Experiences and Attitudes of Nurses Caring for People Undergoing Gender‐Affirming Surgery: A Qualitative Study

ABSTRACT

Aim

The aim of this study is to explore the experiences and attitudes of nurses caring for people undergoing gender‐affirming surgery.

Design

This study was designed as a qualitative descriptive study.

Methods

The theoretical thematic analysis approach was used to analyse the data. The research data were collected through in‐depth individual interviews. The study sample consisted of 25 nurses who met the inclusion criteria and provided individualised care to persons undergoing gender‐affirming surgery.

Results

Nurses' narratives about their experiences and attitudes in providing care: (1) nurses' attitudes, (2) factors affecting nurses' attitudes, (3) nurses' experiences of care, (4) procedures affecting care, and (5) suggestions for improving the quality of care were summarised under five main themes. Although nurses did not express negative attitudes toward patients, they were found to have overlapping biases. In addition, using the code map, situations such as lack of information, communication problems, physical environment, etc. were found to affect nursing care.

Conclusions

As a result, it was found that nurses' experiences and attitudes affected the care of people in the process of gender transition; there were many factors that made their care more difficult and easier.

Implications for the Profession

This study underscores the need for targeted training to address biases, improve communication, and enhance understanding of gender transition care among nurses. Creating supportive policies, inclusive environments, and fostering interdisciplinary collaboration can improve care quality.

Impact

This research examines the experiences and attitudes of nurses providing care to individuals undergoing gender‐affirming surgery, highlighting factors influencing care quality and areas for improvement. The study illustrated practice across five domains: nurses' attitudes, factors affecting nurses' attitudes, nurses' experiences of care, procedures affecting care, and suggestions for improving the quality of care.

Reporting Method

SRQR guidelines for qualitative studies.

Patient or Public Contribution

No patient or public contribution.

1. Introduction

Transsexuality was first classified as a psychiayric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM‐III)published in 1980 [1]. This classification primarily reflected a pathologizing perspective toward gender diversity. In the DSM‐5, the term “transsexuality” was replaced with “gender dysphoria,” representing a conceptual shift toward reducing stigma while focusing on the psychological distress that may accompany incongruence between experienced gender and assigned sex [2]. This change emphasises the need for supportive, person‐centred healthcare approaches rather than diagnostic labeling alone.

The World Professional Association for Transgender Health (WPATH) presents rates of gender dysphoria across a broad spectrum. According to the WPATH, it is 0.33% in Canada, 2.8% in Sweden, and 0.7% in Brazil [3]. These variations highlight the growing visibility of transgender individuals within healthcare systems and underscore the increasing need for competent, inclusive nursing care. Nurses play a critical role in delivering gender‐affirming care through clinical practice, patient advocacy, and the reduction of stigma within healthcare environments.

2. Background

Individuals who experience gender dysphoria may seek gender‐affirming surgery to better align their physical body with their internal sense of gender identity and to express themselves more authentically [4]. Treatment protocols for individuals undergoing gender‐affirming surgery are inherently multidisciplinary. This process involves medical, psychological, and social support to align the body with the individual's gender identity. This process is based on clinical and psychological assessment, hormone therapy, surgery, and psychosocial support [5, 6]. Caring for individuals undergoing gender‐affirming surgery represents a specialised area of nursing practice. Surgery is a challenging process for transgender individuals, and appropriate support during this period is critical for improving quality of life. Furthermore, the care process for transgender people is not limited to the postoperative period. These individuals often seek long‐term follow‐up care, treatment and psychosocial support, and nurses play a key role in providing this care [6, 7].

