Communication Discrimination

[WinterLilac]

Hi Everyone,

I have entered a National speaking competition and have chosen a subject that we nurses experience on a daily basis; people being spoken to or treated differently because of the way they talk.

Im touching on a range of people; people with disabilities, aged, mental illness & English as a second language where, because of an accent or way of talking, are spoken to condescendingly, excluded from conversations, yelled to instead of spoken to and spoken about in front of them.

For example, I know a man with cerebral palsy who uses a foot controlled wheelchair. He had recently written his memoirs and worked at the hospital. Acquaintances would sometimes approach him with sympathetic smiles and high pitched "Hiiii! How ARE you!? You look cute in that shirt! I hope you're not giving your carer a hard time!" (I am his friend, not carer).

Or my colleague from Nigeria who has things read out to her like a story book "See here? This says 'No return policy applies after 60 days' so you can't return it after 60 days".

What I would absolutely adore is input from you; your personal experiences, if colleagues, friends, family or patients are treated differently (and how) and what you did or would have liked to do in that situation.

Particularly, what suggestions do you have to increase more dignified and respectful conversations?

I understand that many people who speak differently to another person under the belief they may not understand is not always meant maleficently and often has good intentions but I want to highlight this issue.

Look forward to reading your comments!

[LovingLife123]

I grew up on the east coast and now I live in the Midwest. I get it from all angles now on my accent. Doesn't bother me a bit. I laugh. I figure it's a unique mixture and it certainly makes people's heads turn.

i like being unique!!

[Skippingtowork]

I'm not sure if this is exactly what you're looking for, but this is an example of culturally-based communication difficulty. I used to work at one of the state psych hospitals where there were a lot of foreign psychs (primarily from India). Now you have to keep in mind that we're in the South. Well, a common question to ask psych patients is "do you hear voices speaking to you?" Good Southern Baptists, particularly minorities, will always tell you that God speaks to them. When the Indian docs heard that, they immediately assumed there was a psychotic issue in play when, in reality, there was nothing wrong with them. It was to the point that administration had to make a blanket policy that patients were not to be asked about hearing voices. Sad because that's a valid question, but folks were being admitted to the hospital for being Baptist.

Also, just being from the South is enough for many people (mostly our Northern friends) to decide that we're less intelligent or educated. Very sad misconception.

This is just way too funny. You couldn't have made this up.

[twinmommy+2, ADN, BSN, MSN]

You hit the nail on the head.

I am a black female who was born in the US, as were my parents, grandparents, great-grandparents, and so forth. Six or seven generations of my family has been here. I wouldn't even know which countries in Africa my descendants were from due to slavery.

Anyhow, I have 'proper' speech patterns that stand out like a sore thumb in a region where the majority of people speak with some type of southern drawl. I am often asked, "Where are you from?" or "How did you learn to speak such wonderful English?" or "Where were you born?"

People also comment, "Your speech and intonation are lovely!" or "You have an accent!" or (I cringe at this one) "You talk like a white person!"

I understand people are curious or think they are being complimentary. However, I know I have an accent because the latest observer is the thousandth person who has told me. It gets old really quickly.

Also, the controversially nuanced aspects of speech differences come into play. I suspect none of these people would comment if my speech was stereotypically 'black-sounding.' But since proper English is not commonly associated with certain racial groups, people wonder how I ended up speaking the way I do.

My husband also is told he isn't black enough because of the way he speaks, by his own family!

[TheCommuter, BSN, RN]

My husband also is told he isn't black enough because of the way he speaks, by his own family!

Yep...I can unfortunately relate to your husband's predicament. Members of my own family have referred to me as an 'Oreo cookie,' a term that refers to someone who is "black on the outside and white on the inside."

