of-life care considerations for gay, lesbian, bisexual, and transgender individual. International Journal of Palliative Nursing, 18 (1), 29-34. Rondahl, G. (2009). Students inadequate knowledge about lesbian, gay, bisexual and transgender persons. International Journal of Nursing Education Scholarship, 6 (1), 1-15. Sanchez, N., Sanchez, J., & Danoff, A. (2009). Health care utilization, barrier to care, and hormone usage among male-to-female transgender persons in New York City. American Journal of Public Health, 99 (4), 713-719. Read More