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Psychologists are teaching health care teams to identify and address microaggressions - 心理学家正在教导医疗团队识别和解决微攻击
Psychologists are teaching health care teams to identify and address microaggressions - 心理学家正在教导医疗团队识别和解决微攻击
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Psychologists are teaching health care
teams to identify and address
microaggressions
心理学家正在教导医疗团队识别和解决微攻击
Proactive training is the key to effective handling of subtle forms of discrimination—as well
as avoiding them in the first place
积极主动的培训是有效处理微妙形式的歧视以及首先避免歧视的关键
Date created: July 1, 2023
By Heather Stringer 希瑟·斯金格报道 创建日期:2023 年 7 月 1 日 10 min read
Vol. 54 No. 5
第54卷第5期
Print version: page 76
印刷版:第76页
Racism, Bias, and Discrimination Gender 性 Race and Ethnicity 种族和民族 Socioeconomic Status 社会经济地位
种族主义、偏见和歧视
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As public awareness of systemic racism has intensified since the murder
of George Floyd in 2020, psychologists are seeing increased openness in
clinical care teams to learn about microaggressions—subtle statements,
actions, or incidents that are unintentional or intentional forms of
discrimination against members of a marginalized group.
微攻击在医疗保健中很常见,会导致团队成员感到价值降低,更不愿意分享临床意
见。许多人不愿意表达对与种族、性取向、社会经济地位或性别有关的轻视的担
忧。反过来,这可能会损害患者护理。“当团队成员感到退化和不舒服地与同事和
患者互动时,重要的临床信息可能会丢失,”弗吉尼亚州圣路易斯医疗保健系统的
临床心理学家Veronica Shead博士说,他进行微攻击的团队培训。
By leading discussions about different types of microaggressions, the
impact on patients and team members, and how to address the incidents,
psychologists are pioneering culture change in health care systems.
“Microaggression education is not focused on dismantling systems but
improving them,” Shead said. “And providers want to feel equipped to
deliver the best care possible.”
通过引导关于不同类型的微攻击、对患者和团队成员的影响以及如何解决这些事件
的讨论,心理学家正在开创医疗保健系统中的文化变革。“微攻击教育的重点不是
拆除系统,而是改进它们,”Shead说。“提供者希望有能力提供最好的护理。
While taking time for microaggression training may seem difficult in a
hospital’s fast-paced environment, research suggests that delaying these
discussions can have significant effects on patients and providers.
According to one review paper, studies conducted from 2007 to 2020
showed that microaggressions in the United States and Canada were
associated with anxiety, depressive symptoms, low self-esteem, and
suicidal ideation (Spanierman, L. B., et al., Perspectives on Psychological
Science, Vol. 16, No. 5, 2021 (https://doi.org/10.1177/17456916211019944) ). “If
patients are coming to treatment for an ailment and they experience a
subtle microaggression, this could compound the presenting problem,”
said Lisa Spanierman, PhD, a professor of counseling and counseling
psychology at Arizona State University who studies microaggressions. In
the studies, microaggressions were also linked to back pain, hypertension,
insomnia, and stomachaches among targets of the discrimination.
虽然在医院快节奏的环境中花时间进行微攻击训练似乎很困难,但研究表明,推迟
这些讨论会对患者和提供者产生重大影响。根据一篇评论论文,2007 年至 2020
年进行的研究表明,美国和加拿大的微攻击与焦虑、抑郁症状、自卑和自杀意念有
关(Spanierman,L. B. 等人,《心理科学透视》,第 16 卷,第 5 期,2021
年)。“如果患者来治疗疾病并且他们经历了微妙的微攻击,这可能会加剧呈现的
问题,”亚利桑那州立大学咨询和咨询心理学教授Lisa Spanierman博士说。在研
究中,微攻击还与背痛、高血压、失眠和胃痛有关。
For health care providers, studies suggest that workplace mistreatment
such as discrimination increases the risk of burnout and suicidality (Ehie,
O., et al., Current Opinion in Anesthesiology, Vol. 34, No. 2, 2021
(https://doi.org/10.1097/ACO.0000000000000966) ). One study of more than
7,000 surgery residents showed that roughly one-third reported
discrimination based on their self-identified gender and 16% reported
racial discrimination (Hu, Y., et al., The New England Journal of Medicine,
Vol. 381, No. 18, 2019 (https://doi.org/10.1056/NEJMsa1903759) ). Factors
such as depression, job dissatisfaction, and physician burnout have been
associated with suboptimal care practices, including medical errors.
