Complex Communication 1 Flashcards
What is Racism?
- Practices, and behaviours that establish, maintain or perpetuate the racial superiority of one racial group over another
- A multifaceted construct; includes individual attitudes, cultural schema, pre-existing consequential inequalities, and processes that create or maintain racial dominance
What is Race?
- A concept that is socially constructed and culturally enacted with no biological basis
Levels of Racism
1) Structural Racism
- the established hierarchy of groups based on perceived “race”
- the hierarchy was created to designate superiority to 1 group in order to benefit the oppression and exploitation of other groups
structural racism encompasses all the other types of racism
2) Systemic/Institutional Racism
- prejudice and privilege embedded in the policies, practices, and programs of systems and institutions, including the public, private, and community sectors
- representatives can act with or without racist intention
3) Interpersonal Racism
- the beliefs, attitudes, and behaviours of individuals based on bias, stereotypes, and prejudice
- expressions can be conscious or unconscious, and range from subtle to violent
4) Internalized Racism
- lies within individuals
- we accept inequity as normal
- people targeted by racism believe that the stereotypes and prejudices of racism are valid
- people privileged by racism believe their own superiority
What is Anti-Racism?
- An active process of changing attitudes, beliefs, practices and policies with the goal of dismantling systemic hierarchy and oppressive power
- The focus of anti-racism is acknowledging and addressing power inequities and systemic bias based on race and unearned privilege that is given to non-racialized people
1) Identifying and addressing racism within institutions
2) Taking targeted action to eliminate racism
3) Recognizing one’s role in promoting equity
4) Working to dismantle racist structures by addressing power inequities and systemic biases based on race
10 Ways to be Anti-Racist in Nursing
1) Become story catchers
○ Be intentional when hearing about other people’s experiences.
○ To hear is to learn and understand - which leads to empathy
2) Be genuine
○ Do what you say you will do
○ Keep your word – if you do not have trust, you can not establish a therapeutic relationship .
3) Manage me
○ Resist amygdala hijacking: where generalizations cause you to act out of previous fear and pain, thus letting emotions take control of your reasoning
4) Maximize curiosity. Minimize certainty
○ Ask yourself, “Why am I thinking this about this person?”, “Where did this originate from?”, and “Do I know what I think I know to be true?”
5) Distribute power
○ Give voice to, and support with action, those without power.
○ Minimize power plays in promotion, hiring, and patient assignments
6) Preserve the dignity of others
○ See the humanity in others
○ Are you viewing colleagues as a deficit to your team, rather than an asset and why?
7) Stop labeling others
○ See people as people
○ Eliminate ideas about superiority, inferiority, and where to place people on a hierarchy.
8) Expose unwritten rules
○ Examine your systems
○ Bias cannot be avoided so tweak your systems to overcome it.
○ Make adjustments based on what is going on in the world
9) Support authenticity
○ Allow people to be their authentic selves
○ Accept them with their differences
○ Don’t force people to lose their uniqueness.
10) Manage perception
○ Consider how your decision will impact or affect those not part of the decision process
○ Don’t get caught up in your own intent - the receiver only knows impact of what was done
How do you know if your language is racist?
- Is the language working metaphorically?
- If so, what are the implications behind the metaphor? Does it place a positive connotation on whiteness and a negative one on something else (usually blackness)?
- Does the language imply “otherness” and exclusivity?
- Can it be substituted for something clearer or more literal? (The answer is often yes - Think about what the term means and describe that)
- Are there any groups of people who could be harmed by this? Who and how so? (Thinking about who is affected deepens your understanding of anti-racism)
- Does the language make you uncomfortable, even if you can’t quite articulate the reason?
4 Steps of Anti-Racist Communication
1) Self-educate and acknowledge racial trauma
What identities do your clients bring to the interaction?
How might your clients be impacted by events in and beyond the healthcare system?
How might racial trauma affect your clients (and you)?
2) Interrogate your positionality and (un)conscious biases
- Develop awareness of the choices you make and how your perspective and positionality in society impacts those choices
○ What identities do YOU bring to client interactions, and how might these impact your clients?
○ What biases do YOU hold, unconscious or not, and how can you identify these in your nursing practice?
3) Recognize that everyone has an accent, even YOU
4) Adapt the environment to the client - don’t make the client adapt to the environment
Inappropriate communication from a client
- Racist comments are never excusable and need to be challenged
○ Addressing these remarks leads to greater understanding and respect between nurse and client - Helpful to determine where hurtful comments come from
○ Clients may be experiencing emotional, social and spiritual struggles in addition to physical discomforts
○ Unkind comments may be an expression of “inner turmoil or loss of control
How to deal with Inappropriate communication from a client
- Remain calm
- State how the comment makes you feel
- Shift attention back to the care client is receiving
- Follow up by inquiring if there is a way the team is not meeting the client’s needs or some way in which the client feels disrespected
- A stronger response to inappropriate communication: “I find your comment offensive. We are committed to showing respect to all our clients and we expect the same from them.”
