African American patients - a cultural question

Nurses Relations

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  • Specializes in Acute Care - Adult, Med Surg, Neuro.

I am not an American but from a European culture. I have cared for all kinds of patients and I have no problem with doing this. I have a question I have noticed about a trend I have noticed in some black American patients, but not in other patients I've cared for. (Please note I am not talking about patients from Africa, the Carribean, etc)

When I speak to patients of this culture, I have noticed a percentage of them will ignore me. This has happened many times, enough for me to take notice. For example, I will ask the patient "Are you having pain right now?" or "Are you feeling sick to your stomach?" In a clear tone. The patient will be awake, alert, but will lay on the bed with their eyes closed and not respond. I will ask again, and again they will not respond. Many times, worried that they have gone unresponsive, I will nudge them and say "Are you awake? Are you okay?" And get a look of annoyance from them.

I'm wondering if this is a cultural thing for some black Americans. As a European, who was routinely berated for not responding promptly to people around me, I find this behavior to be perplexing and a bit irritating, as it will go on like this through the interview (with the patient repeatedly not responding to pertinent questions). I know in some cultures, stoic-ness is valued, and I wonder if a history of oppression / discrimination has made some individuals feel that no matter what, their voice will not be heard, so they instead remain silent. I also understand that patients respond differently to pain and other ailments, with some shutting down and others showing their discomfort loudly.

In an atmosphere of today where diversity is a sensitive issue, I'm hoping I didn't offend anyone and hoping that someone can help me understand this behavior so that I can work more effectively with all of my patients.

Specializes in PCCN.

cant say I've ever had that happen before.

mindy kaling, BSN, RN

1 Article; 39 Posts

Specializes in ICU.

I've had that happen a lot, with all kinds of patients not just what you are describing, I am usually persistent and sometimes will let the patient know that this information is important because I feel like sometimes patients think some questions are just routine since so many people ask them. I don't think it has anything to do with being African American and their history......but..again I could be wrong, just my 2 cents

Browneyes80

28 Posts

No you are not offending me. Can not speak for the rest but I will speak for myself. I am of Caribbean descent and I notice the same with their culture. I get attitude, complaints, and yelled at. It is the typical stereo type of what you see out in public. Again, this goes vice versa for Caucasian, Hispanic , African Americans, and etc.

Specializes in Med Surg.

Are you establishing a relationship before you go in with questions about pain? I find that making a connection at the beginning of shift gives the patient more room to open up and won't find my questions intrusive or annoying.

I always start my day with bed side report and once its just me and the patient I ask "What is your main goal for today's shift". usually the answer is to get a good nights sleep or to keep on top of pain medication because I work the night shift.

Good Luck!

ThePrincessBride, MSN, RN, NP

1 Article; 2,594 Posts

Specializes in Med-Surg, NICU.

Black American here.

No that is an not a cultural behavior. That is just being rude.

iluvivt, BSN, RN

2,774 Posts

Specializes in Infusion Nursing, Home Health Infusion.

Are you sensing any anger or agitation as well because this may be passive aggressive behavior or just plain anger. I would simply ask the patient very calmly and in a soothing voice if they are upset about something and then acknowledge their feeling once and if they share. You can say something like "I understand how upsetting this must be for you.". Once that is completed calmly explain that you are trying to help them and how by answering the questions this will help. Remember that this type of patient often feels powerless and helpless....be assertive but respectful and calm when dealing with this type of behavior.

Look for a course on techniques on dealing with the angry and/or uncooperative patient. This will apply to any patient and will be a skill set you will find highly valuable, It also takes a lot of practice and I personally find that role playing helps me. I ask my coworker to play the difficult patient and then I practice responding.

pookyp, LPN

1,074 Posts

I'm AA. I've never experienced this. But I have experienced this with older Haitian patients.

jadelpn, LPN, EMT-B

9 Articles; 4,800 Posts

Sometimes it is a matter of respect and/or privacy. Not an excuse for just not answering, however.

Knock on the door, ask to come in. Call the patient by Mrs/Miss/Mr. Tell them that you are going to ask some questions about their health, and if they choose not to answer, please say so. Otherwise, I would remind them that they can use the call bell if they need anything. Document thoroughly. If there's a pattern to this behavior, I would also ask for a social work consult. I would also see if there's a family member that can help get to the bottom of exactly what is going on.

I had a patient say to me once (and I would classify it as older people, not exclusive to race) "Like I am going to talk to a little girl about my bathroom habits. Get out of my room and get me the doctor".

Older people are used to their MD's. That are usually of the same gender as they are. They can find it intrusive and rude if questions are asked of them by a "little girl". Same thing with not wanting a male nurse. It is a generational thing I have found. And to hear them describe it, they are in the hospital to "rest" and nurses "bug" them. ("Can't you see my eyes are closed?!")

If the are playing possum more often that not, then I would ask the MD if discharge orders can be written. They can lay in the bed with their eyes closed and give the silent treatment at home.

Farawyn

12,646 Posts

I worked with many Haitians, and had Haitian and DR patients. I've noticed there is sometimes a "sizing up" of the nurse, especially by the female patients. I don't think it's a bad thing, and I've never had an issue by the end of the day.

There are cultural differences with people, of course. I'm American, of Irish descent and I chatter to anyone and everyone. I notice that with lots of "my peeps", but not all.

I would approach each patient with the same respect you would give anyone, and adjust accordingly.

TheCommuter, BSN, RN

102 Articles; 27,612 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I'm a black female, and no, the behavior of ignoring when someone is asking a question is not a part of the so-called 'African-American cultural repertoire.'

When a patient ignores you or looks away, you need to reaffirm the importance of the answers. I have told more than one patient, "I don't have a crystal ball to read your mind, so you're only hurting yourself if you don't answer the questions."

KatieMI, BSN, MSN, RN

1 Article; 2,675 Posts

Specializes in ICU, LTACH, Internal Medicine.

I'd seen it with more than African Americans.

In my population, this behavior mostly happens either at or right after the admission, or suddenly in the middle of business as usual. The latter one makes me highly alerted, because acute depressive episodes and psychoses (as well as pure ol' overdose of Seroquel) happen and they warrant immediate action. I saw one curious case of sudden withdrawal 8 hours after bumping up Seroquel, and the reason for that was acute liver failure, with labs became suspicious after another 4 to 6 hours, and all other symptoms in the next 12 or so (Seroquel is eliminated by hepatic metabolism).

If it happens suddenly, I put these folks on my "watch list" with vitals q1-2h and CENA checking on every 30 min or so. Either in couple of hours we see something to call doc with (usually, for psych consult) or they rather impolitely wonder what it is all about. After explanation of how things work while they are there, they more often than not got a lesson to speak up with concerns, if any. Sometimes, they just want to be left alone for a while. Couple of times, they wanted another staff member to provide care but did not want to be rude and say that. Sometimes, they feel intimidated by bodily care but, again, feel like it would be rude to speak up. It is just a bit childish but otherwise perfectly human reaction to "shut it all up and off" when facing something unpleasant and irritating and just pretending it not be there.

On the other hand, all new admits (and families) are explicidly taught the importance of cooperation with treatment and letting appropriate personnel know about any problems ASAP. Couple of times, the "silent" patient and family who then complained loudly that their loved and dear one's (completely unknown) needs were not timely addressed went into very expedited discharge.

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