Diversity Awareness in healthcare

[peacemover]

I am a hospital chaplain at a 500 bed hospital on the east coast. One of the areas that my department has been doing a lot of advocacy work on, in addition to patient and staff care, has been diversity.

About two years ago there was an unfortunate incident where a hospital staff member of color was advised not to enter the room of a patient whose husband was very prejudiced. The situation occurred over a weekend when the primary nurse manager was not there. Well-intentioned advice was perceived as discriminatory and it seemed to elevate what was already pre-existing tension. Some outside organizations got involved, and finally the administration called in a consulting firm that specializes in diversity training.

The entire administration- all the VPs, and directors first went to the training; and then all the nursing, clinical, and support staff went. The initial concern was about race (with the incident), but what I soon discovered when I attended the two day diversity awareness seminar was that the issue was much deeper than race.

What I discovered was that a lot of hospital employees felt that they were frequently disrespected or poorly treated based on their professional role or class. Nurses frequently reported feeling disrespected or interrupted by some physicians; housekeeping and plant operations staff felt that they were treated disrespectfully or not appreciated; a number of clinical associates felt demeaned in certain circumstances, and so on.

In the seminars we did a number of communication exercises and a few common patterns in organizational culture were explored. A few of them being:

-In group vs. out group (in-group being the group that calls a particular unit "home" for instance, vs. employees who make visits and/or travel around the hospital to do their jobs)

-Intent vs. Impact (i.e. the reality that what one intends to communicate can often be quite different from the impact that it makes on the person)

-Going along when it's wrong (i.e. "going along" or laughing, when someone on the staff makes a discriminatory joke or demeaning statement).

-overgeneralizing or ignoring diversity issues (i.e. when someone mentions a diversity-related challenge saying things like "I don't notice any differences between us," or "just get over it," or "Stop complaining," etc.).

-one straw too many (i.e. after repeated patterns of discrimination when a person can reach a sort of relational boiling point when they feel like they can't take it any longer)

These were just a few things discussed. Overall, the seminars and particularly the candid sharing that the nurses and other hospital staff members engaged in has helped me gain a lot more appreciation and sensitivity toward challenges that nurses and other hospital staff, as well as people of diverse backgrounds, face each and every day.

I know the other thread on the "isms" was closed because some people were not respectful, but perhaps some of you could share constructively, and respectfully about some of your experiences with diversity in the healthcare setting.

Impressions?

Insights for offering support for nurses and hospital staff in this area?

Resources that you have found helpful?

Thanks in advance.

Regards,

John

[Nurse Ratched, RN]

Somewhere here we've had lengthy discussions on the merits of not putting a staff member at risk when a patient makes a clear statement that they don't want (insert gender or race here) staff members caring for them.

Opinions have ranged between telling the pt basically to deal with it and we won't accomodate their prejudices, to acknowledging that a patient who already dislikes a staff member for no good reason (or some as-yet-unknown reason based on an association with an unrelated situation) is going to be more picky regarding the inevitable dissatisfiers that occur in a hospital setting. This puts the staff member at greater risk for litigation if something goes wrong. I suspect the latter is behind the well-intentioned advice that started the situation at your facility.

We can't control what comes in through our doors for treatment. We can do our best to respect and protect our fellow staff members. This includes management and those who actually have the power and authority to make decisions when these types of situations arise. Unless the powers that be actually back staff up, all the training and lip service will do nothing.

[peacemover]

We can't control what comes in through our doors for treatment. We can do our best to respect and protect our fellow staff members. This includes management and those who actually have the power and authority to make decisions when these types of situations arise. Unless the powers that be actually back staff up, all the training and lip service will do nothing.

Good observations, NR. As it turns out in this particular case, the policy that should have been followed by the manager was, in effect, to inform the patient that all caregivers on the interdisciplinary team are competent professionals who give and deserve respect. Also, that patients and family members cannot specify that caregivers of a certain cultural, ethnic, or religious background cannot care for them. If they cannot abide by this, then we will assist them with transferring to another facility, but we will not discriminate, or put our employees at risk.

