Client who displays racist or discriminatory behavior
1. Create a scenario depicting an interaction between an NP and a client. Describe the setting and type of encounter.
Gary Jones is a 64-year-old male who presents with a generalized cough at a family medical clinic. Mr. Jones is a new patient and states he wants to establish care with a provider. The patient is informed that a nurse practitioner is taking new patients and is the only provider that could see him as a walk in, today. The patient agrees, is checked in at the front desk, and is asked to take a seat. A few minutes later, the patient is called in by the nurse practitioner’s nurse. After establishing vital signs, the nurse informs Mr. Jones that the nurse practitioner will be in shortly. The patient states, “As long as the provider isn’t of color, I am willing to see just about anybody”. The nurse tells the patient that the nurse practitioner is black and if he would like to get reassigned. The patient states “nah I’m just kidding; I have no problems with her skin color. I just need to feel better”. A few moments later the nurse practitioner comes by to introduce herself and to make sure that the patient is okay with her treating him. The patient reassures the nurse practitioner that he has no problem with her skin color and just needs to be examined. A few minutes into the physical assessment, Mr. Jones starts making racist comments towards the nurse practitioner’s skin color and is mocking her word for word. The nurse practitioner tells the patient politely over and over to stop mocking her and making offensive comments, but the patient continues. The nurse practitioner finally states, “Mr. Jones, I believe I won’t be able to further assess you nor establish care. I recommend you see another provider “. Gary Jones refuses care from any other provider at the family clinic and states ” I will never come back here! I am taking my business elsewhere “. The nurse informs the patient that the nurse practitioner is black and asks if he wants to be reassigned. According to the patient “I’m just kidding; I have no issues with her skin tone. I simply need to feel better “. A few moments later, the nurse practitioner arrives to introduce herself and confirm that the patient is comfortable with her treating him. The patient assures the nurse practitioner that he is not bothered by her skin color and simply needs to be examined. Mr. Jones begins making racist remarks about the nurse practitioner’s skin color and mocking her word for word a few minutes into the physical examination. The nurse practitioner politely tells the patient to stop mocking her and making offensive comments, but the patient persists. Finally, the nurse practitioner says, “Mr. Jones, I’m afraid I won’t be able to further assess you or establish care for you. I recommend that you see a different provider “. Gary Jones refuses to see any other provider at the family clinic and claims “I will never return here! I’m moving my company elsewhere “.
1. Describe the client’s challenging behaviors related to the topic assigned.
The patient’s challenging behaviors included the racist comments made to the nurse practitioner throughout their encounter. He did not stop offending the provider despite her telling him to stop continuously. He also continued to mock her throughout the physical assessment, making it challenging for her to do her job. The patient was unwilling to listen to the provider and was only interested in insulting her repeatedly.
1. Examine the potential impact of the client’s behavior on the client-provider relationship.
The potential impact of the client’s behavior on the client-provider relationship restricts the possibility of establishing care. The client’s behavior is disturbing and seems to be hateful towards the provider’s race. The client does not allow for the client-provider relationship to develop because he is continuously making uncomfortable remarks towards the nurse practitioner. This is concerning because the patient’s behavior does not aid in proper communication. If there is not effective communication between the client-provider, they cannot work together properly to ensure the client’s needs are met. This type of client behavior can also aid in diagnostic errors. Research has noted that diffcult client behavior can lead to misdiagnosing patients (Schmidt et al., 2017). The patient is noted to dislike the provider and does not communicate with her well. The provider cannot work with the patient nor can the patient work with the provider. No proper care could be established in this situation.
1. Analyze techniques to enhance communication with the client and address the client’s behavior.
Staying calm and asking open-ended questions can aid in understanding the underlying cause of why the patient may be having this behavior. Listening to the patient can also help determine what can be done to correct the problem and ensure that the patient feels comfortable in the situation. If the patient has a problem with a provider of color, another provider can be assigned. However, if the patient refuses further care and is unable to work with the current provider, there may be nothing that can be done now. The patient could, however, call back to the clinic when calm to see if he could be reassigned for later.
1. Create sample documentation for the encounter.
Gary Jones is a 64-year-old male who presents with complaints of a generalized cough. After introducing myself to the patient and ensuring that he was okay with me, seeing him as a provider today, I began to establish care. Upon the physical examination, the patient repeatedly made racial comments regarding my skin color. The patient also continued to mock me word for word during the physical assessment. The patient was told to politely stop the racial comments regarding my skin color and mocking me word for word. The patient continued this behavior making it exceedingly difficult for me to examine him. I informed the patient that with this difficult behavior, I would not be able to further assess or establish care. Recommendations were made to see another health care provider. Mr. Jones refused care from any other provider at the family clinic and stated ” I will never come back here! I am taking my business elsewhere! “. Unable to continue care. No follow-up needed at this time.
Schmidt, T., Schuit, S., Van, K., Daele, P., Bueving, H., Zee, T., Broek, W., Saase, J., & Mamede, S. (2017). Do patients’ disruptive behaviours influence the accuracy of a doctor’s diagnosis? A randomised experiment. BMJ Quality & Safety, 26(1), 19–23. https://doi.org/10.1136/bmjqs-2015-004109
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2nd respond……………………………..(faculty question)
As a health care provider in a multicultural area discrimination regarding race or gender happens. There are no clear guidelines in these situations. The patient has the right to choose their healthcare provider. Most large hospital systems provide cultural diversity classes for employees but sadly there are no such requirements for patients.
Despite most hospitals providing cultural diversity classes to employees, it is saddening to note that discrimination also occurs among healthcare professionals in the workplace. The United States (U.S.) Equal Employment Opportunity Commission (EEOC) reported 84,254 workplace discrimination charges in 2017 (Maglalang et al., 2021). Research also notes that most cases go unreported. People of color most often hold the lower wage healthcare occupations, such as nursing aid (Maglalang et al., 2021). Healthcare workers who have been discriminated against have also been linked to fatigue, insomnia, and hypertension (Maglalang et al., 2021). In a toxic workplace like this, who do you think needs to be held accountable?
Dealing with challenging patients is something that all health care providers will encounter. Each of us has been affected by life experiences that has shaped our personal beliefs and behaviors. We are all responsible to reflect on our own personal biases and hold ourselves accountable for our actions.
This is a tough subject to handle. In my experience, I have worked at several “zero tolerance policy” hospitals, but the policy does not seem to be followed. Patients will talk down to staff, and when reported, hospital management will cater to the patient rather than sticking to their “zero tolerance policy.” I believe that the organizational leadership will have to make more of a stand against racism, and stick to it, in order for change to occur. Organizational policies will have to be “enforced” rather than just “advertised” (AMA, 2019). This puts responsibly on the provider as well. When racist comments or situations happen, they need to be reported appropriately so they can be addressed.
AMA J Ethics. 2019;21(6):E499-504. doi: 10.1001/amajethics.2019.499.