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. 2025 Jan;26(1):111-119.
doi: 10.5811/westjem.20919.

Emergency Physicians' and Nurses' Perspectives on Transgender, Intersexual, and Non-Binary Patients in Germany

Torben Brod  1 , Carsten Stoetzer  2 , Christoph Schroeder  1 , Stephanie Stiel  2   3 , Kambiz Afshar  2   3
Affiliations

Emergency Physicians' and Nurses' Perspectives on Transgender, Intersexual, and Non-Binary Patients in Germany

Torben Brod et al. West J Emerg Med. 2025 Jan.

Abstract

Introduction: Providing appropriate healthcare for transgender, intersexual and non-binary (TIN) individuals remains a significant challenge, as this group experiences higher rates of health inequalities, discrimination, and barriers to accessing care. Emergency physicians (EP) often lack formal training and knowledge about caring for TIN patients, while comparatively less evidence is available for other healthcare professionals, including emergency nurses (EN). Therefore, our goal in this study was to explore the experiences, knowledge, and attitudes as well as education/training needs of both ENs and EPs in Germany regarding the care of TIN patients.

Methods: In February 2023, we electronically surveyed EPs and ENs from emergency departments (ED) across Germany. The survey, developed through literature review and collaboration with experts and members of the TIN community, consisted of 15 closed-ended items divided into three sections: experiences and knowledge; attitudes; and education/training needs. We used standard descriptive statistics and tested for group differences using the chi-square test.

Results: Of the approximately 1,665 EPs and ENs contacted, 502 completed the survey and were eligible for further analysis (30% response rate). Of the respondents, 233 (46%) were EPs and 269 (54%) were ENs, with ENs being significantly younger and with fewer years in practice. More than half reported experience caring for TIN patients (71% of ENs vs 61% of EPs; P = 0.002), but there were significant gaps in medical and non-medical knowledge. Attitudes toward TIN patients were generally positive, but differences in communication approaches were noted, with ENs significantly more likely than EPs to limit their communication with TIN patients to what was necessary (25% of ENs vs 17% of EPs; P = 0.006). Most respondents (55% of ENs and 58% of EPs) had no training in the management of TIN patients, with only 8% of EPs and 17% of ENs having received such training during their medical/nursing school education (P = 0.01). Both groups agreed that there is an urgent need to increase awareness of emergency medical care for TIN patients among ED staff.

Conclusion: Both emergency physicians and nurses in Germany demonstrated deficits in knowledge of and clinical preparedness to care for patients in the ED who identify as transgender, intersexual and non-binary, indicating a clear need for enhanced education, training, and institutional support to improve emergency care for this vulnerable patient population.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1.
Figure 1.
Experience and knowledge of emergency physicians and nurses in Germany in caring for transgender, intersexual and non-binary patients. * = P < 0.05. EP, emergency physician; EN, emergency nurse.
Figure 2.
Figure 2.
Attitudes of emergency physicians and nurses in Germany regarding transgender, intersexual and non-binary patients. ** = P < 0.01, *** = P < 0.001. EP, emergency physician; EN, emergency nurse.
Figure 3.
Figure 3.
Education and training of emergency physicians and nurses in Germany regarding the care of transgender, intersexual and non-binary patients. * = P < 0.05. EP, emergency physician; EN, emergency nurse.
Figure 4.
Figure 4.
Education and training needs of emergency physicians and nurses in Germany regarding the care of transgender, intersexual, and non-binary patients. EP, emergency physician; EN, emergency nurse.
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