Apr 01, 2013
By Michelle Danda

Choose your words wisely

The words we use influence our understanding of the client and the client’s situation

I came to understand the power of words early in my career, while working on a concurrent disorder unit in an acute psychiatric setting. The nursing staff delivered specialized care to clients living with mental health and addictions issues. I was attracted to this area of practice because of its focus on talking with clients to build relationships with them. I was shocked to find that some staff openly demonstrated biased attitudes toward our clients, which they communicated through the language they used in their everyday practice. Words like addict, junkie, user and drug abuser appeared on their written charts and came up regularly in informal and casual discussions. I saw anger and frustration on the faces of nurses as their clients struggled with relapse, medication adherence and behavioural issues. It quickly became clear to me that my co-workers’ personal beliefs about addictions affected the quality of care they provided and that the negative language they employed was having an effect on the attitudes of other staff members.

Negative terms contribute to the stigma of already vulnerable populations, creating a culture of shame and guilt associated with any health issues they may have. On this particular unit, some staff made no distinction between the client as a person and the addiction issue the client lived with.

The language we use makes its way into all aspects of our work; documentation is important piece,, so we must be as careful in how we describe a client’s history and current situation in writing as we are in conversation. Even words that might seem fairly benign (compliance and denial are good examples) can perpetuate outdated paternalistic methods of care. It is by practising self-reflection and being aware of our beliefs, values and biases that we will recognize when judgmental and stigmatizing language is being used, so that we can challenge and, ultimately, eliminate it.

I have changed jobs in mental health nursing, but I continue to encounter nurses whose word choices surprise and sometimes appal me. I have realized that regardless of the amount of empathy and understanding I bring to the job, I can be easily drawn into using negative terms and stereotyped language. At those times, I consciously take a step back to reflect on my actions and my understanding of the particular client’s situation.

With the experience I have gained, I now take an active role in trying to influence cultural change by raising awareness of the power of words. When a co-worker referred to a client receiving methadone as an addict, I asked her if she thought it was appropriate to label this man as his illness. Although she was initially taken aback, I believe I opened the door to an honest discussion with her about personal beliefs, the importance of using non-judgmental language and the impact of our language on client care.

As a nurse on the front lines, I am in an ideal place to help transform the negative language surrounding addictions. And, ideally, I would like to see all of us move away from a place of judgment to a place of empathy and understanding — one that allows us to change perceptions of addictions and empower clients who have addiction issues. We must be advocates for all clients and ensure that even the most marginalized individuals have access to care. But our advocacy activities will be of limited value to them if the language we use stigmatizes and oppresses these individuals.

Michelle C. Danda, RN, BN, is a Mental Health and Addictions Nurse in Calgary.
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https://www.canadian-nurse.com/en/articles/issues/2013/april-2013/choose-your-words-wisely