Young, Unfit, Drug Addicted, etc. Mothers

shay · Oct 22, 2004

The way I always have approached it is that it is not my job to sit in judgement of these women. I am their nurse, not their social worker. I know that sounds idyllic and simplistic, but it's honestly the best way to approach it. And I have taken care of MANY MANY MANY crack-addicted mothers, drug users, prostitutes, careless young mothers, etc.. I have seen everything. My coworkers often comment on their amazement at my ability to give such compassionate care to these women. The way I look at it is like this...I am their nurse, my job is to ease their pain, comfort, and make it so that she and her baby have the best possible outcome, whatever that may be. If they are a drug addict and need more pain medicine than a "normal" patient, that means sitting down with the anesthesiologist or OB and asking for additional orders if need be. If they are a teenage mother with no or little support, it means taking extra time with her to help teach her how to care for her baby and showing her that I have faith in her that she CAN DO IT.

It is hard. You have to let go of all your judgements and be calm and patient and above all, honest. You have to approach it from the standpoint that while yes, it is frustrating and makes you angry to see these women having babies, sometimes, the care from just one compassionate nurse CAN make a difference. You never know.

Sometimes these women are violent and beliggerent, that doesn't mean you have to be a doormat and lie down and take their abuse. But it does mean that you have to keep them safe while they are in the throes of a drug binge, and show compassion when they are coming off that drug as it is often physically painful and terrifying.

This doesn't mean you cast aside your value systems and think that using drugs while pregnant is okay, that teenage pregnancy is okay, etc.. It simply means that for the time you are caring for that patient, you let all those judgements go and shed your anger and frustration and realize that while they may be the most difficult patients, they are the ones who are in the greatest need of compassionate, patient care from their nurse. You may be that one nurse that makes a difference and enables them to start turning it around.

directcare4me · Oct 22, 2004

We see a lot of these young moms and dads in the NICU. It does bother me, but I've become less judgemental as I've matured and aged in my profession, and in my life. My disapproval of their life choices isn't going to change them. I have on occasion seen them change their ways after becoming parents. They just seem to decide to "rise to the occasion". I've also over time seen people who are not drug-addicted, not young, very middle class who also, IMO, shouldn't be parents. But it's not my call. My job is to take care of the baby and try to send home (to someone) a healthy and intact child. The rest I leave in Someone Else's hands.

I'm not saying it's easy. But it's just one of many things you have to deal with as a nurse. It helps me to know my limits and just focus on what is before me to do. I use the Serenity Prayer every day, for nursing and for my own self.

Good Luck in all your endeavors.

alphafe · Oct 22, 2004

"...It simply means that for the time you are caring for that patient, you let all those judgements go and shed your anger and frustration and realize that while they may be the most difficult patients, they are the ones who are in the greatest need of compassionate, patient care from their nurse. You may be that one nurse that makes a difference and enables them to start turning it around..."

This is a great summary. When I worked with battered women so many of my friends would say "how can you stand doing all that work and seeing them GO BACK?"

Well, it wasn't hard for me! Partly for the reasons you describe above but also because I knew that abused women return many times before leaving for good (if at all...) and that each time they came to me, my job was to plant the seeds of knoweldge, power and self respect. It takes time to get strong. (It also takes a lot more than a seed to sprout a strong tree!)

The difference for me when contemplating L/D is that now there's a *child* involved and it does trigger all of my mama-instincts. Still, I'll get there re: the right attitude.

Thanks again for a great post.

shay · Oct 22, 2004

I use the Serenity Prayer every day, for nursing and for my own self.

LOL I pray a lot.

