Replacing words that shame and blame in nursing care

/ Jane K. Dickinson / 3 Comments

The last time I wrote about language and health, specifically diabetes, I mentioned several words that impart judgment, shame and blame. People with diabetes live with and manage a demanding and challenging disease. When we use words like non-compliant or poorly controlled we are not taking into consideration all the factors that could be at play. Can the person afford insulin? Are they experiencing food insecurity? Did they ever receive diabetes education? What is their level of health literacy?

Two weeks ago I gave a talk about the messages we send to children and adolescents at diabetes camp. I discussed how we can send messages of judgment, or messages of strength and hope, simply based on the words we choose. Empowering campers is the work of diabetes camp professionals and volunteers. For nurses outside of the camp setting, the focus is also on empowering people – in hospitals, clinics, home care, public health, academics, etc.

At the end of my presentation, there was some discussion. The people in the room who live with diabetes strongly agreed with my suggestions about language and messaging. However, two people (who happen to be health care professionals) raised the point that “there are times when it’s necessary to use words like uncontrolled, good and bad.” They argued that doing otherwise is not giving good care. One of them also shared that she thought my talk was judgmental. At the break another participant came up to me and said she agrees that these words are not “PC.”

My first response to these comments was concern. I am clearly not using effective messaging about messaging if this is how people respond! Then after thinking about this feedback for several days I realized that it was very important for me to hear these points. This is how I can do a better job explaining what I’m trying to say. If I come across as judging people for using certain words, that absolutely defeats my purpose. If I come across as not giving good care by avoiding certain words, that’s not my intent either. And if we are simply thinking of the words we use in health care as “PC” or “not PC,” then we are not looking at the underlying problem. And isn’t that what we learned back in nursing school? (Look at the underlying problem, don’t just treat the symptoms.)

So my approach to all this is to go back to the problem, which is using language that is not appropriate for chronic care. Patients in 2016 are demanding holistic, person-centered care – and language is part of that care. Words create a context for people, and through that context people create meaning. So if they hear words that make them feel judged, they are likely to translate that into “I’m a bad person.” If they hear poorly controlled they may feel they are a failure.

Some ways we can change the messages we send to people include using words that put the person first: woman who has diabetes, people living with diabetes, or child with diabetes, instead of diabetic. We can use words that build on people’s strengths, rather than their weaknesses: takes her medication about half the time, rather than she’s non-compliant. And we can use words that focus on physiology, rather than judgment: blood glucose levels in the target range, elevated A1C, glycemic variability, glycemic stability, or blood glucose management, instead of any version of control.

When a patient has blood glucose levels that are clearly not in a safe or healthy range, we can start by asking questions. How do they feel about it? Find out what they know or don’t know. What are their resources? Ask if it’s ok to make some suggestions or share some guidance. Acknowledge that it’s hard and scary. This is how we can give good care and empower people. It doesn’t require judgment or judgmental words to help people make changes.

By focusing on sending messages that are person-centered and strengths-based, words that are consistent with those approaches will naturally follow. We can’t change the history of health care, or the words that went with it. But we can change the messages we send going forward.

Book of the Year Award – twice!

/ Peggy L Chinn / Leave a comment

On September 14, 2014, I posted news of the newly published book “Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis,”  noting its relevance for all NurseManifesters!  The book is edited by Paula Kagan, Marlaine Smith, and Peggy Chinn, and contains 22 original chapters by some of the leading nurse scholars in the area of Emancipatory textcritical inquiry.  The book has gained some attention, but in January, it was awarded two AJN “Book of the Year” awards – in the categories of History and Public Policy, and in Professional Issues.  You can see the press release about all of the awards here.  The link to. the article online is here.  The detailed comments of the reviewers are posted on the web as supplementary digital content; you can access this information online as a subscriber, or through your library.  The book is available in both paper and electronic formats – here is the Amazon link!