The spur of the moment decision by that particular manager (who left the organization soon after the incident), was perhaps well-intentioned, but incorrect in retrospect. Unfortunately it subsequently led to a "one straw to many" sort of experience for many of the support staff of color.

Your points about "the powers that be" and the "lip service" are good points (albeit a bit cynical I think). In this case, though, the entire administration has committed themselves to investing in genuine change and in re-inventing the organizational culture so that sensitivity to diversity is a primary value. A primary value not only on paper, in mission statements and "lip service," but infused into who we are and how we function. Is there still a long way to go? Of course. But, the one positive that came out of that unfortunate incident was to serve as a wake up call for the administration that this was an underlying issue that was far deeper than they had realized.

So, I guess my reason for bringing it up here is to get a sense of how other nurses and hospital staff members have experienced diversity- either positively or negatively (in a constructive sense), and what hospital leaders need to learn in order to better address these issues.

In my nearly ten years of experience as a hospital chaplain I have gained deep admiration and respect for nurses, because you folks are tremendously compassionate and dedicated and also generally tell it like it is.

I look forward to any feedback or reflections that anyone has about this issue.

[pickledpepperRN]

I posted here a couple years ago about a patient who needed an intra aortic balloon pump (IABP) to perfuse his coronary arteries and support his blood pressure until he was sufficiently stable to undergo open heart surgery. The family had said they only wanted a white nurse caring for him. (They were on vacation from another state).

The charge nurse explained that the only available RN competent in the care of a patient on the IABP that night was black. She explained to this very intelligent and educated patient how the IABP worked. He and his son asked MANY questions. I think they knew more about cardiac anatomy, physiology, and the IABP than most physicians after that night.

After the 12 hour shift the patient and family requested that same black nurse to care for him every night particularly post op.

I know this is not always the case but this particular family was open to learning and their fears were lessened by her explanations and clear concern for the patient.

Once we had a male patient attempt to refuse a male nurse. This guy had thrown objects, dumped his meal tray on the floor, and even thrown a full bedpan at female nurses. He swore almost constantly when awake.

It was difficult because he had gangrene on his only foot after a BK amputation of the other. He had a reason to be angry. Plus diabetes and alcoholism complicated his care.

I cannot say it worked out well but he was no worse with a man then he had been with a woman. When he used insults the male RN his nurse answered, "I think you are too." They got through several shifts and the man was discharged.

[peacemover]

Interesting- particularly the first case you mentioned. It seems that in that case the barrier was overcome, in part, by making assurances about the competence of the nurse.

The second case seems a bit more ambiguous. It seems like he had a grudge against a lot of caregivers in general even though he specifically demanded a female nurse.

I guess the question I would ask in response would be where is the differentiation between non-compliance and discrimination, and what is the best response?

Regards,

J

[purplemania, BSN, RN]

I believe that "cultural diversity" is just another way of saying "Do unto others as you would have them do unto you". A little respect goes a long way.

[peacemover]

I think the "Golden Rule" as you quoted, is certainly part of it. (by the way, here is a poster with the golden rule in about 12 different faith traditions):

That is certainly a great place to start, but respect for diversity has to go further, particularly in our care for patients, to directly and proactively inquiring about specific cultural and/or spiritual needs that patients and families have that we need to be aware/respectful of in our care for them.

Similarly, with our healthcare colleagues, being respectful of diversity is vital.

Treating others the way we would like to be treated is a good place to start, but we also need to remember that the way we would like to be treated is perceived through our own cultural lens, so we need to allow others to educate us about how they would like to be treated (beyond the normal common and professional courtesy).

Peace,

J

[pickledpepperRN]

I think the "Golden Rule" as you quoted, is certainly part of it. (by the way, here is a poster with the golden rule in about 12 different faith traditions):

That is certainly a great place to start, but respect for diversity has to go further, particularly in our care for patients, to directly and proactively inquiring about specific cultural and/or spiritual needs that patients and families have that we need to be aware/respectful of in our care for them.