The term transgender individuals broadly refers to individuals who may experience gender dysphoria. Transgender individuals often face discriminatory attitudes, stigmatising behaviours, and social labeling because they do not conform to traditional gender stereotypes. Similar to the general population, prejudices and negative attitudes toward transgender individuals can also be found among healthcare professionals [8]. These negative attitudes and behaviours of healthcare personnel deprive patients of their right to health, which is a fundamental human right. The gender‐affirming process is a complex period during which individuals have intense psychological as well as physical needs. The quality of care during this process directly affects individuals' quality of life and their trust in healthcare services. However, discrimination and prejudice toward transgender individuals within healthcare settings can limit access to services and hinder nurses' ability to provide effective, person‐centred care. Discrimination in healthcare settings can hinder nurses' communication with transgender individuals and impede the development of trust. Such challenges may lead to role conflict, ethical difficulties, and a reduced capacity to deliver effective, person‐centred nursing care [7, 8, 9, 10].

In order to improve the quality of care and prevent transgender individuals from being discriminated against or exposed to negative attitudes, it is important to identify the difficulties that nurses experience when caring for these individuals. Although gender‐affirming care and the effects of stigma and discrimination have been widely discussed, empirical evidence focusing on nurses' experiences and challenges in providing gender‐affirming care remains limited. In particular, little is known about how discrimination within healthcare settings affects nurses' communication, ethical practice, and ability to deliver person‐centred care [7, 8, 10]. From a caring science perspective, nursing care for individuals undergoing gender transition is grounded in respect for human dignity, compassion, and the alleviation of suffering ([11, 12, p. 25]). Caring science emphasises the nurse's moral responsibility to encounter the patient as a whole human being, respecting existential, physical, and social dimensions. Within gender‐affirming care, this involves creating a safe and affirming environment in which patients' identities are recognised and validated. Such a perspective not only supports holistic healing but also challenges implicit biases and discriminatory practices in healthcare settings. This theoretical foundation guided the present study in exploring nurses' experiences and attitudes toward caring for individuals undergoing gender transition.

3. The Study

This study was conducted between March and July 2023 as a qualitative descriptive study. The research focused on exploring nurses' experiences and attitudes toward caring for individuals undergoing gender‐affirming surgery. A qualitative descriptive design was chosen as it is particularly suitable for exploring experiences and attitudes in areas where limited prior research exists. This approach allows for a comprehensive and straightforward description of participants' perspectives in their own words, without imposing a pre‐existing theoretical framework. Given the aim of the study to explore nurses' experiences and attitudes toward caring for individuals undergoing gender‐affirming surgery, a qualitative descriptive approach was considered appropriate to capture practice‐based insights relevant to clinical care and nursing practice.

3.1. Setting, Participants, and Recruitment

The purposive sampling method was used to form the study sample. The study was conducted in a tertiary healthcare institution located in a large metropolitan area in Istanbul, operating within a publicly funded healthcare system. The study population consisted of nurses who had direct experience in caring for individuals undergoing gender‐affirming surgery. A total of 25 nurses who met the inclusion criteria were included in the study. The criteria for inclusion in the study were defined as follows: (1) voluntary participation, (2) caring for people undergoing gender‐affirming surgery, (3) willingness to provide informed consent. Nurses working in departments involved in the care process—including obstetrics and gynaecology wards, operating rooms, inpatient surgical units, outpatient clinics, and specialised units such as endocrinology and aseptic care units—were eligible to participate. All participants in this study were women. This reflects the gender distribution of the nursing workforce in the study setting, where nursing staff involved in gender‐affirming surgical care were predominantly female. During the recruitment period, no male or nonbinary nurses meeting the inclusion criteria were identified in the relevant clinical units. Therefore, perspectives of male or nonbinary nurses are not represented in the sample.

Potential participants were informed about the study through face‐to‐face invitations and internal communication channels within the hospital. Participation was entirely voluntary, and no incentives were provided. Nurses who expressed interest were given detailed information about the study procedures, and written informed consent was obtained prior to data collection. Recruitment continued until code saturation was achieved, indicated by repetition of existing codes and the absence of new codes or insights during ongoing data analysis.

