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!
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!
Right on! If you can't get out of bed and support yourself, I'll get you a walker. If you can't do it with a walker, I'll get you a bedpan. No one is falling on my back!
Specializes in Acute long term, clinical, office, etc.
I'm a obese nurse.I have quit other bad habbits now working on the fat thing.Patients should be taught the same thing.I feel for them but only if they make a serious attempt to change their dangerous behvior.
worked in an interesting hospital once.. one lady admitted for +3wks for Bronchitis/Pneumonia. almost like clockwork this lady walked downstairs to the "gift shop" all hours of the day... often could not find the pt to give scheduled meds. her room reeked like- you guessed it- cigarettes. she got discharged, was back less than a week later, same problem.
also, this hospital saw many patients that weighed + 350 lbs. i've never understood a person's ability to just lay in a bed and expect me to move their limbs, without their putting in any effort. color me rude, but i will flat out tell a person, if you want moved, you gotta help me. you can't help? then it's gotta wait while i go and get lift help, or a team to help me- you don't want me laid up in the bed next to you with a lame back- i snore!
( i was a heavy second hand smoker for 18 years, untill i moved out of my parents house, and still struggle with my own weight on a daily basis)
there are teams of people that study why we do the things we do....
I find it interesting that absent from this discussion is the (maybe obvious) but important point that there is a dividing line between overweight and even obesity and the level of morbid obesity that limits movement, ADLs, and significantly impacts a patient's care ... as well as exponentially raises the incidence of life-threatening conditions.
By the numbers - the BMI and height/weight ratios used in U.S. healthcare today, most in my entire extended family are "obese" including myself. We are active people who eat a variety of foods, work in a variety of jobs including those requiring physical labor, engage in various sport and recreational activities, etc. One is diabetic. A few over age 50 have controlled HTN. Everyone's weight is more or less stable, give or take 10-15 lbs.
When I see my PCP, my labs have been WNL, I have no specific complaints, and take no maintenance meds. So, inevitably, the discussion turns to weight, as that is the only "problem" to be fixed, right?
I would like to specifically see the health care professions lose the BMI, as I believe it is one of the crappiest diagnostic tools ever in widespread use, and return to acceptance of the multitude of body shapes and sizes that nature has produced. Health care professionals need to instead focus on the mass quantities of non-food being produced in this country, and the emergence of large numbers of people whose weight significantly impacts their ADLs. My own personal line in the sand? If you cannot change position, walk, or attend to your own hygiene -- this is a very different phenomenon from the millions of us who happen to wear plus-size clothing.
Lumping everyone with an unacceptable BMI together produces the confusion of unconditional acceptance vs. "reality therapy" being discussed in this thread.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I don't think anyone has insinuated that obese pts shouldn't be cared for. The asthmatic smoker will still get a breathing Tx and the same care as the non smoker,..however as the nurse it is my job to make sure the patient is aware that smoking is contributing to his illness. If a medication isn't going to be as effective while smoking the pt has the right to know that. The obese patient who is contemplating his/her 3rd hernia repair and is furious because the first two failed deserves to know that weight plays a big part in his/her health issues and frustrations. I can't do anything about what has already happened, but I can educate the patient to help prevent further illness and injury.
Obviously no one is going to tell an HIV positive patient who contracted HIV from a blood transfusion that he wouldn't be sick if he'd used a condom. That wouldn't be true. Now if said pt has never received a transfusion and most likely contracted HIV through unprotected sex than yes he should be aware of how he became so sick! His education should include safe sexual practices, right along with how to take meds and his plan of care.
I was talking about assumptions. Assumptions that obese people are just fat, stupid and lazy and are just too fat, stupid and lazy to help themselves. Why is it obvious that no one would say that to the HIV patient but will say things to fat people? We know that the first Assumption is that anyone with HIV got it sexually or through IV drug use. Assumptions that when behaviors that involve the vices, drinking, drug, sex, food, that those patients don't deserve compassion or some resemblance of understanding. We all know that the medical community ridicules the obese and we should be ashamed. If they would just put down that fork. SOmeone in this post mentiond that when they see obese people "stuffing their face" it "makes em sick"........Well we fat people watching you skinny pretent to eat makes us sick....WE fat folk all know you go and purge in the bathroom.......sounds harsh? It is harsh...........What I am just talking about is the assumptions. I'm not asking anyone to bury their head in the sand.......I am asking the medical community to give this group of people the same dignity and patient teaching (without ridicule) that is given to the mother baby discharge home.
