Case Application: Mireille Ndjomouo

Mireille was clearly feeling a sense of powerlessness; her voice and her own knowledge of her health needs were not respected.

How might Mireille’s story have been different?

Here are a few strategies to consider when engaging in an inclusive assessment with Black clients as offered by Dr. Nadia Prendergast, a nurse scholar who focuses on anti-Black racism research:

1. Be mindful that experiences with racism in society and the healthcare system affect responses to healthcare professionals. The historical injustices of a 200-year tradition of slavery have caused multigenerational traumas that can make Black clients distrust individuals and interventions within healthcare systems (Kennedy et al., 2007). This distrust may lead them to perceive assessment questions as intrusive. Black clients’ historical experiences with the healthcare system may make them reluctant or abrupt in answering some questions. Some healthcare professionals may view this as aggression – you should avoid perceiving this reluctance as aggression. Instead, explain your reasons for asking the questions and reassure confidentiality. Gauge whether it is safe to ask about their previous experiences with the healthcare system, as this may be seen as interrogating. If the nurse had considered Mireille’s experiences with racism, outcomes might have been different. Try to break down any potential or apparent barriers with consistent acceptance, friendliness, genuine care, and patience.
2. Be aware of your own assumptions about Blackness. Blacks share the common experience of oppression resulting from slavery and present-day racial injustices, but they are not a homogenous group. Media and common myths have led to false perceptions of Blackness, including the false idea that Black people do not feel pain because their nerve endings are different. For example, pain is the most disabling symptom of sickle cell disease, but physicians often deny pain medication to Black sickle cell disease clients, seeing them as drug seekers or drug addicted (Bergman & Diamond, 2013). A Black male youth presenting with pain and asking for morphine might be perceived and treated as a drug addict, when he is actually having a sickle cell crisis. This kind of incorrect assumption can lead to improper assessments and care, as with Mireille. Always invite Black clients to share their own knowledge. Being willing to learn from the client creates an equitable environment for healing. Culture is exercised and interpreted differently by everyone, so it is unrealistic for you to learn everything about other cultures; instead, try to come from a place of recognition, awareness, and desire to dismantle racism.
3. Be attuned to your own biases about Black clients. Systemic oppression has worked to influence perceptions of Blacks as primitive and unintelligent (Smiley & Fakunle, 2016). Linked with this are biases around people who speak with an accent as being perceived as not intelligent or being less intelligent, as well as the use of gesticulations and loud voice volumes as being signs of mental health, violence, and uneducatedness. These biases can affect how you engage with Black clients – and even when not intentional, Black clients may interpret behaviours that are dismissive and judgemental as racism. Racism manifests in our biases about racialized people as lesser beings, and therefore, less deserving of the respect and human honouring that are important aspects of an inclusive assessment. Remember that racialized clients are also assessing you as the nurse. It is vital that you actively strive to be anti-racist as opposed to merely claiming that you are not racist. You must always be conscious of your own biases, and in this context, especially about Black intelligence. You should respect the knowledge that Black clients bring to health assessments. In Mireille’s case, her knowledge of her penicillin allergy was not respected.

References

Bergman, E. J., & Diamond, N. J. (2013). Sickle cell disease and the “difficult patient” conundrum. The American Journal of Bioethics, 13(4), 3–10. https://doi.org/10.1080/15265161.2013.767954

Kennedy, B. R., Mathis, C. C., & Woods, A. K. (2007). African Americans and their distrust of the health care system: healthcare for diverse populations. Journal of Cultural Diversity, 14(2).

Smiley, C., & Fakunle, D. (2016). From “brute” to “thug:” The demonization and criminalization of unarmed Black male victims in America. Journal of Human Behavior in the Social Environment, 26(3-4), 350-366. https://doi.org/10.1080/10911359.2015.1129256