Why Worry About Words?

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Joan Devine
Director of Education, Pioneer Network
William Shakespeare posed the famous question, “What’s in a name?” Shakespeare believed that “that which we call a rose by any other name would smell as sweet.” If you called a rose a thistle, then it would still smell lovely.  But, what if you called a thistle a rose? Would it not still be a weed, something to be pulled from the garden?
The message we need to take from this is how important it is to choose our words carefully and use them wisely, because contrary to what Shakespeare wrote, there’s an awful lot in a name. Words carry important messages; they help us express feelings. They stir memories and carry powerful images. Words can define a culture, a way of living. Take, for instance, the words “hippy,” “flower child,” or “groovy.”  If you’re old enough to remember, doesn’t your mind flash to a picture of life in the 1960s, to the culture of that day and time?
Though we might not always think of it as such, those of us in the long-term care field share a culture, and that culture has built a curious language around itself. Considering we have made it our lives’ work to comfort others, we use some cold and impersonal words to describe what we do. Some of that comes from the hospital system. Some of it comes from academia. And some of it we developed ourselves because we didn’t stop to think how our words affect our care.
Former Senior Policy Analyst for the Center for Medicare and Medicaid and Pioneer Network cofounder Karen Schoeneman tells us that clinical language “unintentionally demeans people, contributing to a hierarchical sense of ‘us and them’,” leading to a “dehumanizing institutional culture instead of a nurturing community with respect (for) its members.” 1
Put another way, which would you prefer — being told that you were going to be “toileted”? Or being asked if you would like to be “helped to the restroom”?
Many believe that changing our language is one of the key elements needed to change our culture. The language we use needs to define a new way of being, a new way of believing, and a new way of interacting between those who live and work together.
This process isn’t simply using new words to put a friendlier “spin” on a traditional practice. (While we can call them “extra large dinner napkins” or “clothing protectors,” isn’t the practice of putting a bib on an adult still an undignified practice?) Neither is this process a one-size-fits-all endeavor — words that work within the context of your community’s culture may not work in someone else’s.
The process of re-defining our language is a part of a larger journey. Words are tools we can use to rethink what we’re doing, how we work together, and how we’re sharing these ideas with our residents and their families. It’s a starting place for discussions about how we can improve our care and services. Changing our words alone won’t change our practices — we need to make a commitment to do both.
Person-centered care is so much more than a project or a program. Our new vocabulary must do more than simply describe our surroundings. It must convey our new relationships and our new way of thinking if it is to bring lasting culture change to our communities.
1 The Language of Culture Change “Mayday”by Karen Schoeneman
Published by the Pioneer Network
Reprinted from Word of the Week: Building a Culture Change Dictionary by Joan Devine