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.
Just because you are not judgemental does not mean you are enabling them. I had a patient who was a drug seeker. She was 37 years old and in my nursing home for 1 1/2 years. She knew that I did not buy into her. She knew that I though it was a bunch of crap. I did not tell her in those terms but she knew. I do not think that I enabled her problem. I took every opportunity to tell her about the meds she was on and the problems that they caused. This woman was in for diabetic gastroparesis. She was on 2mg of Dilaudid IVP Q2HR et Phenergan 50mg IVP Q4HR. She vomited non-stop. She said, "My stomach does not work right." I say, "The meds that you are taking only make that situation worse." Both do this. I always educated her. Yes, I still had to give the meds because she was ordered them but did not mean I had to agree with it. I also use the opportunity to educate her mom & dad whenever they asked about it.
The last unit I worked on was 60 beds subacute/ltc. Of these residents 35 had a history of etoh/substance/polysubstance abuse. From that primary dx, sprang their other medical dx. Most of these folks were aaox3/walkie/talkies. Many had served time and prison and had been homeless secondary to drug use.
At first I was astounded by the sheer amount of narcotics for each resident. Typical orders:
Fentanyl 100 mcg Duragesic Patch
Percocet 10/325 ii tabs po q 6 (straight order)
Dilaudid 4mg po q 3 prn dx breakthrough pain
Ativan 1 mg po q4 prn dx anxiety
Then when everyone would literally circle the med cart for their prns, I started to become angry. My internal dialogue was along the lines of castigating these freakin drug seekers who weren't in pain but looking to continue or obtain a high and how dare they whine so much when for the first time they have 3 hots and a cot in a safe environment with all the drugs they want without having to do anything but ask...
Whoa......not being one to enjoy anger...I had to explore the etiology of my feelings. Having had an alcoholic abusive father really was generating feelings I'd swept under the psychic rug.
Two things occurred to me:
1. My residents are in pain. It may not be physical. It is probably spiritual, mental, or emotional. They are reverting to established behavioral patterns to numb that pain. eg the use of drugs. This has not proved effective in the past but and here comes #2
2. What have I done as a nurse to treat the true dx? What tools/alternatives have we provided them? Well none...
So I spoke with the residents and they wanted NA/AA meetings. I went to the DON and the social worker with this information. It was rejected because "We don't want those type of people in the building"
Well fine said I....get someone who is willing to run a meeting and make them closed. The residents also approached the DON and ADMIN. Nothing resulted.
Don't misunderstand...I don't perceive NA/AA to be the great cure all. However it is a starting point to learn tools and change behaviors.
So to answer the question.....was I enabling? You tell me.
Tres
who is much richer for having worked with these residents
Specializes in LTC, assisted living, med-surg, psych.
But, ultimately, if people didn't do unwise things, a lot of us would be out of work.
That's what I always say........if it weren't for drugs, ETOH, and stupidity, we'd have to go out and get REAL jobs:lol2:
Seriously, though, EVERYONE has something---a bad habit, crummy genetics, a few lousy choices---that they're not proud of, and that can impact their health. I work very hard to force myself to remember that whenever a patient/resident tries my patience to the breaking point (and then some). I haven't walked in that person's shoes, so I don't have a right to judge, that's for sure; but then, neither am I going to sit there and blow sunshine up someone's kazoo when he or she is doing senseless and stupid things. I call 'em as I see 'em.........I just try to do it so that the person's dignity is preserved, that's all.
I agree with many of the others, people should be held accountable for their actions. Non judgemental doesn't = nursing.
That said, I always give them a chance (until proven otherwise) regardless of what the previous shift told me in report, such as abusing pain meds.
This is an aside but ...
It's really easy to fall into the nurse gossip mill that frequently occurs, which in and of itself causes problems, i.e, patients can sense when they are not 'liked' or are being avoided by the nursing staff, which in turn I believe leads to an increase of bad behavior and attention seeking (humm ...sounds like a thesis topic....).
Back to the topic
Let's face it , we might think we know what's going on w/ a patient or how they feel, but until they develops some sort of software where we can actually enter another's head and feel what they feel - then I can only accept that when they say they are in pain - they are. I mean how do you know they are lying to you?
