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!

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

The thing that angers me the most is describing someone as being confused when the reality is that he or she may simply be hard of hearing. These individuals are not necessarily responding inappropriately, but are responding to what they thought they heard you say.

Labeling someone as confused in this situation could have a significant impact on prescribed medical treatment and add an unnecessary expense to the patient. We, as nurses, need to take (make) the time for clear communication before entering incorrect findings in the patients' files.

[WinterLilac]

The thing that angers me the most is describing someone as being confused when the reality is that he or she may simply be hard of hearing. These individuals are not necessarily responding inappropriately, but are responding to what they thought they heard you say.

Labeling someone as confused in this situation could have a significant impact on prescribed medical treatment and add an unnecessary expense to the patient. We, as nurses, need to take (make) the time for clear communication before entering incorrect findings in the patients' files.

I hadn't thought of hearing issues. Something else I will include. How often this occurs, someone is asked something, the person doesn't hear correctly and instead of ensuring they understand what was said, the consent is assumed implied. Gahhh, that used to make me mad!

[Scottishtape]

The thing that angers me the most is describing someone as being confused when the reality is that he or she may simply be hard of hearing. These individuals are not necessarily responding inappropriately, but are responding to what they thought they heard you say.

Labeling someone as confused in this situation could have a significant impact on prescribed medical treatment and add an unnecessary expense to the patient. We, as nurses, need to take (make) the time for clear communication before entering incorrect findings in the patients' files.

Yes! This is what I see happen most frequently. Just last week I took report on a patient who I was told was confused and unable to answer questions or even string a sentence together.

I go in to assess said patient and found that not only could he string sentences together, but he answered all my questions appropriately. I will say it took him quite a bit to answer, but that's all he needed; more time.

He he was not confused, he was just slow with speech. Yet, he had been inpatient at this hospital for almost a week with nobody even trying to communicate with him.

Solution: take your time. Do not rush the patient and allow them time to answer, instead of rushing to the judgement that they can't understand.

[KatieMI, BSN, MSN, RN]

This is a primarily US site, so experience in the USA might be different. But I can tell you first hand that in some areas, including where I live, it is a daily reality for many people. I once lost a job, was denied clinicals and was treated like dirt more times than I can remember just because I speak with noticeable accent. I also know several instances when nurses who were born and raised American were similarly treated after their speech became "defective" for purely medical reasons.

People who know that their speech is difficult to understand AND realize importance of communication often acquire skills which are difficult to imagine by those who do not have this problem. I can tell if a person I speak with can't understand me, either in person or over the phone. Funny thing, my accented, very slow speech really makes them listening much closer than usual, so there are situations I am asked to speak with a particularly malignant attending or "impossible" family because "they will hopefully listen and at last hear what they got to hear". Ridiculously, it usually works.

Another moment I take rather personally is the assumption that whoever speaks with an accent is a foreigner, with following "curiosity" about where this person came from, why did it happen, how comes that he is still there and more totally inappropriate personal questionings. It happens even between health care professionals who clearly do not realize how rude it sounds.

In my observations, nurses who have "speech problems" should think twice before accepting jobs in facilities which already have red flags for discrimination of any kind, such as:

- religious organizations - based;

- racial demographics is substantially different from surrounding area;

- claims to "no tolerance of discrimination" or "equal opportunity" expressed more than the mandatory phrasing on job application;

- 1 or more claim with EEOC over the last 10 years (public info);

- feeders for local high-ranked or high-prestige brick-and-mortar graduate programs;

- recent significant economic changes in the area (either way);

- area with history of ethnic/racial tension/discrimination.

[blondy2061h, MSN, RN]

I recently had a unit call me to complain that a patient was being difficult, because he wanted a form we were asking him to sign read to him. He couldn't read the form as the font was small and he was visually impaired. I read the form to him. He asked a few questions. He signed it. I was with him under 5 minutes. He was a bit gruff but I wouldn't say "difficult."

When using an intepreter, speak "through" the interpreter, not to the interpreter, except when you are speaking directly to the interpreter to explain the situation.