Education, compassion, dignity.
I am a nurse who hasn't always been obese. I've been a nurse for 32 years I have always been a "big" girl, but physically fit, but I have only been "obese" the last 3 years. My treatmeant by the medical community and the assumption of my hand to mouth disease is the root of all evil is completly appauling. I have seen a change in the way I am treated, talked to, and percieved and I find that frustrating and sad, really hurtful and mean. I have hear the sneers when I mention that I was a trauma flight nurse and I do hear the sneers behind the desk "like she'd ever fit on a heilocopter" that they think no ones hears. I have a rare disorder of the muscles and skin called dermatomyositis, that render me unable to move around very much, I am essentially wheelchair ridden. I was a pretty girl with porcelian skin who is now obese with purple flaky oozy skin. I am on massive daily steroids daily (80mg)along with intermittent high dose IV (2-5 grams given 3-5 days in a row) with other chemo drugs in an attempt to keep my kidneys from dying form the elevated CPK's due to the muscle destruction. I cannot "workout" too much (although I do do PT) as it just elevates my CPK which can cause more organ damage and muscle weakness and pain. Although my condition is rare and unique.....I am talking about the behavior of the medical community as a whole.
Although my disease has been resistant so far.....I am hoping for remission..... I am not asking for anyone's pity.... for this too shall pass.....I AM asking that we as nurses rediscover our compassion for our fellow man, our empathy to help our fellow man, understanding human fraility and having the compassion to help those in need whether they want it or not.....to find a way to have compassion even if the person we were entrusted to care for doesn't seem as though they want or deserve that compassion. We are care givers......not judges or juries. We are healers and helpers...educators. We the obese are perfectly aware we are obese....... but I have a unique prespective about the predjudice and biasis of the medical profession and their feeling and opinion's in reference to the "obese". I have personal experience in the different way I am percieved and treated at one weight and then another. I know my situation is unique and not the general rule..... but rude demeaning behavoir is rude demeaning behavior reguardless of the underlying disease process or it's cause. and someday when these steroids are gone I will have to bust my butt to get rid of the 80 lbs of padding I've gained to cushion my falls.
I am just asking for compassion and understanding..........not to be judged too harshly and try to not ridicule so harshly............trust me WE CAN HEAR YOU!!!!!!!!!!!!!!!
If a patient can not do their ADL's because they are obese, if they are experiencing serious health issues because of their obesity; this is where it becomes a concern for me as an RN. I want to foster independence as much as possible. That also means independence for the patient to decide on their own if they want to slowly perish from obesity. I honor whatever they wish. But I also am not shy to speak with them (after assessing the sources of their obesity) about the effects of this obesity upon their quality of life. We can not change a life time of dysfunction within one hospital stay. We CAN make the patient aware of how their choices have effected their present disability. Shame and guilt is dehuminizing and has no place in our bedside caregiving. I do not believe that outlining the possible future of the patient's health if they do not change their habits is cruel. It is realistic and truthful. It is not judgement. It is fact backed up by scientific proof. And please do have your research available in a form your particular patient can understand and relate to. As a bedside nurse, one ought to have an ability to see the root of an issue based upon the personality, psychology, temperament of the patient....this kind of personal communication has a lot to do with the level of humanity an RN possesses...All communication ought to be based upon the individuality of the patient which the RN ought to acknowledge upon the first greeting and assessment! So let's get away from how much the obese strain the backs of caregivers, how this one and that one is discriminated against for whatever. Highly attractive slender non-smokers are also discriminated against ya'll!!!!! It all comes down to respect and sharing knowledge with compassion and dignity. When the patient even shows a hint of willingness to change, I am there with all the information and guidance possible...but I wait until I see that hint before I barage them with a bunch of stuff which they may not be ready to take in. Thanks all of you....and continued blessings and beautiful healing!!!