对于医疗保健提供者,研究表明,歧视等工作场所虐待会增加倦怠和自杀的风险
(Ehie,O.等人,麻醉学当前意见,第 34 卷,第 2 期,2021 年)。一项针对
7,000 多名手术住院医师的研究表明,大约三分之一的人报告了基于自我认同的
性别的歧视,16% 的人报告了种族歧视(Hu, Y. 等人,《新英格兰医学杂志》,
第 381 卷,第 18 期,2019 年)。抑郁、工作不满和医生倦怠等因素与次优护理
实践有关,包括医疗错误。
While much of the literature on microaggression intervention focuses on
helping the target respond, this sends a message that the target is solely
responsible for addressing harmful behavior, said Roxanne Upah-
Crenshaw, PhD, a clinical psychologist in the VA Greater Los Angeles
Healthcare System who provides training related to microaggressions
throughout the Veterans Affairs (VA) system.
虽然许多关于微攻击干预的文献都集中在帮助目标做出反应上,但这发出了一个信
息,即目标全权负责解决有害行为,弗吉尼亚州大洛杉矶医疗保健系统的临床心理
学家Roxanne Upah-Crenshaw博士说,他在整个退伍军人事务部(VA)系统中
提供与微攻击相关的培训。
“This can create heaviness and stress for targets, which can lead to
burnout,” she said. “This ultimately affects productivity and staffing
turnover.” By teaching a team about microaggressions, colleagues who
witness the incidents learn to support patients or team members who are
targets. Discussions about these subtle forms of discrimination are often
eye-opening for team members, and the benefits have a positive ripple
effect on the work environment, patient satisfaction, and the quality of
care.
这会给目标带来沉重和压力,从而导致倦怠,”她说。“这最终会影响生产力和人
“
员流动。通过向团队传授有关微攻击的知识,目睹事件的同事学会了支持作为目标
的患者或团队成员。关于这些微妙形式的歧视的讨论通常会让团队成员大开眼界,
其好处对工作环境、患者满意度和护理质量产生积极的连锁反应。
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向医疗保健团队传达的一个重要信息是,没有人能免受这些偏见的影响,哥伦比亚
大学师范学院心理学和教育学教授,微攻击研究先驱Derald Wing Sue博士说。
“这些信念是如此根深蒂固,以至于它们通常在我们的意识意识之外,”他说。“对
于个人来说,探索他们所怀有的偏见是有价值的。在他的新微干预工具包(PDF,
233KB)中,Sue概述了一种称为“隐形”可见的策略 - 将微攻击带到人意识的最前
沿。这允许目标或旁观者以非威胁性的方式表达正在发生的事情。策略包括要求澄
清陈述,例如“你到底是什么意思?”或“我没听错吗?”或提醒肇事者规则,例如
“我们在这里不容忍或宽恕这些类型的行为”。
[ 相关:解除和消除微侵略的策略]
Upah-Crenshaw started increasing awareness about microaggressions at
the VA in 2020. She partnered with Shead to present a national webinar to
geriatric mental health providers who often worked in interprofessional
teams in geriatric units. After the first training, other departments and
specialties from VA health care facilities around the country started
inviting them to speak. “We were getting traction, which suggested that
this was a hot-button topic that had not been formally addressed in
academic or DEI [diversity, equity, and inclusion] employment training,”
she said.
患者对提供者的歧视是医疗保健中微攻击行为的常见途径。随着时间的推移,这些
互动会影响提供者的身体、心理和情感健康。“如果评论发生一两次,这不是问
题,但累积起来可能是有害的,”加州大学旧金山分校麻醉系DEI副主席Odi Ehie
博士说。她经历过微攻击,例如患者询问她来自哪里或在哪里训练。其他人评论她
看起来很年轻,并询问她何时何地完成了居留权。Ehie的一些回应包括要求患者解
释更多关于他们想知道的内容。“这让他们思考他们在说什么,”她说。
Incorrect name pronunciation is another common microaggression
experienced by ethnically diverse team members. These providers will
sometimes encounter requests from patients to use the first letter of their
last name rather than the full name. Upah-Crenshaw has experienced this
personally, and she addresses it by helping the patient learn to pronounce
her name with tips such as “Upah” is like the state Utah with a “p.”
Another type of slight that happens in health care is the assumption that
two different providers of the same race or ethnicity are the same person.
“I might gently point out that they are thinking of somebody else, and then
suggest that they have more interactions with those team members to
become familiar with them,” she said.
