There is an article in this months American Journal for Nursing about nurses showing more encouragement & compassion for obese/smoking patients instead of making the patients feel judged or guilty. I am a pre-nursing student and attempting to formulate a response to this article.
My first instinct when I read this was that it was really sweet, it certainly gave me the warm-and-fuzzies, but it is simply not practical. The United States' obesity epidemic is becoming worse and worse. Researchers now even believe that the avg life expectancy is on the decline for this very reason. I just don't understand why medical professionals are expected to sugar coat their medical advice. Sure, I wouldn't expect a nurse to say, "Holy cow, you're so FAT! Lose some weight!" but I don't see why it would be offensive for a nurse to say, "You need to lose 100 lbs or your diabetes will cost you your legs." In the article it suggested a nurse say something like, "Let's focus on the aspect of your weight issue that's within your control." Does this statement really reflect the severity of the situation? I believe that guilt can be a very powerful motivator in these cases. I don't see guilt being a bad thing when it comes to issues as important as health.
If you would like to just provide a general opinion, that would be great. If you don't mind your opinion potentially being used in my paper, please let me know and I'll send you a message to get more info. Thank you!
Your job is not to dole out "reality" to patients, no matter what you think their health needs are. You can educate, once you've assessed a readiness to learn. Anything else may be seen as judgmental and confrontational.
Why do you have an issue with obese people specifically? Is it because their choices are so easily seen? Tell me about your life: have you ever had alcohol, used recreational drugs, eaten meat more than sparingly, or sometimes laid on the couch instead of exercising? I bet if I looked through your history I could find some flaw. Now imagine for a moment: how would you feel if you're in the hospital, laid out after a surgery, to have some stranger come up to you and lecture you about this unrelated bad habit?
I have a friend who died a few years ago (in her early 40s) of complications r/t fighting anorexia/bulimia her entire life. She was NEVER thin enough. She was a lovely person who did fantastic charity work, and she was a role model for me. It was a tragedy she had to die. She felt could never escape others judging.
Over 50% of teen girls in America have experimented with behaviors characteristic of eating disorders; people can do terrible things to their body without looking "obese" -- all in the name of looking "thinner".
I, even back in high school when I weighed the least, never fit into government weight charts. I simply have a very large build & 5'10" height. And I get my "reality" every time I go to the mall and can't fit into size 4 clothes. My body will never look like the women on TV or in Cosmo. Never mind that I'm healthy, have ideal bloodwork values, and am more active than my peers. Never mind I don't abuse drugs or alcohol, nor do I engage in risky behavior. Because if I walk into your hospital, all you may see is a fatty.
People get this idea in their head of what a healthy weight should be. We're reminded constantly by advertising, TV, magazines. Except what they're telling us is "healthy" and "beautiful" is fake. Have you seen this great short video that Dove created, showing how distorted the image of "beauty" is?
Your role as a nurse is not to give anyone a dose of "reality". Educate when they're receptive to learning. Help them find the support & other resources they need. But please don't go around placing your judgments on your patients.
Compassion is really how you approach the patient and issue. The opposite of compassion is indifference or callousness. Would you treat a patient with callousness? I hope not; you should address reality with the patient in a compassionate way. Your patient will also be more open to what you're saying:-)
When I read the initial post I was offended first as an obese person and second as a nurse with 20+ years of experience that a nurse or a potential nurse would question compassion versus reality. I Read through a great many of the post and can only say WOW to a lot of them. How does compassion get removed from any patient care regardless of the diagnosis or the underlying co-morbities of the patient? You can give reality without removing compassion from the mix. At 320 pounds I did have the "life altering" event that finally got my head straight. Getting the head straight is the key to this not reality of nutrition, exercise, etc. If you truly believe weight loss is only about eating less and moving more is the key to massive weight loss (100 ponds are more) then you no nothing of the issue. The sad part of my personal story is that after a 150 pound weight loss, standing 5'10'', a current weight of 170 and BMI of 26 I am considered overweight by every medical chart out there. If that doesn't say something about how the medical field and society see the weight issue nothing does.
I hope you find the information that you need to make a descion on your question. You have a lot of good responds here and a lot of not so good ones. The one question that I believe you need to ask yourself is: If that was me lying there, not feeling at my best how would I take the "reality" I am about to give?" On this issue I am a little bias, unless you have walked in my shoes, please do not try to tell me what is best, for you have no idea what you are talking about or what I am going through. Its like telling the mother of a dying child that you know how she feels when you do not have a child of your own.
There has been several stories on TV about thin stars putting on fat suits to see what it is like, but they will never know because at the end of the day, they can take the fat suit off and walk away. Maybe this would be an experiment for you to try so that you will have a taste of what the obese truly go through. Then ask yourself the question again and see if your perspective changes. In my personal sitiuaton the compassion was the first "babystep" on the road to reality.
I think nurses and doctors are genuinely concerned with does the patient have insurance and how long do I have to be burdened with this obese patient.
Why am I the one stuck with them?
