Nurse Practitioners Knowledge, Attitudes and Self-efficacy for Working with Transgender Patients

NursePractitioners Knowledge, Attitudes and Self-efficacy for Working withTransgender Patients

NursePractitioners Knowledge, Attitudes and Self-efficacy for Working withTransgender Patients

The United States healthcare hasnot been efficient in providing uniformed and indiscriminativeservices to the Lesbian, Gay, Bisexual and Transgender (LGBT)patients. The LGBT is among the largest group of the undeservedpopulation within the nursing setting (Gayand Lesbian Medical Association, 2010, p.76).The group is constantly exposed to homophobia, aversion, irrationalfear and discrimination. This makes them experience less than theideal environments in healthcare. The nursing profession has beenineffective in the fight against disparities meted to the LGBTpatients. Lack of knowledgeable and competent healthcare providers isidentified as the greatest barrier towards the LGBT healthcare (USDepartment of Health Services, 2013). Studies conducted fortransgender people reveal that finding a healthcare provider withnecessary knowledge about the transgender health issues is quitechallenging(Jeffreys &amp Dogan, 2012).So, does the lack of appropriate curriculum for the nursingprofessionals contributing to the increased disparity in the handlingthe health issues facing the transgender population?

In the research, a sample ofnurse practitioners (n=416) was used to determine the knowledge,attitude and self-efficacy of the nurse practitioners in working withthe transgender patients. The respondents included the nurses who hadprovided their email addresses to the nurse practitioner association.Some of the interesting facts presented by the article is that out ofthe 74.1% of the respondents have positive attitude towardstransgender patients while 82.1% have acceptance full respect. On theother hand, 32.1% had zero confidence while 53.6% had 20% confidencethat their educational background prepared them to provide servicesto the transgender persons. Additionally, 89.3% considered that thepatients they were treating could have been transgender contrary tothe study by Burch in 2005 where 79% of the nurses had reported neverto have considered that the patients under their care may have beenLGBT. Analysis of the potential relationship between knowledge,self-efficacy and attitudes revealed an inverse relationship betweenattitude and self-efficacy as self-efficacy decreased, attitudeincreased positively (r=-.605,p=.001).Lastly, the demographic variables, years of the nurse practitioner,sexual preference, age and spiritual or religion affiliation did nothave any implication on the variance in knowledge.

Accordingto Grove, Gray and Burns (2015), reliability in any research entailsconsistency in methods of measurements used in a study.In critiquing the reliability of the research by Pamela (2013), adescriptive survey was used that comprised of three types ofquestionnaires. The first one was a demographic questionnaire with 47questions, the second was Attitude towards Transgender Survey (ATS)survey by Swanstrom and comprised of Likert Scale questions while thethird one was Health Care Provider Survey (HCPS) by Burch andcomposed of 21 questions of binary type, filling in the blank spacesand Likert scale questions (Pamela 2013, p. 3). Data collection wasdone electronically where the questionnaires were distributed viaemail by the state nurse practitioner to all the members. The use ofthe emails from the nurse practitioner association ensured thatreliable data was collected since the targeted respondents were allnurse practitioners who, by the fact that they were members, meantthat they have been in nursing profession and no doubt they must haveinteracted with the transgender patients. The survey link was sent tothe convenience sample twice at intervals of two weeks in the monthof May. This ensured reliability in the respondents who gave informedconsent. Data from the questionnaire were analyzed using the SPSSsoftware to determine their descriptive statistics. The relationshipbetween attitudes, demographic variables, knowledge and self-efficacywas examined using the Pearson correlation coefficient. This is areliable method of obtaining correlation. Also, to enhance theaccuracy of the results, t-test and ANOVA were not applied,particularly because the assumptions on sample size and distributionwere lacking.

