title: The invisibility of gender diversity: understanding transgender and transsexuality in nursing literature.
abstract: OBJECTIVE
  Increasingly, people are living their lives without strict attachment to one gender. In this paper, we discuss key discourses identified in a literature review of transgender and transsexual issues in nursing. Our aim is to highlight the power of dominant discourse and lack of adequate understanding of gender diversity on the part of nurses. We use stories of trans people to illustrate these discourses. An increased awareness may support respectful care of those who do not fit comfortably within culturally defined parameters of male and female.
  
  
  CONCLUSIONS
  The invisibility of gender diversity in health care remains a threat to ethical nursing care. The effects of invisibility of transgender people in health care result in a cycle of repetition where those who have been denied recognition in turn avoid disclosure. Key discourses addressing trans people in nursing literature include invisibility, advocacy, cultural competence, and emancipation.
  
  
  CONCLUSIONS
  There is a need for further education about gender diversity in order to dispel and counter misunderstandings, stigma, and invisibility. This can be achieved through sustained efforts in nursing research and educational curricula to include gender diversity and trans people. Policies for the protection of those who change their sex or identify outside the dominant gender schema are urgently needed.
authors.affiliation: School of Nursing, University of Victoria, Victoria, British Columbia, Canada.
authors.forename: Lyn
authors.initials: L
authors.lastname: Merryfeather
authors.forename: Anne
authors.initials: A
authors.lastname: Bruce
mesh_terms: D001291:Attitude of Health Personnel; D065246:Culturally Competent Care / Q000379:methods; D003479:Curriculum / Q000639:trends; D004506:Education, Nursing / Q000941:ethics* / Q000639:trends; D005260:Female; D006801:Humans; D008093:Literature, Modern; D008297:Male; D063106:Transgender Persons / Q000193:education*
keywords: Advocacy; cultural competence; discourse; invisibility; nursing; transgender; transsexual