An Evaluative Study of a Nurse-Led Surgical Information Initiative for Gender Diverse Individuals Seeking Genital Surgery.

Ahead of Print

Publisher: Blackwell Scientific Publications Country of Publication: England NLM ID: 7609811 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2648 (Electronic) Linking ISSN: 03092402 NLM ISO Abbreviation: J Adv Nurs Subsets: MEDLINE

Publication: Oxford : Blackwell Scientific Publications
Original Publication: Oxford, Blackwell.

Aim: To evaluate the impact of nurse-led one-on-one psychoeducation sessions on gender diverse individuals seeking gender-affirming genital surgery.
Design: A quasi-experimental, pre- and post-test research design was employed to examine the impact of a nurse-led initiative on improving patients self-perceived knowledge and confidence pertaining to gender affirming genital surgery. The study followed the SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines and the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines.
Methods: The curriculum for the initiative was crafted through literature reviews, expert panel engagements, multidisciplinary team input and was delivered by two specialist gender nurses.
Results: The results indicated a statistically significant increase in all participants' self-perceived knowledge and confidence scores. Furthermore, the study increased confidence in the ability to ask questions and plan for the logistical and financial aspects of surgery.
Conclusion: Participants reported that the sessions were very useful, and for most, the information did not change their desire to seek surgery but did help them make more informed choices about the procedure, timing and preferred surgeon.
Implications for Patient Care: The study underscores the imperative role of support networks and recommends interventions to facilitate open communication within families. The study emphasises the importance of customising healthcare approaches to align with the preferences of patients.
Impact: The study addressed the need for psychoeducation sessions for individuals considering gender-affirming genital surgery. The main findings revealed a significant increase in participants' self-perceived knowledge and confidence, following a nurse-led intervention. The research's impact extends to gender-diverse individuals seeking surgery globally.
Patient or Public Contribution: Four individuals who had undergone gender-affirming surgeries contributed their perspectives to the study design, ensuring that the educational content addressed specific information needs and concerns.
(© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Almazan, A. N., and A. S. Keuroghlian. 2021. “Association Between Gender‐Affirming Surgeries and Mental Health Outcomes.” JAMA Surgery 156, no. 7: 611–618. https://doi.org/10.1001/jamasurg.2021.0952.
Berli, J. U., G. Knudson, L. Fraser, et al. 2017. “What Surgeons Need to Know About Gender Confirmation Surgery When Providing Care for Transgender Individuals: A Review.” JAMA Surgery 152, no. 4: 394–400. https://doi.org/10.1001/jamasurg.2016.5549.
Braun, V., and V. Clarke. 2006. “Using Thematic Analysis in Psychology.” Qualitative Research in Psychology 3, no. 2: 77–101. https://doi.org/10.1191/1478088706qp063oa.
Burgess, L. C., J. Arundel, and T. W. Wainwright. 2019. “The Effect of Preoperative Education on Psychological, Clinical and Economic Outcomes in Elective Spinal Surgery: A Systematic Review.” Healthcare (Basel, Switzerland) 7, no. 1: 48. https://doi.org/10.3390/healthcare7010048.
Casimir, Y. E., M. M. Williams, M. Y. Liang, S. Pitakmongkolkul, and J. T. Slyer. 2014. “The Effectiveness of Patient‐Centered Self‐Care Education for Adults With Heart Failure on Knowledge, Self‐Care Behaviors, Quality of Life, and Readmissions: A Systematic Review.” JBI Database of Systematic Reviews and Implementation Reports 12, no. 2: 188–262. https://doi.org/10.11124/jbisrir‐2014‐1438.
Chung, F. F., P. Y. Wang, S. C. Lin, Y. H. Lee, H. Y. Wu, and M. H. Lin. 2021. “Shared Clinical Decision‐Making Experiences in Nursing: A Qualitative Study.” BMC Nursing 20, no. 1: 85. https://doi.org/10.1186/s12912‐021‐00597‐0.
