How Names and Labels Affect Patient Care

June 24, 2016
A teacher and student having a conversation

What’s in a name?
Let’s see: Crisis Prevention Institute, OK. Nonviolent Crisis Intervention, OK. 
Both of these names identify a topic and an idea of its possible function. They’re clear and unambiguous in their names and purposes. They were named this way for a reason: To represent an idea, a concept, and a philosophy taught and used by many businesses, treatment facilities, healthcare centers, and hospitals, of which we here at the Arizona State Hospital are one. 
Once upon a time our hospital was named the Arizona Territorial Insane Asylum. 
This name, as expressed by many, was thought to be too condemning and not reflective of the care, treatment, services, and assistance afforded the many individuals who came to know this place as their home. Our hospital continues to model and foster the idea and practice of patient Recovery and Empowerment, even before it became a cool catch phrase and the “now” thing to say. 
As the years pass we continue to educate ourselves on what we already knew, but needed some reminding of:

That it is improper to call or reference any patient or group of patients living in our community by any disparaging and demeaning names, labels, or titles. Our patients simply are who they are, and at times they need our help. And as a staff we generally address each patient by name or by an agreed-upon acceptable name. 
So some might ask, What’s in a name?  
And I would answer, Dignity and pride.
When I address patients who are attending specific groups by their names and not by the group name, I find them to be more receptive and engaged. They freely voice their struggles, concerns, and crisis experiences. They speak at times about their vulnerabilities and their wanting to be treated with understanding and respect, just like any of us.  

Use respectful names (not labels) & patients will be more receptive to care.

In my addressing the patients by name they are also more elaborative, take more risks, and speak about their ability to manage more circumstances as they face more challenges. 
CPI incorporates proportional intervention techniques in their training, so as to safely address many risk behaviors with tempered responses. CPI training offers sufficient latitude that staff can apply to any individual who requires a more varied or measured response. This offers the interventionist greater latitude in selecting the appropriate intervention in their assessment of a situation. 
So what’s in a name?
I would answer, Engagement and understanding.
If it’s true that we all share in the responsibility for the Care, Welfare, Safety, and Security℠ of our patients, then we should better recognize our own behavior and shortcomings, given the labeling of patients and others we interact with. 
A crisis could occur by something as simple as mispronouncing a patient’s name or calling a patient something other than what they wish to be called. 
Critical thinking opportunities like these arise multiple times each and every day on every unit. When confronted with these situations, and having our CPI training, it becomes easier to say and do the right things. 
With the support of our state’s Department of Health and our hospital, we as a staff have the opportunity to address and change our behavior through a number of programs. We change by:

  • Dropping any poor interactive practices that may trigger a patient into a crisis.
  • Knowing that words and language can be powerful tools that can calm or escalate a person to crisis.
  • Incorporating CPI’s Trauma-Informed Care principles and strategies into our training.  

CPI aided in educating our staff to become more aware of a patient’s cueing behavior. This allows staff the opportunity for early intervention and working toward averting crisis when applicable.  
Labeling patients by calling them borderlines, anti-socials, schizophrenics, crazies, and nuts shows little compassion and minimizes the fact that these are patients seeking our help.

Words & language are powerful tools that can calm or escalate a person in crisis.

In fact, our patients are individuals with names who are in need of assistance. They hope that the staff they turn to can comfort them.  
So what’s in a name? 
As an optimist, I say: Hope.
Additional education and training is always needed for staff. For you, for me, for all of us. 
The ability and practice of knowing and calling out the names of the patients you support and care for is special. It says you took the time to know me and/or things about me. It’s what the Integrated Experience is all about. It’s a valuable tool for any interventionist to use before, during, and after any crisis event.

Staff may sometimes be unaware of how their fear and anxiety, Integrated Experiences, kinesics, and other verbal and nonverbal communications and/or behaviors can be a triggering event, but your patient is likely aware of how staff responds. Train your staff how to respond in an empathic, person-centered way, and you will see the difference—for patients and staff.

So what’s in a name? 
I would say, Safety.
Proxemics, Communication, and Accountability are three of the major concepts we work on here at the Arizona State Hospital, as we educate our staff and patients on both the value and importance of trust and inclusion in treatment and maintaining a safe environment. 
Patient input is valued as we work collectively toward a Recovery Model. We make every effort to acknowledge our patients’ accomplishments as we promote and reward both their successes and their efforts in treatment through recognition and privileging. 
This is also true of CPI’s Postvention/debriefing model. In examining the questions that are posed in the COPING Model℠, staff find the strength of the model necessary for a number of reasons, one of which is to prevent an occurrence from repeating itself. Another is being able to return control to the individual in the final analysis, having examined the Precipitating Factors as well. 
Knowing the names of the people you care for can be an invaluable resource in maintaining a healthy program.  
Do you know your clients? Can you name them?
So what’s in a name? 
I believe: Caring and respect.

With over 30 years of experience at the Arizona State Hospital in Phoenix, D.C. Foster is a Behavioral Health Intervention Specialist and Master Level CPI Instructor. D.C. works with individuals identified as Serious Mental Illness (SMI), Forensic, and Sexually Violent Persons (SVP). Since 2012, he has been using CPI training to create a more person-centered, trauma-informed, recovery-oriented therapeutic environment for patients. D.C. is also a leading member in the CPI Instructor Community, where he exchanges training strategies and professional development techniques with his fellow Instructors.

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