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
Specializes in Gerontological Nursing, Acute Rehab.
I think it would do all of us, as nurses, some good to remember not to assume anything about our patients. If any one of you would just pull my medical records, look at my labs and vitals, you would think that I would require major "lifestyle" teaching. I have HTN, not too very well controlled despite meds. My cholesterol is borderine high and my ratio could be better.
Guess what? I eat a vegan diet. I don't salt my food after cooking. I'm physically active. Yeah, I could lose 5-10 lbs, but that's nothing. I don't smoke.
Health care professionals need to treat the PATIENT, not numbers on a scale or a lab sheet. And the patient is free to refuse to change.
How to stay compassionate? I have no easy answer for that, because it's very hard. I've had my own struggles with patients like that. You do the best you can, and sometimes I had to fake compassion when I truly didn't feel any for the patient. You know..."First, do no harm." You don't have to like their choices or lifestyle, just do no harm, and try to help. Then go home.
A large part of the problem likely has more to do with socioeconomic status than anything else. Look at it. Cost of a McDonalds double cheeseburger, small fry, and coke = $3 Cost of broiled salmon, asparagus, baked potato, and glass of 100% fruit juice = $12 or more. Geographic data backs this up. You'll find economically depressed area's have a significantly higher incidence of obesity than other areas. This is an area where real change can be made. Yelling at or being rude to obese patients is going to have little no effect on people who lack the will to change. However, donating time or money to educate people in economically depressed areas on ways to eat healthier within a limited budget can be successful. Again however, only if the patient is willing to make the change, but in this instance you'll be dealing with a significantly larger population.
If you are treating an adult, you will not be the first person to tell them to quit smoking, lose wt., get exercise etc.. if it were easy no one would be fat, smoking or drunk..
It's entirely possible to live for years without consuming any methamphetamine. You can go your whole life--if you call it a life--without beer. So, yeah, there's a difference.
And it's entirely possible to live for years without consuming animal products, processed sugars, and all of the other culprits which make it so easy to consume energy far in excess of one's metabolic needs.
As for your assertion that the obese are no better, or worse, than meth junkies, that's fair enough, as long as you're prepared to recognize they are no better, or worse, than marathon runners.
Sure... no better and no worse. And a marathon runner with chronic plantar fasciaitis is just as responsible for their health problem as the obese person is for their T2DM...
or to personalize it: ...just as much as I am responsible for the chronic pain I suffer due to injuries from an accident which was solely due to my irresponsible behavior.
Hitler and Gandhi were fairly fit.
If you say so... though if you're somehow implying that I'm linking fitness to being a quality human being, I'm not sure from where you've derived that view. As a group, pro & college athletes are about as fit as they come... while also providing numerous examples of socially reprehensible attitudes and behaviors.
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My point is, many - perhaps most - of the health problems which our patients face are at some point due to personal lifestyle choices.
Recognizing same helps me to summon compassion and empathy despite the judgmental voice in my head.
IMO, it's not up to us to police the morality of our patients. We have to find a way to meet the patient where they are emotionally.
But with that said, IMO, that does not mean we sugar coat stuff or just don't mention it. I think we should say things with love, compassion, empathy and nonjudging, but WE SHOULD SAY IT!
I'm morbidly obese. My doc and I were talking at my last appointment. I was telling her that I was tired of disgusting myself when I looked in the mirror and that I am finally trying to work on my food addiction. I'm an addict. IMO, there is no difference in any type of addiciton, the only difference is the drug you use. In my life, I have quit drugs, alcohol, sex, cigarettes, leaving food as ,my only drug. As a result I have gained a ton of weight. It's time for me to combat this addiction and truly work on it other than stuffing it like I have been. So as we wer talking, I was telling her that I knew physically how much better I would feel, especially my back pain. I have severe back problems (imagine that at my weight, lol). So as I'm trying to have an open, bluntly honest conversation with her, she actually started saying that my weight wasn't the cause of most of my problems. It was like we had flipped roles. Instead of agreeing with me, I think she was afraid she would hurt my feelings or make me mad, so she took on the role of justification. What I needed was for her to say "you are exactly right! if you'd get this weight off, most of your health problems would go with it".
I think we are too worried that someone will get mad or even threaten to sue. I say if you wanna sue me for speaking the truth, go right ahead. I can defend my actions on the stand. I couldn't defend my not saying anything as that is what we should do as a nurse but Idamn sure can defend myself giving you health advice as I'm supposed to!
and for anyone saying food addiction is not the same as drug/alcohol addiction....addiction is addiction, the only difference is the drug you choose to use- food, drugs, alcohol, sex,emotions...the underlying addiction is the problem, not the substance you choose to use to try to stuff it down.
