By Jacob Molyneux, senior editor
The Reflections essay in the April issue of AJN is called “The Blame Game.” It’s by a nurse who finds herself visiting a family member in the hospital during her shift break at the same hospital. In her distress, she gets little relief or reassurance from the harshly judgmental nurse she encounters.
The vividly told episode raises the question: can the act of casting judgment on another person diminish our ability to see these people as complete human beings, whatever their failings? And also this question: what is the proper attitude of nurses toward their patients?
Please give it a read and see what you think. Is this nurse’s attitude an exception, or more common than it should be, as the author suggests? Here’s a brief quote from near the end:
There seems to be a dangerous epidemic of clinicians blaming patients for their health issues. As a nursing student, I saw more and more of this attitude. The health care profession seems to have evolved a culture of accusation and attack against patients, a group we should be empowering and protecting.
Thank you for sharing this experience, its something we can all learn from. There seems to be a natural tendency to have negative feelings for people who we see as causing their own problems. Let’s say something bad happened to our mutual friend John and when you ask me how I feel about him, I respond, “He brought it on himself.” I’ve said nothing about my feelings but I believe most people would recognize this statement as an expression of my lack of sympathy or positive regard toward John. In a study I did some years ago, about 50% of nurses said the more they felt the patient responsible for the problem the more difficult it was for them to be empathetic toward that patient. If we take the notion that therapeutic, ethical relationships are a healing part of optimal nursing care, then this is a serious issue for reflection. While not entirely unique to nursing, therapeutic relationship, relational ethics – being there and present for patients – is a strength of nursing and a powerful aspect of our identity.
When relationship is considered an aspect of care, blaming patients is a judgment of who deserves optimal care and who doesn’t. Should nurses be in the business of deciding who deserves best care and who should get a lessor form of care? Would you want your firefighter to have that authority?
Further, if a nurse is able to continue a therapeutic relationship with someone who is acting badly, the nurse stands a much better chance of helping that patient change his or her behavior. If you’ve ever worked in addictions you know that Nurse Robert’s attitude harms the chances of getting that patient to consider rehab.
Clearly, it’s not always easy to alter one’s initial attitude toward the behavior of others, but it is a professional obligation to be reflective and try.
My son used to say to me..”HIt the pause button Mom” but that was 20 years ago and what is the equivalent today? Pause, reflect breathe.. There is little time made for this in current patient care situations.. How often are we pulled into care situations that ask us to play out family of origin issues…? Nursing is emotionally thick and data dense, I am glad this story has been told. It provides us with lots of possible alternate actions if we dig deeper.
“Robert” is an ass and obviously unprofessional. I wish all nurses would be better but we all know there are plenty more “Roberts” out there. The author needs to go through channels at the hospital for reporting such behavior.
The issue here for all nurses is to be careful about your own prejudices toward patient behaviors and cultures. It is easy for them to creep into your patient perceptions.
I responded above before I could read the article and have since been able to get into the article on my cell phone, could not on this site. Having read the whole article now, I find the nurse taking care of the patient in the ICU extremely judgmental and love the patient’s aunt (nurse’s mom) reply. Even if we have these opinions, we need to keep them to ourselves and not blurt them out to family members who are grieving. My previous response went into the illness of addiction and it applies to the article.
For some reason I could not read the whole article (I’ll keep trying) but there is accountability and there is illness. Addiction, whether to cigarettes, drugs or alcohol, is an illness and relapse is not that uncommon in people who “get clean since it is a progressive and fatal disease that requires vigilance for the remainder of the addict’s life. I quit smoking 20 years ago but when I smoked and was trying to give it up, my doctor informed me that giving up cigarettes is extremely difficult as they are more addictive than cocaine. The medical field, including nursing, is very unsympathetic to the illness of addiction. So instead of blaming patients who find it difficult to comply or have the illness of addiction, we can really appreciate the patients who are able to comply.
The nurses attitude was not the best in the world. However facts are facts. Holding someone accountable or blaming them…there is a fine line. What about the diabetic that refuses to comply with diet and exercise programs, or the COPD who continues to smoke or the addict who gets clean to reuse. All of these increase insurance costs, tie up beds……..OR should we look at this as job security and say “it is what it is”? I am for accountablity!!!! Date: Mon, 7 Apr 2014 16:11:28 +0000 To: janarm@hotmail.com
I have seen this going on for some time now. It is especially quite evident with the psychiatric patients. I mean, even those with a serious mental illness. Those that have had no control over the gene pool they were blessed with. Those that have actual brain changes that were inflicted upon them to have somewhat distorted thinking. Nursing is turning into a very mean uncaring lacking compassion profession. Why? We are “selling nursing programs” on every corner these days. Telling pretty much anyone can go into nursing to get a job anywhere. No more are we looking for people that really care about other people. Those days are gone. You see nursing students and all they talk about is how much money they can make as a new grad. They want the highest paying specialty. It is a sad reality.