Cultural Humility and Transgender Clients: a Study Examining the Relationship Between Critical Reflection and Attitudes of Nurse Practitioners

Abstract

Background: Primary care nurse practitioners (NPs) in Ontario are central to care for transgender clients in Ontario regarding social and legal transition, medical transition and referrals for gender-affirming surgeries. Transgender people face discrimination in health care resulting in poorer health outcomes for this population. Health policy makers in Canada call for cultural safety as a client outcome without fully addressing how to achieve this goal. Cultural humility is a model that incorporates reflexivity by the practitioner of both their own actions with clients as well as on power and bias within the health care system. It offers a dynamic practice that is grounded in health equity that promotes culturally safe care environments. Objectives: The purpose of this study was to develop a baseline understanding of Ontario NPs’ transgender health related attitudes and awareness from a cultural humility perspective. Methods: A predominantly post-positivist approach was used that incorporated an autoethnobiographical narrative to frame the study context. Research questions address associations between critical self-reflection, and transgender health related attitudes, knowledge, resource and policy awareness while controlling for confounding variables. Data was gathered using an exploratory, cross-sectional, online survey design. Interpretation included exploring alternative formats of the conceptual framework. Results: Participants in this study were strongly self-reflective and had moderate to highly positive attitudes towards transgender people. Awareness of clinically relevant and currently available resources was low even among a sample that was biased towards having positive regard for transgender clients and having had experience with transgender clients. Exploratory analysis of the confounding variables suggest that life experience influences one’s reflexivity. These results also highlight the sharp learning curve that exists for NPs with the initial clients they treat with a new issue or condition. Conclusion: The results of this study indicate the need for increased cultural humility and transgender health specific content in NP curricula, policy, research and practice. Future avenues of research include examining the relationships of self-reflection, rumination, and insight. The cultural humility model can also be modified to reflect new understandings of internal and external processes of clinical interactions.