Coon, D., S. D. Morrison, M. P. Morris, et al. 2023. “Gender‐Affirming Vaginoplasty: A Comparison of Algorithms, Surgical Techniques and Management Practices Across 17 High‐Volume Centers in North America and Europe.” Plastic and Reconstructive Surgery. Global Open 11, no. 5: e5033. https://doi.org/10.1097/GOX.0000000000005033.
Cooper, K., A. Russell, W. Mandy, and C. Butler. 2020. “The Phenomenology of Gender Dysphoria in Adults: A Systematic Review and Meta‐Synthesis.” Clinical Psychology Review 80: 101875. https://doi.org/10.1016/j.cpr.2020.101875.
Coyne, C. A., B. T. Yuodsnukis, and D. Chen. 2023. “Gender Dysphoria: Optimizing Healthcare for Transgender and Gender Diverse Youth With a Multidisciplinary Approach.” Neuropsychiatric Disease and Treatment 19: 479–493. https://doi.org/10.2147/NDT.S359979.
Creswell, J. W., and V. L. Plano Clark. 2017. Designing and Conducting Mixed Methods Research. 3rd ed. Thousand Oaks, CA: Sage Publications.
Djordjevic, M. L., B. Stojanovic, and M. Bizic. 2019. “Metoidioplasty: Techniques and Outcomes.” Translational Andrology and Urology 8, no. 3: 248–253. https://doi.org/10.21037/tau.2019.06.12.
Dunford, C., K. Bell, and T. Rashid. 2021. “Genital Reconstructive Surgery in Male to Female Transgender Patients: A Systematic Review of Primary Surgical Techniques, Complication Profiles, and Functional Outcomes From 1950 to Present Day.” European Urology Focus 7, no. 2: 464–471. https://doi.org/10.1016/j.euf.2020.01.004.
Ettner, R., F. Ettner, and T. White. 2016. “Choosing a Surgeon: An Exploratory Study of Factors Influencing Selection of a Gender Affirmation Surgeon.” Transgender Health 1, no. 1: 124–128. https://doi.org/10.1089/trgh.2016.0011.
Falvo, D. R. 2011. Effective Patient Education: A Guide to Increased Adherence. 4th ed. Sudbury, MA: Jones and Bartlett Publishers.
Fetters, M. D., L. A. Curry, and J. W. Creswell. 2013. “Achieving Integration in Mixed Methods Designs—Principles and Practices.” Health Services Research 48, no. 6pt2: 2134–2156. https://doi.org/10.1111/1475‐6773.12117.
Field, A. 2013. Discovering Statistics Using IBM SPSS Statistics. 4th ed. Oliver's Yard, London: Sage Publications.
Frey, J. D., G. Poudrier, M. V. Chiodo, and A. Hazen. 2016. “A Systematic Review of Metoidioplasty and Radial Forearm Flap Phalloplasty in Female‐To‐Male Transgender Genital Reconstruction: Is the "Ideal" Neophallus an Achievable Goal?” Plastic and Reconstructive Surgery. Global Open 4, no. 12: e1131. https://doi.org/10.1097/GOX.0000000000001131.
Groller, K. D. 2017. “Systematic Review of Patient Education Practices in Weight Loss Surgery.” Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery 13, no. 6: 1072–1085. https://doi.org/10.1016/j.soard.2017.01.008.
Kuvalanka, K. A., J. L. Weiner, and D. Mahan. 2014. “Child, Family, and Community Transformations: Findings From Interviews With Mothers of Transgender Girls.” Journal of GLBT Family Studies 10, no. 4: 354–379. https://doi.org/10.1080/1550428x.2013.834529.
Kwame, A., and P. M. Petrucka. 2021. “A Literature‐Based Study of Patient‐Centered Care and Communication in Nurse‐Patient Interactions: Barriers, Facilitators, and the Way Forward.” BMC Nursing 20, no. 1: 158. https://doi.org/10.1186/s12912‐021‐00684‐2.
Lane, M., E. C. Sluiter, S. D. Morrison, et al. 2020. “Phalloplasty: Understanding the Chaos.” Plastic and Aesthetic Research 7: 51. https://doi.org/10.20517/2347‐9264.2020.106.
Li, J. S., C. N. Crane, and R. A. Santucci. 2021. “Vaginoplasty Tips and Tricks.” International Braz j Urol: Official Journal of the Brazilian Society of Urology 47, no. 2: 263–273. https://doi.org/10.1590/S1677‐5538.IBJU.2020.0338.
Matsuno, E., and T. Israel. 2021. “The Parent Support Program: Development and Acceptability of an Online Intervention Aimed at Increasing Supportive Behaviors Among Parents of Trans Youth.” Journal of GLBT Family Studies 17, no. 5: 413–431. https://doi.org/10.1080/1550428x.2020.1868369.
Morrison, S. D., A. Shakir, K. S. Vyas, J. Kirby, C. N. Crane, and G. K. Lee. 2016. “Phalloplasty: A Review of Techniques and Outcomes.” Plastic and Reconstructive Surgery 138, no. 3: 594–615. https://doi.org/10.1097/PRS.0000000000002518.
