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 PICU, NICU, L&D, Public Health, Hospice.
Hello,
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!
Not only is it practical to treat all of our patients with unconditional regard, it is imperative if we want to establish a functional and effective professional relationship with them. You will learn of nursing theories in school, and this will be a clear theme. Jean Watson would be a good person to google if you are interested now.
While will I admit that there are certain cultures and religions which might function better with guilt as a motivator, I would suggest that over time chronic and persistent feelings of guilt are more damaging than therapeutic for most people. It would be interesting to know what percentage of the morbidly obese already experience persistent guilt. I am going to guess that it might be a significant number and that many of this population may also suffer from depression, anxiety, or other mental health symptoms.
A better approach might be to gain this person's trust and help them to discover ways to gain control of the elements of this disease. In the acute care, hospital setting of nursing care the nurses are focused on helping their patients during an acute interruption of their health status. In the community setting the nurses are generally charged with focusing on the overall health status of their patients. The professional conversations (between nurses and patients) are remarkably different and remarkably the same in acute care and primary care. So...the acute care nurse will address the nursing needs immediate to improving their health status to the degree that they may be discharged from the hospital. The primary care nurse should be addressing the ongoing issues.
Here is the trick about telling them the truth...we must give them the truth, the facts, and NONE of our own personal thoughts about it. This patient must have no clue what our personal biases may or may not be. That is the responsibility of a professional nurse. In addition, we may not speculate about their health. We must, however, tell them what the real and sometimes imminent risks are.
there are some patients that i am sooo tempted to say ' loose 100 lbs. save your back and save my back' but i bite my tongue. smile. boost and strain my back night after night. even with proper body mechanics, HOB down and enough help there are still a lot of patients that break my back.
I have to say...I do agree that PCPs/Nurses really don't have that much information. While "Eat Less, Move More" sounds soooo simple, I think one of the ways obese people really defeat themselves is by setting stringent, multiple goals. Ie, "I'm going to exercise 30 minutes a day and eat less! And healthy!" As ideal as it sounds, I think for someone who's so used to eating unhealthily that it's just too much. Having someone to guide you and show you to take baby steps is practically essential for a lot of people to get out of that area and start adjusting SLOWLY to a healthier lifestyle.
Like some other obese people, my whole family is overweight. All my relatives are overweight. The one exception is my sister who has a lapband and lost weight that way. She still eats junk food, but thanks to the band, not enough of it to gain weight. No offense, but that kind of stuff is JUST as unhealthy as being obese like she used to be. I do think there is potentially a genetic trend, but I think the big thing is that those who grow up in an obese family are more likely to be obese simply due to that's the lifestyle they grew up with.
But the question is, is being more empathetic than honest truly the best way to acheive the desired end result?
I guess what I don't get about your posts is that you do empathy vs. honesty and compassion vs. reality as if they can't exist at one time. It's been said multiple times in this thread that they can be simultaneous. The opposition in terms isn't apparent in all your posts, but in a lot of them. I'm rather confused about your point of view.
Obesity is a problem in this country. It seems there are a lot of easily hurt feelings on here from people who are being defensive about their weight, but the truth is we became nurses to help people. It does not help people to ignore the elephant (no pun intended) in the room and allow them to suffer serious health consequences as a result. It does not help society for everyone's insurance costs to go up. It does not help people with anxiety to be stuck in a plane seat with another person spilling over the armrest and taking up their personal space. These are just realities. I'm sorry if you feel offended by these statements, but they are just truthful and sometimes the truth is offensive because we don't want to hear it... Education and encouragement can take place without judgment or cruelty. It's just a matter of finding the balance between compassion and reality!
Actually I re-read my post and I didn't say anything against obese patients. I never said that they were jealous either. I simply recalled my experiences. i used to be obese so my statements are a combination of professional experiences and personal ones. The fact that you took my post as a personal attack suggesting that I am rude superior and full of myself is kind of my point.
Specializes in Oncology/Hematology, Infusion, clinical.
Hello,
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 haven't read through any responses yet... My immediate reaction is that the two issues listed by the OP (obesity/smoking) are overwhelmingly driven by psychological factors. Ok, ok, not ALWAYS, I know. I have firsthand experience in that I smoke, and had a morbidly obese family member who died (2 years ago today) at age 58, undoubtedly due to his weight. In my personal experience, guilt/disgust/social unacceptance/threats of chronic illness/bluntness, etc., have not been positively effective toward my smoking habit, and obviously they failed to "guilt" my uncle into becoming more healthy. These have likely been tactics of patients' families and friends long before they got to the hospital. That's years and years, most likely. The definition of insanity is repeating the same action over and over, and expecting a different result. Why would it work magically during a brief stay at a hospital? Fat people know they're fat, smokers they smoke, and that goes for many people who practice unhealthy behaviors. In general, these people already know the potential risks that these pose, or at least that they pose risk.
As a nurse/doctor/health care worker, giving patients the facts, nutritional education and suggestions about lifestyle changes are all necessary. However, due to the strong psychological basis of most of these problems, it seems that addressing this aspect of the problem would be more successful-especially if done before the patient is faced with the subsequent health concerns of his/her lifestyle. Being proactive, rather than reactive usually produces better outcomes. (I practice nursing with that mindset and it ain't failed me yet!)