I Obesity is the #1 contributing factor to the top few killers of Americans...IT NEEDS TO BE ADDRESSED!!!
I agree. I had an older sister. She was a lovely and wonderful person and 14 years older then me. She never had a bad or mean word to say to me even if she was very angry with me. She raised 4 children and she had several grandchildren who loved her and she loved them. Sadly she did not love herself enough to help herself and she passed away in February 2010. She spent the last 6 months of her life in the hospital after spending the past 5 years in bed at home. She could not walk anymore due to her weight and her &^&%%& feeder of a 'fiance' was not helping matters any. She was over 650 pounds when she died and 1 month before she died the doctors had to declare her mentally unfit because she would send her fiance throughout the hospital in order to get things like butter, sugar, etc for her to add to the meals given her. She was actually gaining weight in the hospital when she was put in there to lose weight and declaring her unfit was a last ditch effort to help her.
I miss her (my sister) dearly and if she had of cared for herself more I might possibly still have her around. The worst part of losing her is that afer she died I found out when she was 13 years old she was raped and she *might* in actually be my mother and the woman who raised me and the one that I called mother could in fact be my grandmother who passed away in 2002. Sadly because of morbid obesity I will never know the truth and always wonder.
Obesity certainly does need to be addressed but in a non-judgemental way. That, I believe, is difficult to do for some people...not all...just some.
IMO, it's not up to us to police the morality of our patients. We have to find a way to meet the patient where they are emotionally.
But with that said, IMO, that does not mean we sugar coat stuff or just don't mention it. I think we should say things with love, compassion, empathy and nonjudging, but WE SHOULD SAY IT!
Best response so far. Another Southernbeegirl cheerleader here! :heartbeat
And it's the same with obesity. Fat people are people. Except for being fat, they're just like regular people. Hell, in the US, they are the regular people.
and you don't find that a frightening reality?
heck, i am so sick and tired of us all having to tiptoe around a very serious issue...
which ANY addiction is.
and when a person cannot stop eating to extent that it impairs their function and health, i consider that worrisome.
when it's said that the truth will set you free, they're not kidding.
we ALL need to face our demons, no matter what they may be.
Honestly, I don't do much of anything unless they seek out information from me on how to change or improve. Many of the patients that come in are not ready to learn anything. But if they are, I am ready to teach.
I don't preach to people about anything. They know the risks. You will worry yourself to craziness if you try to "save" everyone.
Once they are discharged, they won't have me or other nurses yapping in their ear about what they should and should not do, eat, or drink.
We are healthcare professionals for God's sake. If we have a patient over 300 pounds, as I am, why are we acting like they are not overweight? If we are caring for a diabetic and that diabetic is constantly eating sweets we tell him "you have to stop or you will die". So why are we not telling fat people "look, it's like this...lose weight or die. simple as that". It's not like the fat people don't know they are fat. We KNOW we are fat. I am sick of the "norm" in today's society be that we do not hold people accountable for their own actions!
I'm not saying brow beat them either. But when we are at the doctor's office or in the hospital, we should expect that those caring for us are going to tell us the truth behind our current state of health. Otherwise why even go? I'm sick of people thinking we should tell them only what they want to hear! Honesty hurts sometimes but only when you are in denial. We can't help people until we get them to that "teachable" moment of clarity.
I was in the emergency room last month. I had a whopping case of pneumonia and went into resp. distress at work. So I was telling the ER doc that my PCP had started me on an antibiotic that week for suspected RLL PNA but that the CXR wasn't clear. He says why not clear. I'm like "um..duh! fat patient, old equipment!". You could tell he was startled I would say that. It exasperates me that I get treated like I'm not fat. I'm fat, I know this. I've even had people say "how did you get to this weight?". um...I ate?
help me figure out WHY i eat and I will love you forever.
Best response so far. Another Southernbeegirl cheerleader here! :heartbeat
jkaee
423 Posts
I think it would do all of us, as nurses, some good to remember not to assume anything about our patients. If any one of you would just pull my medical records, look at my labs and vitals, you would think that I would require major "lifestyle" teaching. I have HTN, not too very well controlled despite meds. My cholesterol is borderine high and my ratio could be better.
Guess what? I eat a vegan diet. I don't salt my food after cooking. I'm physically active. Yeah, I could lose 5-10 lbs, but that's nothing. I don't smoke.
Health care professionals need to treat the PATIENT, not numbers on a scale or a lab sheet. And the patient is free to refuse to change.
How to stay compassionate? I have no easy answer for that, because it's very hard. I've had my own struggles with patients like that. You do the best you can, and sometimes I had to fake compassion when I truly didn't feel any for the patient. You know..."First, do no harm." You don't have to like their choices or lifestyle, just do no harm, and try to help. Then go home.