7. Awareness of the ‘other’
CHAPTER OBJECTIVES
• Define and demonstrate a holistic awareness of the ‘other’
• State and understand who the ‘others’ are for health professionals
• Demonstrate awareness of necessary information to understand the ‘other’
• Appreciate the required elements for effective communication with the ‘other’, specifically respect, confidentiality and empathy
• Consider the physical aspects and obvious needs of the ‘other’ when communicating
• Demonstrate awareness of and skills in the use of validation, empathy, touch and silence to relate to the emotional aspects and emotional needs of the ‘other’
• Recognise the significance of the sexual aspect and needs of the ‘other’
• Understand and describe the impact of the cognitive aspects and skills of the ‘other’ (see also ‘A person who has decreased cognitive function’ in Section Four)
• Recognise types of communication for the ‘other’ who cannot use spoken words
• State the basic requirements for the use of alternative communication devices
• Relate to the possible implications of the social aspects and needs of the ‘other’
• Relate to the spiritual aspects and needs of the ‘other’.
The whole ‘other’
The consideration of the ‘other’ in the health professions requires consideration of the whole person (see Ch 9). The ‘whole’ person is a dynamic system in which every aspect of the individual affects and interacts with the other aspects simultaneously. The whole person contains five fundamental aspects: the physical; the emotional, including the sexual aspect; the cognitive; the social; and the spiritual (Brill & Levine 2005). It is important for health professionals to consider the needs associated with all aspects of the person. Consideration of the most obvious aspect of the ‘other’ while neglecting the less obvious aspects limits the potential outcomes of the health service.
The most obvious aspect of an individual is usually the physical one, because it is immediately noticeable. However, the other aspects of this dynamic system become obvious as the health professional relates to the ‘other’. Ignoring the less obvious aspects of the individual can adversely affect intervention outcomes. The emotional side of the vulnerable ‘other’ may dominate the person seeking the assistance of a health professional but may not be immediately obvious. If the emotional aspect of an individual dominates their functioning, it is important to address the issues causing the emotional distress either directly or by referral to an appropriate health professional. Resolution of emotional distress allows the ‘other’ to focus on the set goals of the relevant health profession rather than the dominating emotions. Recognition and willingness to relate to the sexual aspect of an individual may be essential in some health professions. In some cases, unconditional acceptance of the sexual preference of the individual is important for positive outcomes. As the health professional continues to relate to the ‘other’, the cognitive aspect of the person may become more obvious if there is a disability in processing cognitive information. Lack of ability or desire to collaborate is not always resistance. It may arise from lack of understanding because of decreased cognitive ability or limited language skills. The previous social and cultural experiences or background of the individual may be the least obvious and often the most significant aspect affecting expectations and outcomes for individuals. Experiences because of previous social interaction may affect the response of the ‘other’ to particular interactions with health professionals. Cultural norms can also influence interactions and thus awareness of cultural norms is essential when relating to ‘others’ from different cultures (see Chs 15& 16). An important aspect that can dominate the ‘other’ is the spiritual aspect of an individual. Many health professionals neglect this aspect but it may influence the motivation and interest of the ‘other’ and thus the outcomes related to the assistance of the health professional. All the above aspects of an individual contribute to the functioning and performance of the ‘other’. Consideration of each aspect by the health professional is potentially beneficial for the individuals seeking their assistance.
Who are the ‘others’?
Awareness of ‘others’ is important in any health profession. ‘Others’ include those seeking assistance as well as the various health professionals and supporting staff who provide the assistance. Those seeking assistance include the individual who requires direct intervention along with the carers, families, friends and, in some cases, guardians of that individual. Health professional colleagues include individuals from many health professions. Some of these health professionals may form a multidisciplinary team within the particular health organisation while others may contribute to fulfilling the needs of the ‘other’ from outside the organisation. Supporting staff are found in every health service and provide essential assistance to both health professionals and those they assist. These ‘others’ include the person who answers the phone and the person who cleans the floors and toilets. Their contribution is vital and it is important to recognise that their contribution is an equal part of the service of any health profession.
ACTIVITY
• List the various health professions that may also provide assistance to any person you might assist. Consider both government and non-government medical and alternative health services. Do not forget that the person might have feet, teeth, joints and various needs that health professionals outside the traditional medical model are best qualified to fulfil.
• List the various support staff that are necessary for the effective practice of your health profession. Remember the maintenance of the building and also the grounds if you use an outside area for intervention.
What information will assist the health professional in relating to the ‘other’?
