Treating residents/patients like idiots

[Mirai Kangofu]

While I was doing CNA clinicals, I've found that so many people talk to elderly people like they're idiots. I'm talking about the people who use excruciatingly s-l-o-w, simple speech in a loud tone while speaking about 6 inches from their faces, even if they're not hard of hearing or demented, and repeating themselves and asking "O-o-o-kay?" every 5 seconds. I certainly wouldn't like being talked to like that. It reminds me of when insensitive people are talking to foreigners by talking very loudly and slowly while pantomining, even if the foreigner can speak the language. It also irritates me when people feign absolute surprise and adoration when talking to children, making ostentatious gasps and extolling for the simplest things. I talk to all patients respectfully and clearly, only resorting to slow speech at a high volume when it's clear that they can't understand me. Has anyone else witnessed such behavior?

[casi, ASN, RN]

Actually, I was referring to some of the other people in clinicals, as well as the teen volunteers who would come around. Most of the staff were pretty respectful and would converse with the residents in their normal voices, repeating or slowing down as needed. It's one thing to slow down your speech a little bit to give time for your words to be understood. It's another thing to sound like a voice recording played at half speed while deliberately using broken English. My point is better illustrated by this comic.

My nursing instructor is the model I use for conversing with patients and residents. She always treated the residents with dignity, and was a great conversationalist. She spoke German, Spanish, and English, and could always brighten someone's day. She didn't slow down as much as she simply emphasized. There was nothing fake or insultingly obsequious about her manner of speaking.

You have a talent that I admire you for. One of the hardest things for anyone new in patient care is trying to hold a conversation. We all have certian private aspects to our lives that we don't know how to open up to conversation. Have you really ever contemplated what you would want someone to say to you if they asked you if you had to go to the bathroom, or if they were going to help you change your soiled clothes?

I'm currently a CNA and I remember clinicals. I was like a scared little bunny who mainly just watched, I was even like this for most of my training for my current job. I'd watch everyone else to see how they interacted. I was bad at just jumpping in and doing things because I didn't know what language was appropriate and was a bit afraid of how people would respond to having me, a complete stranger helpping them.

Now that I have been working as an aide for over a year it's a completely different story. I know how to approach people and have seen the many different responses that they can give me and am comfortable with handling anything negative.

On the note of term of endearment, I find myself using them on occassion. I think that a big thing is when your working in any environment where you work longterm with a person, you become attached and comfortable with addressing eachother differently. I've been working with many of the same residents for a year now. Hugs and affection really don't bother me. The connections I have with my residents is amazing, I never thought a possition such as this would be so rewarding.

I've had a nights where I was working my unit alone, had to send someone to the hospital and the paramedic almost had me in tears due to their rudeness. I kept my composure and went on with my rounds. While helpping one resident back into bed she grabbed my head and plantted a kiss on top of it. Almost like she knew what I needed. Another resident I had, I had to call out the paramedics due to low Blood Sugar that we weren't able to handle as we don't have a liscensed nurse on at nights and he was only semi-responsive. I was somewhat distressed because he just wasn't doing to well at all. Once they got him sugared up he looked across the room and pointed at me and told the paramedics "That's my girl." So if I accidently call them sweety, dear, or some other name that shows my affection, I'm not going to fret over it.

I can understand the concerns in a short term setting. If I'm spending the night at the hospital, and I'm not comfortable with those kind of terms and a nurse I've never met before in my life starts calling me sweety, I might be a little uncomfortable. I'd also be uncomfortable if they refused to call me anything but Ms. ________. What I think it comes down to is we have to address the resident or pt. as they want to be addressed. One of the aides I use to work at use to work with a resident that insisted that everyone in the facility called her Mama D. and they respected that.

[grannynurse FNP student]

You're very entitled to your opinion. I'm sure your ignoring people or asking them to call you by name works for you.

I automatically respect my patients and treat them with respect. I'm not trying to earn their respect if after intimate care and establishing a rapport I say "hon or sweetie". I often get called sweetie by patients too. Especially when I go above and beyond and they notice and appreciate it.

I have always tried to move beyond formalities, and at the very least get on a first named basis with patients if I can. Especially as I age and a lot of patients are younger than me, I ask their permission to call them by their first name. Saying seeing like "hon, sweetheart, partner, good friend, even 'dude"" is my nature. It's not disrespectful. Never upon first meeting do I use terms of familiarity, maybe even not the first day we're together. But if I give you a bath, discuss your personal life, your bowel movements, etc. and we've established a rapport and like each other, then I move beyond the formalities of Ms. So and So. If someone can't tell by my actions and demeaner the sincerity and think it's disrespectful, then that's o.k. It's how I choose to relate. I always appreciate another opinion and will respect that however.

