HOW DO. WE KNOW?
How Do People Respond
to Patronizing Speech?
Who were the investigators, and what was the aim of the study? Older adults who live in nursing homes face many difficulties with the way people talk to (or about) them. The concept of patronizing speech, discussed in the text, captures the essence of the problem. Ryan and colleagues (2000) decided to see how different groups of people (nursing home residents, staff, and community-residing older adults) respond when a nurse talks in a patronizing way to a resident, who then responds.
How did the investigators
measure the topic of interest?
A written description of the context of an interaction between a nurse and a resident of a fictitious Canadian nursing home was followed by an audiotape of a conversation in which the nurse reminded the resident that it was time to go to a craft activity. Respondents then answered a questionnaire based on the kind of response the resident gave to the nurse. Respondents rated the nurse and the resident separately on a list of 12 adjectives rating her competence ("From this conversation, I would say the nurse [resident] is [competent, respectful, likeable, and helpful]"), manner ("From this conversation, I would say the nurse [resident] is trying to be [polite, cooperative, in control]"), and similar ratings for control adjectives and appropriateness adjectives.
Who were the participants in the study? In Study 1, participants were 48 nursing home residents with no known cognitive impairment and 48 staff members. In Study 2, participants were 49 nursing home residents with no known cognitive impairment, 48 staff, and 48 community-residing older adults. Staff members were about 40 years younger than residents in both studies and about 33 years younger than the community residents in Study 2.
What was the design of the study? For the major project in Study 2, the design examined three groups (nursing home residents, staff, and community-residing older adults), three response styles by the resident (passive, assertive, and humorous), and two further styles by the nurse (continuing to patronize or shift to accommodating).
The conversation scripts had three different responses from the resident to the nurse’s patronizing statement ("Did we forget again, sweetie? It’s time for crafts!"). In one, the resident gave a passive response to the request ("I know it’s time to go. I’d rather not, but if you insist,
I’ll go"). In a second, the resident gave an assertive response ("I’ve already planned to watch my
favorite TV program, so I won’t have time to go today"). The third version had a humorous response ("I think I’ll just pass today. I’ve made more crafts in my lifetime than an overachieving Girl Guide group at Christmas").
In addition, there were two different versions of what the nurse said next: either continuing to be patronizing ("Now, now, I just know we’ll have a nice time. It’s important that we get out of our room for awhile, dear. You just have to give it a try!") or shifting to an accommodating style ("I can see that you are not eager today. But it is important for you to get out of your room for awhile. Mrs. Brown, please consider joining us").
Were there ethical concerns with the study? All participants were volunteers. Nursing home residents were screened for cognitive impairments. Because all participants were given the opportunity to withdraw and were given informed consent, there were no ethical concerns.
What were the results?
The nurse who shifted to an accommodating style was rated more positively, and respondents could clearly describe the differences between the nurse’s responses. However, nursing home residents were much more tolerant of patronizing speech. Patronizing speech was rated more negatively when the resident responded
173 CHAPTER 5
assertively, perhaps because the patronizing speaker appeared less appropriate in contrast. Interestingly, the assertive response did not elicit higher competency ratings.
What did the investigators conclude? The findings are
consistent with previous data showing that patronizing speech is not viewed positively. However, this study marked the first time that this rating was obtained as a direct result of a speaker shifting styles.
The tolerance of patronizing
speech by nursing home residents and the failure to rate assertive responses as reflecting higher competence is troubling and shows the degree to which a culture of dependency pervades many nursing homes.
ill-prepared to talk to family members who are frail, have trouble remembering, and cannot get around very well. The hardest part is trying to figure out what to say in order to avoid patronizing speech. However, visiting residents of nursing homes is a way to maintain social contacts and provide a meaningful activity. Even if the person you are visiting is frail or has a sensory impairment or some other type of disability, visits can be uplifting. As noted earlier in the chapter, high-quality social contacts help older adults maintain their life satisfaction. Here are several suggestions for making visits more pleasant (Papalia & Olds, 1995; adapted from Davis, 1985):
• Concentrate on the older adult’s expertise and wisdom, as discussed in Chapter 14, by asking for advice on a life problem that he or she knows a lot about, such as dealing with friends, cooking, or crafts.
• Allow the older person to exert control over the visit: where to go (even inside the facility), what to wear, what to eat (if choices are possible).
• Listen attentively, even if the older person is repetitive. Avoid being judgmental, be sympathetic to complaints, and acknowledge feelings.
• Talk about things the person likes to remember, such as raising children, military service, growing up, work, courtship, and so on.
• Do a joint activity, such as putting a jigsaw puzzle together, arranging a photograph album, or doing arts and crafts.
• Record your visit on audiotape or videotape. This is valuable for creating a family history that you
will be able to keep. The activity may facilitate a life review as well as provide an opportunity for the older person to leave something of value for future generations by describing important personal events and philosophies.
• Bring children when you visit, if possible. Grandchildren are especially important, as most older adults are very happy to include them in conversations. Such visits also give children the opportunity to see their grandparents and learn about the diversity of older adults.
• Stimulate as many senses as possible. Wearing bright clothes, singing songs, reading books, and sharing foods (as long as they have been checked with the staff) help keep residents involved with their environment. Above all, though, hold the resident’s hands. There’s nothing like a friendly touch.
Always remember that your visits may be the only way that the residents have of maintaining social contacts with friends and family. By following these guidelines, you will be able to avoid difficulties and make your visits more pleasurable.