EDITORIAL BOARD Irene Anderson, Principal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Freelance Lecturer and Writer Dimitri Beeckman, Professor of Skin Integrity and Clinical Nursing, Ghent University, Belgium Jacqueline Boulton, Lecturer in Adult Nursing, Faculty Lead for student mobility, electives and global health, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London Beverley Brathwaite, visiting senior lecturer, Middlesex University Nicholas Castle, Head of Professions/ Assistant Executive Director, Hamad Medical Corporation Ambulance Service, Qatar Jothi Clara J Micheal, Group Director – Nursing, Global Hospitals Group, India Emma Collins, Nurse Consultant, Sexual Health In Plymouth, University Hospitals Plymouth NHS Trust Alison Coull, Lecturer at Queen Margaret University, Edinburgh Angela Grainger, Senior Lecturer, BPP University Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Barry Hill, Programme Leader and Senior Lecturer, Northumbria University Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Jacqueline Leigh, Professor Nurse Education Practice School Health & Society, University of Salford Joanne McPeake, Acute Specialist Nurse/ Senior Staff Nurse in Critical Care; Honorary Lecturer/Practitioner in Critical Care, University of Glasgow John McKinnon, Senior Lecturer, School of Health and Social Care, University of Lincoln Michelle Mello, Deputy Director: Workforce Development / National Clinical Lead, Personalised Care Group, NHS England/ NHS Improvement Aby Mitchell, Senior Lecturer Adult Nursing, University of West London Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser Joy Notter, Professor, Birmingham City University & Saxion University of Applied Science, Netherlands Hilary Paniagua, Principal Lecturer/Head of Doctoral Studies Faculty of Health & Well Being at the University of Wolverhampton Ian Peate, Director of Studies, Head of School, Gibraltar Health Authority Kendra Schneller, Nurse Practitioner, Health Inclusion Team – Vulnerable Adults and Prevention Services, Guy’s & St Thomas’ NHS Foundation Trust John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham Geoffrey Walker, Matron for Medicine, Cardiology and Specialist Nursing Services Poole Hospital NHS Foundation Trust Jamie Waterall, Deputy Chief Public Health Nurse, Office for Health Improvement & Disparities; Honorary Professor, University of Nottingham Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Research Fellow, Oxford Brookes University.
A question of nuance Theresa Bourne, Associate Professor, Midwifery and Undergraduate Medical Studies, Department of Nursing and Midwifery, Faculty of Health, Social Care and Education, Middlesex University, London, firstname.lastname@example.org
Language is a challenging tool with many interpretations that can have deep meanings and cause hurt without intention. I remember being called to the sister’s office as a student nurse for a full dressing down. I had been looking after a male client who was drowsy and disoriented. I had commented,‘You seem quite dopey, are you OK?’ The offending word was ‘dopey’, which she took to mean stupid. She was right, I did need to consider the words I used. I may have meant it in a different way, but it was open to interpretation. I now try to think about what and how I say things but still don’t always get it right.
In today’s changing landscape, there is a strong emphasis on inclusivity, which is important when looking at research and challenging existing health structures. However,with the grouping of individuals we may miss the nuances.
I have just found out that I have cognitive impairment: my mind does not work in the same way that other people’s do. However, my needs are very different from those of others within this broad category. If we use the term ‘disabled’ it implies that I am limited in some way.Yet, with support and changes in the way I work, I am still able to fully function in the workplace.
Similarly, ethnicity is a broad brush that takes in so many cultures and practices.This includes the way the patient or client seeks or asks for help. I am not simply talking about translation (although that is difficult enough in any healthcare system) but how the client asks for help. Sometimes a client may seem confrontational, or a ‘do you think …?’ question is asked and the answer doesn’t address why the question was asked in the first place.
Language conjures meaning but it may be that my meaning is very different from that of the client in front of me. It doesn’t help that I don’t always ask the right questions. I may ask about smoking and I’m told how many cigarettes a day they may or may not smoke, but really I want to know about all tobacco products, whether chewed, sniffed or smoked.When I ask about drugs, I don’t just mean illicit drugs but those self-prescribed and bought over the counter. I also tend to make assumptions when I ask about partners or intercourse in a way that might be influenced by my own cultural background.
Language is linked to identity, whether to the group or the individual, and this can cause tension. Recently there have been discussions over the use of ‘chest feeding’ and ‘breast feeding’. Breast feeding men are not new; indeed, the Aka Pygmy men often suckle their children, and feeding devices used to help women who struggle to breast feed, have been used by men.Transgender men may produce milk.The difficulty in calling it chest feeding is that men as well as women have breast tissue and if we ignore men’s breasts we potentially ignore the fact that 350 men each year are diagnosed with breast cancer in the UK (Cancer Research UK, 2020).
Brighton and Sussex University Hospitals (2020) has bravely released guidelines for perinatal care for trans and non-binary people.This is an important step for a gender group with no previous clear guidance on how to be supported in the maternity service. Nevertheless, it caused tension between two groups who have struggled for identity: women who wished to be considered as a whole rather than just as birthing parents and transgender/nonbinary people who have struggled for identity not only in the world but in maternity care specifically. What I think is ignored at other trusts, charities, and all those involved in maternity care, is that the guidelines were developed with the individual in mind.The language preferences you have are just as important as what name you want to be known by. I think there is enough room in this world for both ‘women’ and ‘birthing parents’.
I know that, despite my years in the health service, I am still learning. Sometimes I make mistakes and it is important to apologise but, more importantly, to reflect and change. Next time could I phrase that differently or use alternative or more appropriate words? More importantly, may I never lose sight of the individual in front of me and use the language that elicits the best care for the patient or client, remembering that the listening is just as important as the talking. BJN Brighton and Sussex University Hospitals NHS Trust. Perinatal care for trans and non-binary people. 2020. https://tinyurl. com/3w3yhza2 (accessed 18 May 2022) Cancer Research UK. Breast cancer in men. 2020. https://tinyurl.
com/2xazx3cw (accessed 18 May 2022) 2020
British Journal of Nursing, 2022, Vol 31, No 10