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!
It makes me wonder why people are obese. I am obese myself. I do not over eat, in fact, I HATE food. I have hypothyroidism, a collapsed left artery where I am on my third for it, I have had heart surgery, epilepsy, asthma, and I can go without eating for a whole week and I did this, and still gained a pound! I hate being fat, I NEVER was this big like this and get this, when I am pregnant, I gain 25 lbs per baby. I didnt gain nothing w/my first son till 3rd trimester, and 50 with the twins, then 25 w/my second set of twins w/one surviving twin outside utero. I drink sugar free drinks and about to go nuts. I am dx gluten intolerant, gastritis, I swell, and more. Yeah, I wrote a lot of stuff that is wrong with me, and I am blessed because there are others who are less fortunate, but I HATE being fat...to me, obese people are disgusting no matter what problem they have, and I am speaking about my self as well.
PS, does anyone have any knowledge of any books outside of nursing that will help with ped dosage calc?
OMG, I am so glad that you're only "trying to be an RN" and not actually an RN. If you hate yourself and judge and discriminate against your patients and are otherwise incapable of delivering the highest quality of care with compassion for ALL of your patients-- not just the ones who earn your stamp of approval-- then you are not fit to a RN.
I have no idea what your story has to do with nursing, but in the context of a hospital and nursing care, they should be treated the same as everybody else! Why would it annoy you that obese people want to be treated the same as everyone else?! We have access to larger wheelchairs and beds. Many of their needs can be accommodated without too much effort. There are challenges of course, when it comes to moving incapacitated morbidly obese patients, with respect to scales or certain procedures which have weight restrictions, but we do the best we can and treat them with the same compassion, respect, and empathy as we treat our other patients (hopefully we are treating them with kindness, respect, and empathy, but the more time I spend on this site, the more I question whether even that is happening).
Don't be so quick to draw. The poster might be referring to having to reposition patients with greater weights who expect you to do it all by yourself. Afterall, it is a quick turn.
Imagine a tiny, puny person having to do all that by him/her self.Not a pretty picture.
Having compassion for patients does not necessitate sugarcoating anything. Sugarcoating, to me, means finding a nice way to express not so nice thoughts. Compassion means being able to let go of your personal judgments of a person in order to recognize their inherent human worth. If you have compassion for an obese patient, there is nothing to sugar coat- it is only when you see them as being inferior to yourself or others that you need to use a sugar coating to disguise your judgment.
A compassionate response to an obese patient would, to me, mean saying, essentially, "I understand that losing weight requires making difficult changes, but if you do not do so, you are putting yourself at significant risk of cardiovascular disease, diabetes, etc, all of which are likely to cause you to become permanently disabled and suffer an early death." There is no personal judgment, nor is there any sugar coating of the consequences of obesity. But the key is not so much being careful about what you say as much as it is about being mindful of your personal reaction to patients.
Also, OP said: "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."
I couldn't disagree more. Guilt and shame are often driving forces in the cycle of compulsive eating. If you think that guilting your patients into changing their behaviors is an appropriate nursing intervention, maybe you should reevaluate your instincts before speaking to patients.
don't be so quick to draw. the poster might be referring to having to reposition patients with greater weights who expect you to do it all by yourself. afterall, it is a quick turn.
imagine a tiny, puny person having to do all that by him/her self.not a pretty picture.
please refer to this sentence in my post that you quoted:
there are challenges of course, when it comes to moving incapacitated morbidly obese patients, with respect to scales or certain procedures which have weight restrictions, but we do the best we can and treat them with the same compassion, respect, and empathy as we treat our other patient.
i rarely move even normal size patients by myself. always ask for help-in the case of an obese person, it may require half the unit. that has nothing to do with treating all patients the same with regard to respect, compassion, and empathy. an obese person who wants "to be treated like everyone else" is not insisting that one puny little nurse move them in order to be treated equally, and i think you're aware of that.