In‐depth interviews were conducted on a completely voluntary basis with 25 nurses who agreed to participate in the study and met the inclusion criteria. Each interview was conducted face‐to‐face and lasted approximately 20–30 min. Participants were able to fully express their experiences within the interview timeframe, and extended interviewing did not yield additional insights, thereby supporting the adequacy of the interview duration and the attainment of code saturation. The “Participant Information Form” was completed by the researcher based on the nurses' statements during the interview. In the in‐depth interview, the opinions of the nurses were obtained based on the questions in the “Semi‐structured Interview Form”. Audio recordings were made during the interviews. After each interview, the audio recordings were carefully listened to and the nurses' statements were transcribed in written form (Microsoft Office Word) without any changes. Data collection was terminated when code saturation was achieved, indicated by repetition of existing codes and the absence of new codes during ongoing data analysis. The “Semi‐structured interview questionnaire” was created by the researchers in accordance with the purpose of the study and consisted of the following questions to learn about the nurses' experiences and attitudes: (1) How do you feel about gender‐affirming? (2) Were your thoughts like this before you cared for transgender people? (3) Have your thoughts changed after providing care? (4) How would you rate yourself in relation to caring for transgender people? Can you tell us about your experiences? (5) What difficulties and reliefs have you experienced in caring for transgender people? If so, what are your methods for dealing with difficulties?

Ethics committee approval was obtained from an independent ethics committee (Approval number: 12.04.2023‐661726). The study was conducted in accordance with the principles of the Declaration of Helsinki and informed consent was obtained from each woman who participated in the study.

4. Methods

4.1. Aims and Research Questions

This study aimed to contribute to the development of a more inclusive, respectful, and equitable approach to healthcare by exploring and describing the difficulties nurses encounter while caring for individuals undergoing gender‐affirming surgery and their responses to these challenges.

Research questions

• What are the experiences of nurses caring for individuals undergoing gender‐affirming surgery?

• What are the attitudes of nurses caring for individuals undergoing gender‐affirming surgery?

• What factors influence the experiences and attitudes of nurses caring for individuals undergoing gender‐affirming surgery?

4.2. Reflexivity

The research team consisted of nurse academics with expertise in women's health and qualitative research. One researcher was employed at the study institution; however, data collection did not take place in that researcher's clinical unit, and no managerial, supervisory, or evaluative relationship existed with the participants. The researchers acknowledged that their professional backgrounds and clinical perspectives could influence data interpretation. To address this, a reflexive approach was adopted throughout the study. This included ongoing critical reflection, collaborative discussions during data analysis, and continuous reference to the raw data to ensure that interpretations remained grounded in participants' accounts. These strategies supported the credibility and confirmability of the findings. This study was reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines, with the completed checklist presented in File S1 [13].

4.3. Data Analysis

Data were analysed using an inductive, reflexive thematic analysis following the six‐phase framework described by Braun and Clarke [14]. Analysis was conducted at a semantic level, focusing on participants' explicit accounts rather than latent interpretations.

First, all transcripts were read repeatedly to achieve familiarity with the data. Second, meaningful data segments were coded inductively by the researchers without the use of a predefined coding framework. For example, statements such as “…the looks from other patients were disturbing” were coded as disturbing looks from patients/relatives, and statements such as “I didn't know how to address” were coded as difficulty initiating communication. Third, related codes were reviewed and clustered into potential subthemes, which were subsequently refined and grouped into broader themes and overarching themes. For instance, codes related to communication, maintaining privacy, and caregiving roles were integrated into the theme care experiences of caregivers. During the analytic process, researchers worked independently during initial familiarization and coding and then met to compare, discuss, and refine codes and themes through reflexive dialogue. This iterative process supported analytical rigor by encouraging critical examination of interpretations rather than quantification of agreement.

Finally, themes were reviewed for coherence and clarity, and illustrative quotations were selected to ensure that the findings accurately reflected participants' perspectives. MAXQDA software was used to support data organisation and management throughout the analytic process.