Some types of information will be more relevant to some health professionals than others. For example, knowing the dominant hand of the individual seeking assistance is highly relevant for particular health professions whereas for others it is irrelevant. There are other types of information about the ‘other’ that are important regardless of the health profession. It is beneficial to know the abilities, age and gender of the person because this guides the expectations, practice and communication style of the health professional. For example, knowing their particular abilities might facilitate adjustment of expectations; knowing the age of a person allows the health professional to adapt their language level; and knowing the gender might guide the topic of conversation.
REFLECTIVE GROUP ACTIVITY
Try to remember a time when the messages you were given were too simple or too complicated, that is, when someone thought you knew less or more about a particular thing. Some examples could be when relating to a tradesman, a doctor, a mechanic or an astrophysicist – an expert in a particular area who continues to use their jargon or simplifies it when you actually understand.
• Discuss the feelings associated with this experience.
• Discuss non-verbal ways of responding to this situation and their possible effects – positive and negative.
• Suggest ways of avoiding inappropriate methods of communicating when practising as a health professional.
When communicating with the ‘other’ it is important to know the reason why the person is seeking assistance and, where applicable, the cause, condition or diagnosis that explains their need. It is important to know what they expect from the service of the particular health profession and to know the goals they want to achieve through intervention. It may be important to know their previous experience with health professions because this information may explain particular reactions. It may also be important to know their background and perhaps their interests. There are usually standardised forms specific to health services that provide a basis for questions to gather the required information. This type of information, while necessary, is not the focus of this chapter. The major focus of this chapter is the unseen needs of the ‘other’ particularly their emotional, sexual, cognitive, social and spiritual needs. Although perhaps considered obvious, the noticeable physical needs of a person can affect the reaction of the health professional and thus require brief consideration as well.
The purpose and benefit of respect
The aim of a health profession is to achieve family/person-centred practice and thus positive outcomes. Respect is essential in order to achieve both of these aims. Respect is more than an attitude or a value about viewing people from a particular perspective (Egan 2007). It provides the basis for appropriate ways of relating to the ‘other’ and requires particular behaviour (Sander et al 1997). The demonstration of respectful behaviour to the ‘other’ requires health professionals to respect themselves. Respecting the self protects the health and wellbeing of the health professional. It also maintains satisfaction and contributes to the fulfilment of both personal and professional goals (Purtilo & Haddad 2002).
Demonstration of respect requires commitment to competent communicative and interpersonal practice – ‘other’-centred practice. While the behaviours associated with demonstrations of respect are usually non-verbal, they are easily recognised as respect.
Defining respect
Respect is an underlying personal value that determines both attitudes and actions; as such, it is difficult to define. The following attempt to define respect combines various definitions of this value. Respect does not respond to a person positively merely because of their status or position/role in society. It is not about liking someone or admiring someone. Respect is an interest in and acknowledgement of the person, their viewpoint and their emotions (Stein-Parbury 2006). It assumes that everyone has innate worth and value (Egan 2007). Respect allows everyone to be themselves and to express themselves honestly without condemnation, ridicule or criticism (Long 1978). It does not impose personal values and thus expresses no judgement (Davis 2006). Respect believes in the potential of each person and provides the basis for action that assists in the fulfilment of this potential. It believes that each person is valuable regardless of appearance or action, past and present (Bergland & Saltman 2002). Respect values a person regardless of age, colour, racial group, position, uniform, state, relationship, social status or other characteristics. It gazes past the negatives and positives to the inherent worth at the core of the person (Purtilo & Haddad 2002) – a worth shared by all human beings.
REFLECTION
• What is your immediate emotional response to
– Someone who lives on the street wearing one set of torn dirty clothes who has all their personal possessions in a damaged shopping trolley
– Someone with a different sexual preference to you
– A local sports star
– A drunken person who offers you a drink
– A policeman
– A 58-year-old slightly overweight woman wearing a tight, short skirt and a singlet top, lots of cheap jewellery and heavy, poorly done make-up whose lipstick is not restricted to her mouth
– A Salvation Army officer?
• Do you have an experience or particular values that explain your immediate response?
GROUP ACTIVITY
• Suggest ways of overcoming any negative responses in order to demonstrate respect.
• What feelings arise in response to the following?
– I say what I think, it doesn’t matter what happens as a result.
– No-one tells me what to do. I make my own decisions.
– I don’t pay ‘board’ (contribution for food etc at home). I couldn’t buy designer clothes if I paid to live at home.
– I must be true to myself and do what I want to do.
– I do whatever I have to for ‘the good life’.
• Decide what is important to the person making each statement.
• Write responses to the attitudes expressed in the statements that demonstrate respect but do not necessarily agree with the statement.
