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's important to partner with the patient, regardless of their appearance, it's imperitive that you find a commongrounds for educating. I find it EXTREMELY easy to get through to patients on a REAL level once you've become their trusted expert advisor.
Talk to these people, get to know them and then present solutions... otherwise it will never stick.
That is a great point! Just on a personal note, do you find it easy to get on a real level? Is it something that comes with experience, or are you naturally the type of person who can put people at ease, become their friend, etc?
Funny, I'm obese and even on this post I've been dismissed. I would like to know the truth about my health absolutely obese or not. All the things you listed about smokers seems to be a genuine concern for there health and well being. When it comes to obesity you get the laughter and ridicule from the health care staff and society. No one makes fun of smokers.
If you can't make someone feel at ease as a nurse, why are you a nurse? What did you learn in school? Just to get A's and be done? Not everything is learned in a textbook.
There is no need to be rude. You can respectfully share your opinion without insulting another's opinion. You've never been motivated by guilt? I surely have. As I previously mentioned, there are differences between guilt and shame. Google it and you'll get a vast selection of literature on the guilt vs shame comparisons.
This seems to really hit a nerve with some of you. I find it curious that society in general finds it acceptable to tell smokers they stink, will get cancer, are killing themselves, have bad breath, have trouble attracting mates, etc. but the obesity issue needs to be tiptoed around in order to not hurt someone's feelings. I was reading another post on this site about physicians refusing even to tell their patients they are "obese" or "overweight" -- to just tell them to watch their "excess calorie stores"? My point is, smoking became taboo because society made it taboo. You do not believe this should be the case for all unhealthy, life-threatening behaviors? I am really not saying we should put a scarlet letter F on all overweight patients and ridicule them. I am saying to be honest about your patient's health condition in a tactful manner while addressing major concerns.
I am absolutely not trying to be rude, but I did find your statement that guilt is a good motivator is nonsense. I cannot think of a better word for it. Please don't ask for opinions if you cannot accept any possible answer. Again, I would like to know what strategies you would employ to get the desired result of guilt.
Secondly, to address this statement:
I find it curious that society in general finds it acceptable to tell smokers they stink, will get cancer, are killing themselves, have bad breath, have trouble attracting mates, etc. but the obesity issue needs to be tiptoed around in order to not hurt someone's feelings.
We are not "society," we are nurses. In what world would a nurse find it appropriate or acceptable to tell a patient that they should quit smoking because "they stink, have bad breath" and "have trouble finding mates?!" I would never say those things to a patient. I would educate them as to the clinical health problems which we are addressing and leave the insults out of it. One does not have to walk on eggshells to educate about the dangers of obesity, but neither should one make judgmental statements in some kind of misguided attempt to "guilt" someone into changing.
The reason some health care workers find it easier to say nothing is because the PC police will immediately show up and start to harass you. In my experiences obese patients are extremely sensitive about their weight and think that you are judging them when you haven't said a word. Heaven forbid you are fit and attractive they become convinced that you are looking down on them and wish them dead. I have seen it too many times in 17 years to count. Either say it or don't. It's like telling someone you don't want to date them. It doesn't matter how you say it, they'll take it hard and think you're an insensitive jerk who was mean to them. Our society has become a politically correct herd of cowards and you see the result of that everywhere.
I hope I never receive care from anyone on this post. I feel bad for any obese patients you come in contact with. Please!! Not all obese patients are jealous of fit patients. Is this the best you can come up with!!! I dislike rude, superior behavior no matter what the size!! Get over yourself!!
I disagree 100% Putting someone on a guilt trip may cause a person to shut down completely and pretty much dismiss everything you say after that. It's the antithesis of therapeutic communication.
great post, dudette...but wanted to comment on above.
i've always maintained that obesity is highly complex and multifactorial.
and if it were just a matter of a, b, and c, we, the u.s., wouldn't be having this very palpable and visible health crisis re childhood and adult obesity.
i happen to believe that obesity entails many deep-rooted psych issues...
that warrant therapy and exploration.
that said, not only could an obese person "shut down completely", i also believe that feelings of self-persecution and hopelessness, would only perpetuate the cycle of self-sabotage/eating.
it's a vicious and cyclical phenomenon.
agree about baby steps...and not looking it as a diet, but as a change in life-style.
it commands 100% support from family/loved ones, resources, and commitment.
it takes a certain level of awareness, as to why we eat what we do, how much, when...what is triggering this need to stuff oneself?
much of the compassion is actually a form of enabling, and i don't agree with that.
however, i do believe that compassion can be supportive, non-judgmental, and patient...while being realistic.
it needn't be one or the other.
but in a million years, i wouldn't ever think of guilting someone to change.
that in itself, prompts for further, unhealthy catalysts...
and folks need to lose weight for the right reasons.
