22 | Nursing in Practice | Summer 2022
COLUMNIST
It ’ s about what we say ,
as much as what we do
The language used in social care is important . It takes a different approach to that used in the NHS but has a valuable contribution to make to the wider care sector , says George Coxon
George Coxon Care home owner
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As a former senior mental health clinical nurse specialist with numerous subsequent NHS roles , I feel I have been indoctrinated with medical model language . I ’ m now a staunch care home activist and have become uneasy about jargon , labelling and words that could alienate and disempower people in my care homes .
I ’ ve got into trouble with the occasional mild criticism of our beloved and revered NHS but I do wish to put the case for how we talk in social care land . There ’ s a growing determination to speak up about progressive , elevated social care work , where what matters to those we care for is more important than what is the matter with them .
I am now challenging a lot of disease- and treatment-oriented terminology in my care homes , partly to embed a more relational care ethos as much as a personcentred one . Mere semantics ? Perhaps , but I do believe we humble , often maligned care home people need to speak up about what makes our work attractive – to create a new narrative with a glossary that illustrates what we offer the healthcare world .
In practice , this means outlawing language such as ‘ challenging behaviour ’, or ‘ doing ’ things to people , such as feeding or dressing . As to terms like ‘ aggressive ’ – I contend that no person living with dementia is ever aggressive , since aggression requires premeditated malicious intent . Even the word ‘ admission ’, when someone moves into a care home , is one I ’ m keen to ban . We are not hospitals , we have ‘ arrivals ’ and we offer homely life , not life in a clinical setting .
So , with that provocative stuff out of the way , I want to share some words that do really matter in my care homes , and to ask what key words matter to you and your work ?
Before the pandemic , I did a TED-style talk at the South West Academic Health Science Network . It was entitled ‘ It ’ s bout time ’ – a play on words that set out to ask about the most important word in care home life . I asked the
Care home people need to speak up about what makes our work so attractive
audience for their views and my conclusion was that the word is ‘ time ’, and how we use time well . My glossary has now expanded ; I ’ m also talking about ‘ atmosphere ’ and how this is shaped by ‘ culture ’, which in turn is very much driven by ‘ language ’.
Can we take this further ? I ’ m eager to hear from others how we can build inspiration , insight and respect across our health and care divide . I think this must include a recognition of difference .
I wrote a piece for the British Geriatric Society about ‘ fun-guarding ’ being as important as safeguarding , and have said – perhaps contentiously – that the word fun very much differentiates the values and themes of NHS and care home life . Fun is something we encourage hugely in a care home , but is a lesser priority in a busy emergency department ! I also wrote an article entitled ‘ It ’ s only words ’ for the Institute of Health and Social Care Management ’ s The Loop ( issue 4 , January 2022 ). Do have a look : talk to colleagues , and let me know what you think .
Social care and care home work have a lot of things to be positive and confident about , and we need to show why we are worthy of parity with our NHS colleagues .