00:01
Hi, I'd like to introduce you
to our next case.
00:04
This is Michael.
Michael is a 25-year-old client
who presents to the obstetric unit
reporting back and
abdominal discomfort.
00:13
Michael is requesting to be
referred to as "he" by the staff.
00:17
Michael's very upset because his
wristband says that he is a female.
00:22
He reports being 36 weeks pregnant,
and he has the onset of
"what feels like contractions."
And these contractions
started about an hour ago.
00:31
And they're in his low back,
and they were occurring
about every five minutes.
00:36
Michael was given a maternal
pre-admission form to fill out
when he arrived on the unit.
00:41
It asked questions about
what type of medications.
00:44
He was taking before
and during pregnancy.
00:46
Michael reported he was
taking testosterone,
which he discontinued about four
months prior to achieving pregnancy.
00:53
He is a Gravida 1, P 0.
00:56
He has lots of questions about
some of the content on the form.
00:59
And it's very difficult for him
to answer some of the questions.
01:03
He's very anxious. As he reports
traveling from out of state.
01:08
The nurse prepares to
perform a vaginal exam
to determine where
Michael is in labor.
01:14
Now let's take all that information
that we just collected
in Michael's history.
01:19
We're going to highlight
the findings
that require immediate
follow up by the nurse.
01:24
This time we want to
focus on gender affirming,
or gender inclusive
language in our care.
01:31
Let's go through them one by one
and really unpack
what should be highlighted.
01:36
Michael requests
that he be referred to as "he".
01:40
However, on his wristband,
it lists him as a female.
01:44
All of that should be highlighted.
01:46
When a client requests
to use pronouns,
he, she, they or something else,
it's important that we honor that,
because that allows
the client to feel like
they belong on the unit.
01:58
It's just like, if your name is
Mary, and someone calls you, Jim,
that wouldn't be okay.
02:03
So whatever the client
prefers to be called,
or whatever the client uses, as
their pronoun is what we should use.
02:11
Michael is 36 weeks,
and he has the onset of what
feels like contractions.
02:15
They started about an
hour before he arrives.
02:17
So certainly this is important
in terms of his medical care.
02:21
But this is not really related
to gender affirming care.
02:24
So we won't highlight
that one in this case.
02:27
Next, Michael was given a
maternal pre-admission form.
02:32
Maternal, which goes along with
the feminine gender pronouns.
02:37
So we want to make sure
that whenever we're giving
anyone a form in a maternal unit,
that we use
gender inclusive language,
on the top of that form,
and all the way
throughout that form.
02:50
Remember, we're going
for a sense of belonging.
02:53
Michael did report that
he was taking testosterone,
which he discontinued about
four months prior to pregnancy.
02:59
Now, this is important to note
in the general sense of things,
but since it was stopped
before pregnancy,
then we're not concerned about
any effects to the fetus.
03:07
So this does not need to be
highlighted at this time.
03:11
In the next item,
we learn that Michael is having
some difficulty
completing the form.
03:16
Now, if this case were only
about maternity care, in general,
then we might not
highlight this item.
03:23
But again,
having questions on a form
that are unable to be completed
because they're not gender
affirming, that's a problem.
03:31
Therefore,
this should be highlighted as well.
03:33
And the last bullet,
Michael appears anxious.
03:37
He's traveling from out of state.
That part not unusual.
03:41
That would make everyone anxious.
03:43
However, the nurse says that she is
about to perform a vaginal exam.
03:49
There's the language again.
03:51
Vaginal refers to female anatomy.
03:54
So for Michael who
identifies as a male,
he may not use the word vagina.
03:59
So it's very important that whenever
we're talking to a new client,
that we ask them,
"What are the words you use
to describe your anatomy?"
That is how we are gender
affirming, and gender inclusive.
04:13
After the pelvic exam,
the nurse notifies
the healthcare provider
that the client is in active labor.
04:20
And then the healthcare
provider writes some orders.
04:24
The Standing Orders
are for vital signs,
starting the fetal
heart rate monitor,
admitting Michael for labor
and obtaining IV access.
04:33
In the next question,
we're going to determine
whether Michael is at risk
or not at risk for the following
barriers while he's receiving care.
