Introduction

As a science and art of care, nursing stands out for providing care from a biopsychosocial perspective, making therapeutic communication with people essential. Caring is the moral basis and central axis of their work, on which professional and ethical obligations are developed. ¹ According to Watson’s Theory of Humanized Care, “transpersonal care depends on the nurse’s moral commitment to protect and enhance human dignity,” which will allow the manifestation of humanized care in the nurse’s work. ²

In this context, the nurse plays a pivotal role in fostering the relationship with the person through interaction. It constitutes a tool that allows reflection on the transcendence of nursing care in people’s perceptions. It also strengthens the profession by implementing actions that contribute to satisfying expectations during the care interaction. ^3,4,5) For this reason, Watson places great importance on nurses’ education in human sciences to understand social, cultural, and psychological aspects that allow them to provide care with a comprehensive approach. ⁶

Watson’s theory emphasizes the importance of the relationship between the nurse and the person, which goes beyond merely providing medical care by connecting with the individual’s experiences, emotions, and perceptions. The term “experience” encompasses both perception and the accumulation of emotions over time. Perception is the information that feeds experiences, which contributes to forming unique and personal experiences. ^7,8

When discussing gender diversity, it refers to the various ways affection, desire, love, and sexuality are expressed among people; these are not limited to relationships between men and women, therefore including heterosexuals, homosexuals, and bisexuals. The term sexual diversity questions the idea that there is only one way to exercise sexuality and emotions, thus making other expressions visible. It includes the idea that gender identity can be independent of birth, gender, and sexual orientation. The concept of a person being a sexual being and how they feel about it is about the personal and internal lifestyle of gender that may or may not correspond to birth gender. However, it is necessary to remember that gender identity is not the same as sexual orientation and includes how a person addresses themselves and presents themselves to others. ⁽⁹

In healthcare, it is necessary to recognize intersectionality, which means that people have diverse identities (gender, race, sexual orientation, among others), and these intersect and affect their health experiences and needs. Differences in access, quality, and care outcomes can exist among different population groups. Therefore, it is essential to have an articulated system that considers the multiple layers of identity when addressing health disparities, recognizing that the experiences and needs of people with gender diversity can be affected positively or negatively. ¹⁰ Studies show that designing public health policies and developing protocols and interventions from a heteronormative perspective hinder connection and care, resulting in fragmented care and, consequently, favoring exclusion and symbolic violence. ¹¹⁾ Healthcare must be provided from a social justice perspective, advocating for equal rights and opportunities for all people regardless of their differences. In the health field, this implies ensuring everyone has access to quality health services.^12,13

Globally, 3% of adults identify as lesbian or gay, 4% as bisexual, 1% as pansexual or omnisexual, and 1% asexual. Men are more likely to identify as gay than women as lesbian: 4% versus 1% on average globally. ⁽¹⁴ Acceptance and recognition of the LGBT+ community vary considerably between different nations. Having a family member, friend, or coworker who is lesbian/gay or bisexual is more common in Latin America, Spain, Australia, New Zealand, and South Africa. Gender diversity is more visible throughout the Anglosphere, Brazil, and Thailand; on the other hand, the visibility of the different segments of the LGBT+ community is lowest in Japan, South Korea, Turkey, Romania, Hungary, and Poland. ¹⁴

In Chile, there is Law 20.584, which sets out the duties and rights of health users, ¹⁵ requiring their recognition as an act of dignity. Knowing the duties and rights of people seeking healthcare to feel valued in their human dimensions is essential to providing humanized care. The “Sexual Orientation and Gender Identity” survey conducted by Casen in 2022 found that approximately 534,417 people, or 37% of those aged 18 and over, report their sexual orientation as gay/lesbian, bisexual, or another non-heterosexual orientation. ¹⁶

Gender diversity can be negatively affected by the heteronorm that has historically governed society. Marginalization of this group in the health system due to discrimination and violations of their rights as sexual minorities can become a barrier to their care. ¹⁷ Therefore, recognition of their rights by nursing professionals is a fundamental factor in healthcare to achieve equality and non-discrimination, making it a current challenge to seek strategies to provide humanized and inclusive care. ^{(18, 19)} Psychoeducation is helpful as a tool that provides information and psychological support to improve the understanding and management of mental and emotional health issues. Another tool is visibility, which helps challenge stigma by recognizing the experiences and positive contributions of minority groups. Visibility can help change perceptions and reduce prejudice, fostering a more inclusive environment.

In Chile, there is the Sexual Health Care and Control Program (UNACESS, for it Spanish acronym), which consists of a multidisciplinary team where nursing professionals participate in the prevention and care of sexually transmitted infections (STI).

Therefore, it is worth asking: What are the experiences of nursing professionals when providing humanized care to people with gender diversity belonging to the UNACESS and STI programs at the Diagnostic and Therapeutic Center (CDT) of a healthcare institution?

This study aims to understand the experiences of nursing professionals when providing humanized care to people with gender diversity in the current context. Watson’s Theory of Humanized Care contributes to raising awareness and increasing the levels of knowledge among health professionals working with gender-diverse individuals, contributing to the disciplinary development of Nursing.

