Tissue vibility expert and Nursing Times’ newest blogger Irene Anderson on the pitfalls of complex language in wound care
Last week I directed a play, it wasn’t launched on the West End or likely to be shortlisted for an Edinburgh Festival award, but it was fun.
It made me think about a comment I heard on the Loose Ends programme on Radio 4 at the end of September, where a contributor said he was going to get a t-shirt printed with the words “but its more complicated than that”.
The play was about how venous disease can lead to the development of a leg ulcer and how compression therapy works. My students were probably a bit surprised. It was not the PowerPoint they were expecting. but they joined in and it was a great ice-breaker for a first session.
This got me thinking about how we understand concepts and try to simplify things for our own understanding and to help communicate it to others.
Simplification may put our patients at risk, especially when the apparent simplicity leads to allocation of tasks with no thought to risks and outcomes.
Sometimes clinical skills are broken down to tasks rather than seen as a multidimensional skill underpinned by an understanding of pathophysiology, and cues to action from ongoing assessment.
Leg ulcer management is a classic example. The argument that “anyone can be trained to apply a bandage” misses the point that the removal and application of compression therapy is part of the assessment - it is this skill which leads to effective therapy and safe patient care.
Complexity of language is also on my mind at the moment, and how terms can be used within disciplines that are not recognised in others. A nurse colleague was discussing bariatric patients with a group of mystified dieticians, who had only ever heard the term in relation to bariatric surgery and not specifically in relation to people.
I asked around, and outside the tissue viability field it was not a recognised term among other specialities and tutors. My trail (it is called avoiding what you are supposed to be doing) led me to an HSE report (2007) on bariatric patient handling pathways.
I have not read all 106 pages, but so far it is interesting and appears that there are local definitions of ‘bariatric’, but not a uniform one.
‘Obese’ is defined as a Body mass Index greater than 30, and BMI greater that 40 is classed as morbidly obese. It may be that the term bariatric is applied locally as the upper limit of patient handling equipment. Nevertheless it is an example of a word simplified but not necessarily understood.
I like simplification, but I need to wear the “complicated” t-shirt sometimes and help spread the message that the language we use and the skills we employ are complex just like the people we care for.
This blog also appears on blogspot.com