IE: "Good morning Mrs. Diaz. How is your pain today?" Correct

"Tell her good morning. Ask her about her pain." Incorrect

[WinterLilac]

I recently had a unit call me to complain that a patient was being difficult, because he wanted a form we were asking him to sign read to him. He couldn't read the form as the font was small and he was visually impaired. I read the form to him. He asked a few questions. He signed it. I was with him under 5 minutes. He was a bit gruff but I wouldn't say "difficult."

When using an intepreter, speak "through" the interpreter, not to the interpreter, except when you are speaking directly to the interpreter to explain the situation.

IE: "Good morning Mrs. Diaz. How is your pain today?" Correct

"Tell her good morning. Ask her about her pain." Incorrect

Impaired vision, another notable disability which is often overlooked in adequate communication. Have noted to include in my speech. You guys are freaking awesome í ½í±

Oh and yes, I agree to use interpreters as a tool not as the patient. Sometimes when using an interpreter, they are spoken to as if they are the recipient while the recipient is left out of the loop. This occurs a LOT doesn't it!

[WinterLilac]

This is a primarily US site, so experience in the USA might be different. But I can tell you first hand that in some areas, including where I live, it is a daily reality for many people. I once lost a job, was denied clinicals and was treated like dirt more times than I can remember just because I speak with noticeable accent. I also know several instances when nurses who were born and raised American were similarly treated after their speech became "defective" for purely medical reasons.

People who know that their speech is difficult to understand AND realize importance of communication often acquire skills which are difficult to imagine by those who do not have this problem. I can tell if a person I speak with can't understand me, either in person or over the phone. Funny thing, my accented, very slow speech really makes them listening much closer than usual, so there are situations I am asked to speak with a particularly malignant attending or "impossible" family because "they will hopefully listen and at last hear what they got to hear". Ridiculously, it usually works.

Another moment I take rather personally is the assumption that whoever speaks with an accent is a foreigner, with following "curiosity" about where this person came from, why did it happen, how comes that he is still there and more totally inappropriate personal questionings. It happens even between health care professionals who clearly do not realize how rude it sounds.

In my observations, nurses who have "speech problems" should think twice before accepting jobs in facilities which already have red flags for discrimination of any kind, such as:

- religious organizations - based;

- racial demographics is substantially different from surrounding area;

- claims to "no tolerance of discrimination" or "equal opportunity" expressed more than the mandatory phrasing on job application;

- 1 or more claim with EEOC over the last 10 years (public info);

- feeders for local high-ranked or high-prestige brick-and-mortar graduate programs;

- recent significant economic changes in the area (either way);

- area with history of ethnic/racial tension/discrimination.

Thank you so much for your comment, I've taken notes because it resonates so much with what I'm talking about.

[cleback]

To play the devils advocate, I think it's really hard to accurately assess someone's communication ability right from the beginning. I mean really, you have to engage them in meaningful conversation before that can happen, right? So I can see how people might want to assume the person has limited understanding from the start and adjust rather than start complex and move the other way. We've all had that experience when the other person responds minimally because we've assumed too much. Depending on what we have to say and how much time we have to get our point across, it may be better to assume a limited communicative ability.

Anyway, I do agree though that assuming someone has limited understanding can be insulting. I was a personal care attendant to a woman with physical disabilities. I helped her run errands sometimes. On our trips I found that if I was wearing scrubs, the store staff was more likely to defer to me for questions, even if she initiated the verbal exchange. I would have to redirect them to ask her. She always handled it with grace but it open my eyes to how people with disabilities are spoken to inappropriately.

[KatieMI, BSN, MSN, RN]

To play the devils advocate, I think it's really hard to accurately assess someone's communication ability right from the beginning. I mean really, you have to engage them in meaningful conversation before that can happen, right? .

Try to do deliruim screen with the wrong order of questions, wrong combination of letters or tasks from MMCE (count 10 back). Give enough time to answer.

[TheCommuter, BSN, RN]

Another moment I take rather personally is the assumption that whoever speaks with an accent is a foreigner, with following "curiosity" about where this person came from, why did it happen, how comes that he is still there and more totally inappropriate personal questionings.

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.

[Libby1987]

I love accents and didn't realize it was so offensive to comment on or ask about them.