Secondary Logo

Journal Logo

Diabetes

Changing the conversation

Dickinson, Jane K., PhD, RN, CDE; Funnell, Martha M., MS, RN, CDE

doi: 10.1097/01.NURSE.0000554614.92598.fb
Feature
Free

Abstract: Nurses can make a difference by carefully considering the language they use to talk to or about patients with diabetes. This article discusses the importance of words and messages in healthcare, particularly in diabetes education.

Words matter. Nurses can empower patients to manage their own care by carefully considering the language they use to talk to or about patients with diabetes.

Jane K. Dickinson is the diabetes education and management program director and lecturer at Teachers College, Columbia University in New York, N.Y. Martha M. Funnell is an emeritus research scientist with the department of learning health sciences at the University of Michigan Medical School in Ann Arbor, Mich., and a member of the Nursing2019 editorial board.

The authors have disclosed no financial relationships related to this article.

Let's work together to make a plan that works for you • Would you like to consider? • Declined • He takes his medication about half the time • Making choices and decisions • Self-directed goals • How long have you had diabetes? • Do you have diabetes? • She is checking her blood glucose levels a few times a week • Plans and choices • Person living with diabetes • May I tell you what has worked for other people? • Facilitating identified goals and creating a plan • He sees insulin as a personal failure

Figure

Figure

AS NURSES, HOW OFTEN do we think about the words we use when talking to or about our patients? Sometimes, the language historically used in healthcare is no longer appropriate or helpful. Nurses have an opportunity to consider the impact of their messages and language on patients in hospitals or other healthcare settings.

Healthcare professionals have been discussing language since the 1950s.1 The movement to revise healthcare language originally concerned patients with disabilities and has since moved to those with obesity and other health disorders, including diabetes mellitus.2-4 In 2017, the American Association of Diabetes Educators and the American Diabetes Association published The Use of Language in Diabetes Care and Education, a joint paper on the impact of the terminology used in healthcare settings.5,6 It included four principles as a reminder of the challenges of managing diabetes, the emotional components of living with the disease, and how healthcare professionals can help (see Guiding principles).5,6

The healthcare industry is still working hard to update the language used in the care of patients with diabetes by focusing on person-centered, strengths-based, and empowering approaches. This article highlights messages that are no longer helpful in healthcare and the role of nurses in changing the conversation around diabetes.

Back to Top | Article Outline

Words and messages in healthcare

The word patient originates with the Latin terms patiens and patior, meaning to suffer or bear.7 Use of this word set the stage for a medical model in which physicians cured patients, nurses cared for them, and patients were expected to be compliant or adherent with treatment based on their acute needs. Today's healthcare landscape is not about compliance; it is about engagement, choices, actions, knowledge, guidance, and support. Patients are more informed about and involved in decisions related to their health.

Diabetes is a chronic disease, and people with diabetes make self-management decisions daily as they monitor their blood glucose levels and administer their medications. The outdated compliance and adherence model no longer reflects diabetes care.8,9

Unfortunately, the authoritative and judgmental language of healthcare has persisted. Nurses hear, read, and speak these words in daily practice. Negative messages appear in scholarly journals, patient medical records, podium presentations, professional conversations, and classrooms. Judgmental terms such as compliance and adherence, good control and poor control, good and bad, diabetic, self-inflicted, and test, which implies passing or failing, are pervasive (see Empowering messages).5,6

These words and messages are the language of society. They describe and influence beliefs, becoming part of societal context and shaping meaning. When that meaning is negative, disempowering, or judgmental, these terms can have a damaging impact on people with diabetes.

Wright and Lopez defined context as “the set of conditions within which something is perceived and that influences that thing's meaning.”10 For example, stigma is an ongoing issue for people with diabetes. As such, describing someone as “diabetic” can steer the context and meaning in a negative direction by stigmatizing the patient in terms of the disease.11 Labeling patients as “diabetic” implies that healthcare professionals view this population as sick and that the illness defines them. Wright and Lopez recommended using a positive concept instead, for example, “a person with diabetes.”10

Because healthcare professionals often use this language, even those living with diabetes will sometimes label themselves “diabetic.” While it is not surprising that nurses also use this terminology, they have an important role in changing the language of diabetes.

Back to Top | Article Outline

How diabetes-related language evolved

Referring to people with diabetes as “diabetic” has been a long-standing societal practice. In healthcare, clinicians have a tendency to shorten words or phrases for speed and convenience. Yet other diseases, disorders, and maladies do not typically serve as the sole identifiers for their respective patient bases; for example, “AIDS victim” was changed to “person with AIDS” very early on. Why is the language surrounding diabetes treated differently?

In addition to the stigma of a diabetes diagnosis, some suggest that disempowering language reflects a failure to understand the emotional side of diabetes. People with diabetes are often blamed for having the disease, as if it is their fault. They are treated as if they are lazy, do not care about their health, or do not take care of themselves.11 Because of this stigma and judgment, the “diabetic” label is not appropriate.

Table

Table

In reality, type 1 diabetes is an autoimmune disease, and up to 11 factors influence the development of type 2 diabetes, only a few of which are modifiable.12,13 In short, people with either type of diabetes are not to blame for their disease. It is time to put that notion to rest, and nurses can help by changing the way they talk to and about patients with diabetes.

