UK nurses lacking skills to treat transgender patients, says research

UK nurses are failing to meet the needs of transgender patients and feel they lack training and experience to treat the growing number of trans people seeking medical treatment in relation to their gender identity, according to research.

A survey of more than 1,200 nursing staff across the UK found 87% of those nurses who have directly cared for a trans patient felt unprepared to meet the patient’s needs.

The survey, which was conducted by the Royal College of Nursing, also found that 76% have encountered trans people during their healthcare work and 56% had cared for trans people directly.

Just one-fifth of all nurses surveyed said they thought the nursing workforce had the skills to care for trans adults and children, while 76% said more training for all healthcare staff was needed.

The survey comes after the Guardian revealed there has been a steep increase in the number of trans people referred to all 14 gender identity clinics around the country, with a number of clinics experiencing increases of several hundred per cent.

Referrals to adult clinics

The Guardian found that healthcare options for trans people at specialist gender identity clinics were inadequate, with an average waiting time of nine months for a first appointment for adults and some patients waiting up to four years for a first appointment.

Trans people also reported they often encounter medical staff who did not know how to engage with them, such as GPs having laughed at them when they said they wanted to transition, having their feelings dismissed as “just going through a phase”and being repeatedly misgendered – referred to by their birth sex, not the sex they identify with.

Kirsty Cass, a trans woman who has worked as a nurse for the last two years, says she has encountered prejudice and misunderstanding from healthcare professionals, most of which involved her being misgendered.

In one instance, several years after she had undergone gender reassignment surgery, she went to her local hospital for a biopsy on a lump on her ear. After the procedure, the porters wheeled her to a male ward and tried to make her stay there.

“To say I was upset was an understatement,” said Cass. “I was inconsolable, I was sobbing my heart out.”

Much of the problem, she added, had to do with a lack of training of medical staff, some thing was that was also identified as a point of concern by nurses in the RCN survey. Just 1% of respondents said their pre-registration training dealt with the treatment of trans patients and 78% said they had no training on the subject.

Tavistock clinic referrals

Louie Stafford, the trans programme coordinator for the LGBT Foundation, said he was unsurprised by the survey results.

“Gender identity issues are considered a speciality field, so unless you’re practising in that field, it’s unlikely you’ll have any training or any guidance. It’s great that the RCN are trying to shine a light on this from the medical perspective, there’s an urgency for academic medical institutions to consider the curriculum and the content that they’re teaching and put some awareness training in there.”

Wendy Irwin, RCN diversity and equalities coordinator, said the college was pushing for training regarding the treatment of trans people to become a mandatory part of pre-registration nursing training as well as part of continuing professional development.

“I think nurses are increasingly aware of the gap in their knowledge,” she said. “All nurses have a deep and personal desire to deliver the absolutely best care for all their patients, what they’re looking for is how to do that.”

UK nurses lacking skills to treat transgender patients, says research

Struggling students are not "lacking resilience" – they need more support

Resilience has been a buzzword in education for years now. Advocates say that young people need to develop the ability to cope with difficulties themselves, rather than expect others to solve their problems. But critics argue that it is used as a catch-all term that removes responsibility from institutions and fails to address the problem of worsening mental health in students.

Related: Tuition fees ‘have led to surge in students seeking counselling’

I have been working as a welfare officer for the past year, and I have rarely seen the term used to encourage self-improvement in an effective way. I have seen students told by their tutors, counsellors and other support staff that they just need to become more resilient. Yet there is little advice on how to do this, or why it will help.

Students often see the word as a synonym for strength, and therefore feel that lacking resilience is a sign of weakness. A professor could be saying “be more resilient” and mean that a student shouldn’t take critical comments on their work personally. But what a student hears is something like, you aren’t strong enough, or you need to man-up, or you lack backbone.

It’s too ambiguous

The word resilience is used too frequently and applied to vastly different situations.

A first-year student at the University of Edinburgh told me she would always ask her professors for feedback about a bad grade, wanting to know how to improve for the future. In response she was told to become more resilient and stop asking for feedback after every assignment. Surely it takes resilience to embrace negative feedback and address mistakes?

Students need to be equipped to bounce back from tough situations or those where they didn’t achieve perfection.

I’ve heard an employer complain that they were being asked for feedback about applications more often, because students “weren’t resilient”.

Times have changed

Problems are often discussed with an “it was different back in my day” attitude. So if students are accessing university counselling services more, it’s because the entire student population is losing its resilience. If disability services are overstretched, the same reason is given. And when tutors are asked to provide pastoral support – historically always a part of the personal tutor role – they feel it’s because these “modern students” need extra help.

Students might be asking for help earlier and for problems that they once might have kept to themselves. But to dismiss an entire generation isn’t fair.

Students are coping with all sorts of factors that make their lives a challenge: the worry about tuition fee debt, an intensely competitive graduate jobs market and the pressure of social media. By recognising this, university staff can start to support their students to become more resilient.