You may think and treat your patients with respect despite calling them sweetie or hon. Have you ever asked them what they prefer? I seriously doubt that many would tell you they prefer to be addressed by their name because they would not want to risk making the wrong choice or being 'labeled'. You ae not a relative and in most cases, not even a close friend. Most nurses bemoan the lack of respect they precieve not receiving but they persist in addressing their patients in terms that they define as endearment, something that quite a few of their patients do not.

Grannynurse:balloons:

[nurse4theplanet, RN]

You may think and treat your patients with respect despite calling them sweetie or hon. Have you ever asked them what they prefer? I seriously doubt that many would tell you they prefer to be addressed by their name because they would not want to risk making the wrong choice or being 'labeled'. You ae not a relative and in most cases, not even a close friend. Most nurses bemoan the lack of respect they precieve not receiving but they persist in addressing their patients in terms that they define as endearment, something that quite a few of their patients do not.

Grannynurse:balloons:

The more I read some of the responses, the more I believe this has alot to do with culture. As many people have said, in the south this is a very common thing from both pts and nurses...I have been call hon and sweetie by nearly ALL my patients. I could get my panties in a wad and insist they call me Nurse so-and-so, but what is that going to accomplish? It may even offend then and hinder open therapeutic communication. If I had a pt that did not want to be referred to in such a manner, then I would speak accordingly. But I do not run across that very often. Does this mean I think my patients are ignorant? H*** no! That's just silly. Do I see it as a term of endearment? Depends on how well you know the pt. Do I have to be a family member to be endearing to my pt? Again, H No. Is this form of address part of my southern culture? I would say yes. If I travel outside my area, I realize that I will need to be conscious of this difference.

[irishnurse67]

I am a person. I am an indvidual. Anyone who addresses me as sweetie, hon or any other term of supposed endearment gets ignored by me. My name is on my chart and you get it during report, as well as it being placed in my room. You want my respect, as your patient, then start treating me with respect, including proper use of my name. And if I am confused, what makes you think I will respond better to being called hon or sweetie? Not on the best day of your life. It is not a term of respect and unless you are a loved one of mine, it certainly is not a term of endearment.

And any physician who calls me sweetie also gets ignored.

Grannynurse:balloons:

I know it's wrong, but sometimes I hear myself call a patient dear or sweetheart. I've never had one get upset, but I still try to refrain from doing it. I don't do it to talk down to patients, it's just that I tend to have that mother hen instinct click in! However, when I have patients call me dear, honey, sweetheart, etc. I feel that they are just trying to be nice, no harm intended. Maybe I'm just getting old. Nah, my hair is getting gray and my glassed are getting thicker for some other reason!

[DusktilDawn]

Actually it is possible to even make a person's own name (ie: Mr. Smith) sound condescending and disrespectful if that is what the speaker intends. Tone, volume, inflection, context, and non-verbal cues also play a role in communication.

I don't get offended when patients or their families refer to me a "dear," "sweetie," "honey," etc since it has rarely been used by them as a means of being disrespectful or condencending. BTW, I've even heard the title "nurse" on numerous occassions used in a disrespectful and condecending manner, sometimes it has even been used as a put-down. Personally I tend to make a point of using a patient's name during conversations to establish the point that they are not just a room number or a diagnosis. This doesn't mean I've never called a patient "dear," or "sweetie," it means that it is not done to be condescending or disrespectful. Sometimes these terms are used when we are trying to be that comforting shoulder or sympathetic ear.

[pannie]

And there are regional differences as well. Here in the south, I am called Honey by random people on a regular basis- for example, the bank teller, my Charge RN, and one recent waitress. Honey, sugar and such are in common usage, so they often get used for patients as well, but in areas where a bank teller would not say- there's your money honey...it probably is a no-no...

I do admit though, it is difficult for people to remember that these people were/are productive citizens- some with really interesting lives. When I did clinical at a very ritzy nursing home, the staff life specialist had done up these posters in each room- they described the patients former occupation, family, and many had photos of them as younger selves, doing activites they enjoyed. It was great to see these, and reallyt sparked some talk, helped me to see many patients with alzheimers and constant repetitive behavior and speech as a "real person"

What a great idea! I'm filing that away since I'd like to volunteer at a nursing home.