"if you weren't so obese, you probably wouldn't have 1/2 the illnesses you do"

[SNB1014]

i'm not sure if this is a vent or just an effort to regain my sense of nursing compassion, but WHAT HAPPENED to honest patient teaching? some of the RNs on my floor seem scared to address the obvious- being an obese smoker who seems allergic to any type of a healthy lifestyle is the main reason a majority of our patients are here, on our med/surg floor.

The main illnesses I see? uncontrolled Hypertension, uncontrolled type 2 diabetes, CHF etc. How can I be more compassionate yet still addressing the truth?

At least in the children, the odds of them being "at fault" for their illness are very, very slim- I'm considering a transfer to Peds.

How can I keep "the hunger" I started with when I see so many chronic diseases that are intrinsicly linked to poor lifestyle choices?

Please help. i dont want to become a RN who is there to clock in and clock out while secretly wanting to smack some common sense into them, lol

Thank you all, in advance.

[linearthinker, DNP, RN]

There is data to support that the ore times people are told they need to quit smoking, lose weight, etc, the more likely they are to do so. With that in mind, I'd say it is the obligation of HCPs to say what needs to be said. Needn't be rude, but it has to get out there. Obese is not a dirty word, and if it is accurate, it isn't a crime to use it.

[AroundtheBlockRN]

I would have to agree with MJB2010. I don't know if you are new to the profession or prejudiced. That being said, simply insisting people take your advice, lose weight and all will be well is too simplistic and callous. Sure, so many things we could all control regarding our health and well-being but we don't. Consider why this particular thing is bothering you. People do listen to what you say, they just can't always go right out and do it. The best you can do for your patients is deliver your care in the most empathetic, caring non-judgmental way while they are in your care. No patient wants to be obese or ill or diseased. It's much more complex than that. You won't get away from these things by going to Peds. Figure out what is really bothering you. You can't control what they do but you can control how you care for and understand your patients. Their time with you is just as important to them as it is to you. You will have a greater impact by checking your bias at the door. If you think they don't sense your disdain, rethink how you approach and interact. I hope you do not lose your compassion but regain it with gusto. Always put yourself in their shoes first. Best of luck.

[linearthinker, DNP, RN]

I totally disagree that it is callous to address important health issues w/ patients just because they may not like it. It is the height or irresponsibility to ignore the elephant in the room.

[kesr]

Another piece of the equation is money. Poor health "choices" cost all of us in additional health dollars. Our insurance and taxes go higher every year, yet the pts with self inflicted (for lack of a better term) problems suck up the bulk of the care dollars.

I don't want to be hateful, but when you see thousands of dollars, and so much time, energy and grief these problems cause, it is hard to stay nonjudgemental. My mother died of lung cancer after ignoring pleas to quit smoking, yet my sister has STARTED smoking. So frustrating!

[OCNRN63, RN]

yes, but what would you say if they were still smoking?

Nothing. I mean, they have CA, the damage is already done. They have the info on stopping smoking, they know by now what the risks of smoking are; they face it every time they come in for chemo. What better object lesson could you possibly have? What am I going to say to a Stage IV lung CA that he/she doesn't already know?

[AgentBeast, BSN, RN]

God, grant us the...

Serenity to accept things we cannot change,

Courage to change the things we can,

and the Wisdom to know the difference

Patience for the things that take time

Appreciation for all that we have,

and Tolerance for those with different struggles

Freedom to live beyond the limitations of our past ways,

the Ability to feel your love for us and our love for each other

and the Strength to get up and try again even when we feel it is hopeless.

- Reinhold Niebuhr

[linearthinker, DNP, RN]

Nothing. I mean, they have CA, the damage is already done. They have the info on stopping smoking, they know by now what the risks of smoking are; they face it every time they come in for chemo. What better object lesson could you possibly have? What am I going to say to a Stage IV lung CA that he/she doesn't already know?

I'd remind them each and every time I saw them their outcome odds would improve if they quit. If they don't want to quit, there seems to be little point in getting chemo, lol.