4.4. Trustworthiness

Credibility was supported through prolonged engagement with the data, reflexive discussions among the research team, and the use of illustrative participant quotations grounded in the data. Dependability was enhanced by providing a transparent and detailed description of the research process, including data collection and analytic procedures. Confirmability was supported through ongoing reflexive dialogue and continuous reference to the raw data to ensure that findings were grounded in participants' accounts rather than researchers' assumptions. Transferability was facilitated by providing a rich description of the study context, participant characteristics, and care settings, allowing readers to assess the applicability of the findings to other contexts.

5. Results

Twenty‐five nurses participated in the study. The participants were all women aged between 23 and 61 years, with a mean age of 37.48 ± 7.8 years and an average of 14.6 ± 9.04 years of professional experience. Most participants held undergraduate or postgraduate nursing degrees, and two nurses were currently working as university lecturers after having previous experience in the obstetrics and gynaecology department. The majority were employed in inpatient services, while others worked in outpatient clinics, operating rooms, or specialised units such as aseptic and endocrinology departments. None of the nurses had received formal education or structured training on the care of transgender individuals, although two reported attending short professional courses. The characteristics of the participants are summarised in Table 1.

TABLE 1.

The characteristics of the participants (N = 25).

Nurse	Age	Education status	Marital status	Working unit	Working time (years)	Education a status
P1	38	Licence	Single	Services b	4	No
P2	29	Licence	Single	Services b	7	No
P3	30	Postgraduate	Single	Services b	7	No
P4	36	Postgraduate	Married	Services b /University lecturer	8	No
P5	50	Postgraduate	Married	Operating room b	28	No
P6	35	Postgraduate	Married	Aseptic b	15	Yes
P7	28	Licence	Single	Aseptic b	3	No
P8	44	Licence	Married	Policlinic b	24	No
P9	34	Licence	Single	Services b	17	No
P10	35	Postgraduate	Married	Services b /University lecturer	13	Yes
P11	45	Postgraduate	Married	Policlinic b	28	No
P12	50	Associate degree	Married	Operating room b	28	No
P13	61	Licence	Married	Services b	41	No
P14	26	Licence	Single	Services b	4	No
P15	45	Associate degree	Single	Operating room b	27	No
P16	29	Licence	Married	Services b	5	No
P17	25	Licence	Single	Services b	3	No
P18	23	Licence	Single	Policlinic c	1	No
P19	47	Postgraduate	Married	Services d	28	No
P20	34	Postgraduate	Married	Services b	13	No
P21	45	Postgraduate	Single	Services e	23	No
P22	36	Postgraduate	Married	Services b	12	No
P23	27	Licence	Single	Services b	5	No
P24	40	Licence	Married	Services b	9	No
P25	45	Licence	Single	Services b	12	No

^a Courses, training or further education for the care of transgender people.

^b Department of Obstetrics and Gynaecology.

^c International Patient Unit.

^d Department of Mental Health and Disease.

^e Endocrinology Department.

The quotations from the in‐depth interviews regarding nurses' experiences and attitudes toward caring for individuals undergoing gender‐affirming surgery were categorised into five main themes: Attitudes, Factors influencing attitudes, Experiences with care, Procedures affecting care, and Recommendations for improving the quality of care. The main themes and subthemes are presented in Table 2.

TABLE 2.

Experiences and attitudes of nurses caring: Main themes, subthemes, codes and subcodes.

Main themes	Sub‐themes	Codes/Subcodes
Attitudes	Seeing it as a human right Acting professionally	— —
Factors influencing the attitude	Having an acquaintance who is transgender Involvement in the nursing process Becoming a parent Empathy The role of nurses: advocacy for patient rights Social media/encouragement Lack of information	— —
Experience with care	Communication	Addressing difficulties in initiating communication Limited communication
	Maintaining privacy	Disturbing glances from patients/patient relatives toward the person Physical conditions Protection of personal information
	The caring role of the nurse	Facilitating factors Professional action Involvement of the individual in care Gaining experience
		Barriers factors Inadequate physical environment Difficulties in maintaining privacy Difficulties in ensuring patient comfort Lack of information
Procedures that affect care	System‐related procedures Procedures related to the facility
Recommendations for improving the quality of care

5.1. Theme 1: Attitudes

Nurses' attitudes toward gender‐affirming surgery were summarised in two subthemes: viewing it as a human right and acting professionally. Fifteen statements reflected the first perspective, and seven emphasised professional conduct. Overall, nurses expressed no negative attitudes, considering gender affirmation a fundamental human right and a personal choice.