04:41
Here's the long list.
04:43
Let's go through each
one of these individually
and determine what
Michaels at risk for.
04:49
I'm going to pause
for a second here
and give you just a minute
to look at each of these situations
and determine on your own
if you You think Michael
is at risk or not at risk.
05:06
Now let's see which
answers are correct?
Is Michael at risk
for a lack of specialty knowledge
from health care providers?
Absolutely.
05:15
Transgender persons all over the
country and all over the world
are constantly at risk
for the lack of knowledge
of the healthcare system.
05:24
Risk of traumatization.
05:26
Yes, Michael is also
at risk for this.
05:29
We've already discussed
one incident. The vaginal exam.
05:33
But there are lots of opportunities
for events and traumatization
on an obstetrical unit.
05:39
Denial of care due
to gender diversity.
05:42
Michael is not at risk for
this particular situation,
because of the Affordable Care Act.
05:47
The Act allows for everyone
regardless of gender identity
to receive
the full spectrum of care.
05:54
A non inclusive environment
is Michael at risk for this.
05:58
Absolutely. There are going to be
many instances in terms of
non gender affirming language,
non gender inclusive language.
06:06
People who stigmatize others
that are different from them
that are going to occur
all over the place.
06:11
Definitely at risk for this one.
06:13
Involvement with
protective Child Services.
06:16
Again, the Affordable Care Act
specifically talks about this
and protects transgender
persons from any situation
that would involve
Child Protective Services.
06:25
Denial of insurance
coverage for the delivery.
06:28
Absolutely not.
All deliveries will be covered,
regardless of gender identity.
06:33
So Michael is not at risk for this.
06:37
So again,
let's look at the risk for,
and then not at risk
for answers for Michael.
06:44
Based on the information
we've covered so far,
let's look at a different question.
06:51
The nurse determines that Michael is
most at risk for experiencing blank
from the healthcare staff
due to blank.
06:59
Take a moment and look
at both option one and two,
and decide what answers
you would place in the box.
07:12
So let's look at each option to
determine which one is correct.
07:15
So under Option one,
a delay in care.
07:19
Well, Michael's
already here for labor.
07:22
So, this is likely
not the right answer.
07:25
A decrease in the quality of care.
07:27
We've already experienced
several episodes where
the staff have not used the
correct anatomical terms,
or had the correct forms
that were gender affirming.
07:37
So there are definitely
some issues around knowledge
that are affecting quality of care.
07:42
Maybe you've peeked over
at Option two
when you see knowledge deficits.
07:46
We might want to hold on
to that answer.
07:48
But let's keep going.
07:50
An adverse event.
07:51
Is it possible that Michael could
experience an adverse event?
Sure. But does that
beat quality of care?
Nope, it doesn't.
08:01
So quality of care definitely is
the correct answer for Option one.
08:06
Now let's look at Option two.
08:08
You already noted that knowledge
deficits certainly apply here.
08:13
But let's look at the
other two answers.
08:15
Barriers to insurance providers.
08:17
The Affordable Care Act
protected us from that.
08:20
So that is not the correct answer.
08:22
And social stigma.
08:23
Social stigma is certainly an
issue for transgender people,
but it's usually related
to delaying health care,
which is not an issue in this case.
08:32
So the correct answer
to this question is
that the nurse
determines the client
is most at risk for experiencing
a decrease in quality of care
from the healthcare staff
due to knowledge deficits.
08:46
For the next set of questions,
we will determine what are the
most immediate and effective ways
for overcoming
the identified barriers
and providing care to the client?
We have four options in this case.
09:01
So let's look at each
one individually.
09:04
Seek out gender diverse
educational resources.
09:08
Well, certainly this is important.
09:10
However, we're looking for immediate
ways to address the issues.
09:14
And this will take a little time.
09:16
So this answer will not work.
09:18
The next option, interview
the client regarding preferences.
09:23
If it's a choice,
you should always choose it.
09:26
Interviewing the client means
that we are asking for preferences
and being willing to follow along.
09:32
This will always get us
to the right place.
09:35
Doesn't allow for
assumptions or anything else.
09:38
Interviewer. Ask.
Yes. Yes. Yes.