Sorry, this one made me a bit crazy and I had to address it- I know in my facility I haven't a clue who has insurance/state insurance/ or private unless the patient decides to volunteer that information. It is simply not a part of my job to deal with that- and I am too busy too really care. I noticed from your profile you are still a student- I
think you will find once you are on the floor that concern for this aspect just isn't there- the billing department deals with that, not me.
A friend and I have discuused this often, the rise in the obese population. This group of pts are hard to care for and have multiple problems. Often they feel entitled to certain things. I have recently- over the past year lost 60 lbs. I find my self having less tolerance for the obese population. I guess I feel that if I can lose weight- and I didn't think that I could when I started- anyone can at least try. I no longer miss the foods that I used to eat all the time. In the long run, we are really accountable only to ourselves.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
on tlc, they had a show on a couple of nights ago, "the 600 lb. mom"...
a woman who was bedridden, and cared for by her 6 dtrs.
a dr. told her to lose 100 lbs, in order to qualify for bariatric surgery...
and he put her on a 700 kcal/day diet.
it showed her in denial about the severity of her problem;
it showed her cheating on her diet...
and frankly, i found myself getting angry at her...
because it wasn't fair to her dtrs having to be available to her 24/7.
iow, i didn't feel much compassion for her, and it bothers me to say that.
tough addiction to deal with, for sure.
leslie
I agree with leslie........how can someone continue to stuff their face like that. It boggles ones mind.
But.........The thing is........this addiction is an addiction that you have to be around everyday. The alcoholic is told "you can never drink alcohol again" the drug addict must "never touch the stuff" again.......they stay "CLEAN". The food addicted person must inbibe in the addiction every day for breakfast, luch and dinner.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I work for a nursing college. I am obese. I have been my entire life. Genetics plays a large role in this as I have a connective tissue disorder that determines what physical activity I may safely partake in, if at all. I'm horrified by the lack of compassion and empathy shown in some of these comments by nurses. The very people we (obese) as patients put our trust and care into are in fact victimizing us. Unless you have struggled with weight issues, you have no idea how difficult, demoralizing and humiliating it can be. When in a hospital, patients are at their most vulnerable and to be treated with disrespect and rudeness because of physical appearence is unthinkable. Yes, we as obese are cognizant of our health dangers, how could we not be? We are living, breathing, sentient beings. That however does not give anyone - even nurses - the right to treat us as less than worthy of empathetic care. Do you treat a lung cancer patient with contempt because he/she smoked their entire life? Or, do you provide compassionate care for them in the healthcare setting - reserving judgment - and doing what is required by your very profession? I may look different from you, but believe me I experience the same emotions you do and I contribute to the world through my community service and professional achievements. I am worthy of your best care by virtue of the fact that I am a human being on this planet. If you are unable to provide compassionate and empathetic care to ALL of your patients, then perhaps nursing is not the right profession for you. Please reserve judgment until you have walked a mile in my shoes.
The problem is that for years we have been coddling the obese and those who participate in poor health behavior. Doctors, nurses and other health professionals don't want to offend, don't want to anger, want to be "politically correct" and they don't address the elephant in the room. We now have children as young as 4 yrs. old diagnosed with Type 2 diabetes (A disease that used to be a disease of older adults). This is child abuse. It is a sin to waste the life of a child. Many of these children have cardiac disease by 15 and will never have the opportunity to live a long, healthy life. We desparately need to adress this issue starting with the adults. Patients need to know they have a choice and that most of their ailments are self induced as well as those of their children. Parents set the example. We cannot condone obesity and turn our heads and pretend it is acceptable. It is a serious epidemic It is very costly in quality of life for individuals and their families. It is costly for society loss of accomplishments of possible outstanding individuals whose lives are cut short or disabled. Just look to see how many of the obese are on disability under age 35 due to their own poor choices. No one who reduces their calorie count will not loss weight. If you eat more than you use - you gain weight - if you eat less than you use you lose weight - if you eat what you need you keep a normal weight even if you don't exercise. It has nothing to do with financial it has to do with portion size. It cost a lot more to maintain a weight of 350lbs than a weight of 150 lbs. It is costly to society SSI, medicaid, medicare costs along with other entitlement programs. It is very costly to be ill or disabled. Type 2 diabetes which is usually related to obesity, unhealthy eating, inactivity is extremely costly. Resulted renal failure may lead to dialysis which requires the patient to seek treatment 3 days a week. This is not just financially costly but quality of life costly. Loss of limbs and vision, CAD, stroke, heart attack are results of unhealthy lifestyle choices and rob individuals of their quality of life, their productivity, their ability to provide for their families. We don't need to sugar cost this behavior...it effects us all...we must address. A coach wants to motivate his team to achieve their goals we should be doing that to all individuals who have chosen an unhealtly lifestyle to we all win the game.
