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Continence care for the transgender community

Photo: Members of the transgender project's working group
The specific continence needs of transgender people will be among topics on the agenda at the Continence Foundation of Australia’s Victorian conference at Torquay this week (May 18-19).

RSL Care + RDNS senior clinical nurse adviser Kate McLeod’s presentation will build on the 2016 RDNS Transgender Project, which included an organisation-wide self-assessment followed by consultation with transgender and gender diverse clients and representatives from peak bodies working with gender diverse people.

Information gathered from the project led to the development of new client narratives for use in staff in-service training and inductions, and to new guidelines to help staff better work with gender diverse people to meet their specific needs.

Separate evaluations of the new tools were released this month, based on trials with 60 staff in two groups.
Of staff evaluating the guidelines, 45 per cent had worked with a transgender person, 90 per cent said the information was easy to understand.

Of those evaluating the client narratives,72 per cent found the new e-narrative helped them better recognise and respond to the needs of transgender clients.

The e-client narratives are now being used in staff orientation across Victoria, and the guidelines are attached to a client’s electronic care record for staff to use as a self-directed learning tool when a client shares their transgender identity.

Ms McLeod said continence was one area where focus groups identified specific needs and considerations for transgender clients.

For example, nurses working with transgender men who had transitioned to female needed to be aware of and educate clients around prostate issues.

“For men who are transitioning to female they often don’t have their prostate removed, so there are potential issues we need to consider,” she said.

“For people with catheters if they haven’t had gender reassignment surgery but are presenting, for example, as female you have to be mindful because they may have an enlarged prostate.”

Some people were embarrassed to ask for help with toileting because they were uncertain of how nurses would react to their body.

Diversity Manager Jaklina Michael said transgender and gender diverse people had often experienced discrimination throughout their lives, and were afraid to access aged care services in the community and in residential settings.

Interviews with transgender clients found identification, respect for the individual, partnership, referral and support and diversity were key themes service providers needed to consider.

Ms Michael said the transgender project, which has also looked at concerns around wound care and dementia for transgender people, would support the further implementation of the RDNS Diversity Framework and build knowledge and capacity in the workforce.

She said she hoped lessons from transgender clients in community care could help inform work across the broader RSL Care + RDNS operations, to help break down the barriers gender diverse people experience in accessing services.

A client narrative – supporting gender diversity in community care clients:
Ms.T is an Australian born 67 year old transgender woman.  She transitioned from male to female at age 62, following the death of her wife.  She has been on hormones for 5 years. She has not yet undergone gender reassignment surgery meaning that she still has male sexual organs.

Ms.T lives alone and has no contact with her family. She now relies on the aged care pension. Due to her tight budget she cut down the amount of hormone medication she needs and is unable to afford treatments for facial hair removal. 

Ms.T has and continues to feel anxious when accessing health services.  She has experienced discrimination due to her gender identity and struggles with depression.

Ms.T was recently admitted to hospital because she was having problems with passing urine due to an enlarged prostate. Her medical management in hospital included the insertion of a catheter.  On discharge from hospital she was referred to RDNS for continence and catheter care. On the referral form Ms.T was listed as male. 

At the first home visit, the nurse was surprised that the client had a female appearance.  After some respectful discussion, Ms.T started to share her gender history with the nurse. She told the nurse that she was happy for this information to be shared at RDNS, but not to anybody else.  The nurse explained the importance of confidentiality of personal and health information at RDNS and recorded the correct self-identification of Ms.T’s gender.

Before the next home visit the nurse looked for more information from the ‘Guidelines for working with transgender and gender diverse people at RDNS’ to better understand Ms.T’s needs and choices. 

During the next home visit the nurse taught Ms T about her catheter and discussed the catheter change procedure that will be used by the nurse.  Ms T’s information was also communicated via the RDNS client records to ensure that other staff are aware of Ms T’s correct catheter equipment and procedures.

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