Why nurses should think twice before using terms of endearment

A report criticising care home staff who call residents ‘darling’ and ‘sweetie’ has opened up a debate about the language nurses should use.

The report was published earlier this month by Care Quality Commission (CQC) inspectors who visited Brackenley Residential Care Home in Yorkshire, which provides services for people with learning disabilities.

The inspectors said that although the language was intended to be friendly, it could be regarded as ‘patronising and demeaning’. Other terms used by staff included ‘love’ and ‘handsome’.

It raises the question of whether terms of endearment are appropriate in the pursuit of person-centred care, and has prompted healthcare professionals to discuss the importance of language in care, which the CQC says it welcomes (see box).

The CQC’s view

A spokesperson for the Care Quality Commission (CQC) says that although inspectors do not have guidelines on what language is appropriate, communication is covered as part of the ‘caring’ criteria during inspections.

CQC deputy chief inspector of adult social care for the north region Debbie Westhead says: ‘There is absolutely nothing wrong with care home managers and staffusing affectionate terms of endearment to address people in their care.

‘What is most important is that people and their families are happy and comfortable with all aspects of their care, and their individual wishes and preferences are always understood and responded to appropriately.’

Its chief inspector of adult social care Andrea Sutcliffe defended the report, which highlighted a ‘lack of person-centred care’ at the home, including rules requiring residents to stay in their rooms between 11pm and 8am. In a blog on the CQC website, Ms Sutcliffe said: ‘In this context, the comment about the language staff used was an indicator of the lack of respect observed.’

She said that while the report made for ‘easy, attention-grabbing headlines’ that did not reflect the ‘whole picture’, the important message was that individuals’ wishes about what they were called should be taken into account.

‘What was welcome, though, was the opportunity to discuss the importance of language in care – how we can make sure that people are treated with dignity and respect,’ she wrote.

Stephanie Kirkman Meikle, chief executive of Harrogate Skills 4 Living, which runs the home, said the provider reviewed the language used, held discussions with staff and patients and re-examined care plans. It concluded that ‘everything had been appropriate’.

RCN professional lead for care of older people and dementia Dawne Garrett says there are two elements to consider. ‘There is the normal nursing assessment, which would include a question around preferred names, and this is usually the immediate question after taking someone’s details,’ she says. But most nurses would then rely on their emotional intelligence to judge how familiar their language with any individual should be, she adds.

‘I don’t think there can be any hard and fast rules. But we should be checking people’s responses to our interactions at every stage and most nurses do that. They tend to be reflective in their practice and aware if they might have said something that could be misconstrued,’ she says.

Local idioms

Making a written record of what people specifically do not want may be more helpful and less time consuming than trying to list the terms they find acceptable, she says.

‘The list could be endless. You would much rather be giving care than writing things in care plans.’

Picture credit: iStock

Cultural sensitivities and local idiom would also influence what was considered appropriate, Ms Garrett adds. ‘In some areas of the country it is highly appropriate to talk to people using terms of endearment, but it is quite specific, often to small regions, what is an appropriate term of endearment in that area,’ she says.

Appropriate use of colloquial terms has been an issue for many years, says Frank Ursell of the Registered Nursing Home Association. The chief executive, who says if he were in a home he would like to be addressed as Mr Ursell until he indicated otherwise, believes staff do not intend terms of endearment to be demeaning.

‘It tends to be Yorkshire and Derbyshire where this is a common way of addressing people,’ he says. ‘It does not happen so much in London, because everyone is in such a hurry to get everywhere.

‘I don’t think there is an intentional lack of respect. It is just the way people are brought up and talk,’ he says. ‘There has been a move to make care more personal and individual. You don’t want a sterile environment where people are addressed in a non-friendly way. It is meant to be home.’

Too much formality surrounding whether residents are happy to be called ‘love’ or ‘darling’ would spoil that homely atmosphere, he adds.

The National Forum of People with Learning Disabilities, which works with government to represent the needs of people across England, has forums in nine regional areas. Its co-chairs Craig Hart and Karen Flood also acknowledge regional differences in language.

‘In Liverpool, people would say “all right mate”. What is important is that the people who live in the care home are happy with the terms used. If they are happy, we don’t feel that this is a problem,’ the co-chairs say.

But the independent care charity Care England’s chief executive Martin Green says it is important to have a conversation about the terms of endearment during a person’s first contact with a care service.

‘I don’t think there can be any hard and fast rules’

–Dawne Garrett

‘It just sets the tone and is important to reinforce for the person that they still have the power over their lives in small ways as well as larger ways,’ he says. ‘As people become more ill or infirm, it may seem that elements of their life and control are slipping away from them.’

Terms of endearment can be seen by some as ‘informal and sloppy’, he says, while others find them friendly, so recording those preferences in the care plan is necessary. ‘It is a bit prescriptive, and what happens is that often, like all relationships, we start off at one point and as we get to know each other we become more comfortable,’ he adds.

Professor Green says a nurse who provides personal care for a patient every day would intuitively understand that the boundaries will change as they get to know that patient. ‘So what we need is something that clarifies the formal position. But if people get so comfortable with each other they become more friendly then that is fine as that’s a change in the boundary.’

Having a written record in the care plan about the terms a resident prefers also helps staff who move into a new setting, he says. ‘If you are just arriving, you need to be brought up to speed quickly on their preferences’.

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