Castleberry 3
better understanding of how gender continuum is used and
how it impacts nursing education, CINAHL and PubMed were
searched using the following search terms: gender, transgen-
der, gender nonconforming, continuum, spectrum, nursing
education, disparity, nursing, and concept analysis. Applying a
significant amount of hand searching, 28 articles were selected
for inclusion in the concept analysis based on their relevance
to the topic, provision of historical context and background of
the concept, and links to nursing.
Results
Significant characteristics of the gender continuum include
four subcategories of gender and the continuum that exist for
each: identity, expression, anatomy, and attraction
(Killermann, 2017; Safe Places, 2016). The subcategory of
gender identity ranges from woman to genderqueer to man
(Killermann, 2017; Safe Places, 2016; Saewyc, 2017). The
subcategory of gender expression spans from feminine to
androgynous to masculine (Killermann, 2017; Saewyc,
2017). Anatomical sex varies from female to intersex to male
(Killermann, 2017; Saewyc, 2017). Scientists further break
down the anatomical continuum based on XY chromosomal
patterns and reproductive function (Ainsworth, 2015).
Examples within the anatomical continuum include men
who possess both internal and external male genitals, those
who possess male genitals but do not have full function of the
sex organs, ambiguous and intersex persons, and individuals
with only the external sex organs and no reproductive abilities
(Ainsworth, 2015). Finally, the sexual and romantic attraction
continuum, which are not mutually exclusive, range from
men only, to all persons, to women only (Killermann, 2017).
There are no criteria specific to the gender continuum
(Killermann, 2017; Saewyc, 2017). All people fall somewhere
within the continuum and in each subcategory. Conventional
gender identities belong on the gender continuum as equally
as nontraditional identities, such as that of a transgender
male-to-female individual who is attracted to all persons.
The gender continuum is not exclusionary to any population
but is diverse and inclusive enough to account for all people
regardless of how they identify (Killermann, 2017; Saewyc,
2017). An individual’s gender identity is the culmination of
all characteristics and attributes defined previously.
Uses in Nursing Education
In most health care settings in the United States, there is no
recognition of gender identities beyond the dichotomous
male and female (Eliason, 2017). Much of medical language,
practice, and research perpetuates assumption that gender is
binary; however, this belief is rapidly changing (Eliason,
2017). The concept of gender continuum is pertinent to nurs-
ing education as the number of openly TGNC individuals
grows. Currently, TGNC persons make up nearly 75 million
people, or nearly 2% of the population in the United States
(Saewyc, 2017). Nursing students will encounter people who
fall on all points on the gender continuum. As such, nursing
students need the tools to appropriately care for people of all
gender expressions and understand the unique needs related
to a person’s gender identity (Kellett & Fitton, 2016).
The primary and fundamental care of all patients is the
same and should be approached in a respectful and nondis-
criminatory manner (Wylie et al., 2016). However, nursing
students must attain knowledge of how to both address and
care for people who do not fit the traditional gender binary
(Ard & Makadon, 2012; Kellett & Fitton, 2016; Wylie et al.,
2016). Some of the unique needs of a TGNC patient include
respectful pronoun use, knowledge regarding hormone treat-
ments and surgical interventions, proficiency in gendered lab
interpretation, psychological consideration as well as educa-
tion on the increased health risks for these individuals
(Nexus, 2018, Wylie et al., 2016). Furthermore, many
Table 1. Terms Essential to Understand Gender Continuum.
Term Definition
Agender An individual who does not identify with any gender
a
Androgyny A term meaning “having the characteristics or nature of both male and female”
b
Cisgender A person who identifies as the same gender to which they were assigned at birth
a
Gender CreativeA term used to describe individuals, generally children and young adults, who creatively define gender in their own
terms based on how they feel on the inside and how they look on the outside
c
Gender DysphoriaIs a term used to describe the internal conflict experienced when a person does not identify as the sex assigned at
birth
d
Gender-Fluid An individual who identify as a mixture of both male and female
e
Gender Liminal An individual who is in transition, does not entirely identify what they were or what they eventually will be
f
Genderqueer An individual who does not identify as exclusively male or female
g
Intersex Persons who possess both male and female reproductive organs in a variety of combinations
h
Transgender Individuals who identify as a gender other than that assigned to them at birth
i
Two-Spirited “A person who identifies as having both masculine and feminine spirit”
j
a
GenderSpectrum (2018).
b
Androgyny (2018, para. 1).
c
Sirois (2018).
d
Gender dysphoria (2018).
e
Gender-fluid (2018).
f
Gender Liminal (2018).
g
Genderqueer (2018).
h
Intersexuality (2018).
i
Transgender (2018).
i
Re:searching for LGBTQ Health (2018, para 1).