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
There are many documented cases of young girls (and I presume boys) who have grown up to be morbidly obese adults because of sexual abuse or assault in their youth.
They grow up with a negative self-image which leads them to seek refuge in overeating, but sadly is frequently not recognized until it is too late.
The "fiance" ought to be watched. This type of character is a sick parasite who will seek another woman to dominate in the same way he did your sister.
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.
truthfully, i don't "preach"/"teach", either.
maybe it's because working in hospice, many of these pts are suffering the consequences of their actions.
and as a heavy, lifelong smoker myself, i could never be that hypocritical, and, am experiencing consequences myself.
i actually don't know how i'd be, if i were in a setting where folks are going to continue and live.
i really believe i'd fight like the dickens, to grab their dbl cheeseburger/fries, under my watch.
I agree, leslie.
help me figure out WHY i eat and I will love you forever.
isn't that a fact?
help me figure out why i compulsively eat, smoke, use drugs...help me figure out why one does anything compulsively.
i do believe it takes yrs of good therapy.
southern honey, stop beating yourself.
you are clearly on the right path in life. :redpinkhe
Operant conditioning should be used a lot more in educating patients than it is. It is incredibly effective. (I'm going to use an extreme example here.) If every time a fat person went to McDonald's they got a punch in the face what do you think would happen? Eventually they would stop going to McDonald's (sooner rather than later I hope:lol2:). Now if every time they went to the supermarket and bought a bunch of fruit, vegetables, and lean meats they got $100 cash what would happen? They would likely continue to go to the supermarket and buy fruits, vegetables, and lean meats. This sort of therapy doesn't have to be extreme nor does it require third parties. Heck, I've used it on myself to keep from procrastinating with my school work. Once I finished my school work I'd reward myself with a Popsicle, piece of fruit, or something along those lines. Pretty soon I started getting my homework done sooner and sooner. Now, I'm not advocating that nurses go around punching patients in the face, nor am I advocating nurses start handing out $100 as rewards for compliance. All I am saying is that operant conditioning can be an incredibly powerful tool in effecting change if understood and used properly.
Operant conditioning should be used a lot more in educating patients than it is. It is incredibly effective. (I'm going to use an extreme example here.) If every time a fat person went to McDonald's they got a punch in the face what do you think would happen? Eventually they would stop going to McDonald's (sooner rather than later I hope:lol2:). Now if every time they went to the supermarket and bought a bunch of fruit, vegetables, and lean meats they got $100 cash what would happen? They would likely continue to go to the supermarket and buy fruits, vegetables, and lean meats. This sort of therapy doesn't have to be extreme nor does it require third parties. Heck, I've used it on myself to keep from procrastinating with my school work. Once I finished my school work I'd reward myself with a Popsicle, piece of fruit, or something along those lines. Pretty soon I started getting my homework done sooner and sooner. Now, I'm not advocating that nurses go around punching patients in the face, nor am I advocating nurses start handing out $100 as rewards for compliance. All I am saying is that operant conditioning can be an incredibly powerful tool in effecting change if understood and used properly.
Can you give some realistic examples of how this works, scott?
There are many documented cases of young girls (and I presume boys) who have grown up to be morbidly obese adults because of sexual abuse or assault in their youth.
They grow up with a negative self-image which leads them to seek refuge in overeating, but sadly is frequently not recognized until it is too late.
The "fiance" ought to be watched. This type of character is a sick parasite who will seek another woman to dominate in the same way he did your sister.
This is what happened to me, sexual abuse. I've spent years in therapy and honestly, I am doing so much better than I ever have. I have more love in my life than I ever believed would be possible. My fat is like my last line of defense against the world, in a way. I want to give it up, I just don't have the guts.
totally off topic...I wish we could give the death penalty to child abusers for what they do. they ruin lives.
maybe it's because working in hospice, many of these pts are suffering the consequences of their actions.
and as a heavy, lifelong smoker myself, i could never be that hypocritical, and, am experiencing consequences myself.
A great comment. I think we have the heart of the debate right here.
- It's hard to tell the difference between preaching and teaching sometimes. So we choose to do neither ...
- It's even harder to try to have an honest, informative discussion with a patient when it involves poor life choices that we ourselves are busy making.
We are socialized to be polite above ALL ELSE. We (understandably) feel uncomfortable judging patients for behaviours that are considered normal/common/personal/un-fixable.
But if nurses cannot make the effort to at least be straightforward with their patients - to attempt to reach out at least a little bit - who will?
