John's care case study by Ella Guerin (staff)

2025-02-05 11:19:40 UTC

Challenge the nurse talking about it. Nothing to do with immediate care being delivered

2025-02-05 11:19:59 UTC

Not making the comments regarding Johns transgender status

2025-02-05 11:20:01 UTC

Judgemental

2025-02-05 11:20:05 UTC

Talking behind his back

Breach of confidentiality and privacy

2025-02-05 11:20:07 UTC

His gender change is irrelevant to his care and does not need to be discussed

2025-02-05 11:20:09 UTC

2025-02-05 11:20:13 UTC

That they’re transgender status was relevant to their treatment or care

Not be talking about a patient within listening distance of other patients

2025-02-05 11:20:14 UTC

2025-02-05 11:20:22 UTC

Staff shouldn’t discuss as has no relevance to there medical condition it’s a lack of confidentiality

2025-02-05 11:20:31 UTC

The nurse was unprofessional

Confidentiality

2025-02-05 11:20:46 UTC

2025-02-05 11:20:53 UTC

Breach of disclosing transgender status

2025-02-05 11:20:54 UTC

Explain that Johns transgender status is not clinically relevant and we should focus on his acute care needs

2025-02-05 11:20:58 UTC

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

Thoughts out loud

2025-02-05 11:21:11 UTC

Your thoughts cannot always be trusted or professional so hold them in and assess why your initial reactions were that.

2025-02-05 11:21:26 UTC

exotifying his gender identity / medical history related to gender affirming care and pathologising this identity by including it in handover when not necessary

2025-02-05 11:21:38 UTC

wondering about their dead name despite already having a name is disrespectful

2025-02-05 11:21:39 UTC

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

The need to wonder his pre-transition name is not relevant clinically or any other way

2025-02-05 11:21:43 UTC

Johns care should not be focused on his gendee

2025-02-05 11:21:50 UTC

John’s dignity is not respected.

The focus is not on his needs

Thoughts

2025-02-05 11:22:00 UTC

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

There was no need to talk about a patients appernce unless it was clinically significant

2025-02-05 11:22:04 UTC

2025-02-05 11:22:19 UTC

this is causing unnecessary gossip, rude comments regarding something that is not relevant to his care

2025-02-05 11:22:23 UTC

Disregarding patient dignity

2025-02-05 11:22:29 UTC

extremely judgemental and breach of nmc code

Protocols are protocols. Next of kin should be the named person irrespective of relationship status

2025-02-05 11:30:54 UTC

If patients able to communicate should be there choice

2025-02-05 11:31:20 UTC

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

2025-02-05 11:31:30 UTC

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

Communication

2025-02-05 11:31:35 UTC

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.

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

2025-02-05 11:31:35 UTC

2025-02-05 11:31:41 UTC

requiring additional proof from Rob to be Johns primary contact when this is not often asked for in heteronormative relationships

2025-02-05 11:31:44 UTC

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

Clerk did not explain WHY system doesn't work that way or alternatives to resolve it. Rude and dismissive

2025-02-05 11:31:51 UTC

Consider if you generally ask for proof from next of kin & follow same procedures for all families

2025-02-05 11:31:58 UTC

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

2025-02-05 11:32:03 UTC

2025-02-05 11:32:08 UTC

The way that Rob was spoken to was disrespectful

2025-02-05 11:32:17 UTC

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

2025-02-05 11:32:22 UTC

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

2025-02-05 11:33:05 UTC

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.

2025-02-05 11:37:16 UTC

Should only be used if looking at relevant pmh but not to him

2025-02-05 11:37:36 UTC

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

2025-02-05 11:38:08 UTC

Seems rooted in prejudice as staff do not struggle with other name changes ie surname after marriage

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

2025-02-05 11:38:14 UTC

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

2025-02-05 11:38:18 UTC

2025-02-05 11:38:22 UTC

Ask the patient how they’d like to be addressed and respect it - tell the next nurse in handover

2025-02-05 11:38:25 UTC

not patient centred, causing distress for the patient and his family and ignoring their legal name which he has had for 30 years

Should the junior doctor have flagged this for change as soon as possible?

2025-02-05 11:38:26 UTC

Datix this. You cant give medications if the drug chart and wrist band says different names??