We are thrilled with these awards, not just because we know how important this book it, but because it is amazing for a book of this type to gain this kind of recognition in a “field” that typically focuses on very pragmatic and even “technical” topics.  Both of the reviewers who selected the book in their category commented on how accessible the content of the book is, even though much of the focus is on complex philosophic ideas.  If you have not yet had a chance to see the book, consider asking your library for a copy, and take some time to browse, and read!  Share your comments here about the details you see as particularly important for manifesting nursing!

Nurses as Healers: Good Work Environments

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

I remember when I became a new nurse 21 years ago, and a friend asked me what I did at the hospital when I worked those long 12 hour night shifts. His thoughts were that the patients were asleep, so it was probably a job where you hung out and drank coffee, occasionally checking in on a patient. I remember walking him through what I usually did on a 12 hour 7pm- 7 am night shift, including most of the tasks and requirements of the job from receiving report at the start of the shift to giving report at the end of the shift. I made sure to include that if- when I got a break,  it was usually around 2am or 3am when I was finally “caught up enough” to take some 20-30 minutes to nourish and hydrate myself.

As I thought of this telling of what nurses do some 20 years later,  I wondered if I included what nurses are really charged with doing, which is supporting the healing of those we care for. Did I focus on all of the tasks and duties I would complete during that 12 hour shift, or did I also include the time spent rubbing backs, holding hands, saying prayers, educating, and supporting patients and their loved ones? Did I include the story about the time I had to call a deaf woman and tell her husband had passed after she left for the evening? Or the time when the family asked me to increase the morphine drip rate because “the doctor said she would be dead before the morning and we are ready for her to be gone”? What about the man with ALS being kept alive on a ventilator and feeding tube who lay lonely in his bed, unable to verbally communicate, and went for weeks at a time without a single visitor?

I believe that as nurses we need to educate the public not just on all of the technical skills we do each day to support patients’ receiving good medical care, but also on the healing aspects of our unique work as nurses: on how we were likely “called” to be a nurse because we want to make a difference, the skills we have developed that support us in creating caring-healing environments for patients, and the rewards of being able to support others through their healing process. I think we should be making it clear to the public as well that we are committed to our own health and healing, knowing that we can’t support others through health challenges if we are not also dealing with these challenges ourselves. And as nurses, we need to support one another in our own healing process, role-modeling what self-care and stress management look like in action.

A recent study research from www.mountainmiraclesmidwifery.com/, showed that supporting nursing and creating “good nursing environments”, with adequate nurse staffing, leads to better long term patient outcomes, with fewer deaths one-month post surgery (http://mobile.reuters.com/article/idUSKCN0UZ2XL). It pays for hospitals to invest in having enough nurses, in treating those nurses well, and supporting nurses in what we have been called to do: create healing environments that support patients toward their greatest health potential. Healthcare facilities need to be moved to support nurses in managing their stress and enacting self-care in order to potentiate the healing of the patients these facilities serve. Good staffing is just the beginning of creating “good nursing environments”: nurses should be empowered to begin dialog with their employers regarding what a healthy and good work environment for nurses looks like in consideration of the healing work that nurses do.

 

 

Nursing History and a Book

/ Jane K. Dickinson / 2 Comments

I was given a first-edition copy of Florence Nightingale’s book, Notes on Nursing, about a year-and-a-half ago. The book was in a glass case and slightly tattered from the looks of it. I was told I could do whatever I wanted with it – keep it, sell it, whatever.

I love old things. In fact, I have a copy of Elliott P. Joslin’s “Diabetic (sic) Manual for Doctor and Patient” that belonged to my great-great aunt and an old First Aid Handbook. But this one seemed different. I immediately felt it belonged in a place where nurses could enjoy it. I felt compelled to give it to my alma mater, University of Connecticut School of Nursing, because I know they have a collection of nursing artifacts and it would be well taken care of and displayed for nurses of generations to come.