OP, in these situations I would take a second to reflect about the patient's circumstances - understand that they have probably already judged themselves - and then try. At least a little. I like the question approach - "What kind of change could you make that would improve your health? What is one thing we (Dr's, nurses) could do to help you meet your goals? Which problem do you think it would be easiest for you to solve first?"
Such an interesting discussion. It's been veering on and off-topic but we seem to have a good debate going here.
The only thing that upsets me about obese people is that they don't care who breaks their back tryting to hold them up. I am not saying all obese people are like this but a lot of them are. When I was an aide I had one obese lady tell me that her legs would not hold her up. As I was trying to help her I told her that she would have to try to because I certainly could not hold her up. If your legs cannot hold you up you would think that would be an incentive to lose some weight. I think with most obese people that a psych isssue plays into the reason for why they overeat. Maybe low self esteem, anxiety , depression, etc. Why else would you allow yourself to become so large? I know some people do have medical reasons for being obese but I think the majority do not. Maybe if their thought processes were healthier they would not overeat. Just my humble opinion.
As an obese person I will give you my opinion. I didn't allow myself to become this large. I always thought large women were prettier than skinny women and in my own family it seems to be true. What happens is that society places so much emphasis on being skinny I say to myself"I d never look like that" and I don't care to look like that,so I'm going to show them you can be big and beautiful".
I'm a nurse but I don't see why someone can't be 240 pounds and healthy? I am.
Maybe if the media put out images of healthy bodies versus rail thin bodies people would be more receptive.
Someone needs to show real people who are about 200 pounds and healthy.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
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.
McDonalds has salads for $4.99 and you can get sliced "apple fries" and milk instead of soda with your Happy Meal. I think your equation of lower income/lack of knowledge of what is healthy food or not is paternalistic. I know many "poor people" who plan and make very nutritious meals. They buy staple items in bulk and cook food at home vs going out for fast food. There isn't a child who spends time in our school system for less than a few months who isn't barraged with the Food Pyramid and posters and programs galore about healthy foods. Very few people of any income level in the US do not have a TV. It won't be very long before you find out somehow that fruit is better than doughnuts for your health.
Being poor doesn't mean "they don't know any better", like a child. When I hear people bandying about banning fast food restaurants in lower income neighborhoods I get a bit insulted on behalf of the vast majority who learned through their mothers and grandmothers how to make a healthy meal. If you go to almost any restaurant nowadays (like Denny's) you will have "heart smart" on one side of the menu and bacon burgers w/ curly fries on the other. People, rich or poor, will go right ahead and exercise their free will to choose the greasy stuff over the grilled chicken breast.
I think we're on to something here; we've touched on child abuse as an underlying cause of unhealthy eating habits.
What about the rest? Smoking, alcohol and drug abuse, anorexia nervosa....far too many of what we see as "bad habits" or "poor lifestyle choices" can be traced back to some or other childhood trauma.
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.
Maybe us obese are confused as to what is healthy. A baked potato is no longer considered healthy. Neither is fruit juice. Heck neither is a salad. Imagine my surprise when I found out a mcdonalds salad isn't a healthier choice than the cheeseburgers.I have even heard just eating healthy isn't enogh to make the body lose weight. I was told even my hour long walks a day weren't enough,I had to do brisk walking. The media sends mixed messages.
As an obese person I will give you my opinion. I didn't allow myself to become this large. I always thought large women were prettier than skinny women and in my own family it seems to be true. What happens is that society places so much emphasis on being skinny I say to myself"I d never look like that" and I don't care to look like that,so I'm going to show them you can be big and beautiful".
I'm a nurse but I don't see why someone can't be 240 pounds and healthy? I am.
Maybe if the media put out images of healthy bodies versus rail thin bodies people would be more receptive.
Someone needs to show real people who are about 200 pounds and healthy.
Errr-a few years ago I weighed 233lbs. I can assure you I wasn't healthy. I couldn't walk, the best I could manage was a slow waddle. My cholesterol was way over the limit and my blood sugar was elevated.
In fact, I was starting to look like a bath plug with legs, but then I'm short.
I daresay you're fairly tall, so you can get away with being a bit buxom....
GHGoonette, BSN, RN
1,249 Posts
canadianwoman, I am so sorry for your loss.
There are many documented cases of young girls (and I presume boys) who have grown up to be morbidly obese adults because of sexual abuse or assault in their youth.
They grow up with a negative self-image which leads them to seek refuge in overeating, but sadly is frequently not recognized until it is too late.
The "fiance" ought to be watched. This type of character is a sick parasite who will seek another woman to dominate in the same way he did your sister.