P18 “…A sex change is a right. I think that everyone should have this right. … I see it as quite normal. So I think they should have all kinds of rights. These procedures are also carried out in our hospital and I support this. As a nurse or as an individual, I support that…” This perspective positioned nurses as allies in the care process, grounded in both professional ethics and personal values.

P22 “…I don't have a negative opinion, in fact I don't think I have the right to have such an opinion, because this is a very personal matter that concerns the individual. … As a nurse, I may have an idea of how I can use my identity as a nurse to facilitate the procedures in their hospital. Because it's none of my business. It's her own decision…” These accounts illustrate how professionalism functioned as a protective framework, allowing nurses to navigate care delivery by prioritising ethical practice, respect, and nonjudgemental attitudes.

5.2. Theme 2: Factors Influencing the Attitude

The sub‐theme with the highest number of opinions was involvement in the nursing process, and the subtopic with the lowest number of opinions was role as a parent. Nurses' attitudes toward gender‐affirming surgery were shaped by a combination of clinical involvement, personal relationships, and life roles, particularly parenthood. Direct engagement in the nursing care process and close contact with transgender individuals often led to increased understanding and respect, challenging earlier assumptions about the simplicity of gender‐affirming decisions.

Several participants described how witnessing patients' struggles and listening to their experiences transformed their perspectives, emphasising the complexity and difficulty of the process.

P10 “…Being with these people and hearing their problems showed me how difficult this process really is. It's not a decision made suddenly; they struggle with many issues.”

Similarly, caring for patients over time fostered empathy and a stronger commitment to supportive care.

P6 “…I used to think it was an easier decision, but after caring for these patients and seeing their hardships, I respect them much more and try to help them.”

Personal life roles also influenced attitudes. Some nurses reported emotional conflict when empathising as parents, describing shifts toward greater reflection and, at times, momentary judgement that required conscious self‐regulation.

P24 “…After I became a mother, I started to think differently. I wondered what I would do if my child were in that situation, and I noticed I became more conflicted.”

Empathy was further shaped by awareness of patients' social isolation and exposure to stigmatising looks from others in clinical settings, which evoked protectiveness and attentiveness among nurses.

P22 “…They are often very lonely, and being exposed to others' looks makes us feel the need to protect them and be more attentive.”

Nurses also described adopting an advocacy role, actively defending patients' rights when procedural or institutional barriers arose.

P13 “…When a decision was made not to operate, I explained that these patients were being treated under unsafe conditions elsewhere, and this led to positive changes in our clinic.”

At the same time, some factors complicated nurses' attitudes. Participants expressed discomfort with the heightened visibility of gender‐related issues on social media and uncertainty stemming from limited knowledge about gender‐affirming care, which sometimes generated confusion or fear.

P25 “…I feel conflicted about how to approach this issue. Dysphoria is very complex, and I don't yet feel fully informed.”

P24 “…I'm also troubled by how much this topic is in the public eye on social media.”

Together, these accounts indicate that nurses' attitudes were dynamic and context‐dependent, shaped by clinical exposure, personal roles, advocacy experiences, and gaps in knowledge—highlighting both supportive orientations and areas of uncertainty.

5.3. Theme 3: Experiences With Care

Nurses' experiences with caring for individuals undergoing gender‐affirming surgery were characterised by communication challenges, difficulties in maintaining privacy, and the need to balance professional caregiving roles within constraining institutional conditions. Lack of formal training in gender‐affirming communication emerged as a key source of uncertainty, particularly during initial encounters.

Several nurses described feeling anxious and unsure about how to address patients appropriately when they first met them.

P1 “…I was very anxious when I first met them because I didn't know how I should behave as a nurse or what I should pay attention to.”