[kakamegamama]

I'm not sure if this is exactly what you're looking for, but this is an example of culturally-based communication difficulty. I used to work at one of the state psych hospitals where there were a lot of foreign psychs (primarily from India). Now you have to keep in mind that we're in the South. Well, a common question to ask psych patients is "do you hear voices speaking to you?" Good Southern Baptists, particularly minorities, will always tell you that God speaks to them. When the Indian docs heard that, they immediately assumed there was a psychotic issue in play when, in reality, there was nothing wrong with them. It was to the point that administration had to make a blanket policy that patients were not to be asked about hearing voices. Sad because that's a valid question, but folks were being admitted to the hospital for being Baptist.

Also, just being from the South is enough for many people (mostly our Northern friends) to decide that we're less intelligent or educated. Very sad misconception.

Well, some of my fellow Southern Baptists might qualify as admittable..........and, I've probably been considered the same from time to time.

Seriously, though....your post brings home an important part of assessing the patient for mental status...take into account their culture, their religion or lack there of, and, really listen to the patient, carefully..... and don't assume that just because they state they hear God that they are in a psychotic state--some people actually do hear Him, but that is a topic for another day........

[NurseLife88, ADN, RN]

I worked in disability services for over a decade and saw my patients encounter this kind of discrimination on a regular basis unfortunately. Often times people who do this don't even realize they are doing it, but there are also those that just don't care. Here are just a few different encounter I have seen.

I had one wheelchair bound client diagnosed with cerebral palsy. This disorder can affect all aspects of the neurological and muscular systems. This particular patient communicates with her eyes using a yes and no blinking system. So many times I can't count she was completely ignored. Instead of asking her what kind of cookie she wants they would ask me instead. She was more than able to communicate but was rarely if ever given the chance to do so. Sometimes out of impatience others out of ignorance.

I had another blind patient. This patient had glasses and a walking stick and only needed me for med organization. Often when picking up prescriptions they would start relaying all this info but always directed to me as the man stood next to me. One day after a few months of this I think he got fed up. He politely says excuse me to the lady then tells her " Hey I know I'm blind, but I'm not deaf and I can speak. Please speak to me directly about my own meds." I swear the lady looked shocked as ever and apologized profusely. She was one of those who legitimately did not realize what she was doing in speaking to me instead of him.

The last example I will use is my own grandmother. She suffered Alzheimer's and dementia for years but was still lucid and A&Ox3 most days, before a quick spiral downhill. She was often ignored and deemed too confused to understand the basics. It got to the point that people often never addressed my grandma but whoever was providing care. Grandma hated this. She would say she wasn't a child, she knew she was confused and dying but she didn't deserve to be ignored and overlooked because of it.

These are just a few examples out of hundreds. Whether this type of discrimination occurs because of diseases, accents, culture, etc. It still happens and more often than not goes completely unrecognized by most.

I'm glad the OP has brought some attention to this under discussed issue and one we nurses can play a big role in helping to fix.

[WinterLilac]

I worked in disability services for over a decade and saw my patients encounter this kind of discrimination on a regular basis unfortunately. Often times people who do this don't even realize they are doing it, but there are also those that just don't care. Here are just a few different encounter I have seen.

I had one wheelchair bound client diagnosed with cerebral palsy. This disorder can affect all aspects of the neurological and muscular systems. This particular patient communicates with her eyes using a yes and no blinking system. So many times I can't count she was completely ignored. Instead of asking her what kind of cookie she wants they would ask me instead. She was more than able to communicate but was rarely if ever given the chance to do so. Sometimes out of impatience others out of ignorance.

I had another blind patient. This patient had glasses and a walking stick and only needed me for med organization. Often when picking up prescriptions they would start relaying all this info but always directed to me as the man stood next to me. One day after a few months of this I think he got fed up. He politely says excuse me to the lady then tells her " Hey I know I'm blind, but I'm not deaf and I can speak. Please speak to me directly about my own meds." I swear the lady looked shocked as ever and apologized profusely. She was one of those who legitimately did not realize what she was doing in speaking to me instead of him.

The last example I will use is my own grandmother. She suffered Alzheimer's and dementia for years but was still lucid and A&Ox3 most days, before a quick spiral downhill. She was often ignored and deemed too confused to understand the basics. It got to the point that people often never addressed my grandma but whoever was providing care. Grandma hated this. She would say she wasn't a child, she knew she was confused and dying but she didn't deserve to be ignored and overlooked because of it.