[erikab987]

I have to say, I feel that many of the posters on this thread referring to the OP as "callous", "rude", "uncaring", etc. seem to come from misinterpretation of the inflection. I, also, was a little taken aback at the poster before I opened and read the entire entry, but the truth of the matter is: nurses are educators and counselors to their patients. Yes, most people know that smoking is bad and that they should quit. Yes, most people know that obesity is linked to many secondary/subsequent illnesses. I think the driving message here is that the OP is hearing fellow nurses/employees candy-coating their patients' conditions when their personal life choices are seriously contributing to the deterioration of their health. Look, I used to smoke; a pack-a-day for 10 years. Yes I knew I needed to quit, but it wasn't until a serious UR infection that it really hit me. Many patients in Med-Surg departments are not there for the first time. Do you want to live? Well, a healthy, lengthy life comes at a price: make good decisions when it comes to your health. It doesn't seem like this post was about "let's bash the fat guy", but an inflection about the lack of responsibility from patients for their own health and how that affects the system and the people who care for them. Obesity is a sad thing, but their are few other countries in the world that even consider it a health condition because it is almost non-existent. C'mon people, you don't think that pt's are responsible for eating themselves to death? Would you fail to mention to an addict in your care that they NEED TO STOP DOING DRUGS? Or do you think saying so is stereotypical? We don't have to be mean, rude or belittling, but it is certainly NOT our job to act like it's OK.

[Spritenurse1210, BSN, RN]

I absolutely refuse to be harsh or rude to obese patients. I've struggled with my weight since 14 years old, and I identify with a lot of them. When I educate my patients about nutrition and blood sugar control, I prefer to say something like:

"It's very important that you eat good carbs instead of refined sugars. Good carbs contribute to better blood sugar control. It's important to control your blood sugar so that you have a healthier and more enjoyable life."

Don't forget as nurses we are supposed to teach our patients, not judge them.

[Spritenurse1210, BSN, RN]

I think the driving message here is that the OP is hearing fellow nurses/employees candy-coating their patients' conditions when their personal life choices are seriously contributing to the deterioration of their healtho you think saying so is stereotypical? We don't have to be mean, rude or belittling, but it is certainly NOT our job to act like it's OK.

I agree with you. You can be professional, but not belittling. Well said.

[fortunato]

Some of these patients are just clueless also! I am fat myself, but I am at least educated about my own situation! I also have a huge heart for these folks! I know how addicting food can become!

I had a patient today (in clinical) who was easily 450 lbs+. In the course of asking stupid questions for a care plan I had to asked her how she would describe her health. Her answer - "GREAT!"

She has bad COPD, CHF, history of MI, 2/3+ edema all over the place and DQ's to boot!

Really? Great huh? LOL! I don't know if it was denial or just what she truly thinks!

[nursemike, ASN, RN]

But, to answer the question posed, I think the key to being nonjudgemental is humility. Your patients are imperfect. If they weren't, as you note, many of them wouldn't be patients. But, at the risk of making an unfounded assumption, I'm almost certain you aren't perfect, either. Some of us are lucky, in that at least some of our shortcomings are easily recognized by only cursory examination. Others may have to look harder. Most don't actually need to look as hard as they may think they do--our flaws have a way of seeming more obvious to others than to ourselves.

I noticed the OP put "fault" in quotes. Why not go a step further and just drop the term entirely. It isn't relevent. Teaching is not scolding. Teaching people what they already know is a waste of breath. How about addressing the un-obvious? Like, smoking outdoors is better than smoking indoors. Why? Because if you go outside to smoke, you won't do it nearly as often. Walking a mile every day is good. Walking ten minutes a day is better than nothing. Fried pork rinds have no carbs.

It's triage, baby. Heroic efforts in a lost cause accomplish nothing but keeping us from more modest, but potentially effective ones. None of us are saints, and we all have moments where we just shake our heads, but still, I think we all know that judging and treating are incompatible. If you can't refrain from judgement, or if your back isn't up to the job, there are many other worthy careers.