Chenjuan Ma

Abstract

Transgender and gender-diverse (TGD) adults experience significant health disparities compared with their cisgender peers. Stigma functions as a fundamental cause of health disparity in TGD communities. Stigma can be tempered by gender-affirming care (GAC), in which TGD adults receive care that validates their gender identity. There is little evidence focusing on outcomes associated with integrated GAC as an approach to care delivery. This integrative review explores the extant evidence on the relationship between integrated GAC and health outcomes in TGD adults in the United States. A comprehensive search of 4 electronic databases was conducted in May 2022. Included studies were peer reviewed, conducted in the United States from 2013 to the present, and described integrated GAC delivery for TGD adults aged 18 and older. After screening 3328 records and reviewing 135 full-text articles, 15 articles were included in this review. Articles were critically appraised, and data extraction and analysis using constant comparison were used to identify themes and relationships across studies. Synthesis suggested that GAC relates to three distinct areas of TGD adult health: physical health, mental health, and health services outcomes. GAC was associated with better overall health and improvements in HIV-related outcomes; significant decreases in mental health symptoms and suicidality; and increases in utilization, engagement, and care retention. There is moderate evidence that GAC delivery is associated with positive health outcomes for TGD adults. This integrative review provides empirical and theoretical support for integrated GAC delivery as an approach to improve health and address stigma-related barriers to care.

Abstract

ABSTRACT: Primary palliative nursing in home health care (HHC) can be delivered to medically complex patients across the lifespan. Primary palliative nursing provides patient- and family-centered care for serious illness by alleviating the stress and symptoms of illness; coordinating care; and supporting the social, cultural, and psychological aspects of care. In this article, two case scenarios of patients in different phases of life serve as examples of primary palliative nursing in HHC. Key elements and challenges of delivering primary palliative nursing care in HHC are also highlighted.