Atención sanitaria trans competente, situación actual y retos futuros. Revisión de la literatura / Competent trans health care, current situation and future challenges. A review

Introducción: Conocemos como una persona trans a aquella que no se identifica con el sexo de nacimiento, este hecho aún recogido como patología por el actual manual diagnóstico y estadístico de enfermedades mentales (DSM-V) va a provocar que existan desigualdades y barreras significativas a la hora de la atención sanitaria. Objetivo: Explorar las dificultades para la asistencia sanitaria percibidas por las personas trans y por los profesionales que los atienden en centros sanitarios. Material y método: Revisión de la literatura. Resultados: Tanto los profesionales como las personas trans perciben barreras significativas. Se podrían agrupar en diversos temas: desigualdades en la atención sanitaria percibidas por los pacientes trans, prejuicios y discriminación sentida, riesgos específicos de salud, déficit de conocimientos de los profesionales y déficit de formación en los planes de estudio actuales. Por otro lado, enfermería ante los pacientes trans puede resultar un facilitador. Conclusiones: Existen numerosos factores que pueden ser modificables y que provocan que las personas trans no perciban una asistencia adecuada. La adecuada formación de los profesionales sanitarios es uno de los que adquiere mayor relevancia Los resultados encontrados aportan una información clave para el futuro diseño de intervenciones dirigidas a mejorar la calidad de la asistencia en este colectivo

Introduction: We know as a transgender person who is not identified with the sex of birth, this fact still collected as pathology by the current Diagnostic and Statistical Manual of Mental Illness (DSM-V) will cause inequalities and barriers At the time of health care. Objective: To explore the difficulties for health care perceived by trans people and by the professionals who assist them in health centres. Material and method: Literature review. Results: Both professionals and trans people perceive significant barriers. They could be grouped by diverse topics: healthcare inequalities noticed by trans patients, prejudices and felt discrimination, specific health risks, lack of professional knowledge and deficit of training in current curricula. On the other hand, nursing with trans patients may result in a facilitator. Conclusions: There are multiple factors which can be modified and which produce that trans people do not notice appropriate care. Appropriate training of health professionals is the one which acquires more relevance. The results found provide key information for the future design of interventions aimed at improving the quality of the assistance in this group

Impact of a Formative Program on Transgender Healthcare for Nursing Students and Health Professionals. Quasi-Experimental Intervention Study.

BACKGROUND: The field of specific healthcare for transgender people has not been included in the official curriculum of professionals. This causes a lack of knowledge that can be presumed to become a barrier to healthcare. Currently, different methodologies are emerging to achieve meaningful learning for students and professionals. The objective of this study was to evaluate the increase in the level of knowledge of final-year nursing students, applying methodological strategies such as problem-based learning (PBL) and film-forum. METHODS: 59 nursing students were randomly assigned to two intervention groups (G1 = 31 and G2 = 28), and another 57 were assigned to the control group (without specific classes or workshops on the subject of the study). The intervention consisted of a specific training course on transgender issues (TGSC&W, TransGender Specific Course and Workshop), where the type of meaningful learning strategy used depended on the group (G1 = film-forum and G2 = PBL). The study was carried out at the Faculty of Nursing Nuestra Señora de Candelaria of the Canary Islands Health Service. The randomization was done by blindly choosing a computer-generated code. RESULTS: The main outcome was based on 116 participants, comparing their level of knowledge before and after the workshop. The comparison by pairs shows that there were statistically significant differences (p = 0.000) between those undergoing the methodological interventions and the control group. Statistical significance between film-forum and PBL was not obtained (p = 1.000): Both methodologies increased the level of knowledge, but there was no significant difference between them. The means for satisfaction with the learning methodology used did not show statistically significant differences. CONCLUSION: The workshop carried out was highly effective and significant in terms of increasing knowledge. No significant differences were observed in the level of knowledge, or in the degree of satisfaction, between the two methodologies used (PBL and film-forum).

Biological, Psychological, Social, and Legal Aspects of Trans Parenthood Based on a Real Case-A Literature Review.

Trans men are people who, based on their genitals, were assigned the status of female at birth. However, their identity and their way of living gender do not correspond to the socially established norms. In this paper, we discuss the different perspectives in relation to transgender people and their desire for parenthood. This review, and the basis of this paper, is inspired by the case of a trans man who desired gestation with his own genetic material. He began the cycle of assisted reproduction when he was a legally recognized woman, but that attempt ended with a miscarriage. From that assisted reproduction cycle, four embryos remained frozen. After the failed experience of gestation, the person completed his transition. Now legally a man, he attempted to gestate using his reproductive organs. This literature review aimed to identify relevant studies describing the relationship between transgender person and biological parenthood. This study comprehensively addresses important aspects one should know when considering a transgender pregnancy. These factors include biological, psychological, social, and legal issues. After reviewing the state-of-the-art information on trans parenthood, the main conclusion is that 'the desire to have a child is not a male or female desire but a human desire'.

Gender Identity: The Human Right of Depathologization.

Background: Transgender people have a gender identity different from the one allocated to them at birth. In many countries, transsexualism and transgenderism are considered mental illnesses under the diagnosis of gender dysphoria. This pathologization impacts on human rights. Maincontent: The United Nations (UN) has denounced violations against trans-people, including attacks, forced medical treatments, lack of legal gender recognition, and discrimination in the areas of education, employment, access to healthcare, and justice. The UN has linked these violations directly with discriminatory diagnostic classifications that pathologize gender diversity. Trans-people have been pathologized by psycho-medical classification and laws all around the world, with a different impact depending on countries. This paper argues that pathologization infringes infringes upon a wide range of human rights such as; civil, economic, social cultural and also the access to medical care. Conclusions: The current situation for trans-people with respect to legal healthcare matters, depends on the country. Human rights are universal, not a question for cultural interpretation. They are the minimum that every human being must have assured only by the fact of being human. Countries must protect these rights by regulating trans-pathologization with special attention dedicated to intersex people and their specific needs.