I was talking about assumptions. Assumptions that obese people are just fat, stupid and lazy and are just too fat, stupid and lazy to help themselves. Why is it obvious that no one would say that to the HIV patient but will say things to fat people? We know that the first Assumption is that anyone with HIV got it sexually or through IV drug use. Assumptions that when behaviors that involve the vices, drinking, drug, sex, food, that those patients don't deserve compassion or some resemblance of understanding. We all know that the medical community ridicules the obese and we should be ashamed. If they would just put down that fork. SOmeone in this post mentiond that when they see obese people "stuffing their face" it "makes em sick"........Well we fat people watching you skinny pretent to eat makes us sick....WE fat folk all know you go and purge in the bathroom.......sounds harsh? It is harsh...........What I am just talking about is the assumptions. I'm not asking anyone to bury their head in the sand.......I am asking the medical community to give this group of people the same dignity and patient teaching (without ridicule) that is given to the mother baby discharge home.
I am just asking for compassion and understanding..........not to be judged too harshly and try to not ridicule so harshly............trust me WE CAN HEAR YOU!!!!!!!!!!!!!!!
In 17 years I have never heard a HCP say anything remotely close to this to a patient or to me. I think it is overblown.
I would like to specifically see the health care professions lose the BMI, as I believe it is one of the crappiest diagnostic tools ever in widespread use, and return to acceptance of the multitude of body shapes and sizes that nature has produced. Health care professionals need to instead focus on the mass quantities of non-food being produced in this country, and the emergence of large numbers of people whose weight significantly impacts their ADLs. My own personal line in the sand? If you cannot change position, walk, or attend to your own hygiene -- this is a very different phenomenon from the millions of us who happen to wear plus-size clothing.
Lumping everyone with an unacceptable BMI together produces the confusion of unconditional acceptance vs. "reality therapy" being discussed in this thread.
BMI is a screening tool, like a lot of other things. Just because it isn't all-encompassing and perfect doesn't make it useless. High AND low BMI are statistically associated with increased all-cause mortality. OF COURSE there are other factors, physical fitness is highly protective for instance, smoking or excessive drinking increases risk, abd obesity increases risk, etc etc. If BMI is being used as a be all end all instead of one piece in the puzzle, then by all means, let's get rid of it. But I don't think that's the case, or at least, it doesn't have to be.
BMI has been shown to be an independent risk factor for certain CV events like CAD. Can skinny people still get CAD? Naturally. Can non-smokers still get lung caner? Yes. BMI is nice because it's easy to do, reproducible across a variety of settings, and statistically significant on a variety of outcomes.
Almost no data gathered on a pt should be looked at in isolation. Having a BMI 25-30 means you have a risk factor, not that you are doomed to get diabetes, HTN, die prematurely, etc. Now, if you have elevated BMI, high CH, HTN, etc, then you're in a much higher CV risk category and more intervention is needed.
Health care professionals need to instead focus on the mass quantities of non-food being produced in this country, and the emergence of large numbers of people whose weight significantly impacts their ADLs.
What exactly do you mean by this? What can I as a health professional do about the mass quantities of non food being produced in this country other than to educate my patients that "non food" is not good food?
I've got to talk to BMI here. CharmedJ7, with all due respect, I do appreciate what you are saying. We do need to have some across the board clinical scales for many purposes. But I also want to make it heard that BMI can be very misleading. My husband has been a professional athlete...full of lean muscle with no fat; yet when his insurance looks at his BMI he is called obese. Rates can go up. We had to fight this once upon a time. This is really a whole new topic now, but my point is that the BMI is really misleading.
Specializes in LTC, assisted living, med-surg, psych.
In 17 years I have never heard a HCP say anything remotely close to this to a patient or to me. I think it is overblown.
Overblown? Not so much.
I once injured my hand and wrist---badly---by punching a refrigerator. Why I did it is a story for another post; but the day after, my hand was swollen, black and blue, and so painful I couldn't even bend my fingers. So I went to the local clinic to get it looked at, and the doctor just said, "This wouldn't have happened if you didn't weigh 240 pounds."
Excuse me??
"Obese people have a tendency to fall, and they always have a harder time recovering from injuries than normal people."
Well, now. Funny, I thought I'd punched the fridge, not fallen on my hand. And I thought I'd punched it because I was mad, not because I was fat. Or maybe the doc thought I was mad BECAUSE I was fat. Either way, he didn't do a darned thing for me except tell me to lose weight and, oh, of course, to come back if the hand got any worse. He didn't even X-ray it.
That's only one of a number of times my complaints have been dismissed, or blamed on my weight alone. So please, don't tell me that prejudice against fat people among medical professionals is "overblown".
clemoi
16 Posts
Right on! If you can't get out of bed and support yourself, I'll get you a walker. If you can't do it with a walker, I'll get you a bedpan. No one is falling on my back!