By Karen Roush, AJN clinical managing editor
Photo by the author
This isn’t the blog post I started out to write. That was a more personal story about someone close to me, let’s call this person Jess, who died after years of chronic illness worsened by self-neglect—after years of being that person Olsen talks about in this month’s article (free until August 15) on helping patients who don’t help themselves (and in his related blog post from last week).
But as I wrote, I realized that it wasn’t fair, that I was leaving out the complex story behind their persistent unhealthy behaviors, behaviors that eventually led to a lingering, awful death.
And without that background knowledge, it was too easy to be judgmental—as it is sometimes too easy for us as nurses to be judgmental of patients who don’t help themselves, who even seem to be willfully destroying their own health: the obese person who keeps drinking those giant sodas, the smoker who lights up another cigarette. As a nurse it can be very frustrating to care for a patient who ignores health recommendations, to their own detriment. As a family member or friend, it can be heartbreaking and infuriating.
There are limits to what we can do. We cannot force patients to eat well, take necessary medications, quit smoking, modify their alcohol intake, wear their seatbelts . . . the list goes on and on. Yes, we can and should provide patients with the tools they need to choose healthy behaviors: knowledge, access to treatment, realistic options, high quality, evidence-based care. We need to be persistent in our efforts and objective, and we need to show concern for their well-being. We also need to keep the politics—cost to society, impact on health insurance costs—outside the clinic or hospital door and outside the therapeutic relationship between nurse and patient.
Sometimes when I think about Jess I feel angry, but mostly I just feel terribly sad. Happy people choose health; they choose life. Jess chose neither. Why someone would do that is perhaps the most difficult thing for us, nurses or loved ones, to understand.
As nurses we are taught to help our patients achieve optimal health and feel so happy when we achieve this task. But when our patients do not achieve optimal or do not want to achieve optimal health for themselves, we feel like failures. As nurses we must not view this as a failure, but instead look for different reasons to why this is occurring. When a sick patient is refusing to be compliant we must look for underlying factors to this problem like depression, lack of emotional support, or lack of financial resources. Providing these patients with the necessary support along with a treatment plan will produce positive outcomes. Although all of our patients may not achieve optimal health, I believe it is essential to treat the patient as a whole and not just the sickness.
I share in your frustration as I have experienced the same tragedy. My aunt was diagnosed with kidney failure and died a year later due to her own noncompliance. As nurses we have absolutely no control over one’s will to recover. We can only act as a support system to the patients we encounter. Judging a patients decision to refuse treatment and hence choose death is not our place as health care providers. In my experience, my anger and judgmental attitude towards my aunt’s decision making cost me valuable time in the end. In retrospect, I would’ve focused more time on her then her illness.
If we identify what we “do” as being compassionate then there are no limits. Having a whole hearted approach transcends the interaction.
Wonderful and needed article.