FLORENCE NIGHTINGALE FOUNDATION
Preventing discrimination through role modelling
© 2015 MA Healthcare Ltd
T
he Equality Act 2010 set out protected characteristics (age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race, religion and belief; sex and sexual orientation) and yet discriminatory attitudes and behaviour continue in British society. Older adults, for example, encounter age discrimination, which is increased by other non-protected characteristics, such as low household wealth (Rippon et al, 2014). In the NHS Constitution (Department of Health, 2013), one of the values, ‘Everyone counts’, sets out that NHS staff should ensure that nobody is discriminated against on account of protected characteristics. Discriminatory attitudes and behaviour undermine the dignity of patients and prevent equitable and just care. In addition, people who regularly face discrimination within society may anticipate similar attitudes from healthcare staff, deterring them from accessing care in a timely way. Last month, we explored how nurses can play an important role in promoting equality of access to health care (Tod et al, 2015). Nurses who promote equity by displaying antidiscriminatory attitudes and behaviour can make a positive contribution to improving health access, as well as quality of care experiences. The stigma associated with certain health conditions increases the impact of ill health and social isolation. In 2015, the number of people living with dementia in the UK will reach 850 000 but negative attitudes towards dementia pose barriers to living well with this condition (Alzheimer’s Society, 2014). Dementia remains under-diagnosed, often because people delay seeking help in primary healthcare due to their fear of the diagnosis. ‘Dementia Friends’, the current high-profile initiative led by Alzheimer’s Society, aims to address stigma and support dementia-friendly communities. We can be hopeful that, with over 1 million Dementia Friends in society (as at March 2015), including the Cabinet, attitudes towards dementia may start to change. The initiative hopes to counter the media images of dementia frequently portrayed with the predominant language being negative and demeaning. Alzheimer’s Society argues that using the term ‘living with dementia’ instead of ‘dementia sufferers’ can help to redress the negativity, as indeed many people can live well with dementia for some time with support and understanding from communities. People with dementia are often living with additional health conditions or disabilities (Alzheimer’s
British Journal of Nursing, 2015, Vol 24, No 5
Society, 2014) and these lead to acute hospital admissions, where the care delivered for people with dementia is improving but is still variable (Care Quality Commission, 2014). Many other people, such as those who are obese or who have learning disabilities, may encounter negative attitudes within society; however they are less likely to have the benefit of large-scale campaigns to influence public opinion, such as Dementia Friends. People who face discriminatory attitudes in society often experience greater health inequalities too. For example, people who are transgender continue to face discrimination, which impacts on their wellbeing, and health. In a survey of people who are transgender, 58% had a disability or chronic health condition, 84% had considered ending their lives, and 35% felt unable to seek help. Many had also encountered negative and inappropriate attitudes from health professionals (McNeil et al, 2012). The report highlighted the need for transgender health and awareness training for healthcare staff to improve equitable access to health care. However, such recommendations attract little attention within the media or health policy. As nurses, we may encounter people who are transgender or have other potentially stigmatised features, such as obesity or an alcohol problem, in any care setting, community or hospital, and the attitudes and behaviour we display will influence their future health-seeking behaviours as well as their care experience. Nurses form a large sector of society and are the biggest group of health service workers, and so we have real potential to influence attitudes and behaviour and promote equitable approaches towards stigmatised groups, both within society and during healthcare delivery and education. Many nurses provide leadership and positive action as role models in promoting equitable care, through setting up supportive and welcoming services for people who encounter discrimination in our society and who fear similar attitudes from healthcare workers. Examples include healthcare for people who are transgender (see http:// cliniq.org.uk/), a Find and Treat service for people who have tuberculosis, many of whom are from marginalised groups in society (see http://tinyurl.com/9rd8ycf), and HIV/AIDS services (see http://tinyurl.com/hivhop). As a profession, we should celebrate and be proud of the achievements of such nurses who are promoting equitable care, reducing stigma and
