Non-Judgemental, does this often equal Enabling?

[FireStarterRN, BSN, RN]

Something came up on another thread about this theme of being 'non-judgemental', which echos a larger question that applies to our society as a whole. We are often encouraged by our culture to be non-judgemental, whatever our religious leanings. It's almost a modern mantra. We often hear it hear regarding our patients.

I'm having one of my days here where I feel as if we nurses are oftentimes enablers. No matter what someone's bad habits are, we are supposed to be non-judgemental and feel compassion for them, because afterall, they can't help themselves. We are to always, always, always believe their reports of pain, if they are a drug addict we excuse it because it's a disease, if they just threw their 4 kids off a bridge then it must be because they need a mental health eval.

If a nurse dares to be critical of her poor patient, no matter how vile he is, she is scolded by some as being Judgemental! No matter if the pt is a manipulative frequent flyer who is milking the healthcare system dry, we healthcare workers are supposed to smile and pretend like everything is just normal, just like all the citizens in the Emperors New Clothes all pretended that he wasn't actually stark naked.

I don't know, I guess I think it's gone too far and that maybe people need to held responsible for their own behavior, and that it's okay hardworking nurses to judge others based on their actions.

[FireStarterRN, BSN, RN]

Additionally, I think that the current legal climate in healthcare further enables malcontents to take advantage of the system. I've read that in UK they have statutes in place to discourage frivolous lawsuits by healthcare consumers.

I also think all this pandering to patients as if they are customers at a hotel also feeds their sense of entitlement.

[Tait, MSN, RN]

There are so many possible conversations in this thread, that honestly I don't have the energy to comment on them all, but someone will.

Personally I am not religious. My non-discriminate attitude stems from my sense of equality among humans.

I believe doing our best not to judge a patient is a building block needed to assess a person holistically. If that means we are able to see the situation from the patients perspective and we sympathize with them, that could lead to someone making the decision to enable. I do not believe intrinsically one leads to the other.

However, our profession has the power to not only sympathize/empathize but to have the ability to help. So by using nursing common sense, ideally, we do what is best for our patients, even if we can understand where they are coming from.

Tait

[SICU Queen]

I think probably what is meant is that you should treat the patient as well as you treat every other patient that you're caring for, and that you're not MORE harsh, or treat them badly, because you don't like what they do. This doesn't mean that you're not allowed to have an opinion about their lifestyle, or that it can't be verbalized.

I have told more than one patient that, while I absolutely will give them 100% of my nursing skill and support, this does NOT mean that I condone or support whatever life style choices that led them to their current state of health that required hospitalization.

Non-judgmental does not mean enabling. It means that you've developed the ability to have an opinion while still giving excellent care.

[leslie :-D]

admittedly, it's really difficult to be non-judgmental.

but it is a quality i aspire to.

NOT to be confused w/compassion.

hell, no.

i don't feel compassionate much of the time.

i believe in calling a spade, a spade.

and i resent that nurses are synonymous w/being compassionate, angelic.

and my pts do come to know me as being up front and sometimes, outspoken.

if i think someone is med seeking, i tell them so.

the gray area lies in the fact that i'm dealing w/the dying.

and so, if they are med seeking (or have other undesirable behaviors), what is anyone going to do about it?

if this is the way they choose to live out their remaining time, then i support them.

and i tell them that, too.

they know i may not agree with their choices, but they know even more, they have a staunch supporter in me.

i also know, if they weren't dying, i'd call them on my observations/assessments.

i don't do games.

leslie

[nursemike, ASN, RN]

Something came up on another thread about this theme of being 'non-judgemental', which echos a larger question that applies to our society as a whole. We are often encouraged by our culture to be non-judgemental, whatever our religious leanings. It's almost a modern mantra. We often hear it hear regarding our patients.

I'm having one of my days here where I feel as if we nurses are oftentimes enablers. No matter what someone's bad habits are, we are supposed to be non-judgemental and feel compassion for them, because afterall, they can't help themselves. We are to always, always, always believe their reports of pain, if they are a drug addict we excuse it because it's a disease, if they just threw their 4 kids off a bridge then it must be because they need a mental health eval.

If a nurse dares to be critical of her poor patient, no matter how vile he is, she is scolded by some as being Judgemental! No matter if the pt is a manipulative frequent flyer who is milking the healthcare system dry, we healthcare workers are supposed to smile and pretend like everything is just normal, just like all the citizens in the Emperors New Clothes all pretended that he wasn't actually stark naked.

I don't know, I guess I think it's gone too far and that maybe people need to held responsible for their own behavior, and that it's okay hardworking nurses to judge others based on their actions.