This past Christmas I had the opportunity to hand off the cherished book to Thomas Long from the UCONN School of Nursing. He was actually excited that it wasn’t in perfect condition because that indicated that many hands had touched it and turned (and hopefully read) the pages. He asked how I came to own the book and where it had come from. Unfortunately I didn’t even know the story, so I couldn’t share it with him. I only knew that my friend’s mother had owned it.

Soon after I asked the friend who had given me the book and she told me the whole story:

My friend’s father’s sister was a Navy nurse during the 1940s. Soon after she was appointed the guardian of a boy who lost his parents. Later (I believe it was 1959) he purchased the Nightingale book for her (there is a letter with the book that shows the date and price of the purchase). This aunt lived with my friend’s parents the last several years of her life and when she died this book was found among her belongings. My friend’s mother kept it for the rest of her life.

If you are ever in Storrs, Connecticut, be sure to visit the School of Nursing at the University of Connecticut. There you will see the first-edition Notes on Nursing displayed as part of the Josephine Dolan Collection in the Widmer Wing of the Nursing Building. I look forward to seeing it there myself one day.

Courageous Conscience: Engaging in Politics with a Capital “P”

/ Adeline Falk-Rafael / 1 Comment

When I began thinking about a topic for this blog last fall, Canada was in the middle of a federal election and the upcoming U.S. presidential election was already making the news daily. I thought about the changes that have occurred in both our countries and globally since neoliberal ideas privileged “the market” over elected governments in the 1980s. Increasingly, policies reflect the interest of big business and the dictates of “the markets” rather than the electorate. And although both countries are arguably now plutocracies/oligarchies, both maintain a semblance of democracy through democratic structures and processes, such as elections. So what does this have to do with nurses and nursing?

The Nursing Manifesto itself answers that question. It is a call to action and one avenue for that action is engagement with political processes. I am reminded of an address Patricia Moccia gave at a conference in the late 1990s in which she used the term “citizen nurse” to remind us of the importance of bringing a nursing voice to the political table. With the percentage of eligible voters who actually vote near record lows – 54.87% in the 2012 presidential election and 61.1% in the 2011 Canadian federal election – one group could significantly shift results. In fact, in the recent 2015 Canadian federal election, the Liberal party made a concerted effort to get out the “youth vote.” The result was not only a change in governments, from Conservative to Liberal, but an increase in voter turnout to 68.3%. Imagine the possibilities if nurses mobilized to vote!

I’m not suggesting that all nurses will vote alike, any more than “the youth” in Canada did! But I am suggesting that increasing the number of nurses who vote has the potential to influence the outcome of an election. What we have in common is commitment to care for people, for promoting health, for social justice. Our work, then, as citizen nurses is to discover which party or candidate most closely aligns with our own values and become as involved as is right for each of us in supporting that party or candidate. It may involve running for office, contributing money, volunteering to work for a particular candidate, or simply but equally importantly, making an informed vote.

Voters, to my mind, are followers in the democratic process. Robert E. Kelley, who has studied followership for more than 30 years, initially characterized followers on 2 dimensions: active engagement and critical thinking. His 5 categories of followers included sheep and yes-people, neither of whom are critically engaged. As voters, sheep would wait for direction on how to vote, perhaps relying on family or community tradition (my family has always voted this way). A yes-person might be more actively involved with a candidate or party but simply accepts the “party-line” without question. Alienated followers, Kelley asserted, think critically but bring much negative energy with them. Voters in this category might spend that energy criticizing the candidates, parties, the system and either spoiling their ballot or loudly proclaiming their refusal to vote. Pragmatics, Kelley’s 4th category, align themselves with whoever is winning. As voters, they might watch the polls and vote with whoever is leading.

Kelley’s final category is that of effective or “star” followers who are actively engaged critical thinkers with a “courageous conscience” to stand up against illegality and injustice. I think this category of followership exemplifies what being a citizen nurse is about.