# Building trusting relationships while worrying about doing the wrong thing - a qualitative content analysis study on Swedish school nurses experiences of meeting students with trans experiences

## TL;DR

This study explores how Swedish school nurses support transgender students, highlighting their efforts to build trust while facing uncertainty about the best ways to help.

## Contribution

The study provides novel insights into the experiences and challenges of school nurses when supporting transgender students in a Swedish context.

## Key findings

- School nurses build trusting relationships with transgender students through health dialogues and advocacy.
- School nurses often feel uncertain about the proper actions to support transgender students, fearing they might act wrongly.
- Collaboration with school counselors and youth health clinics provides support for school nurses in their work with transgender students.

## Abstract

Young transgender persons who attend school are especially exposed to harassment, bullying, discrimination and violence in the school environment, experiencing an increased sense of mental and physical ill-health. School nurses work health promoting in schools and therefore have a unique opportunity to promote health among transgender students. There is however limited research on school nurses’ experiences of working with transgender students.

To illuminate school nurses’ experiences of interacting with and supporting students with transgender experiences.

An inductive qualitative study with data collected through eight semi-structured interviews, analyzed through an inductive qualitative content analysis according to Graneheim and Lundman. The analysis was on the manifest level, where the steps were conducted in discussion within the research group to reach consensus through each step to ensure their connection to the aim. The analysis resulted in the findings, which is presented in two main categories with three sub-categories each.

The school nurses supported the students with trans experiences through conversations during the health dialogues, building a trusting relationship with the students, and by being a spokesperson and for the students, with other students, teachers and parents. The school nurses also experienced uncertainty in which was the proper actions to support the students with transgender experiences and feared acting wrongly and therefore not supporting the students adequately or even harming students.

The school nurses’ role in meeting these students is complex, where the school nurse work to build relationships with the students, but lack knowledge and tools. The lack of support and knowledge creates an ambivalence in how to best support these students, placing the school nurse before ethical dilemmas. The school nurses found support in the collaboration with the school counselor, as were the youth health clinics. School nurses should therefore, besides added education, be provided with arenas to discuss ethical dilemmas surrounding gender identity with other professionals who work in the school environment, or with adolescents.

The online version contains supplementary material available at 10.1186/s12912-025-03208-4.