I have long been concerned about power and ‘parentalism’ in healthcare.
As a student nurse in the early 1980s – the times when there was a traditional ward round, with passive patients neatly in their beds – being talked at from on high by a retinue of fully dressed, white-coated ‘authorities’, made me distinctly uncomfortable.
“A shortage of time does not give us the right to be careless, judgemental, shaming or patronising”
This was especially the case when the talk was equally patronising and dismissive – which it often was. To be honest, even though the performance of a ward round is much more relaxed, the language used still can seem like this.
With the passage of time, and my own professional and personal, negative experiences to draw on, I have long made it my business to champion person-centred and humanity-based approaches to people; long abandoning the word ‘patient’ from my vocabulary in favour of person or people.
The latter is remarkably easy to do – and has certainly changed the nature of my interactions. I have written, pondered and spoken about the issues of language many times.
In the light of all the above, it’s especially good to be part of the new NHS England guidance Language Matters, which was released to mark Diabetes Week, where the theme was ‘talk about diabetes’.
Although this is focused on diabetes, its contents can actually be applied to many other – all, I might even argue – conditions and situations.
“These people describe so movingly the devastating effects of careless, judgemental or patronising language”
Along with two others, I wrote much of the main text and recommendations, all drawing from the literature and, most importantly, from the lived experiences and shared anecdotes of people living with diabetes.
These people describe so movingly the devastating effects of careless, judgemental or patronising language in relation to them and their diabetes.
What does this document say for my fellow nurses? Hopefully, you’ll recognise some of the common phrases and comments we’ve included, trying to show why they might be problematic, and then be interested in the alternatives we’ve suggested.
As I said earlier, it takes no more time to say things in a different way, but can make the world of difference to an individual’s experience, self-esteem and self-care.
To take an example from the document, if someone says ‘I’ve been a bad diabetic’ or similar, look for the meaning behind the words – they could reveal up to a lifetime of judgement, blame and tellings-off.
Rather than agree or seek to blindly reassure, a response such as ‘it sounds like diabetes has been hard work for you’, or ‘diabetes can be relentless, can’t it?’, can do much to ameliorate the distress these attitudes produce.
Diabetes of whatever type, acquisition or duration is really hard work, intruding on every aspect of daily life. It’s often disobedient, caring little for the textbook answers we might know.
As nurses, we encounter people with diabetes in the clinical situations we work in, where our job is to help. The words we choose to use and the attitudes they project at these times can make a huge difference to the person’s wellbeing.
Language Matters gives real-life examples that can be used in even the busiest, most time pressured clinical environments. A shortage of time does not give us the right to be careless, judgemental, shaming or patronising.
To conclude with the words of one young woman about her clinic experience: ‘I feel like an HbA1c on legs’. Please see if you can use what we’ve written to avoid that happening in your encounters.
Rosie Walker, registered nurse and director, Successful Diabetes
Biography Rosie Walker
I own and run the independent company Successful Diabetes, which provides workshops, books resources, education and consultancy for people living and working with diabetes.
I’m a former diabetes specialist nurse and have worked both locally and nationally in developing diabetes services and education since 1985. In addition to nursing and diabetes, I’ve gathered additional academic qualifications and expertise in psychology, higher education, active listening and counselling.
I’m inspired by a person-centred philosophy in all aspects of my life and work.