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 Acute Care - Adult, Med Surg, Neuro.
I have noticed this behavior, but it's not exclusive to any specific race. I agree with traumaRus that it does seem to be more common with chronically ill people who are in and out of the hospital often. That may be an ESRD patient, sickle cell, COPD, or someone with chronic pain. Sometimes frequent flyers, sometimes people who generally exhibit drug seeking behaviors.
I just explain that I need an answer (pain assessment, nausea, ect) before I give the medication they have requested. If they won't answer (but obviously can) I'll say I will come back and try again later.
I definitely have an image in my head of a patient with the sheet pulled up over their head who I have to hunt down their wrist under their blankets for their armband to scan, or their IV line to push medication. They'll sigh angrily if the sheet needs to be removed, flip it back quickly, being annoyed that I have inconvinced them. I am the rude one for needing access to these things to give their medication.
Anyway, that sometimes goes along with the no response/blank affect type of patient the OP described, for me anyway.
Yes, this is the behavior I am describing. I hope it's not my approach that is eliciting this response. I speak respectfully and always use "sir" or "ma'am." It is with the younger crowd. Now that you mention it, I can think of other cultures that I have seen this (white American). But I've had 3 black American patients this week that have displayed this behavior so I thought it was perhaps a cultural response.
Yes, this is the behavior I am describing. I hope it's not my approach that is eliciting this response. I speak respectfully and always use "sir" or "ma'am." It is with the younger crowd. Now that you mention it, I can think of other cultures that I have seen this (white American). But I've had 3 black American patients this week that have displayed this behavior so I thought it was perhaps a cultural response.
Do your coworkers see the same behavior from these patients? If so, it's probably not your approach and is just the patient.
I'm from Texas, and I'm as sweet as honey. It doesn't matter. Patients who behave like this do it in front of me and our less than sweet nurses too. In report it's usually passed along that the patient "has a blank affect, doesn't want to be bothered, is uncooperative with some assessments". Psych may or may not already be consulted, and there may already be a psych diagnosis know.
I don't think you should take it personally at all. Go with the flow. I will explain I need an answer to continue, and I usually then get one. If it's a physical assessment they are not cooperating with, I will briefly educate them to the importance, and document any refusal verbatim in the chart or, "patient not responding to nurses questions after repeated attempts, will let patient rest/have quiet time then reassess and attempt later."
Specializes in ED, Cardiac-step down, tele, med surg.
Like someone else said above, I think it's just rude behavior. I had an asian patient once and we had a mis communication and he did the same thing as you describe, ignore me and would not do anything I suggested. It was very weird. In these days of patient satisfaction, it's hard to address this in a direct way.
Specializes in Cardiology, Cardiothoracic Surgical.
I'm real with any folks like this "Look, I have x other patients to take care of as well, what do you want/need out of today/right now?" Especially if you're alert and oriented, and not in distress from your condition (doped up on pain meds, frustrated from cords/lines/etc.) I need you to communicate like the adult you are (thirsty? hungry? need to void? bored? etc.); my medical and nursing knowledge only gets us so far.
It usually doesn't take long for them to realize they have to participate in their care on some level.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I am white, so clearly cannot speak for black (not just "African") Americans, but honestly in 19 years' nursing, I have never run into this and I take care of many black American patients. They have always been polite.
If you are noticing this behavior from a large group of individuals have you considered that it may be your approach. I would just be careful in assuming that it is of a culture to be rude. As a black american I am telling you no that is not of my culture.
It's not an African American culture. African American here. This thread is really uncalled. It's really offensive. You shouldn't have specific. That's why we learn cultural competence in nursing school.
It's not an African American culture. African American here. This thread is really uncalled. It's really offensive. You shouldn't have specific. That's why we learn cultural competence in nursing school.
I don't think the posters underlying intention was to be offensive. I think they were just wondering if there are underlying behaviors from the culture like how we are taught in school that Asians sometimes are stoic. Op I think it means you might not have developed that trusting relationship with the patient. It's not a cultural thing. Whenever this has happened to me from people of all races and age groups I look at my approach. I also let them know all questions asked is to help me take better care of them. Simple.
With all due respect, I have worked in an area of this country that is extremely stratified and in which there was an appalling double standard for in patient care. A hospital in which people who are poor, uninsured, Black or Latino did indeed receive substandard care. These patients were mainly silent, suspicious and guarded due to institutional racism.
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0.adamantite
233 Posts
Yes, this is the behavior I am describing. I hope it's not my approach that is eliciting this response. I speak respectfully and always use "sir" or "ma'am." It is with the younger crowd. Now that you mention it, I can think of other cultures that I have seen this (white American). But I've had 3 black American patients this week that have displayed this behavior so I thought it was perhaps a cultural response.