A confusion of words?

The tower of Babel (engraving by Gustav Dore)

I am fascinated by the use of words. Well, I should say that I am fascinated by how people use certain words to present a desirable image of themselves. An everyday example is the obvious one of politicians – you can see them deliberatel pausing several times in an interview to think carefully about what words utter from their mouths.
Rightly so. We all know how easily people can be insulted over a few words (ask Mr Clarkson from Top Gear about this) and so choosing our words is vital.

Using the wrong word can spell doom. I recently marked an assignment where a student ‘psycho-educated a patient on holidays abroad’. Yes this could be psycho education before someone comments but in the context of the essay it clearly was not. Put simply, if you do not know what a word means, then don’t use it as incorrect use sends a very clear signal of the level of your knowledge on the subject!

One phrase that irritates the hell out of me is ‘1:1 intervention’. I saw a football match the other week where the result was 1:1 so if a nurse says they had a 1:1, does this mean they played football? What is so wrong with saying ‘I spoke with…’ or heaven forbid whats wrong with saying ‘I chatted with…’? I am extremely proud that I have never conducted a 1:1 intervention with a patient but I am equally as proud that I have chatted with many over the years. I think that the meaning of ‘1:1 intervention’ has been lost/warped over time, this is evidenced by a student seeing me and explaining how they had a 1:1 with a patient and their family. I explained that one to one means a private chat between two people but this was lost on the poor soul because his mentor (a nurse in practice) had informed him that this work was indeed classed as a’1:1’.

We also ‘ob’ patients. The phrase ‘observe’ has been lost or to be precise the meaning has been lost. To ‘ob’ someone is simply to aimlessly follow someone around with the bizarre belief that this helps. What is wrong with chatting anyhow? Chatting with someone allows for the assessment of memory, orientation, delusional ideas, concentration, anxiety, paranoia – well the list goes on. It is the skilful nurse who uses these informal opportunities to gather information and to develop the greatest tool in a nurse’s armoury – the therapeutic relationship.

So why do we use these words? Well, I believe it comes to us as nurses losing our sense of self pride. What is wrong with saying I chatted with Fred? Answer – it simply doesn’t sound professionally credible. Are we scared that other health professionals may say ‘but talking isn’t really work that a professional does’ and so we disguise it by saying we conducted a 1:1 intervention? Perhaps those who are familiar with a previous post “Registered Nurse Plumber” may already know the direction that I am going.

Who do you want caring for you and your loved ones – the nurse who conducts 1:1 interventions with patients or the nurse who chats with you?

5 thoughts on “A confusion of words?

  1. I notice that a lot of people are using the term ‘mental health illness’ – this is a pet hate of mine!

  2. And you know one of mine Tony, “therapeutic relationship”!We assume as nurses that having a “1:1” or a chat with someone will automatically be termed therapeutic! Who for?

  3. In practice as student nurses we are given guidance on record keeping regarding the terminology to use – eg ‘appears stable’, ‘no management problem’ and the dreaded ‘1:1’.
    And at each handover we are allocated service users who we are to “have 1:1’s” with, this is to be recorded as a “1:1 in the notes”… and furthermore make sure its recorded in the “1:1 book” for auditing.
    I agree it’s a horrible term (it makes me think of 1:1 sparring when I was learning karate as a kid!) as are the other aforementioned phrases, however there appears to be the need for standardised terminology when record keeping in the clinical setting. Personally I like to get around this by saying “1:1, today I had a lengthy chat with Fred about…” – record keeping standards satisfied and it’s a bit more personal.
    And I’d NEVER say ‘appears stable’ – what if they fell over?? – I could be sued 🙂

  4. Hi Guys, Thought I would drop by and see how the tea party is going……and strong it still is, excellent work!!!
    O.K, some very valid points raised here regarding terminology so I thought I would add a small contribution.

    1:1….mmmmm yes, I can see the reason for such dislike of this term. often confused, I find with a person to person verbal interaction or is it a 1:1 as in, 1 member of staff per service user?

    The term “Key worker” session is used where I am currently based and seen as I am not a regular member of staff and am not assigned to be anyone’s “key worker”, how do I therefore address such interactions? maybe it is a “bank nurse session”? This would not be a reasonable title I think. So, yes I have also documented my verbal interaction with the service user as a 1:1….maybe, Verbal Interaction is more appropriate? A VI.

    Other terminology….”no management problem”….guilty as charged. I always remember from my training that we must remain, objective rather than subjectivve and only state facts, no assumtions and no summising. The patient has not been a problem to manage, hence….no management problem. I see nothing wrong with this statement so long as it is elaborated on.

    Appears stable….they may well fall over, but if this happens after the write up, it does not make the write up inaccurate, as, at the time of writing, the service user appeared stable, but maybe added to this …”in mood and mental state”.
    Finally, I will add one of my own dislikes in the terminology of mental health nursing…..”escort”. I am not an escort, I have not been ON an escort and I do not want to escort, however, I have attended hospital appointments with service users, court hearing and various other visits in the community, so, i will gladly “join” you for a walk to the shops. 🙂

  5. Hello Everybody,

    I find myself nodding in complete agreement with the theme commenced by Tony Barlow and developed by others highlighting the changing nature, power, and potentially misuse of language used within all fields of nursing. In fact, I have probably inadvertently joined in this game when referring to “fields of nursing” which I understand replaces “branches”. I am sure there is a reason for these terms/ metaphors that are currently beyond me.

    On a different but, I think, related thread, I feel it is also important to consider the impact and power of communication across all forms of information exchange. Within our different roles and relationships we are increasingly required to use technology in the form of e-mail, text, moodle, & many others to convey information; and to reflect on experiences and feelings that relate to people we either work with or are attempting to offer care.

    Yet, increasingly these forms of communication appear rushed and poorly considered, examples might include missing off a person’s name, using text speak, and substituting letters for words. Perhaps we are all too busy getting our the main message across without having time to consider the influence of our words, our tone etc on the receiver?

    We are all undoubtedly facing increasing pressures to demonstrate more for less with ever finite resources. Perhaps the irony is that it is within this changing culture of ever greater efficiency and time pressures where communication becomes of even great importance?

    As people, engaging and working with and across a range of settings with people, we must all endeavour to communicate effectively, compassionately, and personally. Or, are we just too busy to care?



    Paul Millwood
    Senior Lecturer
    Mental Health Division
    Room 027
    Bevan House
    South Campus
    Birmingham City University
    B15 3TN

    Mental Health Branch Leader – Graduate Diploma
    CAMHS Pathway Leader
    Mental Health Admissions Tutor.

    0121 331 7170

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