Respect

1. Discuss the benefits of respect in the relationships in healthcare

2. Identify behaviors that demonstrate respect in relationships

3. Participate in exercises to build skills in demonstrating respect

Respect is like air. If you take it away, it’s all people can think about.

Patterson and colleagues (2002), as cited by Kaplan and colleagues (2010)

Recognizing the benefits of respect

Respect, the foundation of helping interventions (Egan, 2006), is the communication of acceptance of the client’s ideas, feelings, and experiences (Haber et al, 1997). When we show respect to our clients and colleagues, we are sending them the message, “I value you. You are important to me.” Together, warmth and respect form what is called unconditional positive regard (Stuart, 2009). When helpers demonstrate that they care in a nonpossessive way, they transmit unconditional positive regard. This means accepting others for what they are, not on the condition that they behave in a certain way or possess special characteristics. Respect for the client is part of maintaining the person’s dignity (Milika and Trorey, 2004; Griffin-Heslin, 2005).

Receiving respect makes people feel important, cared for, and worthwhile. These examples illustrate such reactions. Your co-worker tells you: “I love going to my new physician. Besides being a good clinician, she makes me feel so important. She’s on time for my appointments, her receptionist remembers my name, and she follows up on all my requests.” Your neighbor tells you about her recent experience with the nursing staff on the unit in which her husband is hospitalized: “The nurses are busy, of course, but they seem to have time to say ‘hello’ and pause for a few minutes to tell me something new about Jack. They never seem too busy for the little touches that make you feel so special. Not like the unit he was on before, where they scowled if you asked for something and gave you the impression that they didn’t have time for you.”

In contrast, when people do not receive respect, they feel hurt and ignored. For example, a middle-aged woman complains about the health unit coordinator on a busy hospital unit: “She didn’t even have the courtesy to raise her head to speak to me when I asked her where Dad’s room was. I might as well not have been there.” A nurse reports her frustration at the disrespect she encountered: “Boy, I’m glad I don’t work there! When I came down to borrow some syringes, the two nurses ignored me and kept on talking! It didn’t even register that I was in a hurry and needed the stuff quickly.” When people sense that they are not being treated with respect, they feel angry and rejected.

Experience shows that a positive correlation exists among respect, warmth, empathy, and successful treatment outcomes in psychotherapy clients. Indirect evidence supports the notion that respect, in terms of access to the desired physician, provision of convenient clinics, and reduced waiting times for appointments, has a beneficial influence on client compliance with the therapeutic regimen.

Moments of Connection. . .

Respect for the Sacred Relationships in Marriage

“I was the home health nurse for an elderly woman who was dying. Her husband was her primary caregiver. They had been married for more than 50 years and had always slept together. Now, however, the patient was sleeping in a hospital bed. One day the husband seemed more upset than usual. I asked him what was wrong and whether he needed more help. He began to cry and talked about missing her. I suggested he get into her bed with her and snuggle. He was afraid he would hurt her. I convinced him it would probably mean as much to her as it did to him. At the next visit she was comatose. He confided that he had gotten into bed with her the night before and slept all night with her. She had slept through the night without pain medication. He was so grateful I had made the suggestion.”

Showing respect to your clients

Respect is communicated principally by the ways nurses orient themselves toward and work with clients. The following ideas about respect reflect the philosophy of holistic nursing. To respect a client is also to have the humility to appreciate that the client is more than a set of symptoms classified as a disease. A person is body, mind, and spirit. These parts of the person are interrelated in such a way that the sum of them is greater than the parts, a whole with inseparable parts. “The whole is in dynamic interaction within itself, between and among other humans and with the universe. When all parts are balanced and in harmony, maximum well-being exists. Well being can exist in the presence or absence of physical ailment. Although health can be discussed in several ways—physical, social, emotional, cognitive, or spiritual health—to be truly healthy, one must experience a sense of well-being. An imbalance and disharmony within the human, human to human, and human to universe interfere with a person’s well-being” (Erickson, 2007, p. 140).

