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!
,but when you see a very obvious obese person chowing down, it's upsetting.
Because obese people shouldn't eat? If it is upsettting to you to watch an obese person eat, than don't look. And you know what? Being rude and judgmental in the guise of 'political incorrectness' is still rude and judgmental.
None of us are perfect. We all have our unhealthy issues. Whether it is smoking, drinking, drugs, not exercising, over eating, anorexia, eating "diet/chemical foods" drinking soda, caffeine ingestion, sleeping pills, poor sleep habits, etc. NONE of us are perfect! I don't think obese patients need to be shamed. I am sure they are aware of the fact that they are obese and it is not healthy for them. I am sure most have tried diets. Why not be kind, and gently suggest things that can be a good start, like walking up the street instead of driving, drinking more water, more fruit and veggies, etc.?
I am not obese, but you know, who is to say that I never would be? I don't want to be shamed ever time I go to the doctor b/c I drink decaf coffee. Yes, it stains my teeth and I get shamed horribly from the dental hygienist that cleans my teeth. I have actually been asked if I brush. YES I know my teeth are stained. Do you really need to be rude to me about it? I do own a mirror. Clean my teeth like you are supposed to and keep your mouth shut!
Yeah but the first lady is genuinely concerned for others health and doesn't make fun of their plight.
Who said anything about making fun of obese people to get them to lose weight?! I mean seriously, who does that in the real world?
My original question was is, is it better to be gentle about the issue to protect the patient's feelings or reactions, or straight-forward in order to communicate the dangers of being obese?
Look, shame is a feeling that effects self-esteem. Shame is very internalized and destructive. Healthy guilt is what gets your butt off the couch. It's what made me walk my dog last night after a 16 hour day. It's what made me have a cup of turkey & black bean chili and vegetables for lunch today because I had a crapton of chicken sausage & pasta for dinner last night, not to mention all the valentines sweets. Guilt is directed at a particular action or responsibility, not at the internal self. That is what I meant about stating it could be a powerful motivator, not that you should be telling their patients that they "did this to themselves" and drive them into a deep depression... that would be shame, which is not effective or called for.
Because obese people shouldn't eat? If it is upsettting to you to watch an obese person eat, than don't look. And you know what? Being rude and judgmental in the guise of 'political incorrectness' is still rude and judgmental.
Don't look?!! There she/he sits chowing down and bulging at the sides and there I sit, with one celery stick & a miserable expression.
It's upsetting because I WANT that food but willpower and the future outcome of that lapse will cost me. And don't go telling me I can let go once, because I want it all the time!
LOL, I've up and lost my clunkers, now I'm derailing:lol2:
Sorry I can only go by my own experience and friends of mine that are obese. If you don't like dealing with humans whatever the addiction then truly you should not be a nurse. Work in fashion were everyone is thin and you'll never have to see an obese person again.
Yeah but the first lady is genuinely concerned for others health and doesn't make fun of their plight.
Hmm, you speak with feeling. I know not a nurse, who would support making fun of a person needing their help. That's just wrong on all levels.I never would codone that as I'm sure the OP would not either.
guilt (glt)n.1. a. The fact of being responsible for the commission of an offense. See Synonyms at blame.
b. Law The fact of having been found to have violated a criminal law; legal culpability.
c. Responsibility for a mistake or error.
2. a. Remorseful awareness of having done something wrong.
b. Self-reproach for supposed inadequacy or wrongdoing.
tr.v.guilt-ed, guilt-ing, guilts To make or try to make (someone) feel guilty.
Do the above really have any place in health care? What I want to see as a health care worker are patients who substitute unhealthy behaviors for healthy ones, not as a function of guilt, but as a function of doing something that makes them feel more energetic, less sluggish, less dependent upon medications, and better able to do things which are fun and make them happy.
The struggle to lose weight isn't about guilt. Or shame. Or winning someone else's favor.
It's about believing it can be done. And breaking the big picture into little pieces. And linking the resulting baby steps to small, reachable goals. And building one tiny success upon another.
You lose weight one pound at a time. And you do it because something has made you want to move forward, not because someone has told you something about guilt that you already know.
Please, take the time to connect with your patients. Find out what it is they truly want. You'll be able to help them so much more effectively (and you'll have earned their respect) if you are prepared to listen.
