It's long, dangerous, but worth typing, to me!

MaryPush · Oct 15, 2007

...(snip)... but these patients belong on a psych unit because their diseases are psychologically base. I am not a psych nurse. I don't want to be a psych nurse....(snip)...

You may believe they belong there, but unless the morbidly obese patient has a gun to head, knife to throat or pills in mouth an acute psychiatric hospitalization is not going to be covered by most insurances. Being morbidly obese for whatever (psychological) reason, unfortunately, is not going to be addressed in an acute psychiatric setting.

But I hear what you are saying.

pagandeva2000, LPN · Oct 15, 2007

One thing I thought of is that while the OP may have mentioned two particular situations that sincerely irritated her, there may also be others, but these were the two that either stood out the most often, or that happened recently. I don't think she was stating that these people did not need or deserve care...she said that these behaviors burn her out. I think that most people know that we, as nurses are responsible for whatever patients come our way as effectively as possible, but not one person can actually say that they do this daily with a smile, a halo and the Nightingale lamp at our midst each and every day. Sometimes, it is not all about willing, really, but ethical to care for them all. However, most people will occasionally mumble under their breath at least ONCE in their career.

jb2u, ASN, RN · Oct 15, 2007

Well, if I may....I am a new grad; and so, I do not have that much experience in nursing; however, I am a reader. I believe many posters have only read the top part of the OP's post.

First, the OP has stated that she spends so much time CARING for the addict and obese pt that she can not give proper care to her pt with a brain tumor. This is to say that she DOES care for and does NOT neglect her addicted pts. She is expressing anger over caring so much for one that she does not care adequately for the other. This is a valid concern, and one that shows she is a great nurse!

Second, she stated correctly that she deals with an ever increasing problem with addiction and obesity. Again, this only shows what a great nurse she is. A great nurse will recognize trends in healthcare and work towards a solution. Which, if you read her WHOLE post, is exactly what she is seeking. She cares so much that she does not want to turn her back on nursing, but instead, is seeking a solution.

We must all, in a way, be judgemental as nurses. What do I mean? Well, if my pt is a smoker, I need to judge that to be unhealthy and something that he should quit. If I see a 300 lb. pt come in, I should judge that that is too much weight and that she needs to lose that weight. If I have a diabetic pt that states, "I keep my sugar in check", but his HA1C is in the clouds, I have to judge that he is not telling the truth and needs to adhere to his Dr's orders!! All of these are judgements that a good nurse will make. The solution, as I see it, is in nursing involvement. We must judge who needs to stay away from McDonald's and who needs to seek rehab. We must go into the room with smiles on our faces and a caring hand, but we should not just "give into the pt's unhealthy desires." Instead, we should initiate a conversation about weight management, diabetes management, addiction, etc. You or I could be the one that makes the right judgement about a pt that sets him/her along the path to health. We can not treat all pts the same. The obese pt NEEDS a reduce calorie diet. While we take care of the addicts plea for a pain med, we should also deal with his/her NEED for the pain med! I welcome these pts. I may be the one, a NURSE, that helps deal with this ever increasing addiction and obesity. And, if I don't get through to these pts, I will go home knowing that I did my best. Maybe next time will be THE time I get through. If not, at least I did my best and that is good enough for me!!! I have a great life, wife, kids, great profession, I get to work for this great website; however, some people's lives really do stink; and so, they turn to food or crack. Of course this only makes it worse, but that is what makes my position so much better for the pt. I can see what he or she can not. That life can be better for them....IF only they would let ME help because I CARE!!! I am not some delusional new grad. I know I will not make the difference 99.9% of the time, but I am looking for that 0.1, but I will only find him if I care for all 100% of them.

missrose, I hope tomorrow's shift brings a new perspective for you. And, I hope you find your 0.1%!!! I will leave with your own words....

Yet lately, I leave work feeling inadequate. I feel my SICK patients are being shorted by the overwhelming needs of my addicted patients... whether they are addicted to food or drugs. But how can I help them if they refuse to help themselves?? We need new parameters for caring for diseases that originate in the mind (choices) versus diseases that originate in the body (no choice).... even if those choices have deep roots such as background, lifestyle, lack of knowledge or awareness.... they must be addressed and repaired. And soon! (sigh! Just typing as fast as I'm thinking here, folks!) At least I still possess the compassion to care about finding a solution!! I haven't walked away from my chosen profession yet. I'd like to find a solution!![/I]

EmmaG, RN · Oct 15, 2007

I think you forgot to highlight this in your above quote:

We need new parameters for caring for diseases that originate in the mind (choices) versus diseases that originate in the body (no choice)

:angryfire

nursemike, ASN, RN · Oct 15, 2007

2shihtzus,
I believe that addiction is addiction is addiction. It doesn't matter if it is to food, sex, alcohol or drugs. The person is still self medicating, just with different things.