Now some of the cynics out there might call me an enabler because I give my pain meds as requested by the patient (within the parameters and after appropriate assessment).
It's not my job to pass judgment, it's my job to take care of them to the best of my ability. And believe you me, I think you'd rather have me, then some of my judgmental co-workers taking care of you.
Just imagine laying there in pain, and at the mercy of a nurse who is trying to decide if you really have enough pain to warrant .... you get the picture. Now that doesn't mean that I don't try other tactics, like distraction, repositioning, exercise, etc...
If I worked in long term then it might be a different story, it's hard to say.
But I work in acute care and my patients have pain.
if a patient thinks they are putting one over on you it is human to make them realize that you are not being buying into it
i think of inabling more on a personal level than on a professional one..if you do things which harm you to prevent a confronaation with a family member you are enabling and encouraging them to continue
I feel like its not our job to judge, its our job to take care of that person the same way we'd take care of any other.
That said, I can be judgemental at times, I just keep it to myself.
Also, I don't think being miss agreeable is giving the best care. If someone is doing something to harm themselves, or that is detrimental to their overall well being, I'm likely to try to talk to them about it. Its our job to care for the whole person, and if they are messing up their life in an obvious way, thats part of the whole person IMO. I won't condone bad behavior, I'll say what I have to say about it, give them the information they need, and then its their choice what to do with it.
Of course there are always situations where thats always easier said than done, and I'm not a nurse yet (Hurry up May!!) but I guess I'm kind of this way with people in my life in general, so I hope that I'll be able to continue to be this way with my patients in the future.
I tend to be a polite, yet very direct and honest person. I don't really do the whole beat around the bush or tip toe around the issue thing.
But I have a family member who was hospitalized a few years back due to a mental illness out of control. On his meds, he is great! But as he was being diagnosed, well, not so great.
Anyway, I am so grateful for the nurses who cared for him. He was held in a general hospital for almost a week until a bed in a psychiatric hospital was available. I am sure he looked like a lost cause to them, and was annoying and irritating as well, but they never let on and treated him with great respect, as well as us family. Too bad they can't see him now, that he's doing well.
Specializes in trauma, ortho, burns, plastic surgery.
I had a case very closed to may heart, the husband of one of my best friends, he worked couple of years in dangerous places, finally at retirement he was amfetamine dependent. He was one of the firsts of my drug addicted patients. Emotionally implied in, we cried a lot togheter trying to find an escape for him and my friend accepted each relapse of him, in a country where the drugs problem and dependency is not so big or may be not so big advertised. It was enabling? Not was not! We tryied to do everything human possible, supporting spirtual and material also....one day was the final....we need to say "that IS, we can't change it, we need to accept the reallity" We cried like he was dead already, and from that moment, togheter, not emtional implied we decided what we can do for the future.
IS a labeling, is a acceptance? Not from my point of view...is just REALITY and like nurses we need to accepted it....one day!
IMO,there is a difference between being non-judgemental and tolerant. A person who is non-judgemental is just that - not passing judgement, therefore cannot be considered an enabler. A person who is tolerant, however, may have passed judgement, but chooses to not allow that judgement to get in the way of the care they give. This may be seen as enabling by some.
fultzymom
645 Posts
Just because you are not judgemental does not mean you are enabling them. I had a patient who was a drug seeker. She was 37 years old and in my nursing home for 1 1/2 years. She knew that I did not buy into her. She knew that I though it was a bunch of crap. I did not tell her in those terms but she knew. I do not think that I enabled her problem. I took every opportunity to tell her about the meds she was on and the problems that they caused. This woman was in for diabetic gastroparesis. She was on 2mg of Dilaudid IVP Q2HR et Phenergan 50mg IVP Q4HR. She vomited non-stop. She said, "My stomach does not work right." I say, "The meds that you are taking only make that situation worse." Both do this. I always educated her. Yes, I still had to give the meds because she was ordered them but did not mean I had to agree with it. I also use the opportunity to educate her mom & dad whenever they asked about it.