This is what I was struggling to say...you said it far more eloquently than I.:)
Here goes the guilt tactics to get me into submission. Not everyone can be excused as having an underlying factor.
I speak based on chowing. I too, love to eat but have to weigh the consequences of not being able to eat any and everything in sight. It is a conscious but difficult choice.
Someone once said something along the lines of," with the money models make, they sure look ****** off all the time.". Yup, it's hunger. And then to watch someone chow down mindlessly, it's hard. LOL,reread my comments and laughed at me:clown:
i don't 'do' guilt tactics...seriously.
and agree that not all have underlying factors....but do believe the majority do.
(we're not talking 'overweight'...we're talking morbidly obese, more than 100 lbs over ibw).
we're talking about extremes, here.
and i truly believe that many of these folks, have MUCH self-hatred.
and that is why they often treat US despicably.
many come across as entitled, spoiled, lazy, and helpless, in the hospital setting.
yet you don't see much of this as behavioral/psychological?
all i'm saying is will-power is only a small facet of wt loss.
there can be sev'l other issues at hand, that need addressing.
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?
I find it to be a little bit of both. I knew this was the field for me after working in a sales environment for years, even within that sales environment I learned all the "basics" for caring about people (it sounds crazy but there are a TON of similarities between sales and nursing). It's all about everything coming from a real place when you say it. I notice a lot of co-workers saying things along the lines of "I understand" or "no problem" and sometimes even "I can imagine what that must feel like". If those statements are not coming from a REAL place, they're just categorized to your patients as catch-phrases that they're used to hearing on a daily basis.
You can't teach people to care, I learned that a LONNGGG time ago, but you can teach caring people to properly engage and partner. It was a rough struggle but patients will be so incredibly cooperative and helpful once they absolutely know that you're to be trusted and you're there for them.
Again as an easy first step, try to eliminate saying those catch phrases and instead use examples to convey partnership, especially if you do actually understand, if it is actually no problem and if you really, honestly can imagine what it feels like.
USE EXAMPLES! Patients love hearing them, scary or not, it's important.
Why do I have to choose to be compassionate or realistic? Who says I can't be both?
The response that was suggested in the article was a textbook therapeutic response. Since I started nursing school, I've learned all about therapeutic communication. The techniques are really useful, but a lot of the textbook responses I've seen aren't very realistic. Because of that, whenever I see a statement like the one the article suggested, I don't take it literally--I'm never gonna say something like that to a patient in real life! I've learned to translate those statements into something that I would actually say that has a similar meaning. So, to me the response from the article is basically saying, "Hey, let's come up with some realistic goals to help you manage your weight".
I don't think think the intent was to say that nurses can't be upfront with obese patients, or at least it shouldn't have been. When you're establishing a relationship with a patient, it's actually better if you're honest with them. I don't think being realistic and making them feel guilty go hand in hand though. Judging a patient or making them guilty purposefully would be detrimental to your relationship with them. A patient is more likely to do well if they know they've got someone on their side who they can trust. Besides, most people don't need anyone else's help feeling guilty anyway. Guilt may very well be a personal motivator, but it shouldn't be something a nurse uses.
and agree that not all have underlying factors....but do believe the majority do.
(we're not talking 'overweight'...we're talking morbidly obese, more than 100 lbs over ibw).
we're talking about extremes, here.
and i truly believe that many of these folks, have MUCH self-hatred.
and that is why they often treat US despicably.
many come across as entitled, spoiled, lazy, and helpless, in the hospital setting.
yet you don't see much of this as behavioral/psychological?
all i'm saying is will-power is only a small facet of wt loss.
there can be sev'l other issues at hand, that need addressing.
no simple fix, for sure.
leslie
Most people with eating disorders have "MUCH" self-hatred" to quote you.Both extremes- one seeks to chow more,while the other seeks to lose more weight. How is it more acceptable to talk about anorexia or bulimia(because they are skinny?) than to talk about obesity.
Obviously there is an underlying sense of ,"Look I'm doing this to myself." kind of guilt,which is why the subject is so touchy.
lt)n.1. a. The fact of being responsible for the commission of an offense. See Synonyms at 
lifelearningrn, BSN, RN
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