Racism: Expanding Compassion

Patti 2nd gen RN · Nov 20, 2006

firstyearstudent said:

I never thought of myself as a racist, but I'm noticing in clinical that I've been more compassionate and supportive and possibly giving better care to patients that I see as like me. This sometimes happens with people who are the same race, but can also be same language, age, culture, sex, education, sense of humor, etc.. What can I do to help ensure that I give the same great empathetic care to patients with whom I don't identify.

The fact that you are acknowledging that we all make generalizations of one sort or another is a first step--very responsible--and in itself may take you farther than you would think. When you hear yourself think in any generalizations--use it as a red flag to really look at your way of thinking and then at your actions. Many times you may be accurate in your assessment, other times you will need to find another way to choose to speak and behave--but know this--any nurse who thinks they don't make some kind of generalization or another is lying to themselves first and foremost. Me--my mountain to climb is patients who lie to me---be it about drug seeking, manipulative behavior--just because that's what works at home--or whatever. And I get really nuts when non-nurses (family, administration, whoever) try to tell me how to do my job. So in these sitiuations--that I know I have a problem with--I choose to take 'mental space' before I respond--and if I can't in that moment--well--I work with a great team on nights--we have patients that belong to 'the floor' and not just a particular assignment, and we take turns going in there, so nobody gets too close to the edge of behaving unprofessionally. And then we also have multiple techniques to deal with them, and several diffeent perspectives, assessments, and when needed--witnesses and documentation. Choose your mentors wisely, and remember to forgive yourself, and move on when you are less of a 'great' nurse than you want to be. Blessings!

TxChic82 · Nov 20, 2006

I think its really great that you are able to see this. Nobody wants to be prejudice, and I think many people refuse to look at themselves in this kind of light. As everyone else has said, simply acknowledging it is a great first step. I think if everytime you go to care for a patient that falls into one of the groups you tend to be less compassionate with if you take 2 seconds to remind yourself of the tendancies you have noticed in yourself in the past, and make it a point to give the best care possible in this situation, that your tendancies will slowly fade. All you can do is take it one patient at a time. Again, I think its really great that youre able to take a step back, look at yourself, question what it is youre doing, and try to make a change. GOOD FOR YOU. If only there were more people like you in the world. :)

Tweety, BSN, RN · Nov 20, 2006

I think it's human that we are more comfortable among our "own kind", whatever group or culture that might be, because you naturally have more in common with them. I recently had to acknowledge that I have only one African American female friend that I see regularly. All the rest of my friends are like me - white, male, middle aged and gay. (off topic I know, just babbling).

I agree with Sharon, that as long as you acknowledge it and work on it you'll be o.k. Everyone person, regardless of color, lifestyle, position in society, religion, deserves the best of me.

KMSRN · Nov 20, 2006

multicollinarity said:

I understand that this would be helpful for many. It wouldn't help me though. I'm an agnostic/atheist leaning Unitarian. People like me need to understand the issues and dissect them, and then compose a philosophy and strategy.
I do *sincerely* think it is wonderful that this has worked for you though.

To get past prejudice everyone need to "understand the issues and dissect them". Contrary to the stereotype, faith and thought are not mutually exclusive.

KMSRN · Nov 20, 2006

I just did some research for a report on cultural aspects of pain management and what I found was very disturbing. In study after study it was found that minorities received considerably less pain medication than non-minority (whites). These are a couple of them.

Study of 127 black and 90 white patients with a diagnosis of long-bone fracture
57% of black patients receive analgesia compared with
74% of whites
Risk of receiving no analgesia is 66% greater for blacks than whites
Patient and physician pain scores were identical for the 2 groups
Implies that any ethnic disparity in analgesic prescribing could not be attributed to differences in pain assessment

In a study of 250 consecutive patients after open reduction and internal fixation of limb fracture. After controlling for other variables:

Whites received 22 mg of morphine/day
Hispanics received 13 mg of morphine/day
Blacks received 6 mg of morphine/day

In a study to evaluate the severity of cancer-related pain and adequacy of prescribed analgesics in minority outpatients with cancer:

65% of minority patients did not receive guideline recommended analgesia compared with
50% of non-minority patients
Hispanic patients in particular reported less pain relief and less adequate analgesia

It has also been found that if the cultural/ethnic background of the patient is different from the caregiver, there is inadequate assessment and treatment. It gives us a lot to think about - our conscious and unconscious attitude, prejudices, and stereotypes.