Validity entails thedetermination of “how well the instrument reflects the abstractconcept being examined” (Grove et al., 2015, p. 290). In critiquingvalidity of the research by Pamela (2013), a descriptive design wasadopted. The survey aimed at exploring the attitudes, self-efficacyand knowledge of the nurse practitioners for provision of healthcareto the transgender patients (Pamela 2013, p. 3). Use of differenttypes of questionnaires demographic, ATS and HCPS, ensured validityof the research. This allowed the researched to correlate allvariables of demographics, knowledge, attitude and self-efficacy datain a comprehensive manner. The researcher kept eliminating thequestionnaires containing valid data from 33 to 29 to 28 to 27 andfinally to 26. This showed that the measurement method and theresearch design were valid.

The article by Pamela (2013)have some strengths and weaknesses. Among the major strength is theuse of descriptive design. Descriptive design is relatively easy toundertake as they may involve just one contact with the studypopulation. The technique was advantageous for the current study asespecially because the researcher wanted to establish the linksbetween the knowledge, self-efficacy and attitudes, and their effectson the delivery of services to transgender patients. One of the majorweakness was is the use of a smaller population of 26 respondents andin just one area of United States (Pamela 2013, p.7). This, to someextent, was considerably smaller compared to the available 416nurses. A consideration for a larger population may be instrumentalin enhancing the accuracy and return rate of results obtained (Pamela2013, p.4). This will also enhance a comprehensive investigation ofthe attitudes, knowledge and self-efficacy in working withtransgender patients. Another major drawback was unavailability ofstandardized definitions for the HCPS ratings and well as limitedtesting and use of ATS and HCPS (Pamela 2013, p.7).

In the lesbian, gay, bisexual,transgender heath guidelines for Family Medicine Residents by AmericaAcademy of Family Physicians (AAFP) (Retrieved fromAmerican Academy of Family Physicians), the need for attitudes, knowledge and skills that promoteeducational competences in nursing and handling of LGBT health issueshave been emphasized. Also, the International Journal oftransgenderism by Coleman et al. (2011), provides guidance for thehealthcare professionals on how to assist transgender, genderconforming and transsexual people with effective and safe pathways toattain a lasting personal acceptance with their gendered selves sothat they can be able to maximize on their self-fulfillment,psychological self and overall health (Retrieved from InternationalJournal of Transgenderism).These guidelines are based on standardized professional consensus.According to the two articles, knowledge in nursing practice has beenemphasized. The two articles demonstrated evidence of major medicalbodies not embracing the efforts to change the existing genderidentify or sexual orientation (AAFP, p.4, Coleman et al. 2011, p.167). The two articles reveal that the nursing education curriculumhas played a major role in the deteriorating efforts towards handingthe health issues facing the LGBT (AAFP, p.2, Coleman et al. 2011, p.179). The articles provide the guidelines that should be adopted toensure that the physicians are equipped on how to provide qualitycare to LGBT patients. According to AAFP (p. 6) and Coleman et al.(2011, p. 179), staff training on non-discrimination behaviors of theLGBT is critical in nursing practice. Therefore, the two articlesupheld the need for knowledge, education and trainings for thepractitioners in their treatment of LGBT.

In the article “Understandingthe unique Health Concerns of Transgender Patients Will help YouProvide Culturally Competent Care” by Laura and Nathan (2014),enhancement of the clinical and interpersonal skills when workingwith the transgender patient population is emphasized. The authorsargue that the nursing practitioners ought to break the barriers andimprove the health of LGBTs. In Laura and Nathan (2014, p. 7), theauthors attribute all the issues related with LGBT treatment to poortrainings. They argue that nurse practitioners are rarely trained onthe need to ask the gender identity or sexual orientation of theirpatients. It is critical for the nurses to be taught how to useinclusive and affirmative language which affects screenings andhealthcare since transgender patients feel more at ease talking theiroverall health and bodies. Laura and Nathan (2014, p. 8) emphasizethe need for nursing practitioners to educate themselves andcolleagues to help in removing the barriers to care and ensuresupportive healthcare environments. According to Emily and Carey(2012, p. 5) in “Meeting the Needs of LGBT Patients and Families”,education of the healthcare providers have been emphasized. Theauthors argue that the practitioners must continuously seek educationopportunities for them to learn about the health of LGBT.

