Refraining from judging

[cmonkey]

I had a conversation with a public health nurse yesterday while I was updating my shots (word to the wise, don't do Hep A&B and TDaP in the same arm). A quote from today reminded me of it: If you want to see how people really live, do some in home nursing care. pts houses I've been to would make a pig look as clean as a new bar of soap from the box. As a paramedic I've seen the worst of the worst. I don't know how many times I have almost pucked from the stench and filth of some peoples houses.

The nurse and I were talking and she mentioned an obese INFANT she had visited and how coming to my house for a newborn assessment had been a real pleasure because it was clean and I feed my children well. I should mention that my house is not really clean, at least as I'd like it. Or maybe it's just cluttered from three kids and I'm picky, whatever, but she related some pretty depressing stories. I mentioned that it would be incredibly hard for me to be tolerant of certain behaviors, smoking in the house/car/wherever with small kids especially, for instance. I know that for the most part, people are doing the best they know how, and oftentimes they're repeating several generations of learned behavior. But in today's information-rich society, I find it hard to be sympathetic to pepole who do things that are in no way, beneficial to anyone, smoking being the obvious first example.

How do you offer sympathetic, genuine care when you see someone doing something stuipd* over and over again? And how do you keep trying when it's clear that people don't want the education you can offer? I know I need to work on this, so I'm looking for hints, tips, and anecdotes to guide me.

Thanks!

*Stupid isn't the word I want but I can't brain today, sorry!

[Caffeinated]

When this nurse shared her horror stories about her other patients, I'd be likely to wonder what fault she'd find in me to share with others. I guess I am lucky to have never really encountered any remarkably bad conditions within a client's home. I suppose you can only try to educate people on more healthy habits; share with them what you know and respect their right to not follow a word of it. People do things all the time that they know are not good for them, but knowing doesn't necessarily make it any easier to change.

[cmonkey]

In her defense, I think she shared because I asked about PH nursing. It's not something she just volunteered out of the blue. We also have a several-year relationship behind us.

But my point was how does one work on accepting that people are going to willingly put themselves and their families in jepoardy, for whatever reason, and still try to continue educating? Should I just avoid PH entirely?

[abbnurse]

I agree with what the previous poster said.... I do think it was inappropriate of the nurse to have related stories to you about her other clients.....although I think her intention was to be complimentary of you and your home.

I have also not encountered any particularly horrible home/living conditions when doing in-home visits. I guess the thing to try to remember is that people have the right to live the way that they want to, and that behaviors that don't seem to "benefit" or make sense to one person may make perfect sense to another person. (I'm sure your patients who smoke do find a benefit from their ciggies!) Also, people's idea of what a "clean" house is can vary greatly!

Hang in there and don't stop trying. As a very wise woman once said "You do what you know. And when you know better, you do better." Words to live by! And you just never know when your continued teaching will help someone to "do better". Your compassion is very refreshing.

Take care.

[brownbook]

Good question, good responses. If the behavior may be endangering a child (filth, drugs, fortunately or unfortunately smoking doesn't fall under child endangerment yet) it is a different issue. Competent adults maybe fine with their unhealthy ways and filthy lifestyles. A clean healthy life style doesn't automatically mean a person is happy with theirself or their life. Keep educating you never know when (like abbnurse said) someone will do better.

[RNperdiem, RN]

Poor decisions/life choices often land people in the SICU.

Without them, I would be out of a job.

[bunsterj]

When I was a new grad I worked in a large urban hospital. Although most of our patients were regular people in with health problems it was not uncommon to encounter drug addicts, gang members, prostitutes, and on one occasion a pimp. In their eyes, they were not there because of those titles, but for a specific health problem; although in my eyes their lifestyles caused/contributed to those problems be it a gun shot wound, a broken sternum from a fight, a stab wound, abscesses at injection sites, or anything else. Smoking cessation assistance, a referral to our alcohol treatment center, visit from our social worker, etc.--all these things were offered with some associated teaching, but once they tuned out--I let them be. I would provide assistance and care for the problem they came in with. Sometimes when patients come in they have a variety of problems and you need to ask them what they hope to get out of this admission, I think the same would apply to in home care. If you are with the same client for a while a relationship might build that would make them more trusting and receptive to information you share.

