Nurse’s Bias on Nursing Care
Communication and Diversity Assessment 2
The task
• This assessment task is designed to increase your awareness of the effect communication has on the safety and quality of an individual’s experience with the health care system, in this case, the experience of an Aboriginal person.
• Using your understanding of the interpersonal communication literature, you will complete an analysis of the consumers experience with the health care system. You are expected to support all components of your discussion with references (in-text and in the reference list) from scholarly, academic papers form journals and/or textbooks.
• What are the consequences of bias for a nurse’s ability to provide culturally safe and respectful nursing care for Aboriginal patients? Discussion should include reference to cultural safety and Indigenous cultural respect and how we can address any imbalance in our personal views and personal bias and our ability to provide non-judgmental and empathic and compassionate care to all our patients.
Impact of Nurse’s Bias on Nursing Care Sample
The Impact of Communication and Bias on Cultural Safety in Healthcare
There are well-documented disparities in healthcare between indigenous and non-indigenous populations in Australia which are often escalated by poor communication and misunderstandings. To mitigate these differences, there needs to be collaborative practices to eliminate all forms of bias mostly contributed to by ineffective communication (Power et al., 2015). Nurses and midwives often need to interact more with patients than any other healthcare providers and therefore need to refine their communication skills to deliver care that matches the expectations set by the Nursing and Midwifery Board of Australia (NMBA). Poor communication often leads to feelings of fear, mistrust and helplessness among patients. The purpose of this essay is to analyze the impact of communication and bias in the provision of culturally safe and respectful care with reference to the experiences of an Aboriginal healthcare consumer.
Story 1: Unconscious Bias
In the case presented, Angela is twice made by the healthcare providers to contemplate of her identity. In the first encounter, the receptionist says that although Angela has been ticked as an Aboriginal, she does not appear like one (UTS Health, 2016). The receptionist concludes that she could easily get away with being white. In the second encounter, a nurse echoes the words of the receptionist that Angela would easily get away with being white (UTS Health, 2016). The receptionist’s and nurse’s comments imply an unconscious bias (Cuellar, 2017). Unconscious bias “refers to personal biases that we are not aware of (Cuellar, 2017, p. 333).” This form of bias is usually as a result of embedded reasoning based on experiences, culture and individual backgrounds (Cuellar, 2017). Unconscious bias is a popular trend not only in the healthcare sector but in all social contexts (Williamson & Foley, 2018). The healthcare providers in this experience are judgmental and stereotypical (Power et al., 2018). The label that Angela could easily get away with being white was informed by the existing stereotypes held by a large section of the global population (Aronson, 2013). Communication in this scenario was inhibited by cultural differences. The healthcare providers did not recognize that not all people who portray certain characteristics have a white identity (Graham, 1999). Clearly, there was a communication breakdown in the scenario, and Angela did not take this lightly as she ended up being scared of the safety of her child.
Healthcare professionals need to be more aware of their values, attitudes and behaviours since any assumptions, biases and preconceptions have a negative impact on the delivery of patient-centred and culturally safe care (Levett-Jones et al. 2014). Increased consciousness would have helped the nurse and receptionist to be more empathetic in their communication. The Aboriginal Australians have a history of oppression and discriminations, and they should not be reminded of it through both direct and indirect inferences to white supremacy (Wotherspoon & Williams, 2018). Nurses should exercise compassion and respect when communicating with patients. They should be non-judgmental and avoid referring to people in a manner that can be interpreted as culturally unsafe or harassment (Nursing and Midwifery Board of Australia). People from varied cultures have individualized constructs of self (Markus & Kitayama, 1991). If the healthcare providers had taken into consideration the cultural differences, Angela would have been less scared and feel freer to seek help (Best & Fredericks, 2014). When nurses use culturally appropriate language, the patients feel more comfortable and willingly seek help.
Story 2: Trivialization of Illness
Nurses are required to adopt practices that uphold diversity and challenge beliefs which are based on assumptions (Kelly et al., 2014). In the second experience, the nurse at the triage is dismissive to Angela’s concern which implies a lack of nurse consideration is some facilities (Durey et al., 2011). In the encounter with the triage person, who is a nurse, Angela is treated dismissively, a practice which demonstrates a failure to apply patient-centred practice (Nursing and Midwifery Board of Australia). The nurse trivializes the illness of Angela’s son, denies her access to the emergency department and even calls the security on her. Many healthcare consumers are denied immediate access to care services which often leads to the escalation of their conditions (Kelly et al., 2014). Effective care is underpinned by the recognition that a patient’s view of illness is shaped by various factors including. Thus, healthcare providers should focus on an individual’s disease attribution (Pitt, Powis, Levett-Jones, & Hunter, 2014). Communication in this scenario was characterized by lack of empathy and probing skills and unwillingness to listen (Levett-Jones et al. 2014). Lack of listening skills among healthcare providers has a negative impact on the creation of trust.
