Sticks and Stones was a paper written during my time at the University of Phoenix in 2009-2010.  It was in reference to labeling people - patients, specifically - with derogatory terms that do nothing to define them either as a patient or a person.  As I typed the information here, I was put aback by how much our culture has changed even in 12 short years.  Following the information I added a "footnote" with my current thoughts, as if I had to write the same paper today.

"Sticks and stones may break my bones, but words will never hurt me."

Do you remember this childhood saying that protected you against name calling bullies?  Somehow, it seemed to work then, but in reality, the saying is wrong.  Words can and do inflict pain than the biggest stick or the heaviest stone could ever cause (Edrick, 2005).

The words chosen to use to describe our patients can hurt them and others around us.  They bring negative connotation and attitude to a situation that should instead be met with empathy and compassion.

We often use many words when discussing patients with other members of the health care team.  Most of the time, these words have a negative connotation. 

For instance, we might refer to patients as "nuts" or "crazy".  They are those that often make doing our jobs difficult because of underlying behaviors or issues. They may talk too much, complain too much, or have behavior or personality issues that prevent us from doing our job of making them comfortable or feel better.  These people make us want to pull our hair out!

The "seeker" is often the name we give a patient who, for one reason or another, requires more pain/other medication to treat symptoms. These patients frequently know what they want, and are very well educated with knowledge about their symptoms. (side note: they can also be VERY manipulative) We as healthcare professionals must monitor their medication use but we must also remember that promise of comfort.

"Alcoholic" has been a term to label patients who have cirrhosis, liver disease, or Hepatitis C with an assumption that this person "must have been a drinker," when, in fact, there are other reasons these diseases occur.

"Non-compliant" patients are those that do not wish to follow our recommendations for their care.  We must remember that we cannot force care (side note: I have learned that yes, yes we can), only educate people about what we believe will provide them the most optimum level of comfort.

"COPD'r" refers to a patient with COPD, often requiring more frequent medical care.  Too often these people "must have been a smoker."

A "junkie" may be a patient who may have/had a drug history.  Regardless of the patient's actions we must treat them as any other patient.  They too are human.

Culturally competent care is defined as being sensitive to issues related to culture, race, religion, gender.  It can also refer to lifestyle choices and behaviors.  

Stereotyping is using prejudiced attitudes that are developed through interactions with family, friends, and others in an individual's social and cultural system. 

Labeling is referring to a patient by his or her diagnoses or problem diminishes the value of the person (Gorman, Raines & Sultan, 1996).

Both of these obstacles to culturally competent care cause nurses and other members of the health care team to focus on the label rather than the patient's underlying needs and feelings - often symptoms are missed, causing the patient greater discomfort.  

Several barriers exist that affect effective clinical decision making that may be caused by using stereotypes and labels in patient care. 

They can exert powerful negative effects at an implicit, unconscious level, even among well-meaning, well-educated persons who are not overtly biased.  For example, if a physician tells the nurse a patient is a "seeker" and "only wants free medicine," the nurse may be reluctant to believe that patient when he or she identifies a symptom that warrants medication (side note: as my experience progresses, I see this as more of a nurse/nurse communication with doctors not questioning why the medication is needed.)

Labels and stereotypes can influence how the patients' information is processed and recalled.  With the previous example, we may choose to ignore the symptom and the request for the medication, thereby causing the patient a greater deal of discomfort or increased symptoms which in turn makes symptom management more difficult.

This behavior may cause healthcare professionals to exert our "self-fulfilling" attitudes on our patients.  For example, treating the patient with COPD negatively based on our assumption or knowledge that they smoked for many years when we ourselves do not smoke' or treating the AIDS patient as if they caused his or her illness or because he or she may have a different lifestyle than ours.  Patients and families see these attitudes, no matter how overt or subtle, and this affects and limits how open their relationship is with the healthcare team.  

Most important, by labeling or stereotyping, we are limiting our ability to see each human being as unique, and to see them with compassion and kindness - something each patient deserves every day, by every member of that team.  

Not only do labels damage those they target, and offend those that hear them, they also damage the person speaking them because the words are a way of distancing ourselves from that which makes us uncomfortable, and that has a way of hardening our heart.

Anyone who has ever felt vulnerable or frightened or in pain or is dying knows when someone else is uncomfortable and unable to BE with their suffering.  

It is important that we understand the reasons WHY people struggle when they are under stress.  It is often common to call them "difficult" or "anxious" or another "fitting" label.

The truth is that WE are the ones who feel anxious when we are dealing with behaviors we don't understand or feel qualified to support.   

Sheldon (2005) stated, "Nurses need to examine and acknowledge their personal assumptions about groups different from their own.  Understanding the complexity of social, cultural, and economic factors allows the nurse to provide culturally sensitive and individualized care." (p. 32-33)

The more we can help people to overcome the urge to push away (labeling, body language, etc.) the more we will indeed express compassion in our work.

We must remember that this understanding and acceptance means neither approving nor disapproving of our patients, their beliefs, habits, expressions of feeling or chosen lifestyles.  All healthcare professionals must acknowledge a patient's rights to be different, and accept that differentness (Chitty, 2005).