Cross-Cultural Communication
-refers to the exchange of information and ideas between people from different cultural backgrounds
- Multicultural communication includes usage, use of words, phrases and non-verbal communication that may be interpreted differently
- Each time we communicate with a different culture, we do so from the worldview of our culture
○ E.g., Western culture tends to have an explicit and direct communication style
○ Do not assume there is one “right way” to communicate - Be aware of how a client’s culture may be impacting their health or management of an illness
- Listen actively and empathetically
○ Acknowledging potential historical events, oppression and mistreatment is crucial for successful communications
Communication Strategies that Impact Culture
1) Cultural Awareness
- the acknowledgement of difference
- does not consider political or socio-economic influences on cultural difference, nor does it require an individual to reflect on his/her own cultural perspectives
2) Cultural Sensitivity
- being aware of cultural differences and understanding the need to respect these differences
- recognizing the differences and similarities exist without assigning values
3) Cultural Competence
- a set of congruent behaviours, attitudes, and policies that come together to enable effective work in cross-cultural situations
4) Cultural Safety
- understand that we are all carriers of culture and the influence that on our work
- apply analysis of power structures and challenge unequal power relations
LEARN Model for Cross-Cultural Communication
L - LISTEN
○ listen with empathy and understanding to the clients perception of the problem
○ observe body language and non-verbal cues
○ allow client to lead conversation
○ consider client readiness for solutions
○ “What do you feel may be causing the problem”, “How do you feel the illness is affecting you”
E - EXPLAIN
○ Explain your perceptions of the problem
○ Offer explanations of “Western medicine” model
A - ACKNOWLEDGE & EXPLORE
○ Acknowledge what the client tells you and discuss differences
○ Ask questions to explore clients perspective
○ Identify enablers and barriers
○ find common ground - resolution of disagreement by bridging the conceptual gap b/w different belief systems
R - RECOMMEND, REFLECT, AND REASSURE
○ Recommend a course of action/plan
○ Ensure client involvement in treatment plan
○ Include cultural parameters when possible if appropriate to enhance acceptance of an adherence to treatment plan
N - NAVIGATE STRATEGIES TOGETHER
○ necessary to understand the clients perceptions to communicate your perspective
Interview Indigenous Clients
- Build Rapport
○ Needed to overcome distrust faced by this group who have faced years of marginalization by government services and systems
○ needed to ensure safety - Use clear (jargon-free) language
- Explain why you need to ask questions
- Double check meaning of words client uses (vice versa)
- Take time
○ do not rush the client
○ In Western culture, emphasis is placed on time to meet and deadlines. Time is perceived differently in Indigenous cultures, as more value is placed on family responsibilities and community relationships - Be mindful of non-verbal communication
○ Some cues used by Indigenous people have different meanings in Western context
○ Be mindful of own non-verbal cues
○ Personal space – standing too close can make the client feel threatened and uncomfortable - Use silence
- Avoidance of eye contact (gesture of respect)
- Be discrete, ensure privacy
- Allow client to consult with their family
- Ensure opportunities to ask questions
Language Barriers
- Be aware that the risk of miscommunication/ misunderstanding cannot be eliminated when HCPs and clients do not speak the same language
- Even if a translator is involved, always clarify the client’s understanding. (If you write important information for the client to refer to, make sure they can read and understand English)
- Translators may not be medically trained; familiarize yourself with the process for requesting and working with translators
- Ensure that the client is comfortable with the available translator. (Sometimes, there are cultural traditions that can affect the translation)
- Always speak to/address the client and attempt to establish a TNCR.
○Promote the client’s active participation in their care as much as possible to provide culturally safe care - If possible, identify staff who can speak other languages in the organization and may be available to assist with translations
- Be creative using various ways to communicate through gestures, drawings, dictionaries, google translate, etc.
○ Be aware about different cultural practices in relation to gestures and eye contact - Even with a translator, the client may not understand you and may not feel comfortable sharing information with you
Cultural & Linguistic Competence
- Clients have a right to culturally and clinically appropriate care delivery provided by the appropriate person in the health care team.
- Accepting and respecting cultural differences and adapting care to be congruent with the client’s culture should not result in nursing practice that would violate professional codes of ethics, nursing practice standards, legal frameworks or United Nations human rights conventions.