Similarly, with our healthcare colleagues, being respectful of diversity is vital.

Treating others the way we would like to be treated is a good place to start, but we also need to remember that the way we would like to be treated is perceived through our own cultural lens, so we need to allow others to educate us about how they would like to be treated (beyond the normal common and professional courtesy).

Peace,

J

Thank you for this. Especially,

"directly and proactively inquiring about specific cultural and/or spiritual needs that patients and families have that we need to be aware/respectful of in our care for them."

We try to do this on our unit. That way when our assumptions are not those of our patients and their families we can do our best to meet their needs. If we don't know what they are we cannot meet them.

[peacemover]

Thank you for this. Especially, We try to do this on our unit. That way when our assumptions are not those of our patients and their families we can do our best to meet their needs. If we don't know what they are we cannot meet them.

That is great to hear, SN! As I mentioned previously I have deep respect and admiration for hospital nurses, because you folks have such a multitude of vital responsibilities in caring for patients, and you folks fulfill that role by enlarge with great competence and compassion.

We actually asked the nurse directors to add a question to the nursing assessment that asks about cultural/spiritual needs that pts have while in the hospital. It is one way to proactively assess the needs, and also generate referrals.

Part of our challenge as chaplains, often times is that there is one of us to every 100-200 patients, whereas there is usually what- about one nurse for 3-4 patients. Very different roles and responsibilities, but my point is that we really appreciate and rely on referrals from our nurses to help us address spiritual and cultural needs effectively as soon as possible.

Thanks again for your insights, and if anyone has any other reflections/insights/suggestions in this area, I would look forward to hearing about them...

Peace,

J

[pickledpepperRN]

I want to thank hospital chaplains for their wonderful work.

Over the years we nurses have been helped as much as our patients.

At one hospital where i used to work we had a retired elementary teacher who was also a nun.

She was trained as a chaplain and was at the hospital all day. She was able to assist patients and families of many faiths and those with no formal religious ties.

Sister would come to our unit with a joke that gave us a laugh. Knowing how busy these were it was short and sweet. A smile and a laugh was so wonderful.

She is also a great listener. She helped in such a loving way when my father died.

I think I am a better nurse because of what I've learned from chaplains.

[peacemover]

I want to thank hospital chaplains for their wonderful work.

Over the years we nurses have been helped as much as our patients.

. . .

I think I am a better nurse because of what I've learned from chaplains.

That is great to hear. It is certainly a goal to be present and available to pts, families and hospital staff on a consistent basis- I think that sets a positive example and also lets the staff know that chaplains are there for them as well. I am glad your experience with pastoral care has been positive.

We do sometimes feel stretched in many different directions, particularly when there are multiple crises occurring simultaneously in different parts of the hospital, but we work together to address the needs as best we can, and somehow it all works out.

I am also sorry to hear about the loss of your father, SN. Losing a loved one is hard enough, but then to return to work in a hospital with so many people facing the uncertainties of illness must be an added challenge.

We also strive to offer support to our nurses and staff in times of crisis and loss. Whenever I hear that a staff member has lost a loved one or had a crisis, I will check in, to offer support, and if desired have a prayer or memorial service. If it was a hospital staff person, we will often have a prayer service right there on the unit, and then have a time of sharing/memorial service in the chapel.

I consider this an honor and privilege to work alongside such fine people of compassion and integrity. I hope I can approach their level of dedication in my daily visitation as I journey with them into the realm of suffering and healing.

I am on comp time today getting some things done, and catching up on correspondences, but I miss getting up there on the floors when my schedule takes me in other directions. There is a camraderie and deep sense of mutual respect among dedicated caregivers, that I have found to be deeply moving and reminds me of why many of us go into these lines of work- to help people in need of care and healing.

Peace be with you,

J