improving access to health care. In addition, all nurses, in every setting, can help to tackle the subtle discrimination that can seep into everyday practice, as it does within society, through labelling of patients or implying that some are less deserving of care. Nurses can be alert to demeaning use of language, challenge discriminatory attitudes and role-model empathy. Within society and the workplace, nurses can rolemodel positive ways of talking about people to students, colleagues and the public. As key health professionals working with vulnerable groups, nurses who role-model equitable practice and challenge discriminatory attitudes and behaviour could contribute to reducing health inequalities in our society, as well as support dignified and person-centred care delivered with empathy and BJN kindness. Alzheimer’s Society (2014) Dementia 2014: Opportunity for change. Alzheimer’s Society, London. http://tinyurl.com/ lmw33wp (accessed 3 March 2015) Care Quality Commission (2014) Cracks in the pathway: People’s experiences of dementia care as they move between care homes and hospitals. http://tinyurl.com/qhfpdce (accessed 3 March 2015) Department of Health (2013) The NHS Constitution for England. http://tinyurl.com/d7sa3wq (accessed 3 March 2015) McNeil J, Bailey L, Ellis S, Morton J, Regan M (2012) Trans Mental Health Study. http://tinyurl.com/kx9tp2b (accessed 3 March 2015) Rippon I, Kneale D, de Oliveira C, Demakakos P, Steptoe A (2014) Perceived age discrimination in older adults. Age Ageing 43(3): 379-86. doi: 10.1093/ageing/aft146 Tod et al (2015) Addressing health inequalities by improving access to care. Br J Nurs 24(3): 137
Lesley Baillie, Christine Norton, Angela Tod, Christi Deaton, Lesley Lowes, Debbie Carrick-Sen, Candy McCabe Florence Nightingale Foundation Professors of Clinical Nursing Research
Elizabeth Robb
Chief Executive, Florence Nightingale Foundation
299
British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on December 1, 2015. For personal use only. No other uses without permission. . All rights reserved.
Preventing discrimination through role modelling
© 2015 MA Healthcare Ltd
T
he Equality Act 2010 set out protected characteristics (age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race, religion and belief; sex and sexual orientation) and yet discriminatory attitudes and behaviour continue in British society. Older adults, for example, encounter age discrimination, which is increased by other non-protected characteristics, such as low household wealth (Rippon et al, 2014). In the NHS Constitution (Department of Health, 2013), one of the values, ‘Everyone counts’, sets out that NHS staff should ensure that nobody is discriminated against on account of protected characteristics. Discriminatory attitudes and behaviour undermine the dignity of patients and prevent equitable and just care. In addition, people who regularly face discrimination within society may anticipate similar attitudes from healthcare staff, deterring them from accessing care in a timely way. Last month, we explored how nurses can play an important role in promoting equality of access to health care (Tod et al, 2015). Nurses who promote equity by displaying antidiscriminatory attitudes and behaviour can make a positive contribution to improving health access, as well as quality of care experiences. The stigma associated with certain health conditions increases the impact of ill health and social isolation. In 2015, the number of people living with dementia in the UK will reach 850 000 but negative attitudes towards dementia pose barriers to living well with this condition (Alzheimer’s Society, 2014). Dementia remains under-diagnosed, often because people delay seeking help in primary healthcare due to their fear of the diagnosis. ‘Dementia Friends’, the current high-profile initiative led by Alzheimer’s Society, aims to address stigma and support dementia-friendly communities. We can be hopeful that, with over 1 million Dementia Friends in society (as at March 2015), including the Cabinet, attitudes towards dementia may start to change. The initiative hopes to counter the media images of dementia frequently portrayed with the predominant language being negative and demeaning. Alzheimer’s Society argues that using the term ‘living with dementia’ instead of ‘dementia sufferers’ can help to redress the negativity, as indeed many people can live well with dementia for some time with support and understanding from communities. People with dementia are often living with additional health conditions or disabilities (Alzheimer’s