名字发音不正确是不同种族的团队成员经历的另一种常见的微攻击。这些提供者有
时会遇到患者的请求,要求使用其姓氏的第一个字母而不是全名。Upah-
Crenshaw亲身经历过这种情况,她通过帮助患者学习发音她的名字来解决这个问
题,例如“Upah”就像犹他州带有“p”的提示。医疗保健中发生的另一种轻视是假设
同一种族或民族的两个不同提供者是同一个人。“我可能会委婉地指出他们在想别
人,然后建议他们与这些团队成员有更多的互动,以熟悉他们,”她说。
Judgments about providers who speak with accents are also somewhat
frequent. When Shead hears a patient make negative comments about a
colleague’s accent, she addresses the implications of the comments. “I
may explain that the statement sounds like the patient is questioning the
physician’s skill set,” she said. “I share that my colleague is a highly
regarded provider on our team.”
对用口音说话的提供者的判断也有些频繁。当Shead听到患者对同事的口音做出负
面评论时,她会谈到这些评论的含义。“我可以解释一下,这句话听起来像是在质
疑医生的技能,”她说。“我分享我的同事是我们团队中备受推崇的提供者。”
在加州大学旧金山分校贝尼奥夫儿童医院,心理学家Marsha Treadwell博士最近
帮助启动了一个针对管理人员的辅导计划,涉及与DEI相关的问题,包括微攻击。
经理们学会了创建“勇敢的空间”,或者定期与他们的团队讨论隐性偏见如何影响团
队成员的归属感。每个单位或团队都被赋予决定会议频率和如何解决问题的自主
权,一个新生儿重症监护室制作了一张海报,展示护士根据他们所经历的微攻击举
着标志。这些标语包括诸如“我不必出生在这里才能成为美国人”之类的短语;“不要
问我'你是什么人?'我是一个'谁',而不是一个'什么'“;“我是中国人,但我没有开始
冠状病毒。它不叫中国病毒。
For Treadwell, the active interest in the Brave Spaces program has been
encouraging. “We are creating an environment where everyone on the
team owns the issue and individuals do not have to feel isolated,” she
said.
对于特雷德韦尔来说,对勇敢空间计划的积极兴趣令人鼓舞。“我们正在创造一个
环境,让团队中的每个人都拥有这个问题,个人不必感到孤立,”她说。
患者也可能是提供者微攻击的受害者,学会委婉地指出这些侮辱可以在团队内部和
患者之间建立信任。Shead在一次会议上注意到了一种微攻击,当时其中一位提供
者警告团队,一名患者和他的家人很困难,大声发声和对治疗计划的抵制。尽管提
供者的目的是让团队为案件做好准备,但黑人女性 Shead 感觉到对黑人患者及其
家人的隐性偏见。她大声疾呼并提醒团队,历史上非裔美国人在圣路易斯的医疗保
健环境中受到的待遇很差。家人的不信任是可以理解的,她鼓励她的同事获得家人
的信任。
Shead has also worked alongside colleagues who do not use the correct
pronouns for patients who have indicated that they are LGBTQ+. When
she noticed this behavior in a physician, she reminded everyone during a
team meeting that the pronouns for the transgender veteran on the unit
were “she/her.” “When a leader on a team intentionally disregards a
patient’s preferences, this can set a tone that discriminatory behavior is
acceptable,” she said.
还与那些没有为表明自己是LGBTQ +的患者使用正确代词的同事一起工作。
Shead
当她在医生身上注意到这种行为时,她在团队会议上提醒每个人,该单位跨性别退
伍军人的代词是“她/她”。“当团队中的领导者故意无视患者的偏好时,这可以设定
一种基调,即歧视行为是可以接受的,”她说。
虽然提供者可能是患者微攻击的目标,反之亦然,但团队成员之间的微妙偏见也会
影响互动。团队成员可能会无意中将患者分配给来自类似边缘化群体的同事,而不
考虑患者关注和专业知识的匹配。例如,LGBTQ+ 的护士或心理学家可能会与
LGBTQ+ 患者配对,即使患者没有提出请求。
等级制度也可能影响报告微攻击的意愿,Shead说。排名较低的人,例如经过认证
的护理助理、技术人员或其他支持人员,在遭受歧视时往往不太愿意说出来。
Shead致力于通过提升这些团队成员来对抗这些固有的等级偏见,直接要求他们对
职责范围内的各种问题提供专业意见。
The healing power of amends
修正的治愈力
While it may feel jarring when a team member points out a
microaggression, apologizing after an incident can improve a professional
relationship. In a study of patients who had experienced microaggressions
from their therapists, the working alliance was stronger after the therapist
discussed the microaggression compared with those who did not. These
repaired alliances were as strong as those in which no perceived
microaggression occurred (Owen, J., et al., Professional Psychology:
Research and Practice, Vol. 45, No. 4, 2014 (https://doi.org/10.1037/a0037420)
).
