Treating people and communicating with them as individuals in their own right is at the heart of providing dignified and respectful care. Communicating recognition of that individuality means that there is a need to recognize any prejudices that nurses may have and work to eliminate them. Stereotypes are widely-shared gener- alizations about members of a social group and these generalizations are highly sim- plified, often derogatory and often associated with prejudice. They may be based on, and lead to, ageism, sexism, racism or other kinds of negative discriminatory atti- tudes and behaviours. Many prejudices are deeply rooted and not always amenable to eradication by rational argument, and particularly where this is the case, nurses need to guard against acting on them. To do so would lead to discriminatory be- haviour, which is both against the law and in violation of the NMC Code (2008).
The reader may wish to refer to The Equality and Human Rights Commission, established in 2007, which provides a useful source of information. Its aim is to end discrimination and harassment of people due to disability, age, religion or belief, race, gender or sexual orientation (see www.equalityhumanrights.com).
Patient perspective
‘I could tell by her attitude that as soon as the practice nurse looked at my notes and saw that I was only 17 years old, she thought “another teenage mother”
and from that moment on she assumed I was a waste of space and would be a rotten mum.’
Health professionals constantly need to communicate with each other about the patients in their care. Although such communication, both oral and written, is vital, it can also be a vehicle for passing on stereotypes and prejudices. By listening to handovers or communications between health professionals you may come across the use of stereotypes and ‘labels’ for particular groups or so-called ‘types’ of patient.
This is a shorthand that professionals may slip into, often without any ill intent.
However, these labels can lead to inequalities in service and care. For example, professionals may carelessly use labels such as ‘bedblocker’, ‘difficult patient’, ‘ old dear’ or ‘timewaster’, and anyone unfortunate enough to be given such a label may be treated in accordance with the label as opposed to their own individual needs and personality. If part of being treated with dignity is to be treated as an individual, then acting on the assumptions that accompany stereotyping and labelling may achieve the opposite.
Reflection point
r What are the labels that are sometimes used when describing patients or relatives in your clinical arena?
r How are they used?
r What assumptions do they lead to?
r Do the labels predispose the patients to different levels of care?
One example of a negative stereotype associated with older people is the view that they are all confused, vulnerable, childlike and needy. These attributes may be true of some individuals (of any age), but to apply this stereotype means that all older people are assumed to have these characteristics and are approached in a way that is both inappropriate and condescending. Sometimes stereotypes will pop into our heads and it would be foolish to claim that they never do, but we can and should make concerted efforts to reject them and ensure that practice is never based on them.
Conclusion
It is essential that we think about patients and how healthcare professionals re- gard and treat them. People become patients, but still remain people throughout their journey with disease and illness towards health or death. Patients need to be regarded as fellow human beings rather than simply ‘someone with a medical prob- lem’. There are a number of points that are important to remember when caring for people:
r Health professionals need to communicate in ways that convey that they value the patient or carer as an individual person who deserves to be treated with dignity and respect, and to do this even in the most difficult and trying circum- stances.
r It is essential for nurses to develop skills to assess their own verbal and non- verbal communication. Self-awareness is the first step to improving the way in which we convey dignity and respect to patients and colleagues and is the basis for developing and communicating empathy for others.
r Communicating dignity and respect must include consideration for the patient’s personal space, privacy and their right to confidentiality.
r Listening and being sensitive to the verbal and non-verbal cues offered by pa- tients and carers is crucial in conveying dignity and respect.
r Humour can be a wonderful aid to communication but it can also be dangerous.
Taking the lead from the patient is safest when making judgements as to whether humour is appropriate.
r As an important part of being treated with dignity is to be treated as an individ- ual, the assumptions that accompany stereotyping and labelling other people are to be avoided at all costs.
References
DH (Department of Health) (2003) The Essence of Care: Patient-focused Benchmarking for Health Care Practitioners. London: DH.
Elaswarapu, R. (2007) Dignity in care for older people in hospital – measuring what matters, Working with Older People, 1(2): 15–19.
NMC (Nursing and Midwifery Council) (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives, www.nmc-uk.org.uk (accessed 11 March 2010).
Walsh, K. and Kowanko, I. (2002) Nurses’ and patients’ perceptions of dignity, International Journal of Nursing Practice, 8: 143–51.
Whitehead, J. and Wheeler, H. (2008) Patients’ experience of privacy and dignity, Part 2: an empirical study, British Journal of Nursing, 7(7): 458–64.
Wilmer, H.A. (1968) The doctor-patient relationship and issues of pity, sympathy and empathy, British Journal of Medical Psychology, 41(3): 243–8.
4 Using technology to communicate
Sarah Kraszewski
This chapter explores the issues concerning effective communication using tech- nology. It includes exploration of synchronous and asynchronous means of com- munication, the use of mobile devices and the use of technology to facilitate the delivery of healthcare. Examples and episodes of care are included to encourage reflection upon the use and impact of technology on the lives of patients and pro- fessionals.
Learning outcomes
By the end of this chapter you should be able to:
1 Recognize the importance of using information technology (IT) in modern healthcare.
2 Learn how to communicate appropriately using the telephone and email.
3 Understand the use and abuse of mobile electronic devices.
4 Understand how to use the internet as an effective learning resource.
Introduction
Developments in IT in recent years have exerted an extensive and complex influ- ence on the ways in which human beings interact with each other, from both a personal and professional perspective. There are many ways to connect us together.
Modern healthcare depends upon communicating information and requires nurses to develop and refine their communication skills using technology. Information needs to be collected and utilized in reliable and robust formats to enable safe and effective usage. Access to patients and other healthcare staff can be facilitated face to face, but also via technology such as the telephone and email. A bewildering array of websites is available to access information on any given symptom or illness and patients may often arrive armed with their research and their inter- pretation of a diagnosis. This makes the skill of communicating via technologies and the dexterity of finding and using evidence-based resources essential for the nurse. This chapter aims to highlight the skills needed to support effective care
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utilizing commonly available communication technologies and to provide a brief overview of the national programme for information technology, ‘Connecting for Health’.