Language in Nursing Practice


I have found myself on a journey that I can no longer avoid. In 1992 I gave an inservice on language to a group of staff nurses on a pediatric unit in a large, teaching hospital. I was then a student in an MSN program (Pediatric Clinical Nurse Specialist Track). The focus of my talk was refraining from calling patients by their diagnosis (the “appy” in room 3 or the “sickler” in room 25, etc.).

I have since chosen a career in diabetes education and management, and twenty years later I am amazed at how often I see and hear the word “diabetic.” I was giving an inservice (on diabetes) to nurses who provide staff education and was amazed at how many negative and judgmental words I heard. Open up any journal, book, magazine, blog, and it’s impossible to avoid seeing this kind of language.

The health care system has been trying to evolve for years (giving some credit here), from one that is paternalistic, controlling, and about healing the sick, to one that is accepting, supportive, patient-centered and about preventing disease. From one that is about the provider to one that is about the patient. But we are not there yet. And our language is, in my opinion, one of our biggest barriers. We need to talk the talk before we can walk the talk.

Words that come to mind include “compliance,” “must,” “should,” “have to,” “need to,” “I want you to…,” non-compliant,” any word that labels a patient (diabetic, asthmatic, leukemic, sickler, and so on), “control,” “good/bad,” and many more that I can’t think of at the moment.

I truly believe that words matter. Even the most caring nurses use words/phrases that hurt – mainly because they “grew up” using them, and often because it’s just faster and easier to use them. But patients deserve to hear words that build them up (strength-based) and put them at the center of their care (patient-centered). Patients deserve to be thought of, approached, and addressed as human beings with a lot more to them than a disease, illness, infection, procedure, or what have you. And it’s true for conversations about patients as well (for instance, at the nurses station or during report).

Those of you who work in health care settings probably (undoubtedly) hear these and more words/phrases every day. You may even have become immune to them. Can I ask a big favor? Can you pay close attention in the upcoming days/weeks, and jot down any judging, negative words/phrases you hear? Could you then come back to this blog and post the words in the comments section? Thanks for your help with this little project! I would also love to hear your thoughts on how we can change the language that is used in health care.

Some history on the origin of the word “nurse”


Thomas Lawrence Long, from the University of Connecticut, has graciously provided a guest blog post on the etymology of “nurse.” I happened to see something Tom posted about Shakespeare and “nurse” and thought this would be an interesting topic to discuss here.

Because historians of health and health care are sometimes preoccupied with the slipperiness of the signifier nurse (see Monica Green’s (2000) caution concerning the term in reference to medieval and early-modern studies), a brief historical lexicography might illuminate the meanings that the word has accrued, absorbed, and may, to some extent, still carry. Here is examined the historical traces of a noun-substantive, from wet-nurse, to caretaker of children, caretaker of the sick, asexual hive bee, and health professional, in which the traces of ideologies of gender identity and gendered work appear to be retained.

The first instance in English of nurse occurred in the early thirteenth century as the Anglo-Norman nurice, derived from the fifth-century post-Classical Latin nutrice, a wet-nurse (hired to provide an infant with breast milk when the infant’s mother would not or could not do so), although by the time it entered the Middle English lexicon, it had already absorbed the figurative sense of any female caretaker of children (Oxford English Dictionary 2010). Etymologically it is related to our modern word nourish, to feed.

Already by the late fourteenth century nurse had also taken on the figurative sense of any thing or any place that nurtures or fosters a quality or condition, and by the early fifteenth century, any person who takes care of, looks after, educates or advises someone.

The earliest attested use of nurse in a strictly medical sense appears in Shakespeare’s Comedy of Errors (ca 1616): “I will attend my husband, be his nurse, Diet his sicknesse, for it is my Office” (V.i.99). The wife as nurse (and the advantage of marriage as engaging a live-in nurse) is also apparent in the Duchess of Newcastle’s Matrimonial Trouble (1662), which contends, “That he might do [sc. marry], if it were for no other reason, but for a Nurse to tend him, if he should chance to be sick.”

