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!
Specializes in LTC, CPR instructor, First aid instructor..
When the fast food places began to exist, millions of people went to them. Some due to our fast paced society, working long hours, more than one job, or long distance traveling to our jobs. Then enter the addictive ingredients the fast food chains began including in those foods. These are some of the reasons for our very obese society.
We need to treat all patients with respect. We also need to be honest and teach, as is our job. I believe we are bound, ethically, do do both.
(Okay--side note--I am just a student. But, this is my belief...)
When volunteering in the ED, I was asked to help with an obese patient that was pretty much immobile. Some staff were asked to move him, and they ditched him without explanation. The patient told me that they looked terrified and scurried away, and he laughed it off. I told him that we'd get him squared away. A lift team did arrive and took care of the situation. Why couldn't the original staff just let him know that the lift team would take care of it? Their behavior was rude and uncalled for.
We should treat patients with the respect they deserve and speak to them honestly, and they will have the choice to proceed how they see fit.
There is a huge difference between guilt and tough love. Guilting and shaming don't generally motivate people. But telling someone the hard truth of, "you are going to lose your legs if you stay on this path" isn't guilt--it's telling them the truth. With that being said, I think the hard truth can be delivered compassionately. You could say, "you are going to lose your legs if you stay on this path--I am concerned about you and your health. Are you open to discussing some ideas about how to get you and your health on track?" And then go from there. I like the baby steps idea mentioned earlier--set the patients up to succeed. More often than not people need some momentum to get them going, some small wins. Switching to using salad plates instead of dinner plates, parking the car farther, using the stairs, joining a support group, starting a food journal, eating consciously (not while busy or watching TV), making a list of active hobbies they think they might enjoy (who says exercise has to be at the gym or doing something you hate! --perhaps volunteering at the humane society to walk the dogs, or taking up swimming). I think most importantly, just listening to patients and being supportive goes a long way. It really saddens me that the previous self described obese poster avoided going to the doctor because of her weight. ...I would like to know what could nurses or doctors do to help? How could we effectively reach and encourage/inform you? ...There are many of us who do really care and who want you to live the life of your dreams in however you define it. Let us know how to help, and we will.
Specializes in Med/Surge, Geriatrics(LTC), Pediatricts,.
There is a big difference between telling the truth without sugar coating things, while being respectful, and being downright disrespectful and mean. I too am chunky, after I lost about 200 pounds of fat, I gained back 50 pounds of muscle, and have the "old lady bulge around my middle." Growing up, as a child I was skinny, my Grandmother was embarrassed about that, since in that time era, being slim and trim was assiated with being poor, being fat, or chunky, was a sign of wealth, so she'd push high calorie foods down me, much to the shagrin of my mother. Fast forward to adult life, when all those calories caught up with me, and I ballooned out like Porky Pigs sister. By this time, society reflects things in the oposite manner, and being over wieght is not acceptable, now we've swung the pendulum the other direction, where being 5ft2in tall, supposed to wieght about 90 pounds.
Lets find a happy, and healthy medium. We can be respectful and get the message across, in most cases. I'd also like to point out a former neighbor from my apartment house. This young lady rented the apartment upstairs from me, she was somewhere around 35 years old, had hypertension, CHF, type II diabeties, and arthritis primarily in her hip, knee and ankle joints. Her wt, was 800 pounds. And she was proud of it, because that made her qualify for wealfare SSI disability. Now, remember, I said: "...most cases..." this is a case that needs point blank here it is in your face, "if you don't do this you'll die" approach. This young lady was just plain lazy! Didn't want to work, so found out that by being fat, she could get disability, then along came the other problems as a result of her obesity. A typical meal for her was a package of hot dogs (12) with buns and trimmings, about six hambergers with buns and trimmings, a bowl of macaroni salad, enough servings for six people, a family size bag of potato chips, and three cans of regular soda pop. Now, who's the blame for her obesity? Herself? Her family? Her Dr.? Society? Yes, society, for making clothes that fit a 75 inch waist line. How about the Social worker who "ok'd" her benefits? The little girl next door, age 12, who bluntly told her "You are fat, you need to get off your duff and loose some wieght!" And then this young lady, cried because her feelings got hurt, so she spent an entire day sitting in her oversized recliner, eating cookies and chips and crying about this all day. And her lesbian partner babied her, and let her just sit there! Telling her she loved her no matter what her size is. When this young lady came crying to me the next day, all I told her is: "Ok, you have two choices, you can sit there and feel sorry for yourself, and continue to eat yourself to an early death, or you can get up off your duff, like the little girl said, and loose some wieght." I also pointed out that her diabeties could be reversed if she got healthy. And I offered to work with her on her diet, and an exercise plan, with her Dr's care. The response was that I was not a nice person, and they avoided me for the remainder of their time at this apartment house, a couple months later were evicted for not paying their rent.
