# data[].attributes.body
Challenge the nurse talking about it. Nothing to do with immediate care being delivered

# data[].attributes.body
Not making the comments regarding Johns transgender status

# data[].attributes.body
Judgemental

# data[].attributes.body
Talking behind his back

# data[].attributes.headline
His gender change is irrelevant to his care and does not need to be discussed

# data[].attributes.subject
His gender change is irrelevant to his care and does not need to be discussed

# data[].attributes.body
That they’re transgender status was relevant to their treatment or care

# data[].attributes.headline
Not be talking about a patient within listening distance of other patients

# data[].attributes.subject
Not be talking about a patient within listening distance of other patients

# data[].attributes.body
Staff shouldn’t discuss as has no relevance to there medical condition it’s a lack of confidentiality

# data[].attributes.body
The nurse was unprofessional

# data[].attributes.body
Breach of disclosing transgender status

# data[].attributes.body
Explain that Johns transgender status is not clinically relevant and we should focus on his acute care needs

# data[].attributes.body
The scars could be noticed and documented so that they are aware that they are old and not a result of something recent but a discussion about them between staff isn't needed

# data[].attributes.body
Your thoughts cannot always be trusted or professional so hold them in and assess why your initial reactions were that.

# data[].attributes.body
exotifying his gender identity / medical history related to gender affirming care and pathologising this identity by including it in handover when not necessary

# data[].attributes.body
wondering about their dead name despite already having a name is disrespectful

# data[].attributes.body
Speculating about the patients dead name in a public setting in front of others, taking focus away from his care and onto his gender identity. Not only disrespectful but a waste of time as it’s not relevant to his acute medical needs

# data[].attributes.headline
The need to wonder his pre-transition name is not relevant clinically or any other way

# data[].attributes.subject
The need to wonder his pre-transition name is not relevant clinically or any other way

# data[].attributes.body
Johns care should not be focused on his gendee

# data[].attributes.body
John’s dignity is not respected.

The focus is not on his needs

# data[].attributes.body
It’s okay to have thoughts we all have them sometimes we think things that maybe don’t need to be voiced. You may not expect an older patient to be trans maybe instead of saying this question yourself why? Is the belief that older people can’t be trans rooted in prejudice or unhelpful beliefs? What do trans people look like? Can you tell- absolutely not

# data[].attributes.headline
There was no need to talk about a patients appernce unless it was clinically significant

# data[].attributes.subject
There was no need to talk about a patients appernce unless it was clinically significant

# data[].attributes.body
this is causing unnecessary gossip, rude comments regarding something that is not relevant to his care

# data[].attributes.body
Disregarding patient dignity

# data[].attributes.body
extremely judgemental and breach of nmc code

# data[].attributes.headline
Protocols are protocols. Next of kin should be the named person irrespective of relationship status 

# data[].attributes.subject
Protocols are protocols. Next of kin should be the named person irrespective of relationship status 

# data[].attributes.headline
If patients able to communicate should be there choice 

# data[].attributes.subject
If patients able to communicate should be there choice 

# data[].attributes.body
family dynamic is unique to the individual relationship on paper do not record emotional relationships and the family dynamic can be more complex than a genetic family tree

# data[].attributes.body
The ward clerk should not be dismissive of anyone regardless of what they're being approached about because the issue is important to anyone going to effort to raise it

# data[].attributes.body
The clerk is not necessarily wrong to not admit Rob as next of kin but her approach and communication style is disrespectful and doesn't involve active listening.

# data[].attributes.headline
Could of explained to Rob the reason they can't just accept he is nect of kin... instead of being blunt and not explaining the why

# data[].attributes.subject
Could of explained to Rob the reason they can't just accept he is nect of kin... instead of being blunt and not explaining the why

# data[].attributes.body
requiring additional proof from Rob to be Johns primary contact when this is not often asked for in heteronormative relationships

# data[].attributes.body
dismissive of not only the relationship but Rob's feelings and increasing distress - should be explained more diplomatically re hospital policies around next of kin

# data[].attributes.headline
Clerk did not explain WHY system doesn't work that way or alternatives to resolve it. Rude and dismissive 

# data[].attributes.subject
Clerk did not explain WHY system doesn't work that way or alternatives to resolve it. Rude and dismissive 

# data[].attributes.headline
Consider if you generally ask for proof from next of kin & follow same procedures for all families 

# data[].attributes.subject
Consider if you generally ask for proof from next of kin & follow same procedures for all families 

# data[].attributes.headline
No one should have to "prove" they are in a relationship with someone. It is hard to understand that we require a blood relative or a formal relationship status such as marriage, it should of been explained more throughly to the robs partner and not been as dismissive 

# data[].attributes.subject
No one should have to "prove" they are in a relationship with someone. It is hard to understand that we require a blood relative or a formal relationship status such as marriage, it should of been explained more throughly to the robs partner and not been as dismissive 

# data[].attributes.body
The way that Rob was spoken to was disrespectful

# data[].attributes.body
To some extent you can understand that a next of kin may not be able to be changed without the current next of kin confirming it but it should have been handled better

# data[].attributes.body
while there are certain processes that have to be followed regarding confidentiality and who can be told what about a patient, there is never a need for staff to be dismissive to relatives/friends/carers in distress

# data[].attributes.body
Understanding that patients may have a partner which they arent married to is important, however i would be cautious just going off someones word as it is not obvious if people are in relationships. On a placement I have managed a patient who had a expartner try and claim they are partners now and needs to be next of kin.

