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How do you confront racism from a confused, elderly patient?

When Una Adderley visited a nursing home she was shocked to witness aggressive racism from some of the patients towards foreign nurses ...

In our part of England, there is a desperate shortage of registered nurses willing to work in nursing homes. Consequently, our local nursing homes are heavily dependent on foreign nurses who have come to England seeking better paid employment. Although I have some significant concerns about the ethics of poaching such skilled labour from poorer countries, I share the nursing homes' gratitude that these nurses are willing to care for our frail elderly populations.

Of course, it's not always plain sailing. There may be cultural differences between practices, much as there would be if I applied my nursing skills in a completely different culture.  Sometimes language and comprehension is a problem and sometimes there is insufficient knowledge or skills for managing clinical conditions or treatments that are a rarity in the nurses' home country. However, with patience, willingness, persistence and humour all these problems can usually be overcome. 

Unfortunately though, one issue that seems impenetrable is the racism that I witness from some of the patients towards these foreign nurses.

Recently, I visited a confused patient in a nursing home. I had first met this patient two months previously and diagnosed a venous leg ulcer. The black African nurses were unfamiliar with our usual care, but we had delivered some training and the ulcer was healing beautifully. My second visit was to check progress and to support these nurses. Before we went into the patient's room, the nurses warned me that the patient could be a bit "rude".

As they had anticipated, the patient was very abrupt and aggressive towards the black nurses despite their gentle and polite care, but courteous to me. As the visit went on, I became more and more aware that what I was witnessing was a subtle form of racism. 

I felt helpless but felt I couldn't just pretend it hadn't happened. After we left the room, I turned to the nurses, voiced my suspicions and as a white person, apologised for what they were having to endure. Obviously, my response was completely inadequate, but I didn't know what else I could do. The older nurse smiled at me. "Yes", she said, "I tell myself that he's confused and doesn't know what he's saying, but he's probably just voicing what he's thought about us all his life."

Unfortunately, it's not only the patients who express concerns about "foreign" nurses. Nurses can also be deeply suspicious.

I don't think there's any easy answer for situations such as these (but I would be very grateful for any suggestions). In the meantime, the example of the Danish people during the Second World War provides food for thought.

Apparently, the reason so few Danish Jews perished was because the Danish people regarded their nationality above any issues such as colour or creed. Consequently, when the Jewish Danes were threatened by the Nazi invasion, the remaining Danish population pulled together to support them because the Jewish Danes were primarily Danish citizens.

We, as nurses, need to ensure that we offer all our nursing colleagues the same level of friendship and support, regardless of nationality, colour or creed. An added bonus is this also helps our patients get the best possible care!

Your comments: (Terms and conditions apply)

"Thank you for your feedback. The comments regarding confronting racist comments, even when the patient is confused, and using the critical incident system in such events was particularly useful food for thought. Thank you - Una Adderley

"I have not experienced overt racism but I do have some sympathies with the elderly patients who have hearing and or cognitive problems when their care is being given by a nurse from whatever foreign country whose accent is so strong that it is a barrier to communication, not only to those in their care but also those of us who are working alongsude them in delivering care. My mother-in-law had a great deal of difficulty in
understanding some of her home carers. The final indignity was when one of them repeatedly stole money from her purse. It has done nothing to improve her feelings of unease and the fact that she has to work so hard for two-way communication to be trusting and effective when a foreign carer visits her" -  Community Specialist Nurse and Daughter-in -law

"Sometimes you just get used to it as a nurse working in a neuro-surgical ward. A few hours post-op the patient can say a lot of racist remarks to you as a black nurse. Some may even apologise later if told what they had said and done to the 'black nurse'" - Name and address supplied

"I have not encountered racism but have witnessed colleagues experiencing this. I think that age and confusion is not an excuse. I think it is important that these nurses feel supported. On several occasions patients have made racist comments. My normal response is that I do not agree with their opinions and that I will not tolerate it. I have been lucky that this has normally stopped any further comments. In this instance this incident should be treated as a critical incident. I believe by not dealing with the situation this is a form of subtle racism as really you are saying that it is ok to have those beliefs and to treat the staff that way" - Name and address supplied

"Una's not alone in feeling inadequate and embarrassed by overt racism towards colleagues. Having moved from a multcultural environment in Essex where I was also a foreigner (being from Yorkshire) to Lincolnshire where racism is voiced openly. I am appalled by the attitudes of the elderly in particular" - Name and address supplied