To manage this uncertainty, some nurses relied on informal strategies, such as discussing appropriate language among colleagues and directly asking patients how they wished to be addressed.

P4 “…We talked among ourselves about how to approach them. I asked which gender she wanted to be addressed as and tried to be careful about my language.”

Maintaining patient privacy was described as particularly challenging due to the physical environment of the hospital and the reactions of other patients and their relatives, which sometimes directly affected patients' willingness to engage in care activities.

P17 “…Sharing the same corridor is very difficult. The patient is constantly stared at, and this affects them so much that sometimes they refuse to walk.”

5.3.1. Sub‐Theme: The Caring Role of the Nurse

Nurses identified both facilitating and barrier factors influencing their caregiving experiences. Care was facilitated when nurses adopted a professional, non‐differential approach, actively involved patients in their own care, and treated them similarly to other surgical patients.

P7 “…If the patient wants to do a procedure himself, we do it together. This really strengthens communication.”

P17 “…We try not to be different in our care, even though we know they are emotionally different from other patients.”

Some nurses also noted gradual institutional and professional improvement over time.

P6 “…The more we care for them, the more we improve. We have started to pay more attention to this issue.”

However, caregiving was complicated by inadequate physical conditions, limited privacy, and insufficient knowledge about gender‐affirming care, which sometimes generated fear of unintentionally harming patients.

P10 “…The hospital conditions make it difficult. They don't want to leave their room because of the looks from others.”

P4 “…I was honestly afraid that I might hurt the patient unknowingly because I didn't have enough information.”

Together, these accounts illustrate that nurses' experiences with care were shaped by a tension between professional commitment and structural limitations, highlighting both adaptive strategies and persistent challenges in providing gender‐affirming care.

5.4. Themes 4: Procedures That Affect Care

Nurses reported that care management was significantly influenced by institutional and system‐based procedures, which at times complicated the delivery of care for individuals undergoing gender‐affirming surgery. Routine clinical requirements and legal regulations were described as sources of tension between standardised practice and patients' emotional responses. Some nurses highlighted difficulties related to mandatory clinical and legal procedures, such as vaginal examinations, which patients sometimes resisted. In these situations, nurses described having to balance legal obligations with sensitive communication.

P8 “…They can be against vaginal examination. They are convinced only after we explain that it is a legal requirement and after discussions with the physician, but this process can be difficult.”

In addition to legally mandated procedures, nurses noted that routine administrative and clinical practices—such as patient registration or blood collection—could also trigger strong emotional reactions from patients, occasionally leading to misunderstandings or conflict.

P22 “…There are very simple routine practices like registration or blood sampling, but some patients get very angry even about these. It feels like they think we are deliberately making things difficult for them.”

These accounts illustrate how system‐level procedures, although intended to ensure standardised and safe care, may inadvertently challenge trust and communication, thereby affecting the overall care experience.

5.5. Theme 5: Recommendations for Improving the Quality of Care

Nurses emphasized the need for structured education and training on the care of transgender individuals, highlighting gaps both in nursing curricula and in clinical practice. Participants noted that the absence of formal education contributed to uncertainty, inconsistent approaches, and confusion during care delivery.

Some nurses suggested that healthcare‐related education programmes should explicitly include content on gender‐affirming care, focusing on appropriate approaches and system‐level organisation rather than attempting broad societal change.

P21 “Even if educating society as a whole is difficult, health‐related departments can address this through training programs or courses. Hospitals could also establish procedures or commissions to evaluate these surgeries, which would fill an important gap in the system.”

Others emphasized that while individual attitudes may vary, professionalism and basic preparatory training could help prevent misunderstandings and improve care experiences.

P22 “Not everyone may change their mindset through training, but professionalism requires separating personal views from patient care. Even basic information beforehand could help prevent confusion and make encounters easier.”

