Language Matters: Megamorphosis pre-work at Youville
Submitted by Jo-Ann Tait, program director, Elder Care and Palliative Services
In health care, we sometimes use terms that are not person-centred. Sometimes we use these terms out of habit or because of a cultural norm that has become acceptable practice when speaking between staff members. Terms such as referring to people we serve as their room number, or referring to people based on their function e.g. "feeder" or even diagnosis "The hip fracture in room..." seem commonplace in our health care areas and often go unchallenged, silently accepted, until someone takes a step to challenge the language we use in our care areas.
“The language we use, ultimately shapes how we think and influences our behavior and interactions with people,” was how Kimberley Smith, site leader and manager of Youville began a shift report in the morning. What started as a discussion about words that may hurt others, revealed an openness of the care staff sharing some of the words that they sometimes use to describe people they serve. Words such as “feeder” or “aggressive” were words that were shared, in addition to words that sometimes appear in documentation referring to people as "difficult" or "challenging." When we use those words, we apply labels to people. Every time we notice the person behaving in that way, only reinforces the label. Words and the language we use can be incredibly helpful, and conversely, can cause a great deal of hurt.
"Hurtful words and labels are like velcro," a staff member chimed in, "they stick for a very long time." We discussed how once a person is labelled as "aggressive" or "violent" at some point in their health care experience - that highly stigmatized label sticks with them for years to come. The difficulty is that when staff hear that a person is "aggressive" it changes the way they interact with the person we serve. Even from a psychological viewpoint, staff may feel some anxiety or be hesitant or fearful of the person - which a resident with dementia can sense and can add extra tension to the care experience.
The pre-work week was sprinkled with several activities on day and evening shifts that sparked the need to start shifting the language used. Two residential care aides (RCAs) were so inspired by one of the activities that they asked if they could alter the activity to include all of the "label" words that we hoped to move away from. Kim quickly adjusted the activity based on their interest and engagement and throughout the shift staff played "clothespin tag" where staff who said one of the words on the forbidden "label" list were discouraged by having one of their clothespins removed by another staff person who overheard them use the word (similar to a wedding/baby shower game). The staff member with the most clothespins at the end of their shift not only won a small prize - but also demonstrated the greatest shift in starting to move a language culture in a positive direction.
The staff were so engaged with this exercise that some asked if they could play it for another day. One RCA said, "You know, I want to stop calling people feeders or even using the term feeding altogether. It's not dignified - these are people who have lived long lives - I'm going to shift to 'assisting people' or something like that. It's a terrible term." We discussed using the actual (objective) words to describe what staff were seeing and how they were documenting.
The Centre for Practitioner Renewal continued their focus with the Youville team on relationships with self and others as the team preparation continued in the third (of four) sessions preparing staff to understand the complex nature of the emotional connection that staff have in themselves and that we want to nurture with others as we being Megamorphosis in a few weeks.
The rest of the week focused on non-verbal communication and shifting to a "Yes! I can help you!" culture. Holy Family Residential Care staff have started to do some work in understanding how we might begin to shift a culture of staff - when they are approached by residents, families and visitors who are asking for help, by responding with a "Yes! I can help you!" Holy Family staff acknowledge that sometimes in our need to speak our truth and clarify things, our typical responses to questions being asked by families or residents can sound like, "I'm sorry, this is my first day back" or "I'm not sure, I'm not your nurse" to walking passed a person quickly who staff know will take more time than they have available in that moment. Holy Family staff came up with the idea of responding to requests like this with a "Yes! I can help you!" which was shared with the Youville team and trialed for the day shift and evening shift. An interesting outcome after a day of responding to people with a "Yes! I can help you!" was that one of the Youville care aides said after her busy day shift, "The place was so much calmer today than I have seen in a long time. Maybe there is something to this - especially if it involves everyone - not just nursing - but all of the leaders and the interdisciplinary team members also saying 'Yes! I can help you!' - just like today. It has the ability to really create a happier, more settled, place."
Next week will reveal "Pain Matters" in a final pre-work prior to Megamorphosis at Youville. Megamorphosis is the term created to reflect the magnitide of evolution towards the culture shift required to achieve the vision in residential care. The Megamorphosis is starting at Youville and will continue to spread across the 5 residential care homes at PHC.
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