Nurses should listen emphatically to healthcare consumers to ensure evidence-based care. Listening emphatically requires an individual to imagine what it would have been like being another person (Krznaric, 2015). Putting ourselves in the shoes of other people enables us to listen objectively, which boosts our understanding of situations. In healthcare, empathic listening is vital for patient-centred care and the creation of meaningful relationships with patients (Durey et al., 2011). All healthcare consumers would like their cases to be handled by care providers who are willing to listen to them and understanding. If the nurse had listened to Angela emphatically, he or she would have determined whether her son required emergency care.
The Impact of Bias on Cultural Safety
Cultural safety is a terminology mostly used in relation to Aboriginal healthcare which mainly implies adoption culturally favourable care practices. Bias refers to the conscious or unconscious partiality, prejudice or inclination against or for an individual or a group which contributes to unfairness (Williamson & Foley, 2018). Cultural safety refers to a practice in nursing and midwifery that takes into account the diverse needs of individuals (Nursing and Midwifery Board of Australia). The practice stresses the recognition of not only diversity and inclusion but also individual needs and preferences (CATSINaM, 2014). Bias in healthcare contexts results in poor health outcomes for the patients involved. It discourages healthcare consumers from seeking help and opening up to healthcare providers about their experiences which might inform their care (Cuellar, 2017). Seeking healthcare attention for people who have been exposed to bias, to some degree, intensifies the impact of inequity in their lives. The impact of bias in the creation of culturally safe care explains assertion that increasing the number of nurses from the Aboriginal descent will substantially contribute to ‘closing the gap’ (West et al., 2010). Bias, both conscious and unconscious, contributes to the creation and maintenance of culturally unsafe healthcare systems.
Conclusion
The experiences of Angela as a healthcare consumer imply that there is much that needs to be done in Australia to ensure culturally safe care practices. Critically, the experiences of Angela would be much better than those of other Aboriginal Australians. Angela, as an Aboriginal Australian is better placed, considering that she is educated and economically stable. Aboriginal healthcare consumers who are socio-economically vulnerable could have worse experiences. Reflecting on Angela’s experiences, there is a need for all healthcare providers to consciously engage in attitudinal and behaviour change to eliminate bias and provide culturally safe care.
References
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Best, O., & Fredericks, B. (2014). Yatdjuligin: Aboriginal and Torres Strait Islander Nursing and Midwifery Care. Port Melbourne: Cambridge University Press.
CATSINaM. (2014). Cultural Safety Position Statement. Retrieved from https://www.catsinam.org.au/static/uploads/files/cultural-safety-endorsed-march-2014-wfginzphsxbz.pdf
Cuellar, N. G. (2017). Unconscious bias: What is yours? Journal of Transcultural Nursing, 28(4), 333. 10.1177/1043659617713566
Durey, A., Thompson, S. C., & Wood, M. (2011). Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication. Internal Medicine Journal, 17-22. 10.1111/j.1445-5994.2011.02628.x
Graham, M. (1999). Some thoughts about the Philosophical Underpinnings of Aboriginal Worldviews. Worldviews: Environment, Culture, Religion, 3, 105-118. 10.1163/156853599X00090
Kelly, J., West, R., Gamble, J., Sidebotham, M., Carson, V., & Duffy, E. (2014). ‘She knows how we feel’: Australian Aboriginal and Torres Strait. Women and Birth, 27, 157-162. 10.1016/j.wombi.2014.06.002
Krznaric, R. (2015, March 2). Empathy with the Enemy. Retrieved from Daily Good: file:///C:/Users/user/AppData/Local/Temp/Rar$EX31.360/CAD%20assessment%202/relevant%20articles/empathy-with-the-enemy-roman-krznaric.html
Markus, H. R., & Kitayama, S. (1991). Culture and the Self: Implications for Cognition, Emotion, and Motivation. Psychological Review, 95(2), 224-253.
Nursing and Midwifery Board of Australia. (n.d.). Code of Conduct for Nurses. Melbourne.
Pitt, V., Powis, D. A., Levett-Jones, T., & Hunter, S. (2014). Nursing students’ personal qualities: A descriptive study. Nurse Education Today, 34(9). 10.1016/j.nedt.2014.05.004
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UTS Health. (2016, March 16). Interview with Angela. Retrieved from UTS Health: https://www.youtube.com/watch?v=lVISLhZKVMg&feature=youtu.be
West, R., Usher, K., & Foster, K. (2010). Increased numbers of Australian Indigenous nurses would make a significant contribution to ‘closing the gap’ in Indigenous health: What is getting in the way? Contemporary Nurse, 36(1-2), 121-130. 10.5172/conu.2010.36.1-2.121
Williamson, S., & Foley, M. (2018). Unconscious Bias Training: The ‘Silver Bullet’ for Gender Equity?: Unconscious Bias Training. Australian Journal of Public Administration, 77(4), 1-5. 10.1111/1467-8500.12313
Wotherspoon, C., & Williams, C. M. (2018). Exploring the experiences of Aboriginal and Torres Strait Islander patients admitted to a metropolitan health service. Australian Health Review, 1-7. 10.1071/AH17096