Together, these recommendations underscore the importance of integrating gender‐affirming care into formal education and institutional protocols to enhance consistency, preparedness, and quality of nursing care. The code map presented in Figure 1 illustrates the thematic relationships identified in the analysis. The thickness of the connecting lines reflects the frequency of co‐occurrence between themes and subthemes. Thicker lines indicate relationships that appeared more frequently in the data, whereas thinner lines represent less frequent but meaningful connections. This visual representation demonstrates how nurses' attitudes, experiences, institutional procedures, and recommendations are interrelated within the overall analytic framework.

FIGURE 1.

Frequently used themes: Code map.

6. Discussion

This study explored in depth the experiences and attitudes of nurses caring for individuals undergoing gender‐affirming surgery. Five main themes emerged from the data analysis: ‘Nurses’ attitudes', ‘Factors influencing nurses' attitudes’, ‘Nurses' experiences’, ‘Procedures influencing care’ and ‘Suggestions for improving the quality of care’.

The findings indicate that nurses largely perceive gender affirmation as a human right and approach the process with a strong sense of professional and ethical responsibility. Nevertheless, some expressions revealed implicit biases shaped by sociocultural norms, even in the absence of openly negative attitudes. Such unconscious beliefs may influence nurses' emotional responses, communication, and clinical judgements, thereby undermining trust, empathy, and the quality of care and highlighting the need for reflective awareness and ethical sensitivity in caring practice [15, 16]. For example, misgendering, avoidance behaviours, or overprotective attitudes—often emerging unintentionally—may hinder the establishment of a caring and affirming nurse–patient relationship. From a caring science perspective, recognizing and reflecting on such biases is essential to uphold human dignity and authentic presence in care encounters [11, 12]. Ethical caring requires awareness of one's own preconceptions and unconditional acceptance of the patient as a whole human being, a process reflected in nurses' narratives in this study. Similar to the findings of Doğan et al. [10], nurses tended to interpret gender transition as a personal preference, reflecting broader cultural and social influences on professional attitudes.

The code‐map analysis further revealed that nurses' lack of knowledge about transgender individuals contributed to uncertainty and negatively influenced their attitudes. A small number of nurses also reported discomfort with the public visibility of transgender individuals on social media, which shaped their perceptions. Consistent with previous studies, nursing curricula often lack sufficient content on LGBTQ+ health issues, including gender dysphoria, resulting in persistent knowledge gaps among nurses [10, 15, 17]. Although nursing has been described as lagging behind other health professions in providing culturally competent transgender care [18], this trend was less evident in the present study, possibly due to participants' higher educational levels and metropolitan context.

Nurses reported experiencing emotional and practical challenges when caring for transgender individuals, particularly in relation to protecting patient privacy in environments marked by intrusive gazes from other patients and relatives. These challenges contributed to emotional distress and could limit nurses' capacity for empathic engagement. Previous qualitative studies have shown that transgender individuals often perceive nursing care as respectful and supportive [19, 20], while nurses simultaneously describe care provision as emotionally demanding, especially in the context of surgical anxiety [10]. Consistent with this literature, nurses in the present study reported that empathy and confidence increased with experience, including the consistent use of preferred names and more effective communication. The code‐map analysis demonstrated that difficulties in ensuring patient privacy and comfort were primarily associated with inadequate physical conditions and intrusive gazes, which frequently co‐occurred and challenged nurses' ability to provide care. In contrast, patient involvement in care, professional conduct, and nurses' clinical experience facilitated the care process. These findings align with previous research indicating that nursing care quality is shaped not only by individual knowledge and experience but also by institutional structures and procedures [15, 18]. The absence of clear hospital guidelines on privacy protection and the management of discriminatory behaviours may undermine nurses' morale, increase emotional distress, and hinder the delivery of person‐centred care for transgender individuals.

Finally, the most prominent suggestion for improving care quality was the need for training. Nursing care for transgender individuals is a specialised field, and existing literature consistently highlights significant educational gaps among nurses [17, 19, 21, 22, 23, 24]. In this study, nurses emphasised that targeted education could enhance both the quality of care and their confidence, particularly in communication with transgender patients. Participants also highlighted the importance of integrating transgender health and care into nursing education curricula, suggesting that education should encompass not only clinical knowledge but also ethical reflection and communication skills.