虽然当团队成员指出微攻击时可能会感到不和谐,但在事件发生后道歉可以改善专
业关系。在一项针对经历过治疗师微攻击的患者的研究中,与没有经历过微攻击的
患者相比,治疗师讨论微攻击后的工作联盟更强。这些修复的联盟与那些没有发生
微攻击的联盟一样强大(欧文,J.等人,专业心理学:研究与实践,第45卷,第4
期,2014年)。
When apologizing, it is critical to focus on the impact of the comment
rather than the intent, said Upah-Crenshaw. “When someone tries to
explain the intent, the conversation shifts to how the perpetrator is feeling
rather than the hurt that was caused,” she said. “Instead, acknowledge the
impact the comments or behaviors had on others.” People who receive
nondefensive apologies are more likely to trust the person again, which
creates a sense of psychological safety and helps teams function more
effectively.
道歉时,关注评论的影响而不是意图至关重要,Upah-Crenshaw说。“当有人试
图解释意图时,谈话就会转移到肇事者的感受上,而不是造成的伤害,”她说。“相
反,承认评论或行为对他人的影响。收到非防御性道歉的人更有可能再次信任这个
人,这会产生一种心理安全感,并帮助团队更有效地运作。
For psychologists at the forefront of the effort to increase awareness
about microaggressions, the possibility of this type of healing in
relationships is motivation to continue educating people on how to
instigate change. “It is very difficult to escape the socialization that led to
my implicit biases, but if I inadvertently commit a microaggression, there
is hope that taking responsibility will create an even stronger
relationship,” said Spanierman.
对于站在提高对微攻击意识的最前沿的心理学家来说,这种关系中治愈的可能性是
继续教育人们如何煽动变革的动力。“很难摆脱导致我隐性偏见的社会化,但如果
我无意中犯下了微攻击,那么承担责任有望建立更牢固的关系,”斯潘尼尔曼说。
To help teams become comfortable talking about vulnerable topics like
microaggressions, consider incorporating discussions about equality,
diversity, and inclusion into weekly meetings, said Upah-Crenshaw. “This
gives the team a chance to learn the terminology and practice their skills
regularly,” she said.
说,为了帮助团队习惯于谈论微攻击等脆弱话题,请考虑将有关
Upah-Crenshaw
平等,多样性和包容性的讨论纳入每周会议。“这让团队有机会学习术语并定期练
习他们的技能,”她说。
Psychologists can not only lead the way in training teams, but also pioneer
research on the prevalence and effects of microaggressions in
interprofessional settings. Most research is focused on individuals in
health care, not teams, said Shead. “I would love to see psychologists
conduct studies in these integrated settings, because we are well
equipped to understand how identity affects work,” she said. “We are
uniquely prepared to ask how microaggressions are impacting outcomes
and patient care.”
心理学家不仅可以在培训团队方面处于领先地位,还可以率先研究跨专业环境中微
攻击的普遍性和影响。Shead说,大多数研究都集中在医疗保健领域的个人身上,
而不是团队。“我希望看到心理学家在这些综合环境中进行研究,因为我们有能力
了解身份如何影响工作,”她说。“我们特别准备询问微攻击如何影响结果和患者护
理。
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Further reading 延伸阅读
Microintervention strategies: What you can do to disarm and dismantle
individual and systemic racism and bias
微干预策略:您可以做些什么来解除和消除个人和系统的种族主义和偏见
(https://www.wiley.com/en-
us/Microintervention+Strategies%3A+What+You+Can+Do+to+Disarm+and+Dism
antle+Individual+and+Systemic+Racism+and+Bias-p-9781119769989)
Sue, D. W., et al., Wiley, 2020
苏,D.W.等人,威利,2020
The GRIT (gather, restate, inquire, talk it out) framework for addressing
microaggressions
解决微攻击的GRIT(收集,重申,询问,讨论)框架
(https://doi.org/10.1001/jamasurg.2019.4427)
Warner, N. S., et al., JAMA Surgery, 2020
华纳等人,美国医学会外科杂志,2020 年
Interrupting microaggressions in health care settings: A guide for teaching
medical students
中断医疗保健环境中的微攻击:医学生教学指南
(https://doi.org/10.15766/mep_2374-8265.10969)
Acholonu, R. G., et al., Journal of Teaching and Learning Resources, 2020
阿乔洛努等人,《教学资源杂志》,2020 年
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