Back to Top | Article Outline

Nursing considerations

Nurses are respected as healthcare professionals and can be perceived as having positions of power.14 When nurses speak to patients, they may help or harm depending on their words and messages. Patients who are described as “poorly controlled,” “nonadherent,” or “noncompliant” may feel like children being scolded. Similarly, using “control” as the benchmark in diabetes care can make people feel that their behavior and lives are out of control. In reality, people with diabetes report feeling that blood glucose levels cannot truly be controlled despite their best efforts.15

Instead, nurses can put patients first and focus on their strengths. Rather than labeling patients as “noncompliant,” find out what is going on in their lives. Perhaps they cannot afford their medication. Similarly, “medication adherence” can be changed to “medication taking” to focus on action rather than judgment. Terms such as glycemic variability, hemoglobin A1C, or blood glucose levels are more helpful and accurate than control.

Back to Top | Article Outline

The future of the language movement

Because it is a chronic disease that requires daily attention to specific tasks and behaviors, people with diabetes are responsible for many decisions. The healthcare staff can empower these patients to be informed and make the safest and healthiest choices to achieve the best outcomes possible. Putting the person first is part of that effort, and language plays a large role.

Healthcare professionals can make a difference by changing their language and terminology.5 Focus on patients' strengths instead of their deficits or weaknesses. For example, rather than concentrating on what is not working, ask what is working and build on that. Recognize self-care efforts, even by simply thanking patients for coming to their appointments or periodically checking their blood glucose levels. After all, the numbers are just information for making decisions, not a judgment.

The language movement in diabetes sheds light on negative, judgmental language in the healthcare industry. The first step is for nurses to become aware of the problem, notice the words and messages being used, and work toward changing them. Ultimately, the goal is for people with diabetes to feel guided and supported in all of their healthcare encounters.

Back to Top | Article Outline

Guiding principles5,6

  • Diabetes is a complex and challenging disease that involves many factors and variables.
  • Historically, a stigma has been attached to a diagnosis of diabetes and may contribute to stress, shame, and judgment.
  • Every member of the healthcare team can serve people with diabetes more effectively through a respectful, inclusive, and patient-centered approach.
  • Person-first, strengths-based, and empowering language can improve communication and enhance the motivation, health, and well-being of people with diabetes.

Reprinted with permission from the American Diabetes Association: Dickinson JK, Guzman SJ, Maryniuk MD, et al. The use of language in diabetes care and education. Diabetes Care. 2017;40(12):1790-1799.

Reprinted with permission from SAGE Publishing: Dickinson JK, Guzman SJ, Maryniuk MD, et al. The use of language in diabetes care and education. Diabetes Educ. 2017;43(6):551-564.

Back to Top | Article Outline

REFERENCES

1. Wright BA. Physical Disability: A Psychological Approach. New York, NY: Harper & Row; 1960.

2. Kyle TK, Puhl RM. Putting people first in obesity. Obesity (Silver Spring). 2014;22(5):1211.

3. Puhl R, Peterson JL, Luedicke J. Motivating or stigmatizing? Public perceptions of weight-related language used by health providers. Int J Obes (Lond). 2013;37(4):612–619.

4. Swift JA, Choi E, Puhl RM, Glazebrook C. Talking about obesity with clients: preferred terms and communication styles of U.K. pre-registration dieticians, doctors, and nurses. Patient Educ Couns. 2013;91(2):186–191.

5. Dickinson JK, Guzman SJ, Maryniuk MD, et al The use of language in diabetes care and education. Diabetes Educ. 2017;43(6):551–564.

6. Dickinson JK, Guzman SJ, Maryniuk MD, et al The use of language in diabetes care and education. Diabetes Care. 2017;40(12):1790–1799.

7. Neuberger J. Do we need a new word for patients? Lets do away with “patients”. BMJ. 1999;318(7200):1756–1757.

8. Anderson RM, Funnell MM. Patient empowerment: reflections on the challenge of fostering the adoption of a new paradigm. Patient Educ Couns. 2005;57(2):153–157.

9. Funnell MM. Patient empowerment: what does it really mean. Patient Educ Couns. 2016;99(12):1921–1922.

10. Wright BA, Lopez SJ. Widening the diagnostic focus: a case for including human strengths and environmental resources. In: The Oxford Handbook of Positive Psychology. 2nd ed. New York, NY: Oxford University Press, Inc.; 2009.

11. Abdoli S, Doosti Irani M, Hardy LR, Funnell M. A discussion paper on stigmatizing features of diabetes. Nurs Open. 2018;5(2):113–119.

12. Defronzo RA. Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58(4):773–795.

13. Schwartz SS, Epstein S, Corkey BE, Grant SF, Gavin JR 3rd, Aguilar RB. The time is right for a new classification system for diabetes: rationale and implications of the β-cell-centric classification schema. Diabetes Care. 2016;39(2):179–186.

14. Roscigno CI. Challenging nurses' cultural competence of disability to improve interpersonal interactions. J Neurosci Nurs. 2013;45(1):21–37.

15. Dickinson JK. The experience of diabetes-related language in diabetes care. Diabetes Spectr. 2018;31(1):58–64.

Back to Top | Article Outline

RESOURCES

American Association of Diabetes Educators. What you say matters. 2019. http://www.diabeteseducator.org/practice/educator-tools/diabetes-language-paper.

American Association of Diabetes Educators. Speaking the language of diabetes: language guidance for diabetes-related research, education, and publications. 2017. http://www.diabeteseducator.org/docs/default-source/practice/educator-tools/HCP-diabetes-language-guidance.pdf?sfvrsn=8.

American Association of Diabetes Educators. Media guide: the power of language in reporting on diabetes. 2017. http://www.diabeteseducator.org/docs/default-source/practice/educator-tools/diabetes-language-media-guide.pdf?sfvrsn=0.

Keywords:

context; diabetes; diabetes education; diabetes-related language

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.