It’s been 30 year which indicates it’s permanent

2025-02-05 11:38:27 UTC

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

2025-02-05 11:38:29 UTC

Using the dead name can cause trauma particularly for more recently changed names and make them feel like they are somehow wrong

Deadnaming

2025-02-05 11:38:31 UTC

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.

Nursing isn’t about ease

2025-02-05 11:38:35 UTC

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

2025-02-05 11:38:42 UTC

could be dangerous in terms of medication errors, as johns name and his deadname causes confusion for staff.

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

2025-02-05 11:38:50 UTC

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

2025-02-05 11:38:55 UTC

Change the record to stop this “confusion” and discuss in handover that john should only be referred to as John

2025-02-05 11:39:10 UTC

2025-02-05 11:39:37 UTC

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

2025-02-05 11:39:45 UTC

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.

Be respectful

2025-02-05 11:45:21 UTC

2025-02-05 11:45:23 UTC

Whatever rob wants to be referred to refer to them as that

2025-02-05 11:45:39 UTC

Simply acknowledge and include both

2025-02-05 11:45:46 UTC

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

2025-02-05 11:45:52 UTC

Undermining johns role in robs life

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

2025-02-05 11:45:56 UTC

2025-02-05 11:45:59 UTC

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

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

2025-02-05 11:46:05 UTC

2025-02-05 11:46:13 UTC

Condescending, undermining and not the kind of communication we should be using with anyone

2025-02-05 11:46:15 UTC

The doctor should have asked rob (if able) who he wanted present while discussing his condition

Mirror the language of the patient/ next of kin/ family and use the terms they prefer / use themselves when describing how they are related

2025-02-05 11:46:17 UTC

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.

2025-02-05 11:46:38 UTC

2025-02-05 11:46:42 UTC

Rob being dismissed is going to diminish his value as John’s partner

2025-02-05 11:46:42 UTC

We should be asking about the relations instead of assuming and causing the patient and loved one to feel uncomfortable

Advocation would be really important

2025-02-05 11:46:47 UTC

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

Cultural differences

2025-02-05 11:47:50 UTC

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.

2025-02-05 11:50:05 UTC

If the patient and their family don't trust the team they are less likely to listen to advice that could help recovery

Lack of professionalism

2025-02-05 11:50:10 UTC

2025-02-05 11:50:14 UTC

Very unprofessional and confidentiality breach

2025-02-05 11:50:20 UTC

Were you bothered about what was going on down there before you knew he was trans?

Unprofessional conduct

2025-02-05 11:50:26 UTC

2025-02-05 11:50:35 UTC

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

2025-02-05 11:50:52 UTC

If the nurses truly felt that his identity could cause issues in an emergency, they should request advice, protocols and training in this area

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

2025-02-05 11:51:29 UTC

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

2025-02-05 11:51:41 UTC

2025-02-05 11:51:49 UTC

Was there a need for that last nurse to pass the comments onto rob?

Adding fuel to the fire

2025-02-05 11:51:50 UTC

I’m confused why the other staff member would relay to Rob the inappropriate comments made by the other staff members.

This foster a disrespectful and potentially harming environment for John to be a patient in. Also could affect any other patients and visitors

2025-02-05 11:52:15 UTC

2025-02-05 11:52:21 UTC

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

Whilst the comments were wholly inappropriate, is this also some point scoring by the other staff member?

2025-02-05 11:53:07 UTC

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

Just why?

2025-02-05 12:02:42 UTC

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

2025-02-05 12:02:59 UTC

Kept their thoughts to themselves

2025-02-05 12:03:01 UTC

Ask John if he wants to see the screen or not? Would you ask that to patients anyway?

2025-02-05 12:03:10 UTC

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

If you cannot say something appropriate, do not say anything at all!

2025-02-05 12:03:14 UTC

Cultural Differences

2025-02-05 12:03:30 UTC

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.

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

2025-02-05 12:03:36 UTC

2025-02-05 12:04:27 UTC

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

Sensitivity for the person should be the priority

2025-02-05 12:04:33 UTC

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

2025-02-05 12:04:42 UTC

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

https://www.kcl.ac.uk/news/inclusive-communication-clinicians-lgbt-people#:~:text=King's%20College%20London,-Go%20to...&text=Recommendations%20from%20this%20study%20could,that's%20funded%20by%20the%20NIHR.

2025-02-05 12:11:29 UTC