SPIRITUAL CARE FOR GENDER AFFIRMATION PATIENTS: THEMES AND ISSUES IN A SMALL CASE SERIES
February 03, 201711:36 AM-February 03, 201711:48 AM
JoHirschmann, BCC, ACPE Associate Supervisor;
VanshSharma, MD ;
DavidReich, MD ;
RobbieFreeman, MSN; RN NE-BC;
ZilGoldstein, BSN; MSN; RN ;
BarbaraWarren, PsyD ;
In the context of increasing recognition of the importance of gender-affirming care, a psychosocial model for preoperative assessment of transgender people has been proposed (Deutsch, 2016). However, less is known about the emotional wellbeing of patients in the immediate post-operative period. This presentation describes themes that arose in post-surgery inpatient visits to transgender surgical patients under the auspices of the Center for Transgender Medicine and Surgery (CTMS) of Mount Sinai Health System in New York City.
Materials and Methods:
In the period between the initiation of the surgical program on March 7 and June 30, 2016, there were a total of 19 post-surgical inpatient hospitalizations. Of these, 15 were FTMs and 4 were MTFs. The chaplain assigned to this unit was a cisgender female rabbi who was serving as a chaplain resident within the Mount Sinai Health System. In the absence of a standard spiritual care screening protocol, the chaplain who conducted these visits received updates about new admissions from the concierge on the inpatient unit for patients who required a post-surgical hospital stay. This resulted in 6 visits that involved conversation longer than the chaplain briefly introducing herself. The chaplain’s narrative notes in the EMR were reviewed along with other notes made by the chaplain.
Three major themes emerged in these chaplaincy visits.
Serving the "spiritual but not religious" – Patients frequently identified themselves as "spiritual but not religious." They identified coping strategies and sources of support that included prayer, reading Psalms, art, music, dancing, family members, and friends. Despite the transphobia within some religious denominations, the chaplain did not meet patients who outwardly exhibited negative transference towards her as a religious professional.
Witnessing gratitude – A majority of the patients expressed gratitude for their surgeries and for the next step in their "journey," a frequently-used word. They tended not to view surgery as the conclusion to their journeys but, rather, as the next step in an ongoing process. They appeared to find comfort in having their gratitude – and perhaps also their physical pain as they recovered from surgery – witnessed by a chaplain. Three of the patients requested a prayer from the chaplain.
Honoring ambivalence – One patient described how she was not celebrating her surgery as joyfully as her friends and family were. This ambivalence may reflect a theme that should be further investigated among post-surgical patients. In this instance, the chaplain provided non-judgmental listening that could be a valuable intervention for future patients.
Using themes from the interviews, the authors propose that spiritual care services are an important part of recovery, as they were welcomed by transgender surgical patients in this small patient sample. There is likely value in including chaplains in the multidisciplinary teams that serve transgender surgery patients. This small case series demonstrates that transgender surgical patients frequently identify their spirituality and religiosity as positive forces in their lives. Chaplains can help patients affirm their spiritual lives; describe their social, emotional, and spiritual supports; celebrate milestones in their transition journeys; and give voice to ambivalence.