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Gender-Affirming Care - Exploring Inclusive Terminology

Shaely Ritchey (RN, BScN) and Kalina Hunter (UVNS 3)


Language has the power to shape how we see the world as well as imagine ourselves and others within it. While words might seem insignificant at times, especially in busy practice settings, language can foster agency and hope amongst ourselves, the people we work with, and patients and clients. Language can also perpetuate harmful stigma and cause the erasure of marginalized groups. Indeed, language is one of the most powerful tools we carry with us as nurses in our everyday practice.
 

As our cultural awareness of the power of language and the importance of inclusivity expands, the application of awareness into real and tangible change in our practice settings becomes our collective and individual responsibility as nurses. Shifts in our understanding of the power of person-first language, trauma-informed care, cultural competency, colonial violence, and gender-affirming care require significant practice adaptations, one of which is careful reflection on the language and terminology we use when interacting with colleagues and those for whom we care.
For those of us who occupy intersections of privilege – whether we are white, cis-gendered, heterosexual, neurotypical, able-bodied, and so on – our awareness of needed change can be quite low, as we may never have encountered or questioned the dominant views and common language in our workplaces. Even simple terms, such as "female caregivers only" or "male/female catheterization" have consequences for marginalized individuals. What might seem like nothing to those of us who are privileged, can perpetuate further erasure of diversity, and perpetuate stigma.
 

To be clear, a specific care requirement such as "female caregivers only" can be a very important part of someone's care, but it is important to reflect on what is being asked in this care consideration. Is the ask for female caregivers only, or is it a request for cis-gendered and female-appearing caregivers only? What are the implications of this on staff who identify as non-binary or transgender? If someone is transgender, are we asking them to then identify themselves as such? If someone is transgender and considered passing or not passing, does this change whether they are able to provide care for this patient? If that is the case, there are significant transphobic implications.
 

Similarly, "male or female catheterization" might seem like a simple anatomic statement, but gender identity and anatomy are not the same thing. Another important consideration is that many individuals who identify as transgender may decide against having gender-affirming surgeries or hormone therapy, but that does not make them any less of who they are.
 

Anatomy exists on a spectrum, the same as gender. We see examples of this in anatomical differences at birth. However, this comparison needs to be used cautiously as there is the tendency to frame these differences as birth "defects" or medical conditions which could be harmful to the individual in this circumstance, and highly stigmatizing to transgender persons as their experiences are not disorders, illnesses, or defects.
 

In a health care system that is already highly stressed, this conversation may seem superfluous, but it is lifesaving for gender-diverse individuals, both those accessing health care and working within it. There are serious mental and physical consequences related to stigmatization, erasure, and limited ability to access gender-affirming care.
 

Reflecting on the ways in which we use language to both help and harm, is a simple way of supporting inclusivity and co-creating safe spaces for those whose access to these kinds of environments is limited. While creating change at an organizational and systems-level is challenging, bottom-up approaches are just as important as trying to create change from the top-down.
Creating safety starts with us – as human beings interacting together and creating community between each other. Part of this work in creating change, includes challenging one another and having uncomfortable conversations between those with lived and living experience and those who work with them. In moving forward, it is important to honour the capacity of each of us, to participate in creating meaningful change with, and determined by, those who experience marginalization.
 

Questions for reflection:

  • In your own nursing practice, how might you practice better gender-affirming care?
  • As you reflect on this piece, are there are other language practices that could also be stigmatizing? If so, what are some examples and how might they be mitigated?

Further Reading and Resources:

  • Gender-inclusive language guide
  • Re-defining anatomical language in healthcare to create safer spaces for all genders
  • Inclusive queer curricula in medical education

Author Biographies

Shaely Ritchey (she/they) is a registered nurse who works in complex surgery. Originally raised upon unceded Lheidli T'enneh traditional territory; currently living upon unceded Lək̓ʷəŋən traditional territory Shaely is passionate about the power of language in health care settings, particularly for marginalized and stigmatized communities. In their free time, Shaely enjoys wildlife and nature photography, reading and art, as well as mental health advocacy.
 

Kalina Hunter (she/her) lives on Lək̓ʷəŋən lands as an uninvited settler and is entering her fourth year of the BScN Nursing program at UVic. After graduation she hopes to work with the pediatric population. Kalina has a special interest in how childhood experiences impact brain development, functioning, and behaviour. She is a lover of many creative endeavours, from playing violin to painting to searching for sea glass on the beach.

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