This study has several limitations. The qualitative design limits the transferability of the findings, as the results reflect the experiences of a specific group of nurses. The relatively small sample, drawn from a single metropolitan healthcare setting, may not represent nurses working in other contexts. In addition, interview length may have limited the depth of some accounts, and social desirability bias cannot be excluded due to the sensitive nature of transgender care.

Despite these limitations, this study contributes to the literature on gender‐affirming care by highlighting nurses' experiences and ethical challenges within a caring science framework. While nurses largely view gender affirmation as a human right, the findings indicate that implicit biases and structural barriers may still influence care encounters. By foregrounding human dignity, ethical sensitivity, and authentic presence, the study underscores the need for reflective practice, institutional support, and education to strengthen person‐centred nursing care for transgender individuals.

7. Conclusion

In conclusion, nurses' attitudes and experiences of nursing staff in relation to the gender‐affirming process are one of the cornerstones of an ethical health service. Nurses' positive attitudes, empathy, and professional approach to the process play a crucial role in ensuring that transgender people benefit from health services in an equitable and respectful way.

The research results show that nurses, for the most part, view gender‐affirming as a human right and demonstrate professional behaviour toward patients. However, a lack of knowledge and societal prejudices about the process can lead to nurses having difficulty communicating and feeling confused. In particular, hesitation about how to address patients and initiate communication can be a barrier to effective care. In addition, inadequate physical environmental precautions in health facilities and negative attitudes of other patients or family members make it difficult to protect the privacy of transgender people and can negatively affect the care process. This situation can exacerbate discrimination against transgender people when accessing health services. Overall, these findings highlight the need to strengthen nurses' knowledge, communication skills, and ethical sensitivity in gender‐affirming care. Supporting nurses through education, reflective practice, and institutional policies that ensure privacy and inclusivity is essential to reduce discrimination and improve the quality of care. Addressing these needs may contribute to more equitable, respectful, and person‐centred healthcare experiences for transgender individuals.

7.1. Limitations

The sample of this study consisted of nurses working in a tertiary healthcare institution located in a large metropolitan area. This may affect the results of the study. The results of the qualitative research cannot be generalised to the entire population and are limited to the sample. The study sample consisted exclusively of female nurses, which may limit the transferability of the findings. Perspectives of male or nonbinary nurses, who may experience and interpret caring for individuals undergoing gender‐affirming surgery differently, are not represented. Although this reflects the gender composition of the nursing workforce in the study context, future research including more diverse nursing perspectives may provide a more comprehensive understanding of attitudes and experiences in gender‐affirming care.

Author Contributions

All authors have read and approved the manuscript. Conceptualization: B.P., M.M.K. Data curation: B.P. Methodology: B.P., M.M.K. Validation: M.M.K. Formal analysis: B.P., M.M.K. Writing‐original draft: B.P., M.M.K. Writing‐review and editing: M.M.K.

Funding

The authors have nothing to report.

Ethics Statement

Ethics committee approval for the study was obtained from a state university in Istanbul—Number: 12.04.2023‐661726. The study was conducted in accordance with the principles of the Declaration of Helsinki and informed consent was obtained from each woman who participated in the study.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: scs70216‐sup‐0001‐Supinfo1.docx.

Peynirci B. and Mecdi Kaydırak M., “Experiences and Attitudes of Nurses Caring for People Undergoing Gender‐Affirming Surgery: A Qualitative Study,” Scandinavian Journal of Caring Sciences 40, no. 1 (2026): e70216, 10.1111/scs.70216.

Data Availability Statement

The data supporting the findings of this study consist of qualitative interview transcripts and field notes, which contain sensitive and confidential information. Due to the ethical considerations and privacy concerns of participants, the data are not publicly available. However, anonymized excerpts from the data can be made available upon reasonable request to the corresponding author, subject to ethical approval and participant consent.