Both my PCP and the nurse who ran a smoking cessation program I tried made a very good point about obesity: you can't give up a food addiction "cold turkey." I can live without tobacco. I can't live (long) without food.

nursemike, ASN, RN · Oct 15, 2007

This thread has angered me beyond words. I've been reading it since it was posted, and have so far avoided getting into the fray.
Jojo said "I guess I could understand (and agree with) your frustration a little bit more if your complaints were directed at specific patient behaviors than at specific patients." and I have to agree with this; beyond that, I think the original post is simply ignorant. But I'm not going to point out its obvious fallacies.
When I first read it, I thought of my aunt--- who was really a second Mom to me (more so after my own mother died). My aunt was "morbidly obese". 5'10" and I'd estimate at least 300 pounds. And she was the kindest, most compassionate person you'd ever want to meet. And YES, she was "appreciative, humble and pleasant even" (God, I'm getting furious here just quoting those words...) even though she was "morbidly obese".
Did she like to eat? Of course she did. I don't recall her appetite being that much greater than anyone else's, however. She was always on the go--- worked hard, volunteered her time with disabled children. Yeah, she "chose to eat" and she enjoyed it. But I thought that was normal; as I recall from my days as a student, NOT wanting or liking to eat is pathological. Ah well, I guess I must have misunderstood.
But no worries. Her cancer cured her of her "addiction". Why, when she died, she was positively svelte.
I watched as her nurses cared for her in her final days; I'm so damned glad it was they who were there for her.
If you know what I mean.

Before I became a nurse, I was assigned as a sitter on suicide precautions for an 18 y.o. addict in withdrawls. The day I can't feel compassion for a kid like that, somebody put a bullet in my head.

As a nurse, I had a pt on comfort care pass. He'd suffered a head trauma from shooting himself in the head (intentionally) and developed an abcess in jail. Didn't get to know him, really, but his family sure loved him. I gather the whole situation evolved from mental health problems, initially.

I can't argue with whoever said some of the people objecting to the OPs remarks about obesity were overweight, themselves. I'm overweight. I'm not happy about it, although I'm happy enough in general. Obesity is not all there is to me. I'm a kind, intelligent, thoughtful, caring, honest, fun-loving, patient, decent, courteous person who doesn't wear speedos in public. I'm actually pretty healthy, in spite of my vices, and at the risk of sounding self-righteous, I'm sort of glad I'm flawed enough not to judge others too harshly.

I recognize the need to rant. I do it myself, at times. I get frustrated with my patients from time to time, too. Last night, I had three tough pts. One was a CVA who was impulsive, non-compliant, a huge fall risk, and accidently pulled out his IV three times over the weekend and pulled off his tele leads more times than I can count. Another was a CA pt who was as sweet and considerate as you could want, but pretty sick. The third was an SAH whose LOC had been decining steadily all weekend and ended up going to CT twice.

So, yeah, it would have been a blessing if the one patient would have just stayed in the darned bed and left his wires and tubes alone. (I'm not saying this is quite the same as the OP's situation--he wasn't a CVA by choice, although he did smoke, and he wasn't rude or demanding, just hard to take care of at a time when others needed me worse.)

So yes, let the OP blow off steam. But if she is going to generalize and pass judgement, I don't see anything wrong with calling her on it.

jb2u, ASN, RN · Oct 15, 2007

I think you forgot to highlight this in your above quote:
We need new parameters for caring for diseases that originate in the mind (choices) versus diseases that originate in the body (no choice)
:angryfire

I did not forget. I highlighted the parts that reinforced the spirit of what I was trying to say. "We need new parameters for caring for diseases that originate in the mind (choices) versus diseases that originate in the body (no choice)" is simply missrose's view/solution for a problem that she sees and I appreciate her trying to help a situation instead of offering just criticism. And, the thought that we do need different parameters for caring for diseases that originate in the mind vs. those that originate in the body is a valid view, seeing how we do treat pysch pts differently and on different units than med/surg. So, good point emmanuel!!! Maybe I should have highlighted the fact that missrose wants a new set of parameters for these clients.

leslie :-D · Oct 15, 2007

an acute psyche unit, will not do anything for obese, drug-addicted pts.

if anything, they'll be given prn's and limit-setting.

long-term therapy is the only solution to explore the intracisies of addictive behavior.

and a lot of support.

leslie

EmmaG, RN · Oct 15, 2007

I did not forget. I highlighted the parts that reinforced the spirit of what I was trying to say. "We need new parameters for caring for diseases that originate in the mind (choices) versus diseases that originate in the body (no choice)" is simply missrose's view/solution for a problem that she sees and I appreciate her trying to help a situation instead of offering just criticism. And, the thought that we do need different parameters for caring for diseases that originate in the mind vs. those that originate in the body is a valid view, seeing how we do treat pysch pts differently and on different units than med/surg. So, good point emmanuel!!! Maybe I should have highlighted the fact that missrose wants a new set of parameters for these clients.

So you agree that obesity and addiction is a choice, and originate in the "mind" as opposed to "the body"?

Amazing.

