This is an experience that I have had during a clinical rotation at UNE. I feel that this story has shaped the kind of nurse I hope to be. I was able to identify personal bias and an ethical dilemma and responsibly remove myself from the situation. This has taught me therapeutic communication skills that are only learned by experience.

I would feel surprised and interested to talk more to this couple. I would feel surprised as I haven’t had a patient like him before during my maternity clinical. I don’t think being surprised is negative as I enjoy learning more about other people’s lives. I would ask questions and make sure the couple is healthy as a whole because the pregnant person and the spouse can be affected by this pregnancy. I think I would also like to know more about the medical side of this patient. I would want to work with the endocrinologist to understand more about how his hormone treatments could potentially affect the growth and development of the fetus. I would also make sure that the medical team is all using the correct pronouns and asking for consent whenever they are performing any assessments on any patient.

I would make sure the chart is all up to date with proper pronouns and verbiage about this patient’s care. I would also make sure that we use neutral terms like pregnant person or dad when referring to this patient. As a nurse in the maternity unit, we are with the patient 24/7. We have to make sure that they feel comfortable during this transition and ways we facilitate that is by asking questions to see what they may have in mind for the birth of their child. This is their birth experience that we are assisting them with. The patient should have complete control over what they would like to happen. As for education since the patient no longer has breasts I would make sure the lactation specialist doesn’t come in and start talking about breastfeeding as this is unrealistic. I would have the specialist talk about other options such as donor breast milk or formula feeding. This is a choice the couple can make together. I may also look up support groups in the area that could facilitate an easier transition into the world of parenthood. Overall, I would try my best to ask questions and correct any inappropriate comments. 

I would like to have a conversation with this patient before birth about what vocabulary they would like to use regarding their genitalia. This is something that can cause mental stress on the patient as they identify as a male but have female genitals. This is just as important as keeping the patient’s wishes concerning religious or cultural requests. I would also make sure that the chart is updated so that everyone in their healthcare team can be up to date with this information and provide a comfortable environment. If this couple were to have a good experience with the quality of care during the pregnancy they may be more likely to have another child. This may also demonstrate to other people in this situation that they can have a similar experience. A trusting relationship between the patient and their healthcare team is very important and will last a lifetime. If a person doesn’t feel comfortable with the healthcare system they will not be as open to receiving the care they may need in the future.

A few of the comments and gestures made by the lady giving me a report made me very disgusted and mad. The nurse started by stating the patient’s name which was difficult for her to pronounce. The nurse then said “Who knows where he is from” with a chuckle and an eye roll. This comment was weird to me as she just spent 12 hours with this person and didn’t seem to ask him how to pronounce his name or if that was what he wanted to be called. Another comment was made about his skateboarding accident. The nurse goes on to say “he is one of those people you know what I mean” with an eye roll implying that he is not a good person for enjoying skateboarding just because it is in a less fortunate side of town. The nurse also mentioned that the patient had a skateboarding accident and used air quotations. This implies that she doesn’t believe the patient’s story.

Each of these statements is important for me to address because they contain implied bias. This is a pre-reflective attribution of particular qualities by an individual to a member of some social out-group. The nurse is stereotyping her patient and this could affect the quality of care this patient may be receiving. The nurse may not trust the patient and it could harm the patient’s mental and physical health. The nurse may be implying that the patient was getting drugs since he was hanging out on this side of town and may not give him the proper analgesics because she thinks that he may be an addict. This is one of the ways these statements may be impacting this nurse’s delivery of care.

If I were the nurse to receive this report, I would feel confused and uncomfortable. I would be confused as to what evidence she has to be making such accusations. The way the nurse is implying that this patient is participating in illegal activities is harmful to him and his family. I would ask if she asked the patient how to say his name and if he has any nicknames. I would then ask the nurse if she asked the patient about his injury directly rather than just reading the notes. I felt uncomfortable because I did not know how I would respond to the nurse. I would ask her for the facts politely to try to restrict her use of bias within the report. I am not sure I would address each of the comments directly as I would be trying to get ready for my shift and receiving reports from other people. I would put it in the back of my head to ask the patient directly to prevent these biased thoughts from affecting my quality of care. The best thing any nurse can do is ask the patients questions directly to better understand their lives.

I have recently witnessed a report between two prenatal care nurses about a new mother who had a lot of mental health issues. The nurse began to say “My four-year-old knows how to function better than her” and began to laugh. This made me sad as the patient did have Asperger, anxiety, depression, and was on the Autism Spectrum. Birth is a traumatic and hard event for all new mothers. It is important to realize that this transition from pregnancy to postpartum is emotional and can be very stressful. This may alter the new mother’s way of thinking. This patient in particular has preexisting mental health conditions that are managed at home therefore this eventful time was a lot for her to deal with. The nurse receiving the report giggled at this comment as it seemed to not phase her. I did not say anything at the moment to the nurse I was following as I felt I did not have the authority to say anything. Thinking back now, I realized that if it made me uncomfortable I should’ve told my clinical instructor about this interaction.