# data[].attributes.body
Should only be used if looking at relevant pmh but not to him

# data[].attributes.body
Using old names (or the wrong name for someone who has never changed it) can make the patient feel dismissed, not understood, ignored or seen as just another patient that you don't really care about

# data[].attributes.body
Seems rooted in prejudice as staff do not struggle with other name changes ie surname after marriage

# data[].attributes.headline
Patient safety, if there are two names being used for the patient there may be issues regarding medication safety he may miss medications if the nurse doesn't recognise the name or thinks the prescription doesnt match the patient name

# data[].attributes.subject
Patient safety, if there are two names being used for the patient there may be issues regarding medication safety he may miss medications if the nurse doesn't recognise the name or thinks the prescription doesnt match the patient name

# data[].attributes.headline
Impact can be that John and his partner loose trust in the medical facility and their members of staff potentially leading to complications seeking care/treatment in the future 

# data[].attributes.subject
Impact can be that John and his partner loose trust in the medical facility and their members of staff potentially leading to complications seeking care/treatment in the future 

# data[].attributes.body
Ask the patient how they’d like to be addressed and respect it - tell the next nurse in handover

# data[].attributes.headline
Should the junior doctor have flagged this for change as soon as possible? 

# data[].attributes.subject
Should the junior doctor have flagged this for change as soon as possible? 

# data[].attributes.body
Datix this. You cant give medications if the drug chart and wrist band says different names??

# data[].attributes.body
not patient centred, causing distress for the patient and his family and ignoring their legal name which he has had for 30 years

# data[].attributes.headline
It’s been 30 year which indicates it’s permanent 

# data[].attributes.subject
It’s been 30 year which indicates it’s permanent 

# data[].attributes.body
If someone was married and had changed there name you wouldn’t use there maiden name so regardless of ease of notes the correct name should be used that is there legal name so that’s what should be used on the notes and also we should prioritise people and respect and use the name that they wish to use

# data[].attributes.body
Using the dead name can cause trauma particularly for more recently changed names and make them feel like they are somehow wrong

# data[].attributes.body
It is very disrespectful to deadname someone. Their previous name does not need to be known or mentioned, this can cause unnecessary distress to the person and their family.

# data[].attributes.body
Nursing isn’t about ease it’s about what is in the best interest of the patient. For family and for John hearing his dead name is going to cause distress and discomfort potentially resurfacing trauma. As said it’s also causing confusion amongst the team- that doesn’t sound like the easiest option either

# data[].attributes.body
could be dangerous in terms of medication errors, as johns name and his deadname causes confusion for staff.

# data[].attributes.headline
If staff are being corrected they should not be using a pateints dead name, yes it can be confusing but nurses must be in compliance with the choices about thier own care. Dead naming can be hurtful and really damage ones self confidence 

# data[].attributes.subject
If staff are being corrected they should not be using a pateints dead name, yes it can be confusing but nurses must be in compliance with the choices about thier own care. Dead naming can be hurtful and really damage ones self confidence 

# data[].attributes.headline
It maybe easier for the staff but it could be a name that’s very difficult for John to hear and the staff aren’t considering his feelings and they aren’t respecting his reasons for changing his name 

# data[].attributes.subject
It maybe easier for the staff but it could be a name that’s very difficult for John to hear and the staff aren’t considering his feelings and they aren’t respecting his reasons for changing his name 

# data[].attributes.headline
Change the record to stop this “confusion” and discuss in handover that john should only be referred to as John 

# data[].attributes.subject
Change the record to stop this “confusion” and discuss in handover that john should only be referred to as John 

# data[].attributes.body
There was no problem until the junior doctor found out his dead name so this is obviously rooted in prejudice and not what is easier

# data[].attributes.body
It’s very common for cisgender patients to want to go by another name or a nickname and yet when it is a transgender patient not wanting to go by their ‘dead name’ it’s a controversial problem.