Please refer to this sentence in my post that you quoted:
I rarely move even normal size patients by myself. Always ask for help-in the case of an obese person, it may require half the unit. That has NOTHING to do with treating all patients the same with regard to respect, compassion, and empathy. An obese person who wants "to be treated like everyone else" is not insisting that one puny little nurse move them in order to be treated equally, and I think you're aware of that.
Then you must not have seen patients who picked offense because back-up was called for in repositioning him/her.
OP- Personally, I'd re-read the article and see if it's really saying your should shield your patients from knowledge about the consequences of obesity- because I doubt it really is. It sounds like it's probably saying not to over-emphasize those consequences with patients who already have an understanding of the consequences. Why would you waste time educating a client when it's not their lack of knowledge that's responsible for their obesity. You need to assess your patients and identify what barriers exist to changing their behaviors, and then address those issues.
You said that guilt can be a powerful motivator, but you should understand that guilt and shame are often driving forces in compulsive behaviors- including overeating.
Compassion means being able to see the inherent human worth in your patients- and being mindful of your personal value judgments so they don't interfere with that ability. As such, you need to address each obese client as an individual, and not just react and say "lose weight or you're going to get sick and die," because chances are, they already know that.
Obesity is a very sensitive issue because it is an outward reflection of a type of mental illness. I truly believe that just as alcoholism or drug addiction is a form of mental illness (self medicating) to soothe inner demons, so too is over eating to the point of self destruction. Self destruction is self hatred. The person can not help themselves, their self hatred motivates their self destruction. So to answer your question, I feel complete compassion for those persons who are obese. However, in order to help those suffering with this disorder, we as nurses need to turn that compassion into action by motivating our patients to help themselves through psychotherapy and other forms of self help. Introducing "reality" to someone that is mentally ill is very difficult and very complicated. You can not just tell someone to "lose weight or you'll die." You need to incorporate intense psychotherapy and probably psychotropic medications such as antidepressants.
You can argue that I am wrong, but this is what I believe can help those that "self medicate with food." It's the same idea when someone is anorexic or bulimic.
I take my health very seriously, and prioritize going to the gym (even when I'm dead tired and would much prefer the couch) and eating healthy. It is a choice, and it is as simple as that. Would I like to eat pizza and cookies for every meal and lay on the couch all day? ABSOLUTELY. I'm not one of those people who loves working out and will go crazy if I miss a day in the gym...every single workout is a pain in the butt for me and I would really rather not go. But I make myself. For this reason, I have a difficult time being compassionate towards those who do not prioritize their health and are okay with being morbidly obese. I know many of you will respond to this that nobody is "okay" withe being morbidly obese...but if that's the case, what is stopping them from changing? And I just don't buy it when people say they have tried every diet and they don't work...here is the solution to losing weight: consume fewer calories and burn more calories. It will work, I promise.
Luckily I don't have to deal with a whole lot of obese patients...most of our surgeons will not perform necessary surgeries until patients lose weight because they know the outcomes will be poor on an obese patient. Of course, they don't have this luxury if it is an emergent procedure...but I have had countless patients tell me they have lost 50+ lbs so that they could have their surgery. It's great: they kick-start a new healthy lifestyle and also get the surgery they needed. I love it.
I take my health very seriously, and prioritize going to the gym (even when I'm dead tired and would much prefer the couch) and eating healthy. It is a choice, and it is as simple as that. Would I like to eat pizza and cookies for every meal and lay on the couch all day? ABSOLUTELY. I'm not one of those people who loves working out and will go crazy if I miss a day in the gym...every single workout is a pain in the butt for me and I would really rather not go. But I make myself. For this reason, I have a difficult time being compassionate towards those who do not prioritize their health and are okay with being morbidly obese. I know many of you will respond to this that nobody is "okay" withe being morbidly obese...but if that's the case, what is stopping them from changing?.
This is where you lack empathy.. there are so many people out there that believe everyone else in the world should live by what motivates YOU. People don't realize that everybody is DIFFERENT. It's so early for someone with an IQ of 145 to say, "I was able to get through college, I have no compassion for those who can't." Life simply doesn't work that way. Some people were raised in such a culture of food that it is embedded in their very fabric. Why do you think it is so hard for people to KEEP weight off once they lose it? It's not an issue as simple as "I do it so you should too!"
