AU Current Demands of The Healthcare System Discussion Responses

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Answer to discussions:

1—  The case scenario provides by Kersey-Matusiak is a situation that I have experience many times.  Sadly, I would admit that there are times where I have said absolutely nothing, but other times I have been able to speak up.  Having gained experience, and being more self-aware of others needs, I would start by ensuring my colleagues were focusing on the patient’s health concerns at hand.  Obesity is not something that can be change overnight, the patient currently has no control over the situation.  It is important that we address this situation with support, compassion and kindness.  In addition, the comment about the meal is inappropriate because regardless of her weight, the patient has received insulin, and needs to maintain a meal schedule that is relevant to her insulin dosing.

Negative stigma around weight is incredibly common.  It not only impacts the patients, but can impact nurses and how they manage care.  I found the findings in the Tomiyama, et al. (2018) to be incredibly interesting as they linked stigma to weight gain and poor health.  Stigma prevents people from asking for assistance, or for discussing their problem for fear of judgment.  In regards to my nursing practice, I would be sure to provide a safe space for my patients, and do not be afraid to initiate positive conversations with them.

Understanding the research an evidence impacting a topic can help us to recognize the need for change or adjustment.  In this case, there is significant evidence indicating the harms of weight stigma.  We must ensure that we practice in a way that does no harm and supports patients.

2—–   It is normal in our health care culture to blame the obese patient and judge them. Saying things like, “I’m sure she could afford to miss a meal,” is not uncommon. In the ED, we typically don’t feed our patients, and this is something that is totally acceptable to say. I consider myself a very compassionate and accepting person. One day, a coworker was taking pictures of us with a filter that made us look obese. When she showed me my picture, I had a very unexpected reaction. I started crying. It took me a while to be able to articulate why I was so upset.  The truth was, I didn’t recognize myself and if I had met “obese me”, I would not have wanted to talk to her. I didn’t see myself as worthy of friendship. This really shocked and saddened me to think how often we only see obesity and not the person inside. It was a real eye opening for me.

“Perhaps more than any other patient, the morbidly obese patient requires the understanding and compassion of a culturally sensitive nurse. Nurses caring for these patients must be willing to identify and address the patient’s primary health issues in a way that is sensitive to the patient’s feelings about themselves, their obesity, and the way they are being perceived by the staff” (Kersey-Matusiak, 2018). To the nurse who said, “Delaying lunch won’t hurt you a bit”, I would remind her that she had gotten her insulin. I could offer to give her some crackers while we get organized and settle her. We so often see the obesity as the bigger problem (probably because of the extra work and manpower it requires for us) and we overlook the primary diagnosis.

A nurse can improve her bias by learning more about obesity, including the physiology and psychology of weight control. Empathy and compassion can be cultivated when partnering with the patient. Taking the time to ask the patient questions about how they perceive their health. We can teach this compassion and empathy to our coworkers through role modeling. Helping the patient with self-acceptance and being aware of our own verbal and nonverbal communication is important. When planning care, we should take into consideration all the obstacles and values the patient has. 

I reviewed the article “Obesity, Stigma and Discrimination- Stat Pearls” (Fulton, 2020), and found useful takeaways. One was that the term “obese” doesn’t motivate weight loss, the stigma leads to physical and psychological consequences. It exacerbates the suffering of the individual. It is very concerning, considering the health care professionals are the ones stigmatizing the obese. It was shown that less time is spent with the patients and the provider’s bias interferes with their ability to offer support.  When a patient has felt mistreated in a medical setting, they are more likely to cancel appointments and avoid preventative care. Something I can do, in the ED, is to be more sensitive to my obese patients. I can choose words carefully and provide their comfort and privacy. Often the gowns and BP cuffs do not fit, I need to anticipate and grab the right size before trying the smaller ones. Also, if a lift is needed, try assembling the team in a way that doesn’t humiliate the patient. I will try to role model this compassion behavior better.