Thus, the effect of treatments, medicines, and nursing interventions is influenced by all parts of the person. A person who is sad may be pessimistic and not open to getting better. A person who has a positive attitude about life, believing that every moment is precious, may not consider a physical symptom or a diagnosis of a disease as the most important thing, the focus of life. This is the person who looks for meaning in illness, a way to reflect upon what is most important in a life limited in time but not in the quality of embracing joy in life even in small moments.

To respect a client we try to “develop an image and understanding of the client’s world, as the client perceives it” (Erickson et al, 1983, p. 254). “Through this process of ‘Modeling’ the nurse respectfully gains greater understanding of the client’s model or world view. Based on the client’s model of their world the nurse is then able to facilitate and nurture the individual in attaining, maintaining, or promoting health through purposeful interventions” (Erickson et al, 1983, p. 254). To respect a client is to appreciate that a person has an inherent ability to grow and become the most he or she can be, an inner voice or inner wisdom, self-care knowledge. To respect a client is to listen to what the person identifies as a need and to work to incorporate meeting that need into nursing care. To respect a client is to recognize the power of caring in the nurse–client relationship in which a “caring field” (Watson, 1979) is established . . . when the nurse and client connect on an energetic level . . . in caring moments . . . in a relationship that can “create new possibilities for the well-being” (Erickson, 2007, p. 150) of the nurse and client.

Although respect starts as an attitude, this mental outlook needs to be translated into behavior to demonstrate respect. A behavior that demonstrates respect is acknowledgment.

Acknowledging clients

Feeling respect for your clients is not enough. They will receive the message that you think they are important and worthwhile only if you deliver the message clearly and directly. The following list provides concrete actions you can take to show respect to your clients.

• Look at your client.

• Offer your undivided attention.

• Maintain eye contact.

• Smile if appropriate.

• Move toward the other person.

• Determine how the other person likes to be addressed.

• Call the client by name and introduce yourself.

• Make contact with a handshake or by gently touching the individual.

Acknowledgment means demonstrating your awareness of your clients as individuals. One nurse wrote about a touching experience with a man sitting in an intensive care unit waiting room across the hall from where she was struggling with paperwork. Seeing his sadness, she walked over to him, sat down, and asked if she could help. Receiving no response, she simply placed her hand on his and sat in silence with him. After a time of silence, he revealed that both his wife and his son had recently died and that now he had been asked to donate his son’s organs. The nurse told him she knew this was a difficult time for him and that she was there for him. After more silence, he told her he had made a decision, looked at her sadly, and left.

Moments of Connection. . .

Respect in Quiet Moments

“I work in an out-patient chronic pain center. We needed a piece of equipment that was unavailable, so I went to the intensive care unit to borrow the machine. The nurse told me I could take it from a room in which a patient had just died. I went into the room, which was very quiet, with no sounds of talking family or life-sustaining equipment. I stood in the quiet and honored that person who had died, saying a silent prayer. We face sadness, horror, and death, but in this quiet moment I felt peace, respect, and honor for that person—I felt a connection.”

Simple gestures may communicate feelings when words miss the mark (Taylor, 1994). Copp (1993) identified the waiting room as a place of “lost lessons” and comments that students of nursing could learn about the demonstration of caring by being sensitive to the “weary travelers” who have come long distances, the waiting relatives who feel unsure of how to care for the loved one at home, or the waiting friends or relatives who have put their own lives on hold to be there.

Showing respect involves using verbal and nonverbal skills. Looking at our clients or colleagues as they speak shows attention, but it is the quality of our facial expressions that reveals whether we are interested in what our clients or co-workers are saying.

In the United States, introductions are accompanied by a firm, brief handshake. This custom may not be the same in all countries from which clients or colleagues come. In some cultures handshaking is prolonged, and taking our hands away too quickly could be misinterpreted as rejection. Within reason, it is best to allow the client to end the handshake.

In addition, after opening acknowledgments are made, a period of small talk usually follows, during which impersonal and trivial subjects (such as the weather) are discussed to break the ice. Some cultures prolong this period of discussion.