Another curious figurative usage is attested to in the early nineteenth century: nurse as an entomological term, explained by the OED as “A sexually imperfect member of a community of bees, ants, etc., which cares for the larvae; a worker,” citing Kirby and Spence’s Introduction to Entomology (2nd edition): “The workers, termed by Huber nourrices, or petites abeilles (nurses), upon whom the principal labours of the hive devolve.” The Huber in question was the Swiss naturalist François Huber (1750-1831) whose Nouvelles Observations sur les Abeilles was published at Geneva in 1792 and translated into English in 1806. Perhaps by association the later zoological term nurse shortly came to characterize any asexual invertebrate, a spineless sexless creature.

The semantic process whereby the word nurse begins by denoting a woman hired to provide surrogate breast milk and comes to denote a sexless worker insect may be related to the religious associations of woman as healer and caretaker of the sick, particularly the ubiquitous presence of European women’s religious orders comprised of celibates (and thus, in the medieval view, sexless) devoted to the wellbeing of others.

Reference

Green, Monica H. (2000). Documenting medieval women’s medical practice. Women’s healthcare in the medieval West. Aldershot, UK: Ashgate Variorum, pp. II, 322-352.

When you think of the word “nurse,” what comes to mind for you?

Redefining the meta-language of nursing science


Due to technical difficulties with my webinar last week I decided to make a recording of my presentation that is now available as a YouTube video. The length is just under 30 minutes. I hope you will join me for “lunch” or “tea” to experience the video, and share your thoughts and critique here or on the Advances in Nursing Science Journal blog.

This presentation covers some of the ideas from my recent paper “The Integrality of Situated Caring in Nursing and the Environment” published in the current issue of Advances in Nursing Science. I sincerely look forward to the dialogue that I hope this presentation and paper will provoke. Don’t be shy, please share your thoughts.

Nursing and the Environment


Valentine’s Day edit: Here is a narrated version of the presentation I gave last week. Redefining the Metalanguage of Nursing

I just watched the film “The Politics of Caring” featured on the nursemanifest.com website and oh, does it make some powerful statements about politics in nursing that are still relevant today! A core messages in the film is the importance of improving hospital working conditions, both for the nurses, and for the safety and health of patients. Growing out of my involvement in the NurseManifest Project, much of my current work directly focuses on research about the nursing work environment, including nurse staffing and management practices.

One of the defining moments of my nursing education was learning about the concept of “Upstream Thinking” in my senior year Community & Public Health Nursing course. We learned about John Snow’s classic work on the London Cholera Epidemic of 1854 and read Patricia Butterfield’s seminal “Thinking Upstream” article (Adv Nurs Sci 1990;12(2):1-8) that challenged nurses to think beyond one-to-one caring relationships and embrace the social, environmental and political determinants of health. This was reinforced the following year in my graduate nursing theory course, with the addition of Butterfield’s then new paper, “Upstream Reflections on Environmental Health” (Adv Nurs Sci 2002;25(1):32-49). While nursing education programs are working to integrate new content in (epi)genetics, (epi)genomics and environmental health it is more important than ever to emphasize the interconnectedness (or integrality) of human beings and the environment.

The macro-level and micro-level (holographic) ways that human beings, including nurses, are interconnected with their environment and each other will be the main focus of a free webinar/seminar that I’m giving next week and hope you will be able to attend. The presentation is titled Redefining the Metalanguage of Nursing Science: Contemporary Underpinnings for Innovation in Research, Education and Practice  and will be on Wednesday, Feb 8, 2012 (12-1:30 EST) at the University of Pennsylvania, Barbara Bates Center for the Study of Nursing History. This presentation will utilize images and narrative to explore the ideas presented in my new paper, The Integrality of Situated Caring in Nursing and the Environment, currently featured on the Advances in Nursing Science website. To register for the webinar: https://www2.gotomeeting.com/register/210662026