"if you weren't so obese, you probably wouldn't have 1/2 the illnesses you do"

nerdtonurse?, BSN, RN · Nov 2, 2010

Ah, the lovely non-compliant frequent flyer. Has a host of conditions which they might decide to ignore or exacerbate at least monthly-- CHF, DM, COPD, ETOH abuse, drug abuse, drug overdose.

We, as nurses, only have X amount of energy -- physical energy, spiritual energy, emotional energy. If I run dry, I can't help anyone, so I have to manage that resource just like you'd manage any other resource that takes time to recharge.

My solution? I can expend the energy I have the way I choose. I choose not to waste my time and irritate a patient who's not going to listen anyway. You come in with the same thing twice, I teach, try to inform you, try to get you to care enough about yourself to help yourself. The third time, I stop fighting a battle I can't win, I treat the symptoms while you're with me, and don't bang my head against the wall anymore. Should any of them ask me what they can do in subsequent visits to help themselves, I would willingly teach. But otherwise, I remember the words of the computer Joshua in the movie "WarGames" -- the only way to win is not to play. And if you want to play on the train tracks despite repeated warnings, I'm not going to get hit by the train (back problems, HTN, stress, depression, burnout, etc.) trying to drag you off the tracks.

erikab987 · Nov 2, 2010

I really don't see where all the accusations of insensitivity are coming from...especially those commenting specifically on obesity. A few posters on here commented that they themselves would be considered overweight or obese and seem personally offended at the fact the the OP thinks nurses should address this serious medical state with their patients. If you went to the hospital for a related condition/symptom, wouldn't you worry about the quality of patient care if no one suggested a lifestyle (specifically eating/exercise plan) change? Like I said before, no one would be complaining about lack of sensitivity if the OP was, "does anyone else have a problem with nurses they work with not telling addicts that their choices were killing them?" If you smoke, fine, but don't get upset when healthcare professionals tell you it's bad for your health, or worse, it's killing you. I HAVE smoked before, it IS an addiction (sometimes compared to overeating, which is obviously not the only contributing factor to obesity), but please don't misplace your sympathy (of a condition you may struggle with yourself) for a patient (struggling with obesity, addiction, etc.) by accepting their choices as unchangable and inevitable because you think telling them might come off as mean or insensitive. Obesity is the #1 contributing factor to the top few killers of Americans...IT NEEDS TO BE ADDRESSED!!!

saltwaterstat · Nov 2, 2010

i'm not sure if this is a vent or just an effort to regain my sense of nursing compassion, but WHAT HAPPENED to honest patient teaching? some of the RNs on my floor seem scared to address the obvious- being an obese smoker who seems allergic to any type of a healthy lifestyle is the main reason a majority of our patients are here, on our med/surg floor.
The main illnesses I see? uncontrolled Hypertension, uncontrolled type 2 diabetes, CHF etc. How can I be more compassionate yet still addressing the truth?
At least in the children, the odds of them being "at fault" for their illness are very, very slim- I'm considering a transfer to Peds.
How can I keep "the hunger" I started with when I see so many chronic diseases that are intrinsicly linked to poor lifestyle choices?
Please help. i dont want to become a RN who is there to clock in and clock out while secretly wanting to smack some common sense into them, lol
Thank you all, in advance.

step away from the donut.

carolmaccas66, BSN, RN · Nov 2, 2010

As nurses and human beings, we are not perfect. Patients will never be perfect, we all know that. The poster is talking about those who won't or don't admit their weight or whatever they have, is causing health problems. We all overeat, maybe drink too much, could lose a few kilos, etc. But these fat, obese patients (whatever term u like) do not want to listen. They rearely have insight into their conditions, or their future (if they have one). They shrug off the 10th admission into hospital as 'just a little set back', not the next thing that's going to possibly kill them. They like their fatty lifestyles. They will not change no matter how much education u give. They don't WANT to change. Most of them are like beached whales, won't do any rehab for themselves (even after numerous joint replacements), won't listen re their diabetes, won't even reach over to pick up a magazine, they ring the call bell instead. So I just sound them out firstly, & leave them to it. No amount of talking/nagging whatever will change them. If someone does listen, I talk to them re their WHOLE life, not just their illness/illnesses and take it from there. I admire those who try to change, even in little ways. I mean sick people will always need our help, but doesn't the government & healt professionals have to start drawing the line somewhere?

In mental health, it is important to empower the patient to help themselves. Some never will, they just don't care. You as a nurse can only do so much. Nurses shouldn't reinforce bad behaviour and why is everyone so afraid to tell patients 'I can't lift you at all, because I will damage my back 4ever?" I tell big/obese patients this all the time. It is YOUR BACK, no-one else will look after it EXCEPT YOU. The patients will not care if you end up in hospital and ur career is over.

You can only do so much. The rest has to be up to the person themselves, but even if they are willing to make little changes, encourage that, or smile and leave them to live destructive lifestyles. You have to look after your own mental and physical health as well!

StNeotser, ASN, RN · Nov 2, 2010

I think it's the subject title that the OP decided to be appropriate that is raising some ire.

It's OK to say "you need to lose weight, or you need to stop smoking"

It is insensitive to say "if you didn't weigh so much you wouldn't have half the illnesses you do!"

Yes, we all think that. But to vocalize it in such a manner is not the art of nursing.

Sure, I'll get very ****** if you were an overweight diabetic that were demanding their fourth bowl of ice cream and were rude and threatening to report me. Or if you are expecting me to waste half an hour to walk you and your IV pole to the smoke station.

