How do you stay nonjudgmental?

banditrn · Dec 31, 2007

Alcoholism isn't alcohol abuse, nor is it a lifestyle choice. It's a disease. There's this really cool thing called the disease model of addiction that's worth checking out. Basically it says that people are vulnerable in differing degrees to addiction to substances, just as people are vulnerable in differing degrees to infection by various pathogens. Some may have repeated exposure and never suffer, some may have one and that's all she wrote. So the only way to be absolutely sure a person won't contract the disease is to ensure they're never exposed (either to pathogens or addictive substances). Explaining this model is the way to go when raising kids.
I've got to disagree with you. I was raised in a family of alcoholics.
When I had children, I schooled them extensively on the dangers of drinking and talked to them about the 'gene for addiction'. Yet two of my son's grew up and developed drinking problems. They made the CHOICE to begin drinking after they had been warned about what could happen.
Many alcoholics progress to where they have diseases that affect their bodies, but initially they have made that CHOICE to drink.
It may be just semantics, but calling it a 'disease' gives some the crutch they need to continue the harmful lifestyle. It's a 'disease, after all, so there's not much they can do about it'.
My son's both found out that once started, it was very hard to quit, but they realized that if they didn't, they could die - so they made the CHOICE to quit.

jackson145 · Dec 31, 2007

Many alcoholics progress to where they have diseases that affect their bodies, but initially they have made that CHOICE to drink.
That's how we felt about my dad's situation. He knew that we had many alcoholics in the family. After having no alcohol for over a year, he chose to have "just one drink", and within a week he was right back to his previous lifestyle. A disease didn't cause him to have that "just one drink". He made a very poor decision. In the end, it cost him his life.

siggie13 · Dec 31, 2007

How do you try to care when you know that the patient's lifestyle has caused their disease. Whether it be sex, drugs, alcohol? I had a patient today that was very sick due to their lifestyle choices. They were very rude, hateful, particular, and flat out annoying.. I found it very difficult to be empathetic for this patient. It got to the point where I couldn't stand to be in the room anymore.. This patient was flat out disgusting.. They would try to wipe their stool on me purposely, talk very nasty and cuss. I don't even know if i can stand to take care of this person tomorrow. I'm not even going to tell you the nasty things they did today. It just makes me sick.... How do you stay empathetic???
Tiger

First, realize that there are just nasty hateful people in the world, who would be that way even if they were healthy. This person may be acting out for many reasons, none of which matter when comes to excusing their behavior. Someone in authority (manager, doctor,supervisor) needs to talk with this individual and lay down some ground rules. No one has the right to treat staff this way and their behavior needs to have consequences. Allowing such behavior to go uncheck just magnifies it, it never gets better. Believe me. Help yourself and others that have to care for such individuals, and nip this in the bud.

Virgo_RN, BSN, RN · Dec 31, 2007

How do you try to care when you know that the patient's lifestyle has caused their disease. Whether it be sex, drugs, alcohol? I had a patient today that was very sick due to their lifestyle choices. They were very rude, hateful, particular, and flat out annoying.. I found it very difficult to be empathetic for this patient. It got to the point where I couldn't stand to be in the room anymore.. This patient was flat out disgusting.. They would try to wipe their stool on me purposely, talk very nasty and cuss. I don't even know if i can stand to take care of this person tomorrow. I'm not even going to tell you the nasty things they did today. It just makes me sick.... How do you stay empathetic???
Tiger

I just remind myself that this is a human being, somebody's child (I may even visualize them as a child), and that whatever led them down this path, what a sad and undignified way to end up.

sleeplessonthelake · Dec 31, 2007

When it comes to pts. like the afore mentioned, laughter is the best medicine. You can allways find soemthing humorous in the actions/behavior of these special pts. :lol2:

anonymurse · Dec 31, 2007

There are 3 different issues mixed in the original post.
1. A pt's lifestyle, while it may summarize a long list of risk factors, being no more than risk factors, can't cause disease. That's unscientific, so it doesn't even cross my mind to pass judgment on pts' lifestyles.
Respectfully disagree.As a nurse with many years in Public Health and Case Management, I can tell you that lifestyle and risk factors have as great an impact on the disease process as anything. We all know that smokers are at higher risk for cardio disease and lung cancer, obesity carries risk for diabetes. In my current job, I deal with many patients who are chroniclly ill because of lifestyle choices. Some, like mental illness or addiction, are unavoidable. But many are choices, such as obesity and smoking. THese are the folks I have a problem with - the people who are ill because of behaviors they could change.
I understand where you're coming from. No doubt the concept of risk factors is built on solid ground. However the introduction of blame doesn't fit anywhere in my model. This is really what I mean, I don't mean there are no such things as risk factors.