Por qué y cómo realizer diseños multimétodo en investigación en salud. Una experiencia concreta / Why, and how, undertake mixed methods design in health research: a concrete experience

El uso de mezcla de métodos para abordar problemas de salud genera un mayor conocimiento de la realidad al obtener un análisis más completo del problema que se investiga. Este hecho se basa en que las respuestas a las preguntas que se formulan son tan subjetivas como los propios individuos, siendo necesario, por lo tanto, datos cuantitativos y cualitativos para una aproximación más real y completa al objeto del estudio. ObjetivO: Reflexionar sobre esta metodología mediante un ejemplo práctico. SínteSiS. Explicamos, a través del Programa Educativo Participativo Centrado en el Paciente de Cirugía Oncológica Colorrectal (mezcla de métodos multistrand, secuencial y mezclado en cada una de sus tres fases), en qué consiste esta metodología y sus ventajas. La segunda fase del estudio emerge de los resultados de la primera, y así sucesivamente. Al final del estudio surge un metarresultado que da sentido y respuesta al estudio en su totalidad. COnCluSión. A pesar de los retos que supone, la mezcla de métodos nos ofrece una perspectiva más precisa del fenómeno de estudio; nos ayuda a formular el planteamiento del problema y la forma más apropiada para estudiarlo; y, por último, se apoyan con mayor solidez las inferencias científicas (AU)

The use of mixed methods to address health problems generates more knowledge of reality to get a more complete analysis of the problem under investigation. This is based on the fact that the answers to the questions posed are as subjective as the individuals themselves. In that way, it is necessary quantitative and qualitative data for comprehensiveness (a more realistic and comprehensive approach to the object of the study). Objective.Reflect on this methodology through a practical example. SyntheSiS. We explain, through Participatory Education Program Focused on Colorectal Cancer Surgery Patient (mixed methods research project: multistrand, sequential and mixed in each of its three phases), what is this methodology and its advantages. The second phase of the study emerges from the results of the first one, and so on. At the end of the study a metaresult, that gives meaning and response to the study in its entirety, arises. cOncluSiOn. Despite the challenges, mixed methods gives us a more accurate perspective of the phenomenon of study; It helps us to formulate the problem statement and the most appropriate way to study it; and finally, the scientific inferences obtained are more solidly supported (AU)

[Why, and How, Undertake Mixed Methods Design in Health Research: A Concrete Experience]. / Por qué y cómo realizar diseños multimétodo en investigación en salud.

Summary: The use of mixed methods to address health problems generates more knowledge of reality to get a more complete analysis of the problem under investigation. This is based on the fact that answers to the questions posed are as subjective as the individuals themselves. In that way, it is necessary quantitative and qualitative data for comprehensiveness (a more realistic and comprehensive approach to the object of the study). Objective: Reflect on this methodology through a practical example. Synthesis: We explain, through Participatory Education Program Focused on Colorectal Cancer Surgery Patient (mixed methods research project: multistrand, sequential and mixed in each of its three phases), what is this methodology and its advantages. The second phase of the study emerges from the results of the first one, and so on. At the end of the study a metaresult, that gives meaning and response to the study in its entirety, arises. Conclusion: Despite the challenges, mixed methods gives us a more accurate perspective of the phenomenon of study; it helps us to formulate the problem statement and the most appropriate way to study it; and finally, the scientific inferences obtained are more solidly supported.

Construcción de una herramienta de evaluación en un proyecto de aprendizaje basado en problemas / Building an evaluation tool for a problem-based learning Project

El aprendizaje basado en problemas (ABP) es una metodología docente ajustada a la evolución de los sistemas de enseñanza. Utiliza un conjunto de actividades alrededor de un caso o problema para que el alumno aprenda a buscar, analizar, utilizar la información y a integrar el conocimiento; constituyendo un modelo de educación real y efectivo. El propósito de este trabajo ha sido mostrar la construcción de una herramienta de evaluación de los resultados de un proyecto dé ABP en los estudios de grado de Enfermería. Para dicha construcción se establecieron grupos de consenso interdisciplinares formados por enfermeros, médicos, psicopedagogos y antropólogos. La herramienta quedó constituida por una hoja de evaluación que hace uso de rúbricas divididas en dimensiones y criterios. El proceso de ABP es evaluado por todos los agentes implicados: alumnos, tutores y expertos. La herramienta evaluativa elaborada permitirá a la sistematización y recopilación sobre el proceso de aprendizaje, tanto cualitativa como cuantitativamente, posicionándose, por tanto, como significativa y necesaria en el autoaprendizaje, así como en el desarrollo de estudios de investigación aplicables al campo docente

Problem-based learning (PBL) is a teaching methodology adapted to the evolution in learning systems. It uses a set of activities around a case or problem, so that the student will learn to search, analyze, use information, and integrate knowledge; and it represents a real and effective education model. The objective of this paper has been to show the building of a tool for evaluating the results of a PBL Project in the Nursing degree studies. For said purpose, interdisciplinary consensus groups were set up, formed by nurses, physicians, educational psychologists and anthropologists. The final tool was an evaluation sheet which uses rubrics divided into dimensions and criteria. The PBL process is evaluated by all agents involved: students, tutors and experts. The evaluation tool prepared will allow the systematization and compilation of the learning process, both qualitative and quantitatively; therefore, it will be positioned as significant and necessary in self-learning, as well as in the development of research studies applicable to the teaching area