09:41
So let's look at the other options.
09:43
Apologize ahead of time
that the preferred terminology
will likely be misused.
09:49
So asking ahead of time
to do something that is offensive
does not make it okay.
So this is not the correct answer.
09:57
And finally referenced previous
electronic medical records.
10:01
Well, that might provide information
on previous health conditions,
but it may not provide the
information that we want to know
about this particular
client's wants and needs.
10:12
Remember, we're talking
about gender affirming care,
and those needs may change.
10:17
So we need to ask the client
every time, every visit.
10:20
So this is also not
the correct answer.
10:23
Interview the client?
Yes, yes, yes.
10:27
Michael's labor has progressed.
He is now 8 centimeters.
10:32
And he is requesting that
the nurse use the term
front pelvic opening
rather than vaginal opening.
10:37
His vitals remain stable,
and his TOCO diameter or fetal
monitor is still in place.
10:44
The contractions are now
two to three minutes apart.
10:47
Now we have a new
nurse coming on shift.
10:50
So let's look at the quotations
to see if our nurse is giving
gender affirming communication
with the new nurse.
10:58
Look at this list and see
which of these statements complies
with gender affirming care.
11:11
Now let's go through
each one individually.
11:14
The nurse says,
"I call the information technology
to have the chart flag
to notify staff that the client
identifies as 'he'."
Should the nurse do this?
Absolutely.
11:27
The Maternal heart
rate has been stable
between 80 to 100 beats per minute.
11:32
The first thing you might see in this statement
is the heart rate
It is within normal limits
However the issue here is the term "maternal"
We often default to feminin terms
such as "maternal"
Michael identifies as male, therefore the
gender affirming term should be "paternal"
This is seemingly a benign statement
but this would be incorrect, even in
conversations between colleagues.
11:56
The significant other is
currently at the bedside.
11:59
Significant Other. It does not
identify gender language.
12:03
So it's not binary. It's open.
12:06
Definitely want to check this one.
12:09
The client identifies
as transgender.
12:11
It it asked about
chest feeding the baby, 'it'.
12:16
Definitely not gender affirming.It
should not be checked.
12:19
And finally,
I completed the cervical exam
through the front pelvic opening.
12:25
Remember, this is the terminology
that Michael requested.
12:28
So this is a gender affirming
communication statement.
12:32
These are the options
that are correct.
12:35
Michael has had his baby.
12:38
And so now let's take a peek
and see what's going on.
12:43
He delivered a healthy baby
through his pelvic opening.
12:47
Skin to skin contact was
immediately initiated
and the client was
evaluated after delivery
and everything is going well.
12:56
Michael responded that initially.
12:58
He was very uncomfortable
when he received a wristband
that identified him as a female.
13:03
He was also given a form
that displayed maternal
instead of paternal.
13:09
Maternal is not how
he describes himself.
13:12
He also stated he understood
that it could be confusing,
but he was glad the wristband
was able to be fixed.
13:19
He also felt like everyone
was trying to do their best
to be respectful to someone
who identifies as trans.
13:26
He was especially appreciative of
the correct use of terminology,
and that showed
respect for his body.
13:33
Look at the statements
provided here
and determine
which statements affirm
that Michael perceives
that he received
gender affirming care.
13:45
Now, let's break down the answer.
13:47
The first statement, Michael says,
"I understand it can be confusing,
and I'm glad the wristband was fixed
quickly and I was given an apology."
This is a positive statement.
13:58
Michael acknowledges
that a mistake was made.
14:01
But he also feels better
that he was given an apology
and the error was corrected.
14:07
The next statement.
14:08
"I especially liked
how terminology was used
to fit and respect my body."
Again, a positive response.
Michael feels heard and respected.
14:19
And the next statement,
Michael says,
"I feel like everyone was
trying to do their best
to be respectful to
someone who was trans."
Michael is appreciative that
the staff was respectful
regardless of his gender
identity and diversity,
Another positive statement.
14:35
Finally, maternal is not
how I would describe myself.
14:39
Remember the admission form.
Maternal, not paternal.
14:44
That is not how Michael identifies.
14:46
So this would not be an example
of providing gender affirming care.
14:52
Here's the final list.