In conclusion, this paper soughtto determine whether lack of appropriate curriculum for the nursingprofessionals plays a major role in the increasing disparity in thehandling the health issues facing the transgender population. Thenursing curriculum have been determined to have huge gaps on how tohandle the health issues facing the transgender population. Withproper review of the curriculum and trainings, the health issuesfacing transgender population can be handled. Educating the providersrequire curriculum enhancements and structured learning opportunitiesby the transgender experts and speakers. Nurse educators in charge ofcrafting the curriculum content should give attention to transgenderminority. All these efforts will be critical in filling the gap innursing education on how to effectively work with the transgenderpatients.

Part 2:Visual Aid

Pico Question

Does the lack of appropriatecurriculum for the nursing professionals contributing to theincreased disparity in the handling the health issues facing thetransgender population?

Fact 1

  • 32.1% of the respondents had 0% confidence that their educational background prepared them to provide services for the transgender persons (Pamela 2013, p.5)

  • 53.6% of the respondents had 20% confidence level that their education background prepared them to provide services for the transgender persons (Pamela 2013, p.5)

  • 35.7% of the respondents can be rated “low” in their level of knowledge to caring of transgender patient (Pamela 2013, p. 6)

Fact 2

  • Survey results revealed that almost 19% of the 6,000-plus transgender population reported having been denied healthcare because of being transgender (Laura and Nathan 2014, p. 4)

  • Nurse practitioners are rarely trained on the way they are supposed to ask patients about their gender identity and sexual orientation (Laura and Nathan 2014, p. 7)

Fact 3

  • HHS memos and IOM report have recognized that lack of cultural competency training have posed a major barrier to the LGBT populations receiving adequate healthcare.

  • Mandatory Competency training program for HHC is among the major efforts meted at breaking the barriers in LGBT heath care (Emily and Carey 2012, p.4)

Fact 4

  • Without the education that is LGBT-focused, then the healthcare professionals will be unprepared to care for transgender population

  • Lack of knowledgeable practitioners is identified as one of the greatest barriers to handling of the transgender health issues (Jeffreys &amp Dogan, 2012).


  • Continued education in development and assessment of communication skills in transgender clients through attendance to professional meetings, seminars, workshops, mentoring from a certified and experienced clinician, participation in research on gender-identity issues and conducting independent studies on transgender and related health issues (Coleman et al. 2011, p. 198).

  • Medical educators should address health disparities for transgender populations by providing appropriate and medically accurate education on medical students (AAFP, p. 7)

  • Special effort should be made to enhance competency evaluations and adequate preparation related to caring for the transgender populations, especially the underrepresented medical education (AAFP, p.8).

  • Transcultural nursing care should be emphasized early enough in nursing curriculum to provide a strong platform for cultural competence (Jeffreys &amp Dogan, 2012).


AAFP. (n.d.). Recommended Curriculum Guidelines for Family Medicine Residents: Lesbian, Gay, Bisexual, Transgender Health. American Academy of family Physicians.

Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., &amp Feldman, J. (2011). Standards of Care for the Health of Transsexual,Transgender, and Gender-Nonconforming People, Version 7. International Journal of Transgenderism 13, 165-232.

Emily, K., &amp Carey, R. (2012). Meeting the Needs of LGBT Patients and Families. Nursing Management, 43-46.

Gay and Lesbian Medical Association. (2010). Healthy People. A Companion Document for Lesbian, Gay, Bisexual and Transgender (LGBT), 50-58.

Grove, S. K., Gray, J., &amp Burns, N. (2015). Understanding Nursing Research: Building Evidence-Based Practice (6th ed.). St Louis: Elsevier Saunders.

Jeffreys, M., &amp Dogan, E. (2012). Evaluating the Influence of Cultural Competence Education on Students Transcultural Self-efficacy perceptions. Journal of Transcultural Nursing 23, 188-197.

Laura, C., &amp Nathan, L. (2014). Understanding the unique health concerns of transgender patients will help you provide culturally competent care. Lippincott Williams &amp Wilkins.

Pamela, J. L. (2013). Nurse Practitioners Knowledge, Attitudes and self-Efficacy for Working with Transgender Patients. Clinical Nursing Studies 1 (4), 1-8.

US. Department of Health Services. (2013). 2020 Topics and Objectives.