The Evolution of the Quality and Safety Education for Nurses (QSEN) initiative started in 2005 and was funded by the Robert Wood Johnson Foundation. It has a principal investigator doctor Linda Cronenwett, who is designated as a Fellow of the American Association of Nursing (FAAN) and dean of North Carolina at Chapel Hill School of Nursing. The goal of this initiative is to show the challenges that future nurses will face and to provide them with the necessary knowledge, skills, and attitudes (KSAs) so that they can provide quality care and improve the safety of patients in the healthcare system (“The Evolution of the QSEN Initiative”, n.d.).
The project was divided in three phases between 2005 and 2012. The first phase (Phase I) lasted between 2005 and 2007 and defined the six competencies of nursing, and the KSAs that accompany them. These associated KSAs were created so that they could be use in pre-licensure nursing programs. The six competencies include patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, informatics, and safety. The second phase of the QSEN initiative took place between 2007 and 2009 and it included pilot nursing schools that integrated the six QSEN competencies from Phase I in their curriculum. Phase III took place between 2009 and 2012 and during this phase both the UNC College of Nursing, and the American Association of Colleges of Nursing (AACN) received funding from the Robert Wood Johnson Foundation.
Doctor Cronenwett continued to be the primary investigator in this phase, along with Geraldine P. Bednash who is the Executive Director of the American Association of Colleges of Nursing (AACN). Phase III of the QSEN initiative was to develop the expertise of faculty of the nation’s nursing schools, so that they can successfully teach these competencies to their students. Another goal of this phase was to incorporate these competencies in textbooks, licensure, accreditation, and certification. During this phase three QSEN forums were held and eight regional faculty development institutes to prepare nursing faculty in undergraduate programs.
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The national QSEN initiative was also extended to graduate nursing programs after the AACN received $964,388 by the Robert Wood Johnson Foundation in 2012 (“The Evolution of the QSEN Initiative”, n.d.)Patient-centered care is one of the competencies of nursing and involves a partnership between the patient and the provider. The healthcare provider builds a relationship with the patient, discusses their unique concerns, preferences and values and they choose together the appropriate treatment for the patient.
There is a set of knowledge, skills and attitudes that a nurse should have when caring for a transgender individual (TI). Transgender is any individual that doesn’t identify with their assigned gender at birth (Selix & Rowniak, 2016). Some of them might have had gender reassignment surgery that usually also includes the use of hormones, while other TIs might prefer to dress as the other gender (Sedlak, Veney, & Doheny, 2016). Gender reassignment surgery is not an option for some TIs since it can be very expensive; they might not have a health insurance or access to healthcare (Sedlak et al., 2016).
The transgender population in the US is about 0.3% but this may not be accurate since there are underreporting issues and this number is expected to grow in the upcoming years (Barrett & Wholihan, 2016). A nurse should have extensive knowledge when working with such a diverse population that has special healthcare needs. There are some health issues that the transgender population may be more susceptible to (Barrett & Wholihan, 2016). The transgender identity was listed as a psychological disorder in the Diagnostic and Statistic Manual of Psychological disorders (DSM) until 2013 and TIs face more discrimination than any other minority (Barrett & Wholihan, 2016). A national survey conducted in 2008 investigated the experiences of TIs in the healthcare system.
There were 6456 participants and 19% of them were denied care by a healthcare provider, 28% of them were harassed verbally and for those reasons 28% of them postponed their medical care and 33% postponed preventive medical care (Selix & Rowniak, 2016).There are certain health issues the nurse should be aware of when working with TIs. The Human Immunodeficiency Virus (HIV) affects disproportionally transgender people. When undergoing hormone therapy there are severe physical and psychological implications such as an increased risk of diabetes, cardiovascular disease and thromboembolism (Barrett & Wholihan, 2016). TIs are also more susceptible to stress and mental health issues such as anxiety, depression, post-traumatic stress disorder and suicide (Barrett & Wholihan, 2016).
More specifically, 41% of TIs have reported attempting suicide and some point in their lives (Selix & Rowniak, 2016). The nurse has to ensure that her patient has a primary provider that works closely with them to prevent these implications and monitor their physical and psychological health.A nurse working with a transgender individual should possess a set of skills to ensure satisfactory quality care for them. The nurse should incorporate their values, preferences and needs in their care and communicate those with the other nursing staff. She should also provide patient-centered care with sensitivity and respect for the diversity of transgender individuals. When working with a transgender individual a nurse should discuss their access to healthcare, health history, past use of hormonal therapy, cardiovascular health, mental health and safe sex and ways to prevent sexually transmitted infections (STIs) (Sedlak et al., 2016).
The nurse should be aware that if the transgender individual hasn’t had reassignment surgery they should be screened for prostate, breast and cervical cancer. If there is a male to female transgender individual that had surgery that involved the construction of a neovagina and hormone therapy, a mammogram is appropriate (Sedlak et al., 2016). The nurse should be sensitive, courteous and supportive when taking a past medical history. They shouldn’t be judgmental when taking sexual and social history and should use gender neutral language so that a relationship of trust is built with the transgender individual. The nurse shouldn’t make assumptions about gender or sexual orientation based on appearance and should use open ended questions (Barrett & Wholihan, 2016).
She should ask questions such as “What name would you like to be called?”, “What are your personal pronouns?”, and “Who is family for you?”. The nurse should use the word “partner” when referring to a transgender individual’s significant other and should respect that the patient might want to share things at a slower pace (Barrett & Wholihan, 2016).The nurse should recognize her personally held attitudes about TIs and remember that her role is to provide patient-centered top quality care, even if a patient’s opinions and values differ from her own.
She should encourage respectful communication and try to see things from her patient’s perspective. Unfortunately, there is a lack of nursing education on transgender individuals and nurses can find it challenging to interact with this population because of their lack of knowledge. Nursing programs should start educating their students on the LGBTQ community and incorporate this population in the nursing curricular content. A possible way to do that is with live actors in stimulation laboratories that present a realistic nursing scenario with a transgender individual (Barrett & Wholihan, 2016).
Health care facilities should create an inclusive environment to make transgender individuals feel safe and comfortable to share their medical history and needs. Demographic forms should include non-straight sexual orientations and there should be a prominent display of nondiscrimination policy when it comes to sexual orientation and gender identity (Barrett & Wholihan, 2016). Nurses should have access to educational brochures on LGBTQ issues and research resources that they could provide their patients with to make living as a transgender individual as smooth for them as possible, and receive the physiological health and mental health support they need (Barrett & Wholihan, 2016).
Reflecting on my research on the transgender population, I realized that I am very fortunate we had the opportunity to write about this topic. I believe I have never researched about transgender individuals in the past, and was unaware of who is considered to be transgendered and what kind of challenges they face in their everyday lives, but also in the healthcare system. I didn’t know that they are more susceptible to certain physical health and mental health issues. I believe that now I feel more prepared to have a successful communication with them, make them feel comfortable, create an inclusive environment and provide the best quality care that I can. I am grateful this class included transgender individuals in our curriculum, because I am not sure if that will happen in any of my other nursing classes in this program.