[dscrn]

I think like most people, I'd say that my house is not as clean as I'd like....my husband is a serviceman, and he says he's come upon dead dogs, MUCH animal excrement, piles and piles and piles of stuff. Guess all we can do is try to set a good example with others...

[~Mi Vida Loca~RN, ASN, RN]

In her defense, I think she shared because I asked about PH nursing. It's not something she just volunteered out of the blue. We also have a several-year relationship behind us.

But my point was how does one work on accepting that people are going to willingly put themselves and their families in jepoardy, for whatever reason, and still try to continue educating? Should I just avoid PH entirely?

Before you walk through that door, or even room (you will see plenty of stuff in the hospital as well) you check your judgments at the door, you realize that you don't have to agree with the persons lifestyle, but you need to give them good care, you also need to understand that their is a lot of back story that you don't know about and if you haven't walked in their shoes, you can't understand. Every persons situation is unique and it's easy to try and lump people into a box and stick your nose up at them, in nursing, you simply can not do this.

In many fields you can't do this, but nursing is a pretty big one that you really need to check yourself. I saw a woman on my L&D rotation get treated very poorly by the nurse, she didn't get the care she deserved, the nurse had got report from the previous nurse, nothing bad, this patient was actually a pretty easy patient, but she had a colorful hx. Multiple kids by multiple men, very young, spent some time in jail during her pregnancy, on medicaid, but she hadn't done any drugs and wasn't on any or anything like that. Just didn't make the best decisions. This nurse didn't know this patient from adam but went into the patients room with a bad attitude, talked crap and made fun of this patient at the nurses station to other nurses. I saw this patient starting to get into a lot of heavy contractions and asking for meds and the nurse who HAD NO OTHER PATIENTS sat around saying she could wait, that the patient mentioned being hungry and hour before so she obviously can't be in that much pain.

It was appalling to see and I hoped this nurse wasn't always like this. I don't think she was because by the end of my shift when things started getting worse with the patient, I saw the nurse change and start being a lot more caring. Before I left,the nurse apologized to me for her behavior and told me she wanted me to know she was not always like that (I hadn't said a word or even let on I was annoyed with her at all). She acknowledged her behavior and tried to explain the day she had.

I understand we all have bad days and strong feelings, but if you are unable to set that aside and give your patients the care they need, then nursing isn't for you. This topic is one that hits home for me because I have been judged so much in my life for being a teen mom and as a kid for going to school with bruises and dirty clothes and un-bathed and un-brushed hair. Being the kid that the teachers pitied and the students picked on.

At the end of the day when you're done with your shift and you have all these bottled up things inside that you set aside to do your job, come to AN and vent about it and get it out. I bet most people (besides some of us students or pre students LOL) will completely understand and offer you the outlet you need.

*please know my "you" are in general and not an attack on you, just my overall feelings about this sort of thing and I am not saying you would do any of this*

[~Mi Vida Loca~RN, ASN, RN]

Here is a tip for those that can't keep immaculate houses. Whenever you are feeling down and feel like your house isn't clean, watch Hoarders on A&E, makes you feel like you have the cleanest house on the block!!!!

[laynaER]

As much as you'd like to, you can't save everyone. Sometimes we as nurses just have to accept that. We can try our damndest to help steer a patient in the right direction, but if they don't want the help or don't want to take heed, we can't make them. Just take satisfaction in the fact that you tried your hardest, you put in the honest effort to educate them, and you've done your best. That's all we can do. But if you beat yourself up everytime someone doesn't want to listen to you, you'll never let yourself off the hook. It isn't your fault. Not everyone is teachable.

[Zookeeper3]

You are no different than any of us! We all have hang ups and predjudices, everyone. With certain situations I have to pay close attention to my verbal filter making sure it's on! As well as being careful with my facial expressions, my feelings are always easy to read so I am extra careful.

You may never get rid of your personal hang ups but you do have controll of your verbal and non verbal language.