Demonstrating respect
The following attitudes, characteristics or behaviours demonstrate respect: interest, warmth, friendliness, approachability, active concern, honesty, authenticity, responding to the needs of the ‘other’ and giving careful attention to those needs (Purtilo & Haddad 2002).
GROUP ACTIVITY
• Have each group member think about someone they do not respect – someone with different values and beliefs.
• While considering that person attempt to act with the following: warmth, friendliness, approachability, interest, active concern, honesty, acceptance, care and understanding.
• How easy is it to demonstrate these attitudes when you do not actually feel them?
• As a group, discuss whether the expression of the above attitudes appeared authentic and honest. What would make them authentic and honest?
It is not always easy to demonstrate respect even when there are shared values, beliefs and positive feelings towards someone. Thus, to demonstrate respect when the ‘other’ acts contrary to the values and beliefs of the heath professional can be extremely challenging. In such situations it is difficult to recognise the worth of the individual – to believe in the reality of that worth and to act according to that worth.
GROUP ACTIVITY
Discuss possible strategies that would overcome the barrier to demonstrating respect when relating to someone who you find difficult to respect.
The ‘other’ is vulnerable and thus responsibility lies with the health professional to demonstrate respect. It is imperative that the health professional behaves in a manner that communicates the ‘other’ is important – worthy of the investment of time and energy. Also important is acceptance of the person and availability for them regardless of their dysfunction, disfigurement or the demands on time. Rogers (1967) suggests it is beneficial to expect or believe that somehow the ‘other’ will be able to overcome the current challenges; that they will persevere and reach the established goals. In situations where the ‘other’ appears resistant and uncooperative it is important that the health professional demonstrates understanding of their perspective and feelings, assisting as necessary to achieve collaboration. While challenging, it is also important to demonstrate respect when personal values and expectations are different to those of the ‘other’. Respect does not mean that the ‘other’ can manipulate or avoid responsibility for their actions. Respect requires the health professional to challenge the ‘other’ to act to achieve the established goals of the intervention (Egan 2007). Respect is a foundation value that is essential for effective and positive communication in all health professions.
Cultural expectations
Demonstrating respect can cause difficulty for health professionals when relating to ‘others’ from particular cultural groups (see Chs 15& 16). Different cultures have a variety of expectations related to respectful behaviour and thus may expect particular behaviour in specific situations as a demonstration of respect. Some of these behaviours relate to non-verbal cues (e.g. eye contact; see Ch 12) or the use of particular colours in specific circumstances (Devito 2007). Other behaviours relate to specific actions when first meeting or seeing each other after an initial introduction (e.g. some cultures allow men to embrace and kiss in public, others have particular hand shakes, while others kiss twice or maybe three times on each cheek depending on the situation and the culture). Some cultures demonstrate respect according to gender and/or age and thus expect particular behaviours related to the gender and/or age of either the health professional or the person seeking their assistance. When working with people from different cultural backgrounds it is essential to seek information about attitudes and expected behaviour governed by and relating to respect (see Chs 15& 16).
Using names
The name of a person has particular meaning and generally identifies the person. Using the name of a person indicates interest and acknowledges the person as separate from other people. It indicates value and thus demonstrates respect. Asking a person the name they prefer is very important when first communicating. Individuals from particular generations or cultures prefer the use of their family name (e.g. Mr Thomas or Mrs Berk), finding the use of their given name offensive. Using the preferred name during subsequent communicative interactions continues to demonstrate respect and contributes to the development of a therapeutic relationship.
REFLECTION
• If you are in an unfamiliar place, how do you feel if someone greets you by using your name?
• What does this mean for a practising health professional?
Confidentiality
Confidentiality refers to keeping information within a particular context (Stein-Parbury 2006; see Ch 11). It is another way of demonstrating respect. All information about the person seeking the assistance of a health professional is confidential. Confidentiality involves keeping information private. The information, whether written or verbal, is available only to the people with the right to access that information (Higgs et al 2005). It is important that health professionals avoid sharing any information about the people they are assisting in any context except at work. It requires health professionals to restrict what information they provide, to whom they provide the information and when they provide it. Some of this information is kept in a medical record. Medical records should not leave the health service setting except for legal reasons. Taking a medical record home to complete an entry is never acceptable. Leaving it on a desk overnight may not be acceptable either.
When gathering information it is important to indicate to the person seeking assistance what information will be shared, how it will be shared and with whom it will be shared. Many healthcare services require the person seeking assistance to sign an informed consent form (see Ch 11) before commencement of services. These forms generally indicate who could receive information about the person (Higgs et al 2005).