I am a smoker, and I can't tell you how often I've felt embarrassed, ashamed, ridiculed, like an outcast, dirty, all of the above. However, I would never expect my nurse or physician not to address the health complications of continuing to smoke whether I am embarrassed or not. Personally, my health should come before my feelings.
great post, dudette...but wanted to comment on above.
i've always maintained that obesity is highly complex and multifactorial.
and if it were just a matter of a, b, and c, we, the u.s., wouldn't be having this very palpable and visible health crisis re childhood and adult obesity.
i happen to believe that obesity entails many deep-rooted psych issues...
that warrant therapy and exploration.
that said, not only could an obese person "shut down completely", i also believe that feelings of self-persecution and hopelessness, would only perpetuate the cycle of self-sabotage/eating.
it's a vicious and cyclical phenomenon.
agree about baby steps...and not looking it as a diet, but as a change in life-style.
it commands 100% support from family/loved ones, resources, and commitment.
it takes a certain level of awareness, as to why we eat what we do, how much, when...what is triggering this need to stuff oneself?
much of the compassion is actually a form of enabling, and i don't agree with that.
however, i do believe that compassion can be supportive, non-judgmental, and patient...while being realistic.
it needn't be one or the other.
but in a million years, i wouldn't ever think of guilting someone to change.
that in itself, prompts for further, unhealthy catalysts...
and folks need to lose weight for the right reasons.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I am a smoker, and I can't tell you how often I've felt embarrassed, ashamed, ridiculed, like an outcast, dirty, all of the above. However, I would never expect my nurse or physician not to address the health complications of continuing to smoke whether I am embarrassed or not. Personally, my health should come before my feelings.
Have you ever been denied or given ineffective treatment because you smoke? Has anyone told you "I'd use this medicine but you smoke so why bother!" Has hospital staff talked about "that smoker" in room whatever and everyone fight not to care for you because you ae a smoker? Has anyone made comments of why should you be cared for when you refuse to help yourself if you would just stop stuffing cigarettes in your mouth? Would you ever tell a gay male with HIV that he got for a blood transfusion......if you would have worn a condom you wouldn't be sick? I don't think so.......
Empathy, tolerance, and patience. Leadership, mentoring and teaching. Kindness and caring.......just my :twocents:
Wow- making someone feel guilty is a good thing? If this is your idea of motivation, I hope you're never my nurse or the nurse of someone I care about. There is not an overweight adult out there that doesn't KNOW that they have a weight problem and how to fix it. EVERYONE knows the difference between healthy food and unhealthy food. If you ask me, I think medical professionals are often too quick to dismiss health issues on the physical assessment of weight. If an obese person goes into the doctors office with the flu- they don't need to be guilted (or educated once again) on their weight. They have the FLU because someone coughed on them. Or because they touched something infected. Not because they ate a hamburger for lunch.
Obesity is NOT the same as smoking, alcohol and drug abuse. Nobody advocates 'just cutting back' on any of these subtances because we know that doesn't work. Ciggarettes, drugs, and alcohol are all something we can and should live without. An addict needs to quit entirely to get healthy. One can not give up food or they DIE. It is not a problem that is easily addressed with standard addiction treatment.
In my nutrition class last semester I learned that 66% of all adults in this country are overweight or obese. The current statistic for weight related deaths is only 300,000 a year. Honestly, because of all the attitude from the medical community, I expected that to be the number one cause of death in this country by now.
I'm not saying it's okay to be obese or even healthy.. And many, many people who have the 'skinny' genes will never truly understand what it's like to be prone to weight gain nor do they truly understand counting calories and limiting fats.
Who is healthier, the thin, alcohol drinking chain smoker or the person who is 40lbs overweight? Often times, it's the overweight person! A naturally thin person can have a horrible diet and never once be told by a medical professional how important a healthy diet is. A thin person can go into a doctor's office and say, "you know, I'm feeling pretty worn out lately" and the doctor will actually run diognostic tests before jumping to the diet issue. An overweight person will be given 'healthy diet' pamphlets and shoved out the door.
Honestly, I think your attitude toward overweight patients is why so many people don't go to the doctor at all.
I think we all learn some of our behaviors by trying to avoid feeling guilt. Think about all the lessons we learn growing up. I remember feeling "bad" about standing up my girlfriends when we had plans for a girls night out and suddenly Mr Wonderful calls at the last minute and wants to take me to dinner. We learn our behaviors by experiencing the feelings associated with them. At the age of 16 I would have dropped my friends and went out to dinner with Mr Wonderful,..by the time I was in my 20's I probably would have called my friends and begged to change the night or meet them later. We learn to be responsible and accountable partially to avoid those guilt feelings when we aren't!
I would love to see some of your research. I work in the ER and yes it's very frustrating to be expected to coddle patients who refuse to help themselves, especially the patients we see several times a month. I'm not sure I'm doing them any favors by ignoring the smoking, excessive drinking, drug abuse, obesity, etc. Recently we had 2 young adults who were having hallucinations and seizures after smoking something similar to K2, that they purchased at a local convenience store. The parents of one of the young men were livid that this stuff was making their Son so sick. They were talking about finding out who made the product, hiring a lawyer,...yadda yadda. Is the best thing to do in this situation to pat everyone on the back and agree with all they have to say? I think it's my responsibility as a nurse to educate my patients and give them all the facts I can that will allow them to make responsible decisions and choices. When they chose to make poor choices I still take care of them, but re educating is part of that care! Sugar coating the real issue isn't in the patients best interest. It might make them feel less awful at the moment but is doing nothing to empower the patient to be healthier!
:twocents:
stefanyjoy
252 Posts
That is a great point! Just on a personal note, do you find it easy to get on a real level? Is it something that comes with experience, or are you naturally the type of person who can put people at ease, become their friend, etc?