April 9, 2020

Should We Minimize or Accentuate the Gender Element in Nursing Interactions?

If you’re a nurse, you know something of the variety of life situations into which nurses are positioned to speak and intervene. Nurses are often thought of as the health care professionals with the closest contact with patients and their support networks. On the positive side, we contribute to untold and sometimes unpredictable health care success stories. Nurses also often bear the brunt of negative interactions within health care, whether between health care professionals or between members of the health care team and patients and their families.

Recent patient encounters have me thinking about the element of gender with respect to the variety of patient life situations. In one interaction, I helped guide a patient and her husband through a difficult post-op hospitalization, including comprehensive ostomy care and education, which would be performed primarily by the husband for his wife. In another situation, I was involved as a wound care nurse responding to a referral related to a chronic sacral-coccygeal wound, among others. There are many other interactions I could choose from, of course, but these two will serve well here.

In the first situation, I began to follow a case during the early post-op period. As often takes place among our team, the initial referral respondent may not be the one primarily following the case. From the beginning of my working with this patient, it was obvious that both husband and wife welcomed every interaction with our team, regardless of our team members’ respective characteristics. The end result was a fruitful period of education during which the husband gained proficiency in ostomy care, and I knew when the patient was discharged she would be in good hands for her home ostomy care.

The other interaction I referred to began awkwardly with the patient’s initial refusal to allow me to assess her wounds because of the fact that I’m a man. She stated she had received outpatient wound care from a female physician, and I assume all of her day-to-day caregivers were female. The encounter happened to take place during a weekend, at which time I was the only wound care nurse in staffing. I informed the patient that, if she did not want me to assess her wounds, she would have to wait until a weekday when there would be a female wound care nurse available. However, I informed her that that would involve a potentially unnecessary delay in her wound care. I had taken a female patient care technician into the room with me. When the patient considered the risk of delay and the presence of the technician, she consented, and I later overheard her telling the technician that her experience of the patient encounter was “not so bad.”

I know there are many similarities and differences between these two situations, in terms of the details of the patients’ life situations and the purposes and anticipated outcomes of our interactions. Both patients knew I was a man. Both scenarios of care involved exposure, during the course of care, of areas of the patients’ bodies they would otherwise have kept private. However, one was entering a period of hospitalization of unknown length, whereas the other was seen during a post-op course with the anticipation of discharge.

Because of these similarities and differences, I know there’s no formula for “successful” patient interaction that can be derived from just these two anecdotes. On the other hand, when I consider these along with other interactions, I suspect there’s some cross-talk between popular expectations of the nature and behavior of health care professionals in general and popular expectations of men as nurses.

Of note, in my opinion, I handled both of these interactions with a similar level of professional decorum. Initially, I focused on the mutual establishment of goals and what I hoped to provide for their benefit. In the wound care case, I ensured the patient had the tools to make an informed decision and was prepared to accept the possibility of her continued refusal.

In retrospect, I see that I also refrained from apologizing in any way for my maleness. While I do understand that gender is a significant factor in many patients’ decisions, I’m not convinced that the answer is to minimize or discount gender. My integrity as a nurse or as a man is not diminished by a patient’s refusal of care. Neither would it be enhanced by explicitly stating or acknowledging my gender.

Instead, I’ve come to the conclusion that nurses in general, not just men but women as well, contribute to the development of nursing as a profession by simply living engendered lives as nurses. By providing high-quality patient care as we are, as nurses, we walk alongside patients individually in ways that are natural for us, given all of our personal factors, including gender. In addition, we contribute to all that is positive in the notion of gender diversity in nursing. Men in nursing provide nursing care as men can best. Women in nursing provide nursing care as women can best.

What do you think? How have you dealt with the gender element in your nursing care?

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