Cultural Humility and Transgender Clients: a Study Examining the Relationship Between Critical Reflection and Attitudes of Nurse Practitioners
Bibliographic record
Abstract
Background: Primary care nurse practitioners (NPs) in Ontario are central to care for transgender clients in Ontario regarding social and legal transition, medical transition and referrals for gender-affirming surgeries. Transgender people face discrimination in health care resulting in poorer health outcomes for this population. Health policy makers in Canada call for cultural safety as a client outcome without fully addressing how to achieve this goal. Cultural humility is a model that incorporates reflexivity by the practitioner of both their own actions with clients as well as on power and bias within the health care system. It offers a dynamic practice that is grounded in health equity that promotes culturally safe care environments. Objectives: The purpose of this study was to develop a baseline understanding of Ontario NPs’ transgender health related attitudes and awareness from a cultural humility perspective. Methods: A predominantly post-positivist approach was used that incorporated an autoethnobiographical narrative to frame the study context. Research questions address associations between critical self-reflection, and transgender health related attitudes, knowledge, resource and policy awareness while controlling for confounding variables. Data was gathered using an exploratory, cross-sectional, online survey design. Interpretation included exploring alternative formats of the conceptual framework. Results: Participants in this study were strongly self-reflective and had moderate to highly positive attitudes towards transgender people. Awareness of clinically relevant and currently available resources was low even among a sample that was biased towards having positive regard for transgender clients and having had experience with transgender clients. Exploratory analysis of the confounding variables suggest that life experience influences one’s reflexivity. These results also highlight the sharp learning curve that exists for NPs with the initial clients they treat with a new issue or condition. Conclusion: The results of this study indicate the need for increased cultural humility and transgender health specific content in NP curricula, policy, research and practice. Future avenues of research include examining the relationships of self-reflection, rumination, and insight. The cultural humility model can also be modified to reflect new understandings of internal and external processes of clinical interactions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.019 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.006 | 0.004 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".