When I know I'm going to get a really difficult assignment, I say a quick prayer for God to give me the strength and grace to be a good nurse for this woman and to give her the kind of care that she and her baby need. It does help.

purplemania, BSN, RN · Oct 22, 2004

you are wise to consider this now. I had an instructor assign us a project where we had to write down the worst case scenario of a patient in one sentence (like the title of your thread). Then we had to list the reasons this patient was such a challenge. THEN, we had to write an essay on how we would deal with this patient. It helped me to focus on my personal attitudes and helped me find ways to work out this issue. Just a suggestion.

shay · Oct 22, 2004

Also, just something to think about. These women are probably used to nurses and doctors treating them like they're "unfit," i.e., they are curt and rude to them and make it clear with their body language and tone of voice that they do not think very highly of them. When a nurse or doctor approaches them instead with compassion and non-judgement, it is a relief to them, and they are more receptive to your care, kwim? If they see that you are coming to them without prejudices, often your care is more effective.

SmilingBluEyes · Oct 22, 2004

Shay covered it brilliantly. (you go, girl!!!).

I just will add, it helps for you to come to grips with your values and belief systems early-on. Be aware of your prejudices ( and yes, we all have them)--- and also stand ready to have them challenged EACH and EVERY day you are on the job. Not just by your patients, but also by family members, coworkers and associates on the job.

You have to, at times, suspend these feelings you have in order to render compassionate and nonjudgmental care to people in all walks of life and from all social situations. You will meet tough cases. That is a given. The drug-users are not the toughest for me. For me, it's abusers of women and children.

But each of us has to overcome our own personal feelings to rise to the occasion, or we burn out very quickly. Have in place a good outside support system (outside work)--- be that your spouse, or significant other, friends, family or clergy. Do NOT take work home with you. This takes experience and time to learn to do this, but it is ESSENTIAL in order to avoid inevitable burnout otherwise. Pray, if inclined. Meditate. Take care of your own physical , emotional and spiritual needs and you will be better-able to cope with situations that challenge you to the core when you are at work.

That is my best advice as an experienced OB/GYN nurse. Good luck to you!

fergus51 · Oct 22, 2004

GO Shay! I always found the most important thing was remembering that it was too late for me to stop unprepared parents from having babies, so I might as well try to make the experience as positive as possible.

nursemichelle · Oct 22, 2004

I was one of those "young mothers" and my nurses were so compassionate and helped me so much (my parents weren't there with me...too embarrassed) during my 32 hour labor that I will never forget them. I even know that the way they helped and supported me made such an impression on me that I knew someday I would want to do the same for someone else. My son is now 21 and I'm doing just that --by working toward nursing school. I work in a facility now (while I'm in school) that deals with drug addicts, abusers and molesters to help them overcome their problems. I guess in a hospital setting it could be helpful to look at each patient as a "person" and not judgementally, since we don't always know the root of their problems or why they are the way they are. Most of us have never walked a mile in their shoes. I am horrified at the backgrounds (childhoods) most of our clients have and I can't imagine how they have endured all that they have. It makes me understand a little more about why they make some of the bad choices they have made---not that I condone the choices, but I do have a desire to help them make better choices and to model more appropriate behavior in hopes that they will someday be able to choose better and enjoy the happiness that comes with good choices. Hopefully as a nurse I will be able to touch a life, be an encourager, and an inspiration to someone less fortunate than I am. Maybe not, but I can only hope so.

SmilingBluEyes · Oct 22, 2004

Ah yes, it should be said, that being "young" does not disqualify a person from being a good parent. I have seen a more than a few "older" moms (30s to 40s) who were unfit to raise kittens, let alone an infant! Let us clear that up RIGHT away before it gets us into trouble.....

imenid37 · Oct 22, 2004

Treating others well, elevates you and them. Sometimes kindness gets through a tough exterior and people to whom no one is ever nice usually appreciate and notice kindness. This is not to say that you should ever let a patient be abusive to you. It just means you should be professional at all times. No mattr what you can't decide a patient is not a worthwhile person or they are not deserving of your efforts. If you treat someone like they are a person of value, then they may also come to believe it. IMHO, being cruel or harsh to a patient is counter-productive. It doesn't get the patient to co-operate w/ you or make you feel any better about yourself.