SNB1014, RN · Nov 2, 2010

Thank you. I put a shocking title so some people would be "whoa! whats this about?" and read it, and hopefully throw in their 2 cents.

My post was about regaining my compassion....I am a bit suprised that it became lost in translation and some saw it as "callous".

Fact, obesity costs americas $147 BILLION as of 2009, according to CDC. There's a reason Mrs Obama is bent on addressing this.

Both my parents are fat, for petes sake! haha But i still love them more than i could ever say. But my dad is 56 and on 3 heart medications....if he altered his lifestyle, a huge part could be addressed.

Yes i know that there are multifaceted reasons people become overweight/HTN/ diabetes, etc. I am aware, and those are certainly not the patients I am talking about.

I would never have the b*lls/lack of class to speak rudely to a pt. Its just a general, underlying current of annoyance with particular pts. I am asking for ways to look at them as more than just an "obese/noncompliant patient" and to tactfully seize every teaching moment available.

Thank you.

SNB1014, RN · Nov 2, 2010

I can see now that the title, while meant to be sarcastic and attention grabbing, stole the spotlight from my post about compassion and teaching.

SlightlyMental_RN · Nov 2, 2010

I am asking for ways to look at them as more than just an "obese/noncompliant patient" and to tactfully seize every teaching moment available.
Thank you.

You say that your parents are fat....how about you picture the patient as your parent? Perhaps that would help you to think about how you see them and address their issues.

allnurses Guide · Nov 2, 2010

I agree with the person who commented about repetition and the change of poor lifestyle habits such as smoking and overeating, as my mother was one of the most stubborn smokers of all time who could not be wheedled, cajoled, bribed, shamed or threatened (mostly by her own family!) into quitting - most of us had given up as she headed into her sixth decade when an acquaintance told her about a simple "self-hypnosis" guided imagery tape that - miracle of miracles - worked!

She quit smoking, joined Curves and went on daily cardio walks like a trooper from then forward - but unfortunately the damage done was done before and no one could save her from passing away 15 years earlier than she should have. If I heard anyone speaking to her in a judgemental tone they'd be regretting that very soon. Don't give up trying to educate people on these things. What looks like apathy on the outside can mean something very different is in the works on the inside.

StNeotser, ASN, RN · Nov 2, 2010

Thank you. I put a shocking title so some people would be "whoa! whats this about?" and read it, and hopefully throw in their 2 cents.
My post was about regaining my compassion....I am a bit suprised that it became lost in translation and some saw it as "callous".
Thank you.

Oh OK. So then just imagine you're speaking to your parents then. That's what I do. Respectful, yet trying to teach. You know your parents know they're overweight and it's doing them no good.

Also, I do think there's a tit for tat as another poster pointed out, my mother will never be 98, and bouncing between ICU and a skilled rehab for the last three months of her life. At least I've got some idea of that futility.

Knowing where the economy is going in the western world, I do not want some fool telling me because I smoked for fifteen years I lose right to healthcare. I've already seen the errors of my ways. Oh, and I've already been told by a health insurance representative that nurses are an expensive group to insure. I'm sure that health insurance representatives are not an expensive group as they sit on their orifices a lot and don't wear themselves out.

Rabid Response · Nov 2, 2010

It can be so frustrating. The other day my ICU received a patient who had been admitted to med-surg for repiratory distress. While there on bipap he attempted to stuff two cheeseburgers (smuggled in by his wife) into his mouth and promptly choked on them and coded. He weighed around 400 pounds. I really think that there is a big psych component to this problem and that psychiatrists and addiction counselors need to be brought in alongside the cardiologists and pulmonologists treating these patients. Modifiable risk factors such as obesity, smoking, and drinking need to be made a priority by primary care providers and not just addressed as an aside or an afterthought. No, these patients don't need lectures or brow beating, and they certainly do not need to be belittled by cranky nurses, but somebody with some perceived authority needs to let them know how important THEIR participation is to their well-being.

grannyrn65 · Nov 2, 2010

Let's see,I suffer from hypertension, Type 2, asthma and am fifty pounds overweight. When I lived with my daughter,I had visits to the ER about once a month for an acute asthma attacks(her cat's dander triggered them) and being admitted every two months. I remember both my physician and some of my peers, telling me to tell her to get rid of them. And I would just smile. The liklyhood of te cats leaving was less then me leaving. She still has the cats. And I now live by myself, without any cats. I really would have appreciatd my nurses and physician, talking to my insurance company and convincing them to pay for my sinulair,which prevented my attacks.

As for the fifty pounds. My exercise has dropped off. Sorry,my bad back and partial herniated L5 disc,plus my bad knee and ankle prevents me from going for the long walks I once did. But I sure would welcome any helpful suggestions.

I know I have had health problems. All patients that suffer health problems realise their problems. And the ones who do not appear to be dealing with them, they really have a multitude of issues. If you want to be helpful, you need torealise tis and try dealing with one or two problems,at a time. And dealing with them. And not expecting major changes.

Perhaps the years I was educated in followed different rules. We were taught to set goals with the patient,not for the patient.And not to attempt to teach them everything at once. And that they had families who influenced their decisions. And to involve the spouse. There are some that will never be reach. This does mean you write them off. You just keep repeating the steps. And realise that are some that have to suffer negative consequencs before tey accept things.

GrannyRN65:coollook: