Do You judge and treat patients differently depending on who they are ?

Candinse · Aug 16, 2012

To be perfectly honest...after 30 yrs I can say I dislike the human race! I smile a lot and take care of everyone, no matter what.I gave up on judging others...we all are just people, some you will like more than others.

finchfamily4 · Aug 16, 2012

I believe you have no choice but to judge.

I listen, watch and react to my patients based on the situation. If I think their behavior is harmful to their self care then I judge. For instance, a smoker with diabetes and a non healing wound. Their A1c is 15 and they're walking on the wound. I'm going to say something. They've probably heard it but I'll say it anyway - with a kind empathetic tone.

Now you could be snarky and condescending making sure they realize your disapproval but what does that accomplish? It's all in the delivery.......

Asystole RN · Aug 16, 2012

Ethnocentricity compels us to view those around us in a skewed manner, this is a force of nature and is not to be deemed unethical. When we act upon those ethnocentric views to treat those of a perceived undesirable group in a manner that gives a lesser quality of care then we cross the line into unethical behavior.

As professionals we should recognize our prejudices and compensate. That being said, Peplau's therapeutic communication compels us to assess, address, and tailor the nurse-patient relationship to fit the needs of the patient. Leininger's transcultural theory would have us address the specific cultural needs of the patient and provide a type of care congruent with their cultural and/or social identity.

There is a difference between professional individualized care and prejudiced, negligent care.

psu_213, BSN, RN · Aug 16, 2012

Every adult human has their prejudices. They can be a result of personal experience, how that individual was "brought up", who that person associates with, etc. Some are harmless, some aren't (you can use you imagination to fill those two categories).

Acting on them, or letting them have an impact on patient care, is another issue. It would never be ethical to act on them--at any point, not just in nursing.

FMF Corpsman, MSN, RN · Aug 16, 2012

I wouldn't touch someone like that without gloves for my own safety and other patients' safety and I don't think that makes me a bad nurse. And I think that's gross. I do hope someone gave the guy a shower. You can dislike a patient or be grossed out by something the patient has done or has and still give them good care.

You can be as grossed out as you want to be, but I certainly hope you still maintain your professional demeanor. It may not be the patients fault if some fungus has invaded his tissue or if he has some other integumentary system failure. If s/he is walking around like this and has already been the subject of stares and ridicule from the general populace, and you know s/he has, they don't need to get it from you as well.

jgr1001nurse · Aug 16, 2012

Age, race - no. I work in a maximum security prison so you can imagine the people I care for. I actually take a great deal of pride caring for people that most of the world has totally forgotten about. I certainly have my opinions about them, but I don't treat the triple murderer any different than the alcoholic who's in there because of multiple DUI's or the child molester. I do judge and treat differently based on their history with me and the medical staff. You learn who's actually sick and who cries wolf to get out of their cells to come to the clinic. The ones who cry wolf do not receive near the care or attention as those who are really sick.

BrnEyedGirl, BSN, MSN, RN, APRN · Aug 16, 2012

I agree with Katie,...I do make judgments,...especially when this is the 217th visit to my ER this year, twice today and you managed to get your BAL back to 0.437 in under three hours! Judge I do,...however,,...I will still stick a tube down your throat, give you a banana bag, and remove your nasty clothes and place you in a clean gown. I will treat you, and probably keep my mouth shut,..but yes I will judge.

manda0931 · Aug 16, 2012

I think it's human nature to judge. But part of being a nurse is how you deal with that judgment. As long as you treat everyone the same regardless of their name or any other attributes they may have then you're doing what you should be doing.

I remember when I had my senior practicum for nursing school and I had my first patient who was a prisoner. I was a little nervous and wondered how it would go. When I was taking his temperature orally I was so afraid that he was going to bite me or something. I was making that judgment strictly based upon the fact that he was a prisoner. After taking care of the patient for that rest of the day I realized that he was nothing but polite and respectful to me. So shame on me for judging him. It could have easily been Mrs. Smith (made-up name) down the hall that bit me instead but I was only worried about him since he was a prisoner.