British Journal of Nursing, 2015, Vol 24, No 5
Society, 2014) and these lead to acute hospital admissions, where the care delivered for people with dementia is improving but is still variable (Care Quality Commission, 2014). Many other people, such as those who are obese or who have learning disabilities, may encounter negative attitudes within society; however they are less likely to have the benefit of large-scale campaigns to influence public opinion, such as Dementia Friends. People who face discriminatory attitudes in society often experience greater health inequalities too. For example, people who are transgender continue to face discrimination, which impacts on their wellbeing, and health. In a survey of people who are transgender, 58% had a disability or chronic health condition, 84% had considered ending their lives, and 35% felt unable to seek help. Many had also encountered negative and inappropriate attitudes from health professionals (McNeil et al, 2012). The report highlighted the need for transgender health and awareness training for healthcare staff to improve equitable access to health care. However, such recommendations attract little attention within the media or health policy. As nurses, we may encounter people who are transgender or have other potentially stigmatised features, such as obesity or an alcohol problem, in any care setting, community or hospital, and the attitudes and behaviour we display will influence their future health-seeking behaviours as well as their care experience. Nurses form a large sector of society and are the biggest group of health service workers, and so we have real potential to influence attitudes and behaviour and promote equitable approaches towards stigmatised groups, both within society and during healthcare delivery and education. Many nurses provide leadership and positive action as role models in promoting equitable care, through setting up supportive and welcoming services for people who encounter discrimination in our society and who fear similar attitudes from healthcare workers. Examples include healthcare for people who are transgender (see http:// cliniq.org.uk/), a Find and Treat service for people who have tuberculosis, many of whom are from marginalised groups in society (see http://tinyurl.com/9rd8ycf), and HIV/AIDS services (see http://tinyurl.com/hivhop). As a profession, we should celebrate and be proud of the achievements of such nurses who are promoting equitable care, reducing stigma and
improving access to health care. In addition, all nurses, in every setting, can help to tackle the subtle discrimination that can seep into everyday practice, as it does within society, through labelling of patients or implying that some are less deserving of care. Nurses can be alert to demeaning use of language, challenge discriminatory attitudes and role-model empathy. Within society and the workplace, nurses can rolemodel positive ways of talking about people to students, colleagues and the public. As key health professionals working with vulnerable groups, nurses who role-model equitable practice and challenge discriminatory attitudes and behaviour could contribute to reducing health inequalities in our society, as well as support dignified and person-centred care delivered with empathy and BJN kindness. Alzheimer’s Society (2014) Dementia 2014: Opportunity for change. Alzheimer’s Society, London. http://tinyurl.com/ lmw33wp (accessed 3 March 2015) Care Quality Commission (2014) Cracks in the pathway: People’s experiences of dementia care as they move between care homes and hospitals. http://tinyurl.com/qhfpdce (accessed 3 March 2015) Department of Health (2013) The NHS Constitution for England. http://tinyurl.com/d7sa3wq (accessed 3 March 2015) McNeil J, Bailey L, Ellis S, Morton J, Regan M (2012) Trans Mental Health Study. http://tinyurl.com/kx9tp2b (accessed 3 March 2015) Rippon I, Kneale D, de Oliveira C, Demakakos P, Steptoe A (2014) Perceived age discrimination in older adults. Age Ageing 43(3): 379-86. doi: 10.1093/ageing/aft146 Tod et al (2015) Addressing health inequalities by improving access to care. Br J Nurs 24(3): 137
Lesley Baillie, Christine Norton, Angela Tod, Christi Deaton, Lesley Lowes, Debbie Carrick-Sen, Candy McCabe Florence Nightingale Foundation Professors of Clinical Nursing Research
Elizabeth Robb
Chief Executive, Florence Nightingale Foundation
299
British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on December 1, 2015. For personal use only. No other uses without permission. . All rights reserved.
