You've Gotta Know the Lingo

**VivaLasViejas**, ASN, RN

So this morning as I was enthroned upon the seat of wisdom, trying to decide what I was going to do with these precious 48 hours of weekend and instead thinking about work, it occurred to me that each area of nursing has its own language.....a special jargon which can be used by anyone, but only truly understood by insiders. The ER immediately comes to mind with its alphabet soup of acronyms that describe a vast array of patient conditions and ailments (not all of which are physical in nature) in terms that the average person would probably call "politically incorrect".

But while emergency nursing garners all the publicity, geriatric nursing---even with its (undeserved) reputation for being dull and boring---has a rich vocabulary all its own. Much of it is euphemistic: geriatric nurses don't, as a rule, call people "old" or refer to incontinence products as "diapers". Heck, we don't even call our patients "patients"---in our world, they are residents and the nursing facility is no longer a "facility" but their home....as in "Hey, Cara, will you take Miss Ellen home after you get done feeding her?" (Actually, we don't "feed" people anymore, either; we "assist them to eat".)

Our unique lingo spills over into daily life, both at work and everywhere else we go:

1) While dining out with the family recently, I requested some "clothing protectors" for my young grandsons and wondered why the waiter was looking at me so quizzically. I've worked in long-term care for so long that I completely forgot that those are called BIBS, especially when the wearer is under age 6. Oops.

2) Elderly folks never die, or God forbid, expire. They "pass".......as in "Honey, did you see the obituaries tonight? Your old friend Tim's father passed yesterday". I use it because it's a sweet, quaint, sentimental term that speaks of the passage of a soul into eternity rather than the cold, clinical reality of death. Despite presiding at dozens of "passings" in the course of my own career, I prefer to think of dying as the last and greatest adventure of the life cycle; so did many of the folks I've worked with and seen off on that final journey.

3) Has anyone else noticed that "people with impaired mobility" don't use walkers and wheelchairs anymore? According to Madison Avenue, they employ "mobility devices" that "assist them in maintaining optimal quality of life". I'm not sure how the actual users of such devices feel about that; in fact, most of the ones I know absolutely hate the fact that they depend on such equipment to get around. I experienced a taste of life with impaired mobility myself last Summer when I had to use a walker for a few days after my knee surgery; believe me, I wasn't too proud to call the thing what it was, even if I did feel kind of, well.......old.

4) Speaking of which: there is no such thing as an "old man" or "old lady" anymore. They are "chronologically gifted", "senior citizens," "the Greatest Generation" (and we Boomers are hot on their heels, approaching age 65 at approximately the speed of light); but if we don't care about semantics, we usually just call them "the elderly".

5) A seasoned geriatric nurse has an average vocabulary of some 500 descriptive terms for a substance the chronologically gifted tend to produce either in massive amounts, or hardly at all. The business of doing one's business is BIG business for the manufacturers of medicines that regulate aging bowels; you've got pills and potions to get things started, and more to slow them down once the system is cranked up and running on warp speed. What's more, we can walk onto a LTC unit and know immediately which resident "went" and what, if anything, was used to make it happen......just by sniffing the air.

6) One of my personal favorite words is "perseverate", which I'm not even sure IS a word. I've always suspected it was a made-up combination of "persevere" and another word---"irritate", maybe?---that's used so often that healthcare professionals have accepted it as part of the lexicon. It's certainly used often enough in residents' progress notes when nurses are particularly exasperated with hearing the same complaint over and over, e.g. "Harriet has come to the nurses' station 12 different x's this shift, perseverating on the idea that roommate is stealing her underwear even w/ staff reassurances to the contrary". And frankly, if perseverate really isn't a word..........it certainly deserves to be.

7) You don't ever want to tell the average male resident that you're going to put a "gown" on---or "change"---him at bedtime; he is apt to punch you in the nose. What you want to do instead is help him get into his "nightshirt" and put some clean "britches" on. 'Nuff said.

? We don't "distract" our "demented patients" from doing things that would get them ostracized from the common areas of the home (such as fingerpainting) or are outright dangerous (like trying to get out whenever the front door opens): we "redirect" our "cognitively impaired residents" to more appropriate activities. The techniques for doing this have been much improved over the past 12-15 years; when I was starting out in nursing, we were routinely instructed to re-orient confused people to time and place, which was an approach I instinctively disagreed with even as a green CNA.

My reasoning was simple: if a resident with dementia believes it's 1964 and she's meeting her kids at the bus stop in five minutes---and that part of her life was much more pleasant for her than her current situation---why not try entering her reality, instead of trying to impose our own? It's entirely possible to dissuade her from zipping out the door if we make time to ask her about her family and learn what her life was like back then; many older individuals enjoy telling stories about their younger selves, and may become agitated and anxious when they sense that no one is listening to them. As a longtime geriatric nurse, I can attest that encouraging even the most confused residents to talk about their life experiences often goes a long way toward decreasing adverse "behaviors" (another term I dislike when it's applied to older adults) and improving mood.

9) Climbing back down off my soapbox and referring to #5 for a moment: Geriatric nurses also have a number of methods at their disposal to deal with constipation (and yes, we still use that term). There's "power pudding"(pureed prunes, oatmeal, and applesauce).......the "black cow" (gotta love that molasses and milk of magnesia combo).........and the notorious Triple-H enema (high, hot, and helluva lot). Personally, my weapon of choice is one I first heard of here at AN: the "Hot Slider", which is simply a mixture of six ounces of prune juice, two pats of butter, and 30 ml MOM or Karo dark corn syrup, which is zapped in the microwave for about 45 seconds, then stirred and given to the resident to drink. Within hours, the blockage has broken up and everything heads for the exit the way grease goes through a goose. (I've known this concoction to fail only once in all the times I've given it, in a gentleman who hadn't had a BM in over a week and was later diagnosed with "obstipation", a country doctor's term for what nurses simply call FOS.)

10) Then there are the acronyms and other expressions we all know and love:

LOL (Little Old Lady)

FOS (full of, um, stuff); sometimes spelled FOSS (full-of-stuff syndrome)

GOK (God Only Knows what's wrong with this resident)

SOS (chipped beef on toast, a common entree served in long-term care facilities, which is about as palatable as its name)

PITA precautions (resident and/or family are a pain in the posterior to deal with)

ECF (Eternal Care Facility) or Celestial Transfer (resident "passed")

There's more, but the weekend is calling, those 48 hours are now down to about 38, and I've got to play executive director next week while the boss is out of town. Such is the life of a geriatric nurse!

You've Gotta Know the Lingo

Our unique lingo spills over into daily life, both at work and everywhere else we go:

About VivaLasViejas, ASN, RN

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