Context: The transgender community experiences excessive discrimination in in healthcare. Data continue to reveal that health care providers lack sufficient knowledge in transgender health, as well as difficulty in referring individuals to competent providers, to ensure the continuum of care (Brennan, Barnsteiner, Siantz, Cotter, & Everett, 2012; Cruz, 2014). Methods: A modified Cross-Cultural Care Survey consisting of 56 questions was implemented via Qualtrics to 1,134 nurse practitioners (NPs) in the California Association of Nurse Practitioner to measure their cultural competence through the domains of attitude, knowledge, and skill. Results: Completed responses were obtained from 30 out of 38 NPs (78.9%). Knowledge was positively correlated with Skills (Pearson's r = .688, p < .001); negatively correlated with Negative Attitude (Pearson's r = -.458, p = .011) and positively correlated with Positive Attitude (Pearson's r = .371, p = .043). Skills was positively correlated with Positive attitude (Pearson's r = .646, p < .001); however, the negative correlation between Skills and Negative Attitude was not statistically significant at the .05 level (Pearson's r = -.345, p =.062). There was a negative correlation between Negative Attitude and Positive Attitude, but this correlation was only marginally not significant at the .05 level (Pearson’s r = -.358, p = .052). Conclusion: The results indicated that the balance between skills and negative attitudes may have created a barrier to care in transgender patients.

This thesis researches the phenomenon ‘caring relationship’. The empirical studies in this thesis were carried out in China with the aim to describe the caring relationship in China through the lifeworld experiences of professional caregivers and patients. The result of this study will later on relate to a study of Swedish caring relationships. For this phenomenological study 9 patients, 10 medical and healthcare workers and 4 nursing tutors were interviewed. They were from 5 different medical and care units from two hospitals, one private clinic and a nursing school in Southern China. This study shows that caring relationship in China has many layers. Embedded in the basic interpersonal relationship is a ‘relationship of need’. The relationship carries a goal: to help the patient to restore a personal harmonic existence and regain the responsibility for their health. The relationship is temporary and normally ends when the goal is achieved. The relationship is initiated by the patients need for help. The two main actors in the caring relationship are the patient and the caregiver with their roles as care seeker and care provider. This study shows that to become a patient is a process of diminishing the natural ordinary self which makes the person feel vulnerable. Caregivers take a leading role which carries responsibility. They feel an obligation to use all their knowledge and resources for the benefit of the patients. They teach them how to live and how to stay healthy. A main function in the caring relationship is the transfer of knowledge. The caregivers feel the need to create a dialog to get access to the patients’ unique knowledge about themselves so that the caregiver’s general knowledge of health and care can be applied to the individual. Through the informal chats they share the patient’s experiences, emotions and history. It creates en opportunity for the interpersonal relationship to grow deeper and for the patient and the caregiver to meet as fellow human beings. In the Chinese caring relationship the patient’s family is included. It is considered to be every contributor’s duty to be responsible for oneself and for others. Mutual understanding and respect in a caring relationship are important in getting the patient back into balance.

<p>This thesis researches the phenomenon ‘caring relationship’. The empirical studies in this thesis were carried out in China with the aim to describe the caring relationship in China through the lifeworld experiences of professional caregivers and patients. The result of this study will later on relate to a study of Swedish caring relationships.</p><p>For this phenomenological study 9 patients, 10 medical and healthcare workers and 4 nursing tutors were interviewed. They were from 5 different medical and care units from two hospitals, one private clinic and a nursing school in Southern China.</p><p>This study shows that caring relationship in China has many layers. Embedded in the basic interpersonal relationship is a ‘relationship of need’. The relationship carries a goal: to help the patient to restore a personal harmonic existence and regain the responsibility for their health. The relationship is temporary and normally ends when the goal is achieved.</p><p>The relationship is initiated by the patients need for help. The two main actors in the caring relationship are the patient and the caregiver with their roles as care seeker and care provider. This study shows that to become a patient is a process of diminishing the natural ordinary self which makes the person feel vulnerable. Caregivers take a leading role which carries responsibility. They feel an obligation to use all their knowledge and resources for the benefit of the patients. They teach them how to live and how to stay healthy.</p><p>A main function in the caring relationship is the transfer of knowledge. The caregivers feel the need to create a dialog to get access to the patients’ unique knowledge about themselves so that the caregiver’s general knowledge of health and care can be applied to the individual. Through the informal chats they share the patient’s experiences, emotions and history. It creates en opportunity for the interpersonal relationship to grow deeper and for the patient and the caregiver to meet as fellow human beings.</p><p>In the Chinese caring relationship the patient’s family is included. It is considered to be every contributor’s duty to be responsible for oneself and for others. Mutual understanding and respect in a caring relationship are important in getting the patient back into balance.</p>