Giving patients the space to talk about health issues will give them a better chance of health
We have it within our power to give people permission to speak and clearance to be heard - let’s use that power,” says Laura Serrant.
The professor of community and public health nursing and director of research and enterprise in the Faculty of Education, Health and Wellbeing at the University of Wolverhampton, is the developer of The Silences Framework, which highlights what Ms Serrant feels are the overlooked and overlapping silences in patients based on their demographic, life experiences and health conditions - primarily the health issues that are being left unsaid between the patient and healthcare professional.
One of the silences studies looked at the community support for prisoners who have general long-term conditions such as diabetes or high blood pressure and found that the silence is easy to see if one takes the time to look for it.
“We don’t provide the transition from being in the prison, diagnosing the condition, and helping them manage their condition once they’ve been released - yes they’re prisoners, yes they have offended, and yes we are concerned about their offending continuing, but by only focusing on their offences we disregard and silence the concerning aspects of their health.”
“Yes we are concerned about their offending continuing, but by only focusing on their offences we disregard and silence the concerning aspects of their health”
Ms Serrant urges nurses to consider the silences, or overlooked impositions patients may be experiencing when with them in practice.
“It’s important for nurses to hear what is being said by the patient. However, a nurse must also think about what is not being said - what we know to be true from previous experience with another patient. Often that information comes from the patient or the community they are a part of through their personal knowledge and their perspective that we do not have.”
The Silences Framework has four parts, and Ms Serrant intends to develop a fifth as a result of her colleagues’ and students’ applications.
“The fifth part will be about how one would put the framework into action,” she explains. “I believe it will be a reader or book - hopefully it will have chapters with contributions from my students and those who have experienced patients who feel silenced in some way, detailing what has and has not worked for them.”
Ms Serrant will be speaking at The Queen’s Nursing Institute’s Equalities in Our Health conference on 23 April, about the silences framework in relation to sexual health in black and minority ethnic communities.
“Sexual health is a universal experience and the ways we have addressed sexual behaviour in the past have not given all communities an equal chance at sexual health,” she says.
“For example, when HIV/AIDs rates were high, BME communities were stigmatised as high risk or high impact for HIV/AIDs. This certainly impacted many BME patients’ willingness to come forward to health professionals or friends/family so they could be treated, as they didn’t want to fill the stereotype.
“This is the epitome of the framework - when we marginalise any community regarding sexual health [or based on another predisposed condition], we put one silence on top of another.”
Ms Serrant suggests nurses and other health professionals break away from the “script” of questions that they ask and take the time to ask the patient, ‘Is there anything regarding what I am planning to do that may be a problem for you?’ or, ‘Is there anything else I should know regarding your feelings about this treatment?’ in acknowledgement to the proposed procedure.
She finds this gives her patients permission to express their position, and that when talking about a sensitive issue, often the patient may need to share things with a nurse that they may not have considered due to a difference in cultural background or other demographic factor between nurse and patient.
“Silence has the power to either give us or prevent us from having an equal chance of health. If we listen to the silences, we can be the catalyst,” she says.