Patients, like people, come in all flavors, and some of them are jerks. Others are stupid. A lot of them are pretty nice, but even some of those may not be at their best under the stress of being hospitalized.

I think part of the key is too distinguish between symapthy and empathy. I've used the example, before, that if you can encourage a non-compliant diabetic to walk half-a-mile every day, you haven't "fixed" them, but they'll still be better off than they were. It's a start, and it might lead to other changes down the road.

I agree that we should not be in the business of making excuses for patients' bad (that is, unhealthy and/or morally wrong) behaviors. I have been trying to quit smoking. I understand that many patients have as much trouble with that as I have. It would have to be a very sick patient, indeed, that I would tell it's okay to go ahead and smoke. But I know from my own experience that being scolded for smoking doesn't motivate me.

I had a patient on comfort care, once, who had come to our facility from prison. He had done some very bad and not very bright things to put himself in that position. He may also have had some substandard care--I only know his family's side, so I reserve judgement. What I do know is that he was a young man, and his family who loved him was watching him die a slow, lingering death. It's a fact of life that when young people die, there are usually some bad choices involved (not always, of course, but often). But even if I had been able to say I thought he deserved his fate, his family didn't. In reality, though, I didn't feel it was my place to accept or condemn his choices or his bad luck, but to objectively provide the best care I could and keep him as comfortable as I could until he passed.

Patients can be manipulative, and it does seem, at times, that the "system" enables their manipulation. It's trying, and in the quiet of the med room, I've said things I'd never want my grandmother to hear. But what're ya gonna do? There are illnesses that come out of the blue, randomly attacking anyone unlucky enough to get in the way. But, ultimately, if people didn't do unwise things, a lot of us would be out of work.

[FireStarterRN, BSN, RN]

But, ultimately, if people didn't do unwise things, a lot of us would be out of work.

Yeah, I've thought of that, it's job security, eh?

I think I'm feeling cynical today. I guess I'm tired of being "Mrs. Bedside Manner". I'd like to make a comedy, like Liar Liar, where the nurse tells all the patients just what she's thinking. Maybe that would cheer me up.

[leslie :-D]

I'd like to make a comedy, like Liar Liar, where the nurse tells all the patients just what she's thinking. Maybe that would cheer me up.

daaaaang.

perhaps you should be a fly on my wall...:jwdrp:

leslie

[leslie :-D]

daaaaang.

perhaps you should be a fly on my wall...:jwdrp:

leslie

in all seriousness, maybe i am onto something here.

i do have an advantage, where i have the same pts over a period of time.

could be hours to months.

but common feedback i have gotten is, "are you always this honest?"

yet, they're not complaining.

i just act like myself....albeit, obnoxious and likely, intrusive.

but still....my pts do seem to truly love me.

what is so wrong with calling your pt on certain behaviors?

why do we have to pretend otherwise?

as long as we remain respectful and sensitive, it doesn't mean we can't be honest as well.

and i don't mean brutal honesty.

just some observations stated by the nurse, giving the pt something to reflect on.

i don't see anything wrong with this, esp when you feel comfortable w/your pt and your relationship.

i guess i've been lucky to have what i do, w/my pts.

and my bp is just fine.

leslie

[FireStarterRN, BSN, RN]

daaaaang.

perhaps you should be a fly on my wall...:jwdrp:

leslie

Say, what in the name of Jesus is that smilie doing???

[zuzi]

For me is not the same think for true. Nonjudgemental means to not labeling, enabling means to give the ability and make possible to the person involved to do it again....not for sure is not the same and for a logical mind is not any induction relation beetwen.

Nonjudging not means that I am agree or let the thinks to going on or stay passive and agree with, but in the same time like a human you need to know where to STOP. Are moments in nursing life and carrier (in personal life also) when you need to say yourself STOP, is not a good decision to digging more, is not my bussines to be involved in it, in people personal life (even if could be happen that some of people to be very closed to your heart...IS NOT YOUR BUSSINESS and need to STOP). Your decision not means that you let the thinks to be happen again, but is only the final of one path, without any continuity, persistence in helping and helping and trying and trying again and again, is only for a people who are not in contact with real world.

Real world is in moving, let move on, nonjudgemental and noenabling in the same time, logical analytical and emotional - BALANCED, this is the key, and never will have problems with ethical values.

OMG I was sooooo serious on this topic...this girl is not me, somebody else wrote that ....looooooool

[leslie :-D]

Say, what in the name of Jesus is that smilie doing???

dropping his jaw...

which i found appropriate for me, considering his mouth was so big.

leslie