# data[].attributes.body
Whatever rob wants to be referred to refer to them as that

# data[].attributes.body
Simply acknowledge and include both

# data[].attributes.body
This feels like a systemic issue across the unit since generally when an explanation is given at the bedside it is directed at everyone who is present. The fact that the nurses, clerk and doctors all seem to have a poor approach to this situation suggests a wider issue

# data[].attributes.body
Undermining johns role in robs life

# data[].attributes.headline
Maybe the doctor was not informed about john having a male partner, and just assumed it was a friend. However as a healthcare worker he should know this before communications with family instead of rellying on assumptions 

# data[].attributes.subject
Maybe the doctor was not informed about john having a male partner, and just assumed it was a friend. However as a healthcare worker he should know this before communications with family instead of rellying on assumptions 

# data[].attributes.body
at this point the team should know Robs status as Johns partner and should act appropriately, not dismissing him in conversation and allowing him the chance to have his questions clarified

# data[].attributes.headline
It’s extremely disrespectful to undermine someone’s relationship with someone. In today’s society everyone has different relationships with people and are close with different people. He should be spoken to inclusivly 

# data[].attributes.subject
It’s extremely disrespectful to undermine someone’s relationship with someone. In today’s society everyone has different relationships with people and are close with different people. He should be spoken to inclusivly 

# data[].attributes.body
Condescending, undermining and not the kind of communication we should be using with anyone

# data[].attributes.body
The doctor should have asked rob (if able) who he wanted present while discussing his condition

# data[].attributes.headline
Mirror the language of the patient/ next of kin/ family and use the terms they prefer / use themselves when describing how they are related 

# data[].attributes.subject
Mirror the language of the patient/ next of kin/ family and use the terms they prefer / use themselves when describing how they are related 

# data[].attributes.headline
Redgarless of how busy a ward is or stressfull, patient centred care always comes first, the nurse needs to understand non-medical people will not have a clue what we are talking about or have very little knowledge and it can be daunting to hear all of these medical words. 

# data[].attributes.subject
Redgarless of how busy a ward is or stressfull, patient centred care always comes first, the nurse needs to understand non-medical people will not have a clue what we are talking about or have very little knowledge and it can be daunting to hear all of these medical words. 

# data[].attributes.body
Rob being dismissed is going to diminish his value as John’s partner

# data[].attributes.body
We should be asking about the relations instead of assuming and causing the patient and loved one to feel uncomfortable

# data[].attributes.body
As the nurse you become aware of the relationship and understanding the dynamics because you are there having interaction with the family around that patient so correcting other members of the team and advocating for the family as a whole

# data[].attributes.body
The clinician might be from a different part of the world (Dr’s are from a very diverse range of ethnicities in the United Kingdom), where they might not be aware of people who are transgender.

# data[].attributes.body
If the patient and their family don't trust the team they are less likely to listen to advice that could help recovery

# data[].attributes.body
Very unprofessional and confidentiality breach

# data[].attributes.body
Were you bothered about what was going on down there before you knew he was trans?

# data[].attributes.body
staff member relaying to Rob instead of actively challenging comments made - inappropriate and unprofessional.

again exotitifies John's gender identity (wanting to know "what's going on under there") and behaviour is wholly unprofessional and disrespectful

# data[].attributes.body
If the nurses truly felt that his identity could cause issues in an emergency, they should request advice, protocols and training in this area

# data[].attributes.headline
The staff member should have probably reported this to the proper management/HR first. By telling Rob at this time it may has caused alot of unease and panic as they distrust the team however it is hearsay as not been reported

# data[].attributes.subject
The staff member should have probably reported this to the proper management/HR first. By telling Rob at this time it may has caused alot of unease and panic as they distrust the team however it is hearsay as not been reported

# data[].attributes.headline
Why were the commemts relayed to rob where was the need, yes you can have your own opinion, but when in a public setting think twice about what you say not only to colleagues but also patients family mebers as it is not always appreciated. As nurses we must be professional and use our breaks/free time to have discussions but also keeping in mind of GDPR

# data[].attributes.subject
Why were the commemts relayed to rob where was the need, yes you can have your own opinion, but when in a public setting think twice about what you say not only to colleagues but also patients family mebers as it is not always appreciated. As nurses we must be professional and use our breaks/free time to have discussions but also keeping in mind of GDPR

# data[].attributes.body
Was there a need for that last nurse to pass the comments onto rob?

# data[].attributes.body
I’m confused why the other staff member would relay to Rob the inappropriate comments made by the other staff members.

# data[].attributes.headline
This foster a disrespectful and potentially harming environment for John to be a patient in. Also could affect any other patients and visitors 

# data[].attributes.subject
This foster a disrespectful and potentially harming environment for John to be a patient in. Also could affect any other patients and visitors 

# data[].attributes.body
The “light-hearted” comments can actually have a huge impact on John and Rob, making them feel uncomfortable or even fearful of seeking medical support again. He won’t trust the professionals either thus making it difficult for him to advocate for himself potentially and signs of deterioration can be missed. Even needing assistance with washing and dressing can be extremely difficult for John after this

# data[].attributes.headline
Whilst the comments were wholly inappropriate, is this also some point scoring by the other staff member? 

