Racist comments can be both discouraging and hurtful for a caregiver. They shift the focus from the quality of the care you provide to who you are as a person in a way that dishonours both. One way of responding is to make a simple statement about how the comment makes you feel and then shift the attention back to the care the patient is receiving. For example, you might say something like, “I find your comment hurtful and wonder if you made it because you are unhappy with the care we are providing.”

If a patient makes a racist comment about another staff member, your response may be stronger if you start by saying something like, “I find your comment offensive. We are committed to showing respect to all our patients and we expect the same from them.” You could follow this up by asking if there is some way the team is not meeting the patient’s needs or some way in which the patient feels disrespected.

A climate of respect in health care settings begins with the staff. Health care providers who are committed to respecting cultural, ethnic, gender, racial, sexual orientation and religious diversity create a non-discriminatory environment. They model for patients and families healthy and productive ways to relate when giving and receiving care.

However, it is overly optimistic to think that you can create a caring environment in which patients or family members never make discriminatory comments that are insulting or hateful. Although racist comments are never excusable and need to be challenged, you might find it helpful to determine where the hurtful comments come from. At first glance, a patient’s remarks may seem to simply reflect intolerance and bigotry, forces that are still at work in our society. However, there is probably more going on.

Patients receiving end-of-life care are in a situation where their lives are limited by illness. They are likely experiencing not only physical discomforts, but emotional, spiritual and social struggles. So, they may be demeaning to others because they are scared of their situation and of those caring for them. Unkind comments to caregivers may be as much an expression of inner turmoil and a loss of control as evidence of a bigoted character.

Providing opportunities for the patient and the family to share how the illness is affecting them may deepen their understanding of the health care team’s role and decrease their tendency to say nasty things. A referral to a social worker or spiritual care provider may also be helpful, giving them an opportunity to discuss the impact of the illness and how it affects their relationships with caregivers.

If your individual efforts to stop a patient’s racist comments are not successful, you may need to discuss the situation with your care manager. Options for further action could include:

• a conversation between the manager and the patient about the responsibilities of both staff and patients for maintaining respectful relationships;
  
• mediation by the manager of conflicts between the patient and staff members; and as a last resort
  
• transfer of the patient’s care to another staff member.

Racist comments can erode your job satisfaction, self-confidence and compassion as a caregiver. If left unaddressed, they can taint all of your caregiving. Responding to racist remarks directly can be difficult, but addressing them head on can lead to greater understanding and respect between you and your patient.