Jo Dirt · Nov 20, 2006

When I was in OB rotation (which was pretty slow at the time with not much going on) I was in the nursery with a little Mexican newborn who was very dark complected with thick black hair and there was a light complected blond newborn, also. It kind of shocked me and was rather disconcerting at the time (being in my early 20's I guess I was kind of naieve) but I felt an instinctual urge to go to the white baby first. The Mexican baby was "different" to me. Even though I had a neice and a nephew who were half Mexican and a nephew who is half black and I have Native American ancestry myself, so I come from a diverse background, I still was taken back by this behavior in myself.

I was kind of upset with myself at first, because I know we are to treat each patient as an equal. But now I realize I was just leaning toward what seemed most like me that I could relate to at the time.

And what was even weirder was when I gave birth to my son (who has dark olive skin and was born with black hair like his Italian father) I instantly was attached to him and loved him more than life but he looked so different. I still had to get used to him. I can't explain it.

TxChic82 · Nov 20, 2006

I found the pain medication information very interesting but not too suprising. Im white and my daughter is half black. When I had her I learned in discussions with her dads family that its kind of a tradition for women in their family to have natural (no pain meds) childbirth. I was astonished by this becuase I when my contracts started to get rough I was like "OK what do yall have for me" right away..lol. Also, a note on what Motercycle Mama said, for me my daughter looking so much differant from me (IM VERY pale, german decent so im almost translucent, and my daughter doesnt look black or white, somehow she looks mexican.)didnt take any getting used to I was only reminded of how differant we looked when we went out in public and you could tell people were looking trying to figure out if she was mine or if I was just babysitting..lol. Or they would assume she was my friends (who is mexican) Sometimes its a shock tho, to see her skin next to mine, it reminds me of how pale i really am...lol.

Multicollinearity, BSN, RN · Nov 20, 2006

KMSRN said:

To get past prejudice everyone need to "understand the issues and dissect them". Contrary to the stereotype, faith and thought are not mutually exclusive.

Maybe you misunderstood my post, or maybe I wasn't clear enough. I was talking to that particular poster, and her specific recommendation to 'give it to God, there's nothing you can do'. I certainly didn't think or imply that all faith=no thinking.

Thank you for the compelling stats BTW.

teeituptom, BSN, RN · Nov 20, 2006

firstyearstudent said:

I never thought of myself as a racist, but I'm noticing in clinical that I've been more compassionate and supportive and possibly giving better care to patients that I see as like me. This sometimes happens with people who are the same race, but can also be same language, age, culture, sex, education, sense of humor, etc.. What can I do to help ensure that I give the same great empathetic care to patients with whom I don't identify.

Sounds like you qualify as a human being, only God is perfect and maybe Jack Nicklaus

SaharaOnyxRN · Nov 20, 2006

multicollinarity said:

I understand that this would be helpful for many. It wouldn't help me though. I'm an agnostic/atheist leaning Unitarian. People like me need to understand the issues and dissect them, and then compose a philosophy and strategy.
I do *sincerely* think it is wonderful that this has worked for you though.

Well, thank you for being very open-minded towards my point of view. In that case, then you probably could come up with something that helps you analyze this situation better. I would love to be able to do that as well. Good luck. I know that someone can give you very good advice on this. I will be looking forward to that advice as well. I believe that thinking analytically help us all relate to others in society.

Multicollinearity, BSN, RN · Nov 21, 2006

I'm thinking back to a matrix I was introduced to once at a seminar done by a psych professor. These are the four basic states we can find ourselves in:

Unaware + Unempowered

Unaware + Empowered

Aware + Unempowered

Aware + Empowered

In a clinical setting nurses would be 'Empowered' since nurses are in positions of power over patients. The question then would be: is the nurse aware or unaware regarding racist attitudes or bias? The danger for others seems to come when one is Unaware yet Empowered. The danger to self seems to come when one is Aware yet Unempowered.

Focker, CRNA · Nov 21, 2006

firstyearstudent said:

I never thought of myself as a racist, but I'm noticing in clinical that I've been more compassionate and supportive and possibly giving better care to patients that I see as like me. This sometimes happens with people who are the same race, but can also be same language, age, culture, sex, education, sense of humor, etc.. What can I do to help ensure that I give the same great empathetic care to patients with whom I don't identify.

Thats not racism, thats human nature. don't get down on yourself because you're not mother theresa. Anyone who tells you they treat every other person with perfect equality is either lying or fooling themselves. Just do the best you can, the fact that you are concerned about it shows you are not the type of person capable of overt racism.