# data[].attributes.subject
Whilst the comments were wholly inappropriate, is this also some point scoring by the other staff member? 

# data[].attributes.body
This could have been used as an opportunity to challenge and educate privately, leading to better person-centred care by the 2 making the comments. Instead, it does seem a little like they staff relaying the conversation is trying to curry favour with John

# data[].attributes.headline
Not a good comment as even in cis-gender people there are many who are uncomftable with their body for different reasons. The comment is unnecessary and potentially harmfull to anyone so should just be left out

# data[].attributes.subject
Not a good comment as even in cis-gender people there are many who are uncomftable with their body for different reasons. The comment is unnecessary and potentially harmfull to anyone so should just be left out

# data[].attributes.body
Ask John if he wants to see the screen or not? Would you ask that to patients anyway?

# data[].attributes.body
Why was the technician informed of his trans status? Their role is to carry out the procedure and report the findings to the medical staff so they needed no other information besides patient name

# data[].attributes.headline
If you cannot say something appropriate, do not say anything at all!

# data[].attributes.subject
If you cannot say something appropriate, do not say anything at all!

# data[].attributes.body
The technician might be from another another country and have a genuine interest in the fact that John has transitioned, however this does not make the comment right and could be approached in a different way.

# data[].attributes.headline
Talking about a patients body right in front of them when they are clearly in significant pain and have just been in a huge traumatic event is wildly inappropriate and a huge disgrace unpon the NMC code and everything that a nurse stands for 

# data[].attributes.subject
Talking about a patients body right in front of them when they are clearly in significant pain and have just been in a huge traumatic event is wildly inappropriate and a huge disgrace unpon the NMC code and everything that a nurse stands for 

# data[].attributes.body
Completely unnecessary to make these comments, evidently there’s gaps in their knowledge they should be focussing on reflecting on their words and actions and considering how they can improve in the care they are providing

# data[].attributes.headline
Sensitivity for the person should be the priority 

# data[].attributes.subject
Sensitivity for the person should be the priority 

# data[].attributes.body
Every person is unique in the things that make them who they are

But when delivering care we should be uniformed in our approach and consider how our words and actions effect our patient

# data[].attributes.body
Be professional at all times, explain procedure to patient and check for discomfort/ pain throughout procedure.

This would be very traumatic for John to potentially be visually reminded of previous internal gender organs

# data[].attributes.attachment_link.readable_text
Research from King's College London featured as an alert on NIHR Evidence, a platform which aims to bridge the gap between research findings and practice.

The featured research looked at communication relating to sexual orientation, gender identity and gender history in the context of serious illness. Recommendations from this study could improve inclusive communication between clinicians and patients, including people who are lesbian, gay, bisexual, and transgender (LGBT+).

NIHR Evidence provides accessible, plain language summaries of health and care research that's funded by the NIHR. Each NIHR Alert is selected by professionals and members of the public as research that should inform practice.

The NIHR is funded by the Department of Health and Social Care and was established in 2006 to 'create a health research system in which the NHS supports outstanding individuals, working in world-class facilities, conducting leading-edge research focused on the needs of patients and the public'.

In the featured study, researchers interviewed 74 people including LGBT+ people who were seriously ill, their significant others, and clinicians.

This is the largest qualitative study on communication about gender and sexual orientation in healthcare to include LGBT+ patients, significant others and health and social care professionals.

They found that clinicians want to provide inclusive care but are often unsure how to talk about sexual orientation and gender.

LGBT+ people who were seriously ill and those significant to them appreciated neutral language that does not make assumptions, and to be asked questions about their identity as relevant to their care. They also valued signs of LGBT+ inclusivity in organisations. Avoiding discussions about identity and relationships may increase health inequalities for LGBT+ people.

The NHS has a legal and ethical duty to reduce health inequalities, but LGBT+ people continue to report discrimination and exclusion. This can be attributed in part to poor communication between clinicians and patients.

The researchers used their findings to develop the ABC of LGBT+ Inclusive Communication: A guide for health and social care professionals. The research team worked with LGBT+ community members and clinicians to refine the guide. The findings also led to the development of a linked set of posters, for use in health and social care organisations.
Read more about the research Read the full study in BMJ Quality & Safety Fill out this form to receive the LGBT+ inclusive communication posters
Funding: This study is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit programme (Grant Reference Number PB-PG-0816-20001), and supported by the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

# data[].attributes.attachment_link.title
Inclusive health and social care: Improving communication between clinicians and LGBT+ people

# data[].attributes.attachment_link.description
Research from King's College London featured as an alert on NIHR Evidence, a platform which aims to bridge the gap between research findings and practice.