Physical aspects of the ‘other’
A person who is seeking the assistance of a health professional and has obvious physical needs may or may not require specific action from the health professional. Someone in a wheelchair may require a clear passage to a particular destination or may feel more comfortable if the health professional sits to communicate with them rather than standing over them.
There are obvious physical characteristics of the ‘other’ that communicate particular information and it is important that health professionals be aware of their reactions to these characteristics. It may seem possible to assume the socioeconomic background of an individual by their designer clothing or the amount and type of jewellery they wear. However, it is important to remember that the vulnerable ‘other’ is seeking to present a particular image and that their clothing may in fact be an attempt to present a reality that does not exist. Assuming the socioeconomic background of a smelly ‘other’ with dirty and cheap clothing is equally dangerous. It is important that health professionals avoid making assumptions because of the appearance of the ‘other’ and remember to relate equally to the ‘other’ regardless of physical characteristics.
It is sometimes possible to assume the cultural and religious background of an individual because of their clothing; once again, however, it is necessary to take care when assuming anything about someone because of their appearance. Respect and professional training in the health professions guide appropriate responses to the physical appearance and physical needs of the ‘other’, and empower health professionals to respond appropriately to those needs regardless of the physical aspects.
Emotional aspects of the ‘other’
Validation
Validation is important for the ‘other’ who feels vulnerable and uncertain. It confirms the existence of their negative emotions and potentially allows the ‘other’ to acknowledge and accept the existence of these emotions. Acknowledging the legitimacy of the negative emotions is often difficult for the ‘other’ because they may feel confused and ungrateful (see the case study about ‘Eric’ later in this chapter). The process of validation requires the health professional to recognise the emotional cues of the ‘other’ and accurately name those emotions. This process, if performed sensitively, generally releases the ‘other’ to acknowledge those emotions with greater acceptance and less confusion. The ‘other’ often feels more able to express, understand and control the emotions after validation. It is important to note that validation does not indicate whether the emotions are reasonable or appropriate, it simply states the existence of the emotions. Health professionals indicate unconditional positive regard by i) separating themselves from their values and judgements (Rogers 1967); ii) recognising the emotion in the ‘other’; and iii) expressing awareness of the emotion – usually by asking a question relating to the particular emotion, but sometimes with non-verbal cues.
GROUP ACTIVITY
• In groups of four or five, choose five of the following emotions: happy, frustrated, excited, sad, devastated, unhappy, disappointed, confused, bored, sleepy, depressed, guilty, embarrassed, rejected, helpless, irritated, angry, ashamed, insecure.
• Have each member of the group simultaneously express the chosen emotion non-verbally.
• Consider the variations in the ways of expressing each emotion.
• Which of the emotions appeared to be expressed in a similar manner to each other? Why is it important to consider this when validating emotions in the ‘other’?
• List the different ways each group member used different parts of their body to express each emotion.
• Decide what each of these answers means for a health professional.
Clarification within validation
Bergland & Saltman (2002) state it is important to recognise that each individual has a unique communication style. Recognition and understanding of the communication style of the individual ensures positive communication outcomes. Accurate validation of emotions cannot occur without this recognition of individual communication styles. Different cultures, different social groups and different families multiply the variations in styles of communication. Therefore, in recognition of these variations, health professionals might request clarification of their perceptions rather than assume they have accurately recognised the emotional cues of the ‘other’. A request for clarification of the perception of the emotion is appropriate before recognising and validating an emotion. A question indicates the interest of the health professional in the ‘other’ and allows the ‘other’ to decide if they will admit or deny the presence of the emotion. If admission of the emotion follows, the health professional has the opportunity to empathise and explore the emotion with the ‘other’. If denial of the emotion follows then the health professional has lost nothing and is learning about the communication style of the ‘other’. In this situation, another question asking the ‘other’ to name the current emotion may or may not be appropriate. The health professional can then decide whether to pursue the presence of the emotional cues or to leave the ‘other’ to consider the question alone. The question may begin the exploration process of the emotions of the ‘other’ amidst their confusion and fear, and allow verbal exploration later. Strong emotions are inevitable in the lives of health professionals and those around them; denial of these emotions is unwise because the emotional cost is enormous (Davis 2006). Validation of strong emotions is necessary because it begins the journey of acknowledgement and resolution, both of which facilitate understanding and control of often overwhelming emotions.
Accurate validation requires the health professional to request clarification of the perceived emotions to facilitate honest communication. Such communication encourages the ‘other’ to honestly admit and consider the presence of the emotions. Validation prepares the ‘other’ for empathic exploration of their emotional responses. It is not always easy to be honest when considering emotions; however, honesty is essential for the achievement of positive outcomes.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