Anyhow, I apologize for the long blabbering response, and I'm not sure that it says what Im trying to express. In short, I don't think that patients with these problems don't care about their health (and if they don't, it may further support my point in the psychological aspect), but they have thus far been unsuccessful in altering their behaviors sans outside support. We should address what is creating this behavior/habit/addiction and we will be better equipped to initiate a positive change for our patients'.
Wow, if only my working conditions allowed me, at least, the time to address the immediate needs of my patients this thought wouldn't be so crazy.
I work in mental health and we deal with many, many clients from all kinds of backgrounds with various weight issues and eating disorders. It is in MY experience that people will never, ever change or acknowledge their weight issues unless they start being honest with themselves. And people will not change or address anything in their life, including health conditions, until they really, really want to. That's when nurses step in (amongst other people) to help these client. I know obesity is complex, but sometimes I think health professionals and 'weight loss gurus' make it more complex than it actually has to be, and many people are confused. Everything in moderation is a good motto to live by, a little cake, a little exercise, a little pilates/yoga, golf, whatever. And people need to be encourage to do exercise they enjoy.
But I still believe you can have the best Drs, nurses, clinics, healthiest food, et, etc and obese people will not change until they decide that they WANT to change their life and acknowledge their health issues.
there are some patients that i am sooo tempted to say ' loose 100 lbs. save your back and save my back' but i bite my tongue. smile. boost and strain my back night after night. even with proper body mechanics, HOB down and enough help there are still a lot of patients that break my back.
You shouldn't be doing this! I tell patients that I cannot lift them at all for whatever reason - I don't say cos you're too heavy - you are going to ruin your back! Refuse cos no-one else will care once you end up in hospital with severe back pain, least of all these big patients. I just do not lift and in Aust we're told we can refuse - I'm not straining my back for people who don't want to lose weight, can't be bothered, whatever. You need to start standing up for yourself and just say no!
Specializes in Oncology/Hematology, Infusion, clinical.
I'm both a student nurse and patient who happens to be obese. I don't want sympathy or for someone to sugarcoat my health. I am fat. But I do want respect and guidance from someone who is supposed to be a trained and educated health professional period. Talking about some and laughing about them outside there room or were a patient care hear you is disrespectful, teenage behavior which I'm sure you all have NEVER done as nurses.
You've made some pretty broad generalizations in your posts. If you think nurses are "bullies in scrubs", and you'd like to put healthcare workers out of business via WebMD, then what on earth are you doing in nursing school? You seem to be responding based on your personal experiences and insecurities. I can understand that, seeing as you are in school. Once you have been a nurse for a while, you may see things from another perspective and a lot of your preconceived notions of what nursing is like will probably crumble before you. Just as other human beings develop poor coping mechanisms like overeating, drugs, smoking, and other unhealthy habits, nurses and other HCPs do too. People cope in different ways, some not so appropriate. I guess YOU would NEVER do anything so distastful. But after working as a nurse for a while, you might want to reassess the accuracy of the previous statement. Don't say you don't want to be judged and then proceed to judge others.
I am obese, I am a RN. During school my eating had become so compulsive that I could not control what I put into my mouth.I wish my doctor would have mentioned to me about my weight. I really didn't even notice it skyrocketing while I was in school and when I did. It took me going going to the doctor because of feelings I was gasping for breath every night to realize it was my weight. When they had me get up on the scale I could not believe my eyes. I literally could not breath because I was so FAT!
I am now trying to get this under control by exercising more and eating less. I watch the biggest loser for inspiration, and I have also gotten on a medication to control compulsive behavior. With the medication, I now eat with a purpose, and have lost 9 lbs in a month without "dieting" at all. I am going to start a diet this month and hopefully within the next 6-9 months I will be at my goal weight.
I say be compassionate and encouraging while providing the education. I don't see where guilt should come into play in the nurse-patient relationship. I do think that providing the education in a straightforward and objective way is appropriate and required. We wouldn't tip toe around telling a high-risk sexually promiscuous patient to wear a condom, so why wouldn't we warn a high-risk diabetic or cardiac patient about necessary diet changes. It's all health promotion, prevention, intervention, treatment, etc. That's our whole purpose as nurses.
tewdles, RN
3,156 Posts
Not only is it practical to treat all of our patients with unconditional regard, it is imperative if we want to establish a functional and effective professional relationship with them. You will learn of nursing theories in school, and this will be a clear theme. Jean Watson would be a good person to google if you are interested now.
While will I admit that there are certain cultures and religions which might function better with guilt as a motivator, I would suggest that over time chronic and persistent feelings of guilt are more damaging than therapeutic for most people. It would be interesting to know what percentage of the morbidly obese already experience persistent guilt. I am going to guess that it might be a significant number and that many of this population may also suffer from depression, anxiety, or other mental health symptoms.
A better approach might be to gain this person's trust and help them to discover ways to gain control of the elements of this disease. In the acute care, hospital setting of nursing care the nurses are focused on helping their patients during an acute interruption of their health status. In the community setting the nurses are generally charged with focusing on the overall health status of their patients. The professional conversations (between nurses and patients) are remarkably different and remarkably the same in acute care and primary care. So...the acute care nurse will address the nursing needs immediate to improving their health status to the degree that they may be discharged from the hospital. The primary care nurse should be addressing the ongoing issues.
Here is the trick about telling them the truth...we must give them the truth, the facts, and NONE of our own personal thoughts about it. This patient must have no clue what our personal biases may or may not be. That is the responsibility of a professional nurse. In addition, we may not speculate about their health. We must, however, tell them what the real and sometimes imminent risks are.
I think you ask good questions.
Good luck!