What I learned from this was that your initial judgment aren't always correct. It was a very interesting learning experience for me.

FMF Corpsman, MSN, RN · Aug 16, 2012

I agree with Katie,...I do make judgments,...especially when this is the 217th visit to my ER this year, twice today and you managed to get your BAL back to 0.437 in under three hours! Judge I do,...however,,...I will still stick a tube down your throat, give you a banana bag, and remove your nasty clothes and place you in a clean gown. I will treat you, and probably keep my mouth shut,..but yes I will judge.

RN Cardiac, I presume you live in a nice house, perhaps with your family? I obviously have no way of knowing any of this, but as a professional, it is the given norm. Given your post here, I’m somewhat astounded by your attitude. What do you know of your patient except for what you wrote? Anything? The second visit of the day, was the 217^th of the year? Your ER doesn’t have a clothes locker? Couldn’t you have provided him with clean clothes during the first visit of the day? Did he get a bath and maybe a shave during his first visit? He had to be sober in order for you to D/C him the first time; did anyone try to place him anywhere? What does his H&P show? How did he end up on the street, has anyone bothered to try to find out? Does he have family that anyone can contact or does anyone care? You obviously don’t. This man could be a Veteran, there are scores of them on the streets, but most people who are in a position to help are just like you, too damn busy judging them. If you were living on the streets and usually had to deal with what the average homeless person has to deal with, you would probably try to stay drunk most of the time as well. I know I would. There is an old saying about “not judging someone until you’ve walked a mile in their shoes.” Then there is an even older one you might prefer, “Judge not, lest ye be Judged.” I asked about your home, because what if suddenly you longer had it and you were forced to live on the streets? What exactly would you do? This isn't such a far out scenario, it happens to people everyday. It is worth considering.

PennyWise · Aug 16, 2012

I remember in an English Comp. class, a phenomenon of "Bringing yourself to the reading" was discussed often. Basically, the point was, there is no such thing as absolute non-bias reading. No matter how much we want to have a clear mind, read with a critical eye and interpret the books meaning from a non-bias standpoint..........we involuntarily bring our own experiences and personality to the table with us. This is not to say being non-biased in our reading and efforts to learn are wasted. It does shed light though on the fact that in order to read a book free of judgment, we must make a definite/conscious effort to do so. Being non-biased is not something we are born with nor is it something one can achieve simply through awareness/wishing for the quality.

Same goes for caring for a patient and treating them the same. It is human nature to bring our personality and biases with us when we seek to give care. Some are better at not doing this than others, but no one is perfect at it.

What makes things complicated, IMO, is that we must be our own mentors with regards to delivering unbiased care. Our leaders (as in the ones who pulled you into the meeting and insinuated there was a problem with this) often speak out of both sides of the mouth when preaching against "biased" care. If we were to follow healthcare admin. and management on how to better be socially/culturally sensitive, we would spend an eternity walking in circles.

First and foremost, the action of making judgments on patients is promoted in many ways, beginning in nursing school. We've all heard of Erickson's stages of development. We've all seen job descriptions posted by HR offices and managers that include: "Must be able to give developmentally appropriate care" or however they phrase it (its been awhile since I applied for a job so, I don't recall the exact wording). We've all heard during the hospital security portion of orientation or in emails following an event to "report any suspicious individuals or behavior." Can't do any of these things without "judging" your patient/the individual in some way.

My point is, you have to police yourself with regards to delivering unbiased care to your patients. You know when you are judging them for the right or wrong reasons. Don't get too caught up in the double talk that comes down from administration. They have no answers and take a "wait and see" approach. They wait and see the results, and if they don't like them..........they tell you that you should have known better and that there are policies in place for/against what happened. As I said before though, their policies and attitudes towards the whole issue reflects lack of understanding of the issue and are double sided.

PennyWise · Aug 16, 2012

FMF Corpsman, I prefer:

Don't judge anyone until you've walked a mile in their shoes. That way, when you tell them what you think.............you have a one mile head start on getting away from them.

jadelpn, LPN, EMT-B · Aug 16, 2012

The thing about judgements is, they are not always correct.....