By Margaret Heale, RN, MSc, CWOCN
Looking back on a previous New England WOCN Society regional conference I attended, it strikes me that there where several impressive items discussed relating to the topic of pressure injuries.
In listening to Dr. Joyce Black give a little background on the NPUAP rationale for the recent changes made to pressure injury staging, it was clear that much thought had gone into changing the term "pressure ulcer" to "pressure injury". It has always seemed odd to have intact skin called an ulcer and it was good to hear her state the trouble they went to in considering the changes, particularly regarding litigation. People were worried if patients hear the word "injury" they are more likely to place blame for the wound on the facility and this might lead to more litigation. The lawyers contacted about this concern did not think it would make any difference; indeed, some were pleased with the change as when jurors hear the word "ulcer" they often tend to think of stomach ulcers and this is not helpful.
The Practice of Pronunciation
There were a couple of statements that I found interesting to do with terminology commonly used in wound care and pronunciation, which Dr. Black would like us all to pay attention to. I always thought I was the only one who cared about this type of thing and as I have a rather distinct accent, I keep quiet on the subject. She commented on the way people call slough "slow" (as in "plow", was her example) or even "sloth" (as in the very slow ape like creature). Dr. Black advised that we must be careful with our terminology use as mispronounced, misused or misspelled terms makes us appear unknowledgeable as wound care professionals.
From a patient or caregiver perspective, how much confidence can you have in your health care provider if they can't use correct language? I will stick my neck out here in total agreement and list a few terms I have observed being commonly misused, misspelled or mispronounced that might worry an informed consumer of our professional competence.
- PH instead of pH relating to acidity and alkalinity (the 'p' is a mathematical constant and the 'H' is the international formulary for hydrogen).
- AG for silver rather than the internationally recognized formulary Ag.
- HG for mercury instead of Hg.
- Callous instead of callus. I have been told either spelling is acceptable, but I tend to disagree.
- Atrial ulcer instead of arterial ulcer (that would be a nasty ulcer if it was in your heart).
- Cellutic when referring to a patient's leg that has cellulitis, it should be cellulitic.
- "The data is correct" should be "the data are correct" as data are plural, datum being singular. Online dictionaries point out the expected plural usage of the term is because of a mandate by most journals, whereas the standard usage "the data is correct" is apparently ok now.
- The patient had a "cabbage" instead of Coronary Artery Bypass Graft (CABG) is one of my favorites.
- A wound with pus is purulent, or should be documented as a wound with pus. I can't bring myself to write pussy, pusy, or pusey, they are all just wrong.
There are a few terms I am not sure about. For example, the Achilles tendon is always written with a capital 'A' in the UK, as is the sphincter of Oddi, Doppler and the vein of Galen because they are named after people – Achilles a Greek hero, Oddi and Galen anatomists, and Doppler who was an Austrian physicist.
Other English differences are: colour, odour, orthopaedic, paediatric, homœopathic, hiccough, diarrhoea, aetology, aluminium. Then there are words that are more rarely used in the US, such as pyrexia to mean fever or aperient meaning a mild laxative.
I agree we must be more careful with how we are using language and medical terms in our professional as wound care providers, but as my own spelling and grammar are far from perfect, I will not be throwing any stones, just providing a few suggestions. As a Brit, not being understood because of my accent is fairly common, but it does also give me an excuse! In England of course "Slough" is next to Heathrow airport and though it is pronounced "slow", we have no such word as "plow" (the farm machine that turns the soil is a "plough"), but of course "cough" is not "cow", oh dear!
The Evolving Language of Wound Care
However much I agree with Dr. Black, we do need to recognize that language is not written in stone; it is a growing, almost organic communication tool. It changes with a type of "social consensus" that is often illusive. Rules exist and generally should be adhered to. As professionals communicating with people that we need to trust and respect us, we have a duty to stick to the rules. My suggestion is:
- Do a little reflective practice.
- Make a spelling list of words you know you have a problem with.
- Correct any guidelines, written documents and have the electronic record changed if incorrect.
- When you teach, give out a definition sheet including the above items and others you come across. Communicate to the learners that these rules matter, they make a difference in how we are perceived not just by the public but by our colleagues.
I do wish I could remember how she pronounced "epibole" as I never use the word due to not being able to say it correctly, but then "respiratory" is difficult for most Brits too.
I will be addressing more on pressure injuries with a look at prevention and repositioning strategies in my next blog post.
About The Author
Margaret Heale has a clinical consulting service, Heale Wound Care in Southeastern Vermont and draws on her extensive experience as a wound, ostomy and continence nurse in acute and long-term care settings to provide education and holistic care in her practice.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.