I've noticed a lot of the anti-fat folks here are young. Gosh- I was so good about preaching skinny when I was in my early 20s. I had lost a bit of weight in my late teens and thought I had all the answers. Was NEVER going to get fat. If I could do it, "everyone else could and should"... if only it were that simple.
Ug- I can't believe I let myself get sucked back into this thread..
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 agree that was inappropriate behavior from the aid. There is no reason to speak this way to any obese patient (or ANY patient, for that matter).
However, I couldn't help but wonder if perhaps her outcomes would have been better if she were not obese? I do not know what got this woman into the ICU in the first place, but with patients like this it's often a good bet that they might not even be in the ICU if they had taken better care of themselves.
But, AGAIN, this is NO excuse to mistreat or speak that way to the patient. Just something I thought of.
This is where you lack empathy.. there are so many people out there that believe everyone else in the world should live by what motivates YOU. People don't realize that everybody is DIFFERENT. It's so early for someone with an IQ of 145 to say, "I was able to get through college, I have no compassion for those who can't." Life simply doesn't work that way. Some people were raised in such a culture of food that it is embedded in their very fabric. Why do you think it is so hard for people to KEEP weight off once they lose it? It's not an issue as simple as "I do it so you should too!"
I've noticed a lot of the anti-fat folks here are young. Gosh- I was so good about preaching skinny when I was in my early 20s. I had lost a bit of weight in my late teens and thought I had all the answers. Was NEVER going to get fat. If I could do it, "everyone else could and should"... if only it were that simple.
Ug- I can't believe I let myself get sucked back into this thread..
Seriously? You don't think I realize that everyone is different? Come on. I might be in my 20's but I know enough to know that everyone is different.
Thanks for the lesson on culture, but I am already aware that food is closely related with culture. I happen to be Italian so I know first-hand how important food is to family and our daily lives. This does not stop me from making the CHOICE to cook with whole grain pasta, enjoy vegetable lasagna rather than meat, and use fat-free cheeses. I still get to enjoy traditional Italian cuisine without jeopardizing my health. Saying that culture is what is stopping someone from losing weight is just another excuse.
I'm also not saying that "I do it so you should too!" Rather, I am saying that "I do it so you CAN too."
Back to my age: there is absolutely no reason (except for a very few medical conditions) why a person who was able to maintain a healthy weight in their 20's cannot do so for the rest of their lives. It may get more difficult to do so. I understand that. I bet when I have kids it will be very hard to get off the baby weight, and I will have much less time available to go to the gym when I'm juggling being a wife and mother and also working full time. But I will keep health as a priority in my life, and others CAN do the same.
I also did not say that I have NO compassion; I said that I have a difficult time feeling compassion for those who do not prioritize their health. I do not treat these patients badly, I am simply acknowledging my own prejudice. Any nurse who refuses to admit they have prejudices is blatantly lying. However, as nurses we keep these to ourselves and provide each patient with the best possible treatment (hopefully). Allnurses.com is an outlet where we can be honest about these without mistreating our patients.
I'm glad you got sucked back into this thread because you provided me the opportunity to clarify some of the points I was trying to make.
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!
I'm confused. Are you under the impression that the majority of obese patients don't know they're obese? Or don't know that obesity will greatly increase complications of DMII, HTN, etc... ?
I don't know that it's offensive to flat out say, "You need to lose 100lbs or your diabetes will cost you your legs." I just don't think it's terribly helpful or even new information.
However, the approach of, "Let's focus on an aspect of your weight issue we can do something about." Is helping them to address the problem a bit at a time.
Kitty
41 Posts
OMG, I am so glad that you're only "trying to be an RN" and not actually an RN. If you hate yourself and judge and discriminate against your patients and are otherwise incapable of delivering the highest quality of care with compassion for ALL of your patients-- not just the ones who earn your stamp of approval-- then you are not fit to a RN.