Impact on mental health

The most worrying aspect of this trend is the frequency with which resilience is referenced in discussions about mental health. It is not appropriate to tell anyone suffering with mental illness – be it anxiety, depression, an eating disorder or something else – that you can recover by becoming more resilient.

Doing so strengthens the notion that mental ill-health equals weakness, and can make people feel that they would not be ill if they had only been tougher. A runner with a severe ankle sprain would not be told to fight through the pain and continue training, so why would we tell someone who has panic attacks the same thing?

Related: No one sees how hard it is for students with an invisible illness

How to make it work

Resilience is a great concept. Learning not to be discouraged by past failings and recognising shortcomings is an extremely useful skill. Students need to be equipped to spring back from tough situations, or times when they didn’t achieve perfection – this is vitally important in universities.

As support staff we need to enable students to learn the skills of resilience. We need to standardise what we mean by it. And we should never use the term when discussing mental health.

Being resilient doesn’t mean never asking for help or never being affected by difficult situations. We need to focus our discussion on boosting wellbeing, and teaching a set of skills that help students bounce back from setbacks in life and academia.

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Struggling students are not "lacking resilience" – they need more support

Lacking Education May Be as Deadly as Being a Smoker

Lacking education may be as deadly as being a current, rather than former smoker.  A study on higher education and life expectancy suggests people with a higher education reap the benefits of living longer.

When it comes to improving and saving lives, study evidence shows that education should receive more focus, rather than changing health behaviors, like smoking, drinking, and diet.

Lacking Education Reduces Life Expectancy

Due to a variety of factors, studies show that a higher level of education is a strong predictor of whether a person lives longer.  Healthier behaviors, a higher income and social status, and improved social and psychological well-being, are three basic factors that attribute to a person living a longer life.

A study by researchers at New York University, the University of Colorado, and the University of North Carolina at Chapel Hill estimated the number of deaths that can be linked to differences in education.  The team of researchers found that study evidence consistently shows a strong association between education level and mortality.

According to Virginia Chang, associate professor of public health at NYU’s Steinhardt School of Culture, Education, and Human Development and College of Global Public Health, and associate professor of population health at NYU School of Medicine, public health policies may need to view higher education as a primary focus.

“In public health policy, we often focus on changing health behaviors such as diet, smoking, and drinking.  Education — which is a more fundamental, upstream driver of health behaviors and disparities — should also be a key element of U.S. health policy.”

In the United States there are many people lacking education.  More than 10 percent of U.S. adults between the ages of 25 and 34 don’t have a high school degree.  Additionally, more than a quarter have some college but have not earned a bachelor’s degree.

A considerable part of the link between education and mortality is causal.  That is, one event is the result of the occurrence of the other event.

Study Highlights

Using the Centers for Disease Control and Prevention’s National Health Interview Survey, the study team looked at information on more than a million people from 1986 to 2006.  The researcher’s goal was to estimate the number of deaths attributed to low levels of education. They studied people born in 1925, 1935, and 1945 to understand how education levels affected mortality over time.

The researchers also noted the causes of death — including cancer and cardiovascular disease.  They found in the 2010 population, if adults who had not completed high school went on to earn a GED or high school degree, 145,243 lives could have been saved.

This finding is comparable to the estimated number of deaths that could be averted if all current smokers had the mortality rates of former smokers. Additionally, if adults who had some college went on to complete their bachelor’s degree, 110,068 people may have lived longer.

Encouraging Education

The difference in whether a person lived longer — compared to his or her level of education — substantially improved over time.  For example, life expectancy was longer for those with high school degrees.  However, life expectancy was far longer for people with college degrees.

Encouraging adults who have not finished high school to complete high school could save twice as many lives among those born in 1945 as compared to those born in 1925, according to researchers of this study.

Patrick Krueger, assistant professor in the Department of Health & Behavioral Sciences at the University of Colorado Denver | Anschutz Medical Campus and the Institute of Behavioral Sciences at the University of Colorado Boulder, suggests trends need to change.

“Our results suggest that policies and interventions that improve educational attainment could substantially improve survival in the U.S. population, especially given widening educational disparities.  Unless these trends change, the mortality attributable to low education will continue to increase in the future.”

Impacting Survival Patterns

The researchers said that based on their findings, meeting the goals of Healthy People 2020 could have a substantial impact on future survival patterns.

Healthy People 2020 is an initiative to improve Americans’ health decade by decade.  They set goals for increasing the proportion of students lacking education to complete high school by 2020.

Virginia Chang comments on the need for higher education.

“Broadly, life expectancy is increasing, but those with more education are reaping most of the benefits.  In addition to education policy’s obvious relevance for improving learning and economic opportunities, its benefits to health should also be thought of as a key rationale. The bottom line is paying attention to education has the potential to substantively reduce mortality.”

Published findings of this study titled, “Mortality Attributable to Low Levels of Education in the United States,” are in the journal PLOS ONE.

Lacking Education May Be as Deadly as Being a Smoker