The only way to motivate any addicted person to change his/her habit/s is through motivation. Unfortunately there is a big school of thought out there that it is perfectly okay to be obese. As someone who struggles with her weight, the only thing that has really caused me to make a change in my eating habits has been the thought of having all the problems associated with obesity. How can I go to the doc and say my back hurts if I am 100 pounds overweight? Obese people don't need to feel ashamed; they need to feel empowered to take over their own care. They need to be encouraged that there is hope for them to be healthier and slimmer. I think that at a certain point people think there is no hope for their obesity; if they actually believed that there IS hope they might be more inclined to change their habits.
We need to be aware of our personal prejudices around obesity when we are providing care to obese patients. Some situations are more appropriate than others in which to bring up the subject of weight loss, and I sincerely doubt that there is one single morbidly obese patient who doesn't already know that his or her life would be dramatically improved by losing weight.
Some of the things I have heard come out of the mouths of health care workers have brought tears to my eyes on behalf of certain patients. The other day I had a couple of aids helping me to turn a 375 pound completely incapacitated woman, and one of the aids would not shut up from the moment she entered the room, "OH BOY, we are never gonna turn this one. We gotta call for LOTS of help. Oh my gosh the size of her, blah blah blah." Well this woman is on a ventilator, but she is not sedated at all and as far as I could tell all day was A&O x 3. I shot the aid a look that shut her up, but the damage was already done, I'm sure. The patient is a sweet woman who may never make it out of ICU--is this really the time to be making her feel bad about her weight?
I have heard nurses, aids, rad techs, doctors, etc... say horrible things about overweight patients right in front of them and I always have to question their motivations. Often I think they are just oblivious to how the patient must feel, or they are unaware that the vented patient can hear them talking. But sometimes I think that the morbidly obese patient just makes a good emotional punching bag. They are so easy to take it out on when you've had a bad day. And if someone calls you on your crap, you can always tell them that your negative comments will somehow motivate to patient to make some healthy changes in lifestyle. Everyone knows that self-loathing is a great motivator!
Do I love taking care of severely morbidly obese patients? Absolutely not. One of my worst days ever at work involved giving Vanco enemas to a patient who weighed 400 pounds. I'm sure, however, that the day was much worse for HER.
How is it upsetting? Does it upset you same way to see a person smoke ? or a crack addict shooting up. The latter do it in privacy. People however obese or not have to eat they just cant quit especially if they are diabetic. I guess I am not very judgmental when I see anyone eating food I dont focus on their weight. Its none of my business and as a nurse I have had many patients try to lose weight lose it and it comes back because you have to totally change your lifestyle but I dont understand your comment of a fat person eating making you upset ?
Specializes in Clinical Research, Outpt Women's Health.
Obesity really is it's own punishment. I don't think anyone needs any more censure than the difficulties of dealing with the fall out from obesity.
I also think you can be sympathetic while also stating in a non-judgemental way, but just straight forward: "Ma'am - if you lose 50 lbs your diabetes/Bp/whatever will be much better controlled. If you want support we are here for you. If not, and you choose to keep eating too much/bad stuff whatever, then all we can offer you is to treat the outcome with the meds we have available...."
However, I do have sympathy for people having to deal with the very obese without the proper staffing and equipment as this is a huge safety issue for the patient and employee.
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CeilingCat, ASN, RN
209 Posts
Your job is not to dole out "reality" to patients, no matter what you think their health needs are. You can educate, once you've assessed a readiness to learn. Anything else may be seen as judgmental and confrontational.
Why do you have an issue with obese people specifically? Is it because their choices are so easily seen? Tell me about your life: have you ever had alcohol, used recreational drugs, eaten meat more than sparingly, or sometimes laid on the couch instead of exercising? I bet if I looked through your history I could find some flaw. Now imagine for a moment: how would you feel if you're in the hospital, laid out after a surgery, to have some stranger come up to you and lecture you about this unrelated bad habit?
I have a friend who died a few years ago (in her early 40s) of complications r/t fighting anorexia/bulimia her entire life. She was NEVER thin enough. She was a lovely person who did fantastic charity work, and she was a role model for me. It was a tragedy she had to die. She felt could never escape others judging.
Over 50% of teen girls in America have experimented with behaviors characteristic of eating disorders; people can do terrible things to their body without looking "obese" -- all in the name of looking "thinner".
http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/
I, even back in high school when I weighed the least, never fit into government weight charts. I simply have a very large build & 5'10" height. And I get my "reality" every time I go to the mall and can't fit into size 4 clothes. My body will never look like the women on TV or in Cosmo. Never mind that I'm healthy, have ideal bloodwork values, and am more active than my peers. Never mind I don't abuse drugs or alcohol, nor do I engage in risky behavior. Because if I walk into your hospital, all you may see is a fatty.
People get this idea in their head of what a healthy weight should be. We're reminded constantly by advertising, TV, magazines. Except what they're telling us is "healthy" and "beautiful" is fake. Have you seen this great short video that Dove created, showing how distorted the image of "beauty" is?
http://www.youtube.com/watch?v=iYhCn0jf46U
Your role as a nurse is not to give anyone a dose of "reality". Educate when they're receptive to learning. Help them find the support & other resources they need. But please don't go around placing your judgments on your patients.