It's time we become less tolerant of size, when health matters are concerned. If an obese person takes a trip on a plane, and is over a certian size, they are required to pay double fare, is that being polite when the ticket agent has to ask for the extra from that passenger? How about the steward who has to get the seat belt extender so that passenger can be buckled in appropriately? How about the EMT who has to call for extra manpower so they can lift the stretcher into the ambulance? Even the power stretchers are rated for only 700pounds, and recommended that if a pt is between 500 and 700 pounds that the stretcher remain in low position, so extra manpower has to be called anyway. Unless you live in an area wealthy enough to have another ambulance in the fleet that is designed as a bariatric rig. Meaning it has a special stretcher that fits onto tracks with a wench to pull it into the ambulance, and lowers it out of the ambulance, then the pt has to be able to stand to get from the ambulance stretcher to the hospital stretcher. This only touches the very tip of the iceburg, in order to accomodate people of obese sizes that much, it's a chain reaction of what's needed, oversized wc's, beds, most diagnostic tables aren't made to accomodate such sizes. And all because we have to be politicaly correct, and polite toward those who are that obese. We need to, as health care proffessionals, need to tell it like it is, we can be tactful, we don't need to be hurtful, but being honest, and not babying obese people will be better in the long run. The SS department needs to be involved to, c'mon! being fat a disability so they don't have to go to work! And they just sit at home and eat themselves into oblivion! It's going to take everyone working together, all departments of health care.
The pendulum can swing the other way just as bad too, so rather than put a number on things, why not just get healthy! One can be at ideal wt but not be healthy, yet, be about twenty pounds over and be healthy. Let's loose the number's game, and go by individual health. And stop being polite about things, and tell it like it is point blank.
When eating right foods in the right quantity you begin to feel a lot better more energy, less physical problems it is then you don't feel the need to over indulge you appreciate the phrase in moderation. You learn why it is important to stop
I am so glad you would not be my nurse. If you came in my room with that crap I would kick you out immediately. Do you honestly believe this ? You can give a reality check without a guilt trip. You will learn this when you become a good nurse.
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.
i'm sorry to say that yes, some of these same nurses will treat the lung cancer patient with no compassion or respect because they "brought it on themselves." read through this web site enough, and you find that there are plenty of nurses who don't give a rat's patoot about being compassionate. they don't care about how patients are feeling, they are there to put in their 12 hours, get their paycheck and enjoy their 4 days off. read through the threads about patients in constant pain-not a lot of compassion in some of the responses. see the thread about patients and their family members-some real anger and bitterness expressed in there and zero understanding for the viewpoint of families. how about the thread on the nurse losing her license for having sex with her dying patient. unbelievable lack of understanding about ethics, vulnerability of dying patients and their families, etc.
hopefully when we get sick, we will run into more nurses who are compassionate while being honest than those who feel it is their mission to make sure we understand just whose fault it is that we are ill while giving an extra dose of disgust in the interest of "not sugar coating" it.
i'm not obese, hope i never will be. i don't believe in keeping the truth from them about their condition, but i also know that, depending on factors (disease, car accidents, metabolic disorders, emotional disorders, etc), that could someday be me in that bed and i'll be damned if i'm going to treat anyone other than how i'd want to be treated.
it would be some real karma if someday when we are really sick and in the hospital, that all the nurses assigned to us are exactly the kind of nurse we were. might be a real eye opener.