These are just a few examples out of hundreds. Whether this type of discrimination occurs because of diseases, accents, culture, etc. It still happens and more often than not goes completely unrecognized by most.

I'm glad the OP has brought some attention to this under discussed issue and one we nurses can play a big role in helping to fix.

Your post is very much appreciated. I will use some of these thoughts. Thank you so much.

[Sweetheart2005, ASN]

I had another blind patient. This patient had glasses and a walking stick and only needed me for med organization. Often when picking up prescriptions they would start relaying all this info but always directed to me as the man stood next to me. One day after a few months of this I think he got fed up. He politely says excuse me to the lady then tells her " Hey I know I'm blind, but I'm not deaf and I can speak. Please speak to me directly about my own meds." I swear the lady looked shocked as ever and apologized profusely. She was one of those who legitimately did not realize what she was doing in speaking to me instead of him.

my mom is legally blind and Ive had similar experience. She rarely uses her cane but when she does, people talk to me, not her. And if they do, they talk down to her like she's mentally incapable of speaking for herself and deaf. She's blind. She's perfectly competent and very independent.

[NurseLife88, ADN, RN]

Yep...I can unfortunately relate to your husband's predicament. Members of my own family have referred to me as an 'Oreo cookie,' a term that refers to someone who is "black on the outside and white on the inside."

I can also relate to this as well. It's like people talk to you in a certain tone or expect you to speak in a certain way because of your skin color. I often get suprised faces when I go to doctors appointments and know everything they are discussing, medical verbatim, etc.

[WinterLilac]

So we know of the 'Restraining factors' (keeping the problem status quo), what would you suggest as 'Driving factors' (changing the status quo)?

Im thinking patience, don't assume (assume makes an ass out of u and me!) and speak normally - not too fast and not too slow.

In my experience, people are more than happy to let you know how much they understand (if English is a second language) or how we can communicate the best.

Thoughts?

[kakamegamama]

So we know of the 'Restraining factors' (keeping the problem status quo), what would you suggest as 'Driving factors' (changing the status quo)?

Im thinking patience, don't assume (assume makes an ass out of u and me!) and speak normally - not too fast and not too slow.

In my experience, people are more than happy to let you know how much they understand (if English is a second language) or how we can communicate the best.

Thoughts?

1). If a person is obviously challenged communication wise, why not just ask if there is a method to communicate with them that has been most helpful to them? Do they need/want a translator? (We have a high number of English as a second language patients at the clinic where I work. While many of them speak English, they often want a translator with them so that they can clearly understand and communicate with me their needs, etc.). If they are visually impaired, why not increase the font size on written instructions? If they are deaf, a translator's presence may help, but also, being sure to clearly articulate our own speech can go a long way in helping them.

2) Slow down and not hurry through instructions/health review/etc.

Just a few thoughts of mine

[audreysmagic, RN]

OP---I don't know if this fits, but here are my "peeves" about communication.

1. Please don't assume that just because I have white hair I am hard of hearing.

2. Please don't call me "Sweetie". "Ma'am" would be okay, or Mrs. Kakamegamama, but please, not "Sweetie". I've never liked hearing older people addressed that way, and don't like it for myself, either. In the Southern United States, it is usually not meant condescendingly, but it usually comes across that way, at least to me.

3. It's okay that people sound different than we do. Ask for clarification if you think you heard something different than what you planned to hear. It may be a matter of wrong words usage, or perhaps the person you spoke to didn't fully understand your question.

4. Don't make fun of colloquialisms, especially to the speaker, unless you yourself use those same colloquialisms.

I really find I have to watch the "sweetie" and "honey" because I'm both from the South originally and used to working with kids...it's become a part of my normal speech, and in the Midwest, I have to check myself because I don't want to unintentionally offend. People who do it anyway and then insist "it's just how I talk" when something is known to be condescending or offensive irritate me. It implies to me they don't care enough to consider their audience.