This research is expected to help make the current issue visible and establish new strategies to strengthen inclusive care and respect human rights. Additionally, it aims to provide a solid theoretical foundation in Nursing that promotes a more compassionate and holistic approach to gender diversity care. It follows Watson’s theory principles, emphasizing the importance of transpersonal care and humanization in nursing practice.

Methodology

Qualitative research with a phenomenological approach based on exploring the phenomenon through the perceptions and experiences of health professionals. ^20-22

The universe was comprised of nursing professionals from a public health institution working in UNACESS and STI programs. The sample used was determined by data saturation. Inclusion criteria established that participants were nurses from these programs who had attended to people with gender diversity and agreed to participate in the study. The information collection was carried out over four weeks in October 2022. T1

Table 1: Characterization of the Interviewees  

Semi-structured interviews were conducted individually to facilitate participants’ natural expression. They were conducted in a room within the same institution to ensure a comfortable and confidential environment. Participants read and signed the informed consent before the interviews, which were audiotaped and lasted an average of 30 to 40 minutes, led by the principal investigator. The interviews followed a guiding question script, and once completed, the researchers transcribed the audio recordings, respecting anonymity. Once data saturation was achieved, the interviews (I) concluded with 4 participants, as the data significant to the research questions and objectives began to be repetitive. Subsequently, a discussion group (DG) was formed with the same participants who were individually interviewed to understand their experiences better. This group interview lasted 40 minutes. Data were analyzed through content analysis, beginning with reading the interviews by each researcher separately, followed by a joint discussion based on the objectives and guiding questions. This data led to coding the discourses, establishing different dimensions and categories, and capturing the phenomenological sense using thematic expressions and evocative phrases from the text. The interpretative framework was established according to Watson’s model, applying the ten curative factors of care (CF). ²³⁾

The study was authorized by the Scientific Ethics Committee of the Universidad Santo Tomás South Center with code N° 22-86. It was based on the seven ethical requirements in clinical research established by Ezequiel Emanuel. The participation of the interviewees was voluntary, and they signed informed consent.

Results

The results were organized into three dimensions with their respective categories. The first three were defined based on the objectives, while the last emerged from the narratives (Figure 1).

Figure 1: Dimensions and Categories of the Experiences of Nursing Professionals from UNACESS Program in a Public Health Institution.  

Discussion

This study focuses on exploring the meanings attributed by nursing professionals to the experiences related to the perception of the interaction when providing care to people with sexual diversity to improve the satisfaction of their expectations and promote equity and justice in health. The results obtained allow us to make some considerations, which are presented below.

Among the experiences, when providing humanized care by the nursing professional, empathy, equality, respect and learning stand out. These skills improve the quality of receiving care, joining with Jean Watson’s theory that establishes the 10 charitable factors of care, here the spiritual being of the nursing professional is recognized in a phenomenological context accepting the person. Watson emphasizes understanding people as things appear to them, recognizing the different forces intervening in the interaction between the nurse and the user. Care can be demonstrated and practiced in an interpersonal relationship, transmitted according to culture and human and social needs. Care is contextualized according to time and place.⁴ Society has evolved, and with it, there is a need for respect, trust, and understanding, positively influencing the experiences and health experiences of gender-diverse people and driving nursing professionals to be aware of their perceptions and understand the others’ perceptions.

Attitudes towards gender diversity are directly related to homophobia because if there is prejudice about sexuality, the perception of people’s sexual identity will be similar. Therefore, it is essential to implement training activities to prevent discrimination against the LGBT+ community. ¹⁴

This study underscores the vital importance of continuous training after the initial learning phase. It highlights a significant lack of skill development when working with gender-diverse people. According to the interviewees’ experiences, starting working life, they face situations that can hinder close communication between the professional and the person due to a lack of necessary tools to provide comprehensive care. This relates to Benavides et al. systematic review³⁹ on health care for the LGBTIQ+ population, stating that while comprehensive training for health professionals is sought, it only sometimes manifests in practice when treating patients from the mentioned community. Therefore, it is crucial to integrate these topics into university curricula to offer more holistic care and reduce disparities in care. ^4,39

One of the limitations identified in the research is the sample size. Although data saturation was achieved with the four participants, a larger and more diverse sample could have shed light on aspects emerging about the studied phenomenon. It is important to acknowledge these limitations, as they demonstrate the researchers’ awareness of potential areas for further study.

Conclusión

Understanding the experiences of nursing professionals when providing humanized care to gender-diverse people implies fundamental values such as equality, respect, and empathy, requiring inclusive training from the undergraduate level to consider the person holistically. In this context, Watson’s Transpersonal Care Theory emphasizes the importance of transcending conventional barriers and connecting more deeply with the person, recognizing their individuality and unique experience.

The lack of soft skills acquisition initially leads to difficulties in the nurse-user relationship, mainly due to ignorance about gender diversity. Suspicion of gender-diverse people hinders first consultations as they fear being vulnerable. Integrating the social name from the beginning and promoting timely information integration is crucial. Reception and continuous training, in line with transpersonal care principles, are essential to creating a trusting and safe environment and reducing vulnerability and discrimination.

These findings, reflecting the reality of professionals in the institution where the research was conducted, have the potential to significantly inform and improve healthcare practices in other health institutions with similar characteristics.