Post-Operative Nursing Competence for Transgender Vulvovaginoplasty Patients: A Quality Improvement Project

Title: Post-Operative Nursing Competence for Transgender Vulvovaginoplasty Patients: A Quality Improvement Project Background and Significance: Transgender women and transfeminine non-binary individuals may choose to pursue a vulvovaginoplasty to resolve their genital gender dysphoria. This complex procedure requires an inpatient hospital stay. Even with the best of care, up to 36% of people undergoing this procedure experience complications (Ferrando, 2020). In addition to the corporal challenge of a physically complicated procedure and recovery, this patient population struggles to access equitable and culturally safe care (Safer et al., 2016). Health care personnel can be uniformed or demonstrate inhospitable attitudes and may inadvertently subject the patient to microaggressions and care that traumatizes during a vulnerable time. This barrier is not insurmountable; patients do report increased satisfaction with their overall experiences when they receive culturally competent care (Safer et al., 2016). Problem and Purpose Statements: Vulvovaginoplasty surgeries are now offered at a local community hospital, which created a need for a comprehensive educational plan for nursing staff to acquire clinical and cultural content. There is a lack of current literature that describes best practices on the care of patients undergoing genital gender affirmation procedures. Many staff are unfamiliar with the pre- and post- surgical care requirements of vulvovaginoplasty, and unaware of attitudes and biases that may be held towards this minority population. The goal of this intervention was to ensure the availability of gender care that is informed, culturally safe, with positive perception of the experience by the patient. Methods: All nursing staff and certified nursing aides working on the unit caring for post-vulvovaginoplasty patients attended a four-hour educational module. The educational module included basic concepts about gender identities, societal barriers of this population, the surgical procedure, and the post-operative pathway. Methods of instruction included lecture, small group work, simulations, and time for questions with a multidisciplinary panel. Participants were invited to take an anonymous pre- and post- survey during the four-hour class. The survey was a combination of the TraCKS and TABS surveys, which assess knowledge, biases, and attitudes of health care personnel who care for transgender patients (Collins, 2020; Yasuko et al., 2017). Descriptive statistics of the paired data were analyzed for significant change in five categories of questions: knowledge, perceived competence, sexuality and gender beliefs, interpersonal comfort, and human value. Results/Outcomes: Significant improvement was noted in the categories of knowledge and perceived competence. Improvements were also noted in the categories of sexuality and gender beliefs, interpersonal comfort, and human value but were not statistically significant. Qualitative data gathered from open-ended questions demonstrated that a majority of the participants found value in learning about the procedure directly from the surgeons and appreciated the opportunity to ask questions of content experts. Sustainability: The lectures and simulations were recorded and compiled into an online learning module that will be used to train all future staff hired onto the unit that cares for patients after vulvovaginoplasty. Findings from this project will be shared at a local nursing conference in the fall. Two DNP Students at SPU plan to continue this project in an effort to evaluate the experience of the patients who have stayed on this unit, as well as to prepare a similar offering for other gender affirmation surgeries. Implications: Increased knowledge about the procedure and informed, culturally safe care may improve the patient outcome and experience. Nurses may be more confident and comfortable delivering care for a new surgical population. The institution offering a procedure for which there is much demand and limited access, may gain a reputation for offering a complete package: surgically excellent outcomes in a knowledgeable, culturally safe nursing environment. This intervention may serve as an exemplar to other institutions who hope to offer gender care surgeries. References: Collins, C. A. (2020). Pediatric nurse practitioners’ attitudes/beliefs and knowledge/perceived competence in caring for transgender and gender non-conforming youth. Journal for Specialists in Pediatric Nursing, 26(2). http://doi.org/10.1111/jspn.12321 Ferrando, C. A. (2020). Adverse events associated with gender affirming vaginoplasty surgery. American Journal of Obstetrics and Gynecology, 223(2), 267.el-267.e6. https://doi.org/10.1016/j.ajog.2020.05.033 Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). Barriers to healthcare for transgender individuals. Current Opinion in Endocrinology & Diabetes and Obesity, 23(2), 168-171. Yasuko, K., Cornelius-White, J.H.D., Pegors, T.K., Daniel, T., and Hulgus, J. (2017). Development and validation of the transgender attitudes and beliefs scale. Archives of Sexual Behavior, 46(5), 1503-1515. https://link-springer-com.offcampus.lib.washington.edu/content/pdf/10.1007/s10508-016-0840-1.pd