Chapter 1 – Introduction to Communication and Communication Theory in Nursing
It is important for nurses to embody an anti-racist approach to communication. In order to do so, you need to first understand the concepts of race and racism.
Race has been systemically and historically constructed as a variable of difference, whereby people are ascribed to designated groups based on biology, culture, and/or other characteristics (Bakan & Dua, 2014). Racism is the ideology and practice of sustaining, maintaining and reinforcing difference based on race (Bakan & Dua), and it results in racialized persons being excluded from everyday points of access because of their race.
Anti-racism is the active process of changing attitudes, beliefs, practices, and policies with the goal of dismantling systemic hierarchy and oppressive power (Alberta Civil Liberties Centre, ND). An anti-racism approach involves:
- Identifying and challenging racism within institutions.
- Taking specific and directed action towards eliminating racism.
- Recognizing self as an agent for change towards equity.
The focus of anti-racism is acknowledging and working to address power inequities and systemic bias predicated on race as well as unearned privilege that is afforded to non-racialized people. Linked with racism is the concept of white privilege which refers to advantage afforded to those who are to non-racialized over persons of other racial backgrounds. It does not mean that every white person is rich, healthy, or living a lavish life. In a paper entitled “White Privilege: Unpacking the Invisible Knapsack”, McIntosh (2003) lists several daily occurrences that are privileged based on race. For example, when applying for a mortgage, skin colour will not bias financial credibility when non-racialized people are applying, but it can be a significant determining factor for those of other races. Recognizing white privilege can often be conflated with feeling guilty about race, but this is not the aim. The focus on individual guilt deviates the conversation and intention of anti-racism, which is ultimately to dismantle racist structures that subjugate and discriminate against racialized people.
Nurses play an important role in adopting and embodying an anti-racist way-of-being within their respective institutions. As a nurse, you must take an anti-racist approach in your practice and advocate on behalf of your clients when you see racism. As such, communication is essential to demonstrating anti-racism. It often begins with self-reflection and consideration for the perspective of others. See Case Study 3 for an example of an anti-racist approach to communication related to a racialized client.
Case Study 3
A nurse (RN1) receives report from a colleague (RN2). During the night shift, a client was admitted for generalized abdominal pain, and elevated blood pressure and heart rate. At this time, the etiology is undetermined, but the client is scheduled for a CT scan shortly.
RN 2: Hi Rita, it was a pretty quiet night. We just admitted a patient, I can’t even pronounce her name, in bed 2, for generalized pain. She says it is in her abdomen, but who knows what is going on. She’s giving me a lot of attitude, you know how it can be. If you ask me, I think we should have sent her home and told her to come back if things get worse.
RN1: Why is that?
Rationale: RN1 recognizes that there may be some underlying racist attitudes, and attempts to open up the conversation.
RN2: Well you know how these people are … they come to emerg for every little complaint, over-dramatizing everything. They don’t care about the costs of a visit to the emergency room.
RN1: Lorna, I’m uncomfortable with you referring to this patient as ‘these people’. Your tone and choice of words insinuates that because of how the client looks and their culture that we should dismiss their complaints about pain.
Rationale: RN1 states how they feel using “I” statements and specifically refers to the racist language that RN2 used. RN1 also uses direct language to identify passive actions of RN2.
RN2: Oh no, that’s not what I meant, I am not a racist, I was not trying to say it like that. I just meant that some people are more likely to take advantage of free health care than others.
RN1: I know this might be a difficult conversation to have, but referring to a client as “these people” and “taking advantage of the system” is racist, especially since you have attached it to the patient’s race and culture.
RN2: But that’s not what I meant.
RN1: It might not be what you meant, but the words you chose and the meaning are racist, and not acceptable. Considering our conversation, it would be good that I request our manager to organize a workshop for all of us about racism and language. Additional training will illuminate how language and beliefs like “taking advantage” are micro-aggressions that become pervasive and ultimately lead to poorer treatment and access to healthcare for racialized clients. It’s important to reflect on our communication skills and ensure we are not using oppressive language in our workplace.
Rationale: RN1 is very clear in identifying the communication as racist, but also doing so a respectful way. Even RN1’s language in inclusive in terms of the group responsibility when referring to “our” workplace.
It is important to embody an anti-racist approach to communication. It often begins with self-reflection and consideration of other peoples’ perspectives. This approach involves an active process of changing attitudes, beliefs, practices, and policies with the goal of dismantling systemic hierarchy and oppressive power. As a nurse, you must acknowledge and work to address power inequities and systemic bias predicated on race as well as unearned privilege that is afforded to non-racialized people.