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Person-centred nursing care requires an understanding of how certain terms may belittle, frighten or disempower
When communicating information to patients, the words you choose can be as important as the message itself. A nurse’s choices of language can affect how patients view their health.
Mental Health Practice. 26, 5, 16-17. doi: 10.7748/mhp.26.5.16.s9
Published: 05 September 2023
Clumsy use of language can make a person feel stigmatised and distressed, which, experts argue, can lead to adverse health outcomes. And there are many ways nurses can unconsciously perpetuate unhelpful and incorrect views about various health conditions, in addition to longstanding societal stigmas, such as those around race, gender and sexuality.
How can language stigmatise, and why is recognising it important?
‘Language is important in healthcare because it’s our main way of communicating with patients,’ says Hilda Mulrooney, a professor of nutrition at Kingston University who has written about addressing stigma in obesity.
‘But stigmatising language – anything that gives the impression they’re being viewed negatively, including words, images and non-verbal communications – can define the patient.’
What unintended consequences can language have?
Researchers have found language that stigmatises can make people feel worse about themselves, says Dr Mulrooney – and less likely to seek healthcare in the future.
‘The patient could feel blamed, judged and shamed,’ she says.
Researchers have found, for example, that people living with HIV who experienced higher levels of stigma had poorer mental health and HIV care outcomes than those who experienced less stigma. One example of stigma played out in language is use of the term ‘HIV-infected’ to describe a patient, experts say.
Using stigmatising language can also influence how a nurse’s colleagues perceive patients, Dr Mulrooney adds.
‘It matters how nurses talk to other staff, even when the patient isn’t there,’ she says.
‘We’re always reading between the lines with language, so even if the person handing over at the end of a shift is speaking in a tone that makes it seem like they think something is the patient’s fault, staff – and students – can’t help but be influenced by what their colleague said.’
Dr Mulrooney advises talking about patients in as neutral a way as possible and being mindful of the impression they are giving to colleagues.
What are examples of words and terms that stigmatise?
There are numerous phrases used among healthcare professionals that are potentially harmful. One common example is referring to people by their illness or disease. Instead, the NHS advocates use of ‘person-first’ language.
‘Nurses must put the person first,’ Dr Mulrooney says. ‘They’re not obese or disabled, for example – they’re a person with obesity or a disability.’
However, there are some exceptions to this. National Autistic Society head of guidance, volunteering and campaigns Tom Purser says: ‘Our research shows most autistic people see autism as being an important part of who they are and their identity, so they prefer to use identity-first language, such as “autistic person”.
‘However, when mentioning a particular person or group, we would always recommend asking them how they prefer to be referred to, as this should take precedence.’
Nurses should not refer to someone as ‘suffering’ from a condition, Dr Mulrooney adds, nor should nurses say a patient is ‘complaining’ of something. Instead, saying they have a ‘concern’ may sound more sympathetic.
‘It matters how nurses talk to other staff, even when the patient isn’t there. We’re always reading between the lines with language’
Hilda Mulrooney, professor of nutrition at Kingston University
How can words and phrases stigmatise body weight issues and people with obesity?
Language can make patients feel like they are to blame for their obesity, Dr Mulrooney says.
‘This fails to recognise how complex obesity is, and the large impact genetics can have,’ she adds.
The Association of UK Dieticians advises avoiding combative language. For example, avoid saying ‘the obesity crisis’ or ‘fighting obesity’.
Can we look at how the ‘battling cancer’ metaphor might affect patients?
‘It’s been the consensus for many years, now, that we should not use the language of war or fighting to talk about the management of cancer, because it implies you’re somehow responsible for the success or not of treatment,’ says Christie Hospital NHS Foundation Trust Macmillan survivorship network manager Ben Heyworth.
Using war metaphors may also make people perceive their treatment as being more difficult, research has found.
Mr Heyworth advises against using the phrase ‘cancer survivor’, as many patients live with cancer that is being managed but has not gone away.
What about when referring to a person’s gender identity or sexuality?
Guidance from the King’s Fund states it is important to use a person’s preferred pronouns and chosen name – but more important than memorising ‘correct terminology’ is continual reflection on the language you use.
Mr Heyworth says: ‘It’s easy to misgender someone, but this is a microaggression, and microaggressions add up over time.
‘Ask a person what pronouns they want to be known by, rather than making assumptions based on what a patient looks like. If you misgender someone, apologise and get it right the next time.’
How can I avoid using stigmatising language?
Nurses should listen to the words a patient uses to describe themselves, Dr Mulrooney says.
‘It’s also fine to ask someone how they’d like their health condition to be described,’ she adds.