According to the American Diabetes Association, individuals with diabetes account for nearly 30% of all hospital inpatients in the United States. As a result, regardless of role, nurses are likely to encounter people living with diabetes. Nurses provide patient education, including disease management, medication use, and self-care skills to people with diabetes. Being positioned at the frontline of clinical contact, nurses also drive communication with the healthcare team. As nurses, we should ask ourselves, does the way we talk to and about people with diabetes contribute to their diabetes-related health outcomes?
Negative language about people with diabetes may perpetuate stigma and lead to harmful consequences. Link and colleagues describe stigma as categorizing people by their differences and associating those differences with negative stereotypes. According to findings by Beverly and colleagues, a person with diabetes may feel blamed and judged for their condition when hearing labels such as “diabetic,” “non-compliant,” or “poorly controlled.” By approaching diabetes care through a disease-centered lens, we’re not accounting for the individuality of the patient and the barriers they face.
Dickenson and colleagues concluded that the impact on the patient can be both immediate and long-term, potentially leading to increased diabetes distress and glucose levels, as well as decreased self-care behaviors. From a broader perspective, Akbari and colleagues reported that disease-related stigma can negatively impact self-esteem and life satisfaction and increase feelings of shame and self-blame. In addition, they found that patients may avoid or delay seeking treatment or follow-up care when they anticipate or are faced with stigmatizing language. They also may conceal their disease or symptoms.
Person-first language isn’t a foreign concept to nurses. We don’t use disease-centered language for many other disease processes. In oncology for instance, we refer to the patient as a “person with cancer” not a “cancerous person.” In fact, it’s natural and common to use person-first language for the vast majority of conditions, such as “a patient with Parkinson’s disease” or “a patient with hypothyroidism.” The absence of a label keeps the focus on the person. Similarly, in diabetes care, we should refer to a person with diabetes, rather than a “diabetic,” to facilitate the humanization of the individual. Person-first care is foundational to nursing and our language should reflect that. According to Jean Watson’s Theory of Human Caring, the nurse should view the patient as a whole person to be respected, not an object or a medical diagnosis to be fixed.
Conversations about person-first language regarding diabetes have been ongoing for over a decade, yet there’s still work to be done. Disease-centered language is in medical and nursing textbooks, coding, and electronic health records. Language that’s baked into healthcare is very difficult to change. However, nursing is well positioned to lead the change. The first step is self-awareness and learning to identify harmful disease-centered language. We also need to educate ourselves and others in healthcare on the importance of using language that puts the patient first.
Practicing person-first language is vital in our documentation, and in our interactions with our patients, their families, and the entire healthcare team. As nurses, we can be the change agents who ensure that patients with diabetes receive the individualized care and communication they deserve.
References
Akbari H, Mohammadi M, Hosseini A. Disease-related stigma, stigmatizers, causes, and consequences: A systematic review. Iran J Public Health. 2023;52(10):2042-54. doi:10.18502/ijph.v52i10.13842
American Diabetes Association. The American Diabetes Association and The Leapfrog Group name 17 hospitals as “Recognized Leaders in Caring for People Living with Diabetes.” March 20, 2024. diabetes.org/newsroom/press-releases/american-diabetes-association-and-leapfrog-group-name-17-hospitals
Beverly EA, Hughes AS, Saunders A. Examination of health care providers’ use of language in diabetes care: A secondary qualitative data analysis. Clin Diabetes. 2022;40(4):434-41. doi:10.2337/cd21-0108
Dickinson JK, Posesorski RE, Djiovanis SG, Brady VJ. Impact of negative or stigmatizing messages on diabetes outcomes: An integrative review. Sci Diabetes Self Manag Care. 2024;50(2):167-78. doi:10.1177/26350106241232644
Link BG, Phelan JC. Stigma and its public health implications. Lancet. 2006;367(9509):528-9. doi:10.1016/S0140-6736(06)68184-1
Watson Caring Science Institute. Watson’s caring science & human caring theory. https://www.watsoncaringscience.org/about-wcsi/jean-bio/caring-science-theory/