Altra, BSN, RN · Dec 31, 2007

I understand where you're coming from. No doubt the concept of risk factors is built on solid ground. However the introduction of blame doesn't fit anywhere in my model. This is really what I mean, I don't mean there are no such things as risk factors.
Every patient gets equal, unbiased care.
However, what OP and many are speaking of here is not "blame" but observation of the universal laws of cause and effect.
Frequent unprotected sex = greatly increased risk of pregnancy and STIs. I am not "blaming" a patient when I point that out.
IVDA with shared needles = greatly increased risk of a wide variety of potentially health-threatening infections and infections caused by bloodborned pathogens.
Substance abuse = greatly increased risk of poor nutrition, liver disease and likely impact on employment, social support system and family life that might otherwise mitigate patient's behavior.
OP, without seeing the patient there's no way for us to know to what extent his/her behavior is being caused by withdrawal, preexisting psych comorbidities, dementia or is simply a reflection of his/her personality. But you need not feel guilty about setting limits on this patient's behavior. If the patient is expected to be on your unit for some period of time, everyone would probably benefit from a plan, including physician orders if necessary, so that all staff are dealing with this patient consistently and with the same expectations of behavior.
Hang in there - I hope the next shift is better!

AliRae · Dec 31, 2007

When it comes to pts. like the afore mentioned, laughter is the best medicine. You can allways find soemthing humorous in the actions/behavior of these special pts.

This is my last-ditch tactic. When all else fails, I repeat the follwing mantra to myself:

"EVERYTHING that happens today is happening solely for your amusement."

Taken in this context, shifts like the OP describes become much more bearable.

NurseCherlove · Jan 1, 2008

In my work environment with the mentally ill we HAVE to put up with the crap-smearing(though that's at a minimum) and verbal and physical abuse; there is no option of having them arrested.

Well, of course it all comes down to mens rea (intent/knowledge of right/wrong - sorry - big Law and Order fan here) in these cases. I am not going to hold a confused or mentally ill person accountable. But if they are A&O and just nasty/mean, well....again, see my previous post!

Elvish, BSN, DNP, RN, NP · Jan 1, 2008

"EVERYTHING that happens today is happening solely for your amusement."

LOL, that is great. I will have to use it.

Katie82, RN · Jan 1, 2008

No one should be forced to take abusive behavior, no matter where they work. I can't begin to count the number of times patients have cursed at me over the years. My rationalization is that their behavior is a reflection on them, not me. Some people come from enviornments where abusive language is the norm. I have always let my patients or LOs know, however, that I will not tolerate that kind of behavior. Patients expect nurses to be warm fuzzies, so if you perform your duties adequately, but offer no conversation beyond what is necessary, many patients will take the hint and curb their behavior. With my telephone patients, I give them a few warnings, then hang up after telling them I will call back when they are ready to be civil. Most call me back and apologize. Make sure you document bad behavior, everyone reading the record needs to know what you have endured.

Jo Dirt · Jan 1, 2008

How do you try to care when you know that the patient's lifestyle has caused their disease. Whether it be sex, drugs, alcohol? I had a patient today that was very sick due to their lifestyle choices. They were very rude, hateful, particular, and flat out annoying.. I found it very difficult to be empathetic for this patient. It got to the point where I couldn't stand to be in the room anymore.. This patient was flat out disgusting.. They would try to wipe their stool on me purposely, talk very nasty and cuss. I don't even know if i can stand to take care of this person tomorrow. I'm not even going to tell you the nasty things they did today. It just makes me sick.... How do you stay empathetic???
Tiger

You know, it is one thing to feel empathy for a person who is sick because of their lifestyle choices. Any harm done they have only done to themselves. But when they have no regard for others, I'm sorry, I have no empathy for them.

I'd quit before I took evil forms of abuse from another person.