Guilt is not a powerful motivator to make good life changes for yourself. As a matter of fact there has been a lot of research out there that suggests making someone feel bad about themselves does nothing more than push them back towards the behavior you would like them to quit. Face it - if smoking, eating, using drugs whatever that behavior is makes them feel better, than to make them feel bad just makes them want to do it more. I don't believe that it is a nurses job to make judgements about a person and why they do the things they do. We need to focus on trying to help them do better without causing harm - and causing harm is exactly what we will be doing if every time these people try to receive healthcare we give them a good talking to and make them feel like crud. Then you will have a bunch of people who don't even wish to get any healthcare at all.
I am so glad you would not be my nurse. If you came in my room with that crap I would kick you out immediately. Do you honestly believe this ? You can give a reality check without a guilt trip. You will learn this when you become a good nurse.
I honestly think compassion should be considered part of the job... if you can't have any compassion or empathy (for any group you for whatever reason have contempt for).. I don't want you anywhere near anyone I love. Period!
Honestly- I have to wonder if the contempt for obese patients is more about your job being a little harder those patients than it is about wanting to 'educate without sugar coating'. If you care, you'll find a way to educate without being an ******* about it.. and I believe the whole 'not sugar coating' thing is just a good excuse to be an *******. I'm bowing out of this thread now... I really think this is an issue of people either 'getting it' or 'not getting it'. Fat people know their fat. They don't need their HCP being jerks because of their own prejudices.
Specializes in Care Coordination, MDS, med-surg, Peds.
I have been a nurse for along time, and have observed others making comments similar to those on this board about making others feel guilty about...smoking, weight, etc. I have never seen anyone change their lifestyle due to guilt, or being shamed. I HAVE seen some make life stye changes due to teaching, understanding and education.
I get upset taking care of the COPD pt that hurries up breathing treatment to go out to smoke, and will come back in with sao2 of 80% or so after the cig and want another treatment. I would like to just shake some sense into them.....but you know, I could shake until my arms fall off, and it wouldn't help. THE PERSON HAS TO WANT TO MAKE A LIFESTYLE CHANGE! no matter how much I might think they need it, or even how much I want them to, the individual has to be the one to want it, then do it.
The same with obesity..... I am obese, yes, very, very obese. I went to a new Dr the other day with pneumonia and when I weighed I could see the look of distaste on her face. SO... I said to her...I know that is a horrid horrid number and no one should weigh that much, however, in the last year year, making some changes I have lost and KEPT off 60 pounds. I know I have much more to go, but I am making the changes I need to, so instead of looking down on me, support me and encourage me as I continue to lose! She did change her reaction to me, any ways, so I hope she thinks about he reactions to others. I guess I should have made HER feel guilty?????
I have discovered that if I think "DIET" I don't do as well, as if I thik "lifestyle changes". AND i do them one day, or minute, or meal at a time!
I do try to stay to 1200 calories/day and increase my exercise. Unfortunately, I have severe arthritis and it does limit my activities some, so I just do what I can. Somedays only walking an extra 1/4 mile, sometimes walking an extra couple of miles,depending on my pain level. But..no matter what I do, it will help!! I do sit up, and lift weights some, as well. It has helped me lose what I have lost, so far, and I will continue to lose as I continue to change my life, NOT go on a diet!!!!!!
i won't say that it was "guilt" per se, but i went to my gp last year for the first time in a while to find out my numbers. she looked at my bp and my weight and told me, "you are pre-hypertensive. i can either prescribe you meds or you can eat better, avoid salt and work out". this was after talking to me about my lifestyle and habits. she was compassionate, yet honest.
i lost about 15 pounds, and sure enough, my bp is normal and i do not need meds. the idea of going on bp meds at 28 totally motivated me to put in the work.
my mom went to the doctor and was told she was pre-diabetic. she has lost 28.5 (as of today!) and her numbers get better and better with each check-up.
sometimes being told honestly and compassi0nately what choices you have as a patient can motivate you.
FranEMTnurse, CNA, LPN, EMT-I
3,619 Posts
When the fast food places began to exist, millions of people went to them. Some due to our fast paced society, working long hours, more than one job, or long distance traveling to our jobs. Then enter the addictive ingredients the fast food chains began including in those foods. These are some of the reasons for our very obese society.