With that, I'm out of this thread before I say something I'll regret.

pagandeva2000, LPN · Oct 15, 2007

Well, if I may....I am a new grad; and so, I do not have that much experience in nursing; however, I am a reader. I believe many posters have only read the top part of the OP's post.
First, the OP has stated that she spends so much time CARING for the addict and obese pt that she can not give proper care to her pt with a brain tumor. This is to say that she DOES care for and does NOT neglect her addicted pts. She is expressing anger over caring so much for one that she does not care adequately for the other. This is a valid concern, and one that shows she is a great nurse!
Second, she stated correctly that she deals with an ever increasing problem with addiction and obesity. Again, this only shows what a great nurse she is. A great nurse will recognize trends in healthcare and work towards a solution. Which, if you read her WHOLE post, is exactly what she is seeking. She cares so much that she does not want to turn her back on nursing, but instead, is seeking a solution.
We must all, in a way, be judgemental as nurses. What do I mean? Well, if my pt is a smoker, I need to judge that to be unhealthy and something that he should quit. If I see a 300 lb. pt come in, I should judge that that is too much weight and that she needs to lose that weight. If I have a diabetic pt that states, "I keep my sugar in check", but his HA1C is in the clouds, I have to judge that he is not telling the truth and needs to adhere to his Dr's orders!! All of these are judgements that a good nurse will make. The solution, as I see it, is in nursing involvement. We must judge who needs to stay away from McDonald's and who needs to seek rehab. We must go into the room with smiles on our faces and a caring hand, but we should not just "give into the pt's unhealthy desires." Instead, we should initiate a conversation about weight management, diabetes management, addiction, etc. You or I could be the one that makes the right judgement about a pt that sets him/her along the path to health. We can not treat all pts the same. The obese pt NEEDS a reduce calorie diet. While we take care of the addicts plea for a pain med, we should also deal with his/her NEED for the pain med! I welcome these pts. I may be the one, a NURSE, that helps deal with this ever increasing addiction and obesity. And, if I don't get through to these pts, I will go home knowing that I did my best. Maybe next time will be THE time I get through. If not, at least I did my best and that is good enough for me!!! I have a great life, wife, kids, great profession, I get to work for this great website; however, some people's lives really do stink; and so, they turn to food or crack. Of course this only makes it worse, but that is what makes my position so much better for the pt. I can see what he or she can not. That life can be better for them....IF only they would let ME help because I CARE!!! I am not some delusional new grad. I know I will not make the difference 99.9% of the time, but I am looking for that 0.1, but I will only find him if I care for all 100% of them.
missrose, I hope tomorrow's shift brings a new perspective for you. And, I hope you find your 0.1%!!! I will leave with your own words....

Worded beautifully!

pagandeva2000, LPN · Oct 15, 2007

Bottom line is that different things frustrate different people. What is most important is that we try to do our best for each patient. What the difference is; is that our best depends on several internal and external factors. If we are sick, tired or irritable, the best may be different than when we are well rested, have the support of our administrators, co-workers, familes of the client as well as our own support system available to us during our private times.

I also see that the OP asked for a solution to her feelings and it seems as though she was looking for suggestions on how to manage care for both, the addicted patients as well as those that are unable to physically help themselves. She admitted it was very difficult for her at this time. I can commend her for her honesty. I work in a clinic, so, my problems are not as deep as those that work on the floors, but, I have often toiled over how to help many patients I see on a daily basis. And, I go home and scream as well many, many times. I am no saint.

jb2u, ASN, RN · Oct 15, 2007

So you agree that obesity and addiction is a choice, and originate in the "mind" as opposed to "the body"?
Amazing.
With that, I'm out of this thread before I say something I'll regret.

I treat all of my pts with respect and care for them equally. That being said, obesity, unless the pt has a tumor growing out of control, has something else going on. Unless these pts operate on a different law of physics, a calorie is a calorie. Now yes, some people have slow metabolisms in which they have to either a) exercise more or b) eat less. I do not know too many overweight people that say, boy I exercise four days a week and I am 400 lbs. unless they eat A LOT!! So, obese people do not choose to have a low metabolism, but do they choose to up their exercise or exercise at all? That is the choice part that I believe the OP was talking about.

Addiction, yes it is real!!! However, you have to make a choice to use in the first place. I could be addicted to crack, but I make the choice to not even try it. Once I do, yes it becomes a medical as well as a mental problem, just like when I choose to eat more than my body burn becomes medical after I choose to eat that which I know I shouldn't. Once again, I believe that this is what the OP meant by making a choice. I can not just wake up tomorrow and say "I don't have a tumor or a broken leg" but I can wake up and say that I am going to exercise more or seek rehab. Again, I believe this is what the OP is saying is a choice.

Now, if you are curious...what I believe is that all pts should be treated with dignity and the utmost of care. But, I also think if a 600 lb man comes in and the only thing that you treat is his SOB or pressure sore from not moving in bed, then I think you are not treating the pt as a whole. I think we should HELP addicts and the obese for their sake not mine! Yes, cure their medical condition, but then I believe in MY opinion that there is something in the pt's thinking that needs to be addressed as well!!! To deny that is to deny the underlying problem. I can see Doctors ignoring that, but I feel that Nurses should be more involved with the preventative side of the issue.