Nolan, I. T., C. J. Kuhner, and G. W. Dy. 2019. “Demographic and Temporal Trends in Transgender Identities and Gender Confirming Surgery.” Translational Andrology and Urology 8, no. 3: 184–190. https://doi.org/10.21037/tau.2019.04.09.
Ogrinc, G., L. Davies, D. Goodman, P. Batalden, F. Davidoff, and D. Stevens. 2015. “SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised Publication Guidelines From a Detailed Consensus Process: Table 1.” BMJ Quality and Safety 25, no. 12: 986–992. https://doi.org/10.1136/bmjqs‐2015‐004411.
Pariser, J. J., and N. Kim. 2019. “Transgender Vaginoplasty: Techniques and Outcomes.” Translational Andrology and Urology 8, no. 3: 241–247. https://doi.org/10.21037/tau.2019.06.03.
Paterick, T. J., G. V. Carson, M. C. Allen, and T. E. Paterick. 2008. “Medical Informed Consent: General Considerations for Physicians.” Mayo Clinic Proceedings 83, no. 3: 313–319. https://doi.org/10.4065/83.3.313.
Poceta, J., S. Cousins, C. Wenzel, et al. 2019. “Effectiveness of a Gender Affirming Surgery Class for Transgender and Non‐binary Patients and Their Caregivers in an Integrated Healthcare Setting.” International Journal of Transgenderism 20, no. 1: 81–86. https://doi.org/10.1080/15532739.2018.1528920.
Rashid, M., and M. S. Tamimy. 2013. “Phalloplasty: The Dream and the Reality.” Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India 46, no. 2: 283–293. https://doi.org/10.4103/0970‐0358.118606.
Ronco, M., L. Iona, C. Fabbro, G. Bulfone, and A. Palese. 2012. “Patient Education Outcomes in Surgery: A Systematic Review From 2004 to 2010.” International Journal of Evidence‐Based Healthcare 10, no. 4: 309–323. https://doi.org/10.1111/j.1744‐1609.2012.00286.x.
Sandlin, K., P. N. Bennett, C. Ockerby, and A. M. Corradini. 2013. “The Impact of Nurse‐Led Education on Haemodialysis patients' Phosphate Binder Medication Adherence.” Journal of Renal Care 39, no. 1: 12–18. https://doi.org/10.1111/j.1755‐6686.2013.00343.x.
Sharek, D., S. Huntley‐Moore, and E. McCann. 2018. “Education Needs of Families of Transgender Young People: A Narrative Review of International Literature.” Issues in Mental Health Nursing 39, no. 1: 59–72. https://doi.org/10.1080/01612840.2017.1395500.
Sharek, D., E. McCann, and S. Huntley‐Moore. 2020. “The Design and Development of an Online Education Program for Families of Trans Young People.” Journal of LGBT Youth 18, no. 2: 188–210. https://doi.org/10.1080/19361653.2020.1712296.
Shorten, A., and C. Moorley. 2014. “Selecting the Sample.” Evidence‐Based Nursing 17, no. 2: 32–33. https://doi.org/10.1136/eb‐2014‐101747.
Sim, J., and J. Waterfield. 2019. “Focus Group Methodology: Some Ethical Challenges.” Quality & Quantity 53, no. 6: 3003–3022. https://doi.org/10.1007/s11135‐019‐00914‐5.
Thorne, N., A. K. Yip, W. P. Bouman, E. Marshall, and J. Arcelus. 2019. “The Terminology of Identities Between, Outside and Beyond the Gender Binary ‐ A Systematic Review.” International Journal of Transgenderism 20, no. 2–3: 138–154. https://doi.org/10.1080/15532739.2019.1640654.
van de Grift, T. C., M. G. Mullender, and M. B. Bouman. 2018. “Shared Decision Making in Gender‐Affirming Surgery. Implications for Research and Standards of Care.” Journal of Sexual Medicine 15, no. 6: 813–815. https://doi.org/10.1016/j.jsxm.2018.03.088.
van Driel, M. L., M. D. Morledge, R. Ulep, J. P. Shaffer, P. Davies, and R. Deichmann. 2016. “Interventions to Improve Adherence to Lipid‐Lowering Medication.” Cochrane Database of Systematic Reviews 12, no. 12: CD004371. https://doi.org/10.1002/14651858.CD004371.pub4.
Woolf, S. H., E. C. Chan, R. Harris, et al. 2005. “Promoting Informed Choice: Transforming Health Care to Dispense Knowledge for Decision Making.” Annals of Internal Medicine 143, no. 4: 293–300. https://doi.org/10.7326/0003‐4819‐143‐4‐200508160‐00010.

Keywords: gender‐affirming surgery; nurse‐led initiative; patient education; surgical information; transgender healthcare

Date Created: 20241019 Latest Revision: 20241019

20241020

10.1111/jan.16532

39425745