Date post: | 12-Jun-2015 |
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Uniquely Yours
Safety & Sensitivity in Caring
for the Bariatric Population
By Tracy M. Morris, BSN, RN-BC, Clin. IV
Rucker 4 Clinical Educator
Overview
• Introduction
• View the objectives
• Discuss specific issues bariatric patient’s
encounter
• Discuss issues hospitals face providing
care to the bariatric population
• Conclusion
Objectives
Increase awareness of what weight bias
is, it sources and consequences
Verbalize the safety and sensitivity
needs of caring for the bariatric patient
Understand your role and how important
it is in caring for the bariatric population
Ultimate Goals
• Be inspired to make changes in your practice
• Make adjustments in your perceptions toward caring for the bariatric population
• Better outcomes for our patients
Introduction
• Quick Stats: – Between 1962-2000, the # of obese people
in the U.S. increased from 13% to an alarming 31% (American National Center of Health).
– Today, ~63% of Americans are overweight (BMI of 25 or >) (American National Center of Health).
– 93 million Americans are obese, with the # predicted to climb to 120 million in the next 5 years (Obesity Action Coalition).
– The U.S. spends $147 billion per year on obesity related illnesses (CDC’s Weight of the Nation).
– In Virginia (2006), 20-24% are obese (BMI =or>30).
Introduction
• Based upon:
The escalation of obesity rates + The
# of co-morbid conditions related with
obesity = healthcare providers in
most all practice settings can expect
to care for bariatric pts.
• Providing safe, quality care to this
population can present many
challenges to healthcare providers
and their organizations.
Obesity & Bariatrics Defined
• Obesity – A disease characterized by excessive body fat. – People who are medically obese usually are
affected by behavior, genetic and environmental factors that are difficult to control with dieting (OAC).
• Bariatrics - branch of medicine that deals with the causes, prevention and treatment of obesity. Encompasses dieting, exercise and behavioral therapy approaches to weight loss, as well as pharmacotherapy and surgery (en.wikipedia.org/wiki/Bariatrics).
Obesity & Bariatrics Defined
• Body Mass Index (BMI) r/t ―ideal body weight‖
– 25-29.9 = overweight
– 30-34.9 = obese
– 35-39.9 = severely obese
– 40 & over = morbidly obese
Reasons for Obesity Epidemic?
Issues the Obese Patient Faces
• Weight loss difficulties
• Mounting medical problems
• Psychological stigmas—research has found that obese pts. will often avoid seeking medical care for fear of insensitive handling or that the healthcare facility will NOT be able to accommodate their needs.
Issues/Concerns Hospitals Face in
Providing Care to the Obese Patient
• Financial Impact—the CDC estimates care for the overweight/obese pts. costs an average of 37% more than for people of normal weight adding an average of $732 to the annual bill of each American.
• Daunting safety implications for both the pt. and caregivers.
• Typically, obese pts. need more care than the average-sized person.
What Do You Find to be Different in
Caring for the Bariatric Population?
Areas of Impact with Increase in
the Physical Size of Our Patients
• Skin care
• Respiratory challenges
• Assessment
• Resuscitation measure
• Altered drug absorption
• IV access
• Mobility issues
• ?Injury to patient or you (equipment, workload, etc.)
What is Weight Stigma/Bias?
• Weight stigma is bias and discrimination
aimed at overweight people based on a
series of social attitudes that people
develop overtime, that assumes that there
is something wrong with overweight
people and they deserve to be punished
for their condition. – Rudd Institute
Video
Sources of Weight Bias/Stigma
• Frustration in helping obese pts. to lose weight to no avail
• Fear of injuries
• Aggravation in completing a difficult task
• Challenges associated with providing care to the bariatric pt. can be overwhelming and may elicit feelings of inadequacy, powerlessness, and fear – feelings may be projected on the pt. in subtle and implicit ways and may be experienced by the pt. as bias.
Snuffing Out Bias and
Stigma Associated with Obesity
• Education is the key!
– Project Implicit (Implicit Association Test)
• https://implicit.harvard.edu/implicit/demo
• ―It is well known that people don’t always ―speak their minds,‖
and it is suspected that people don’t always ―know their minds.‖
– Advance Fat Acceptance www.naafa.org
– Obesity Action Coalition www.obesityaction.org
– Rudd Center for Food Policy & Obesity – Yale
University www.yaleruddcenter.org
– American Society for Metabolic & Bariatric Surgery
www.asbs.org
Safe Patient Handling
• The best way to ensure safe pt. handling is through the use of special equipment manufactured to meet the size/weight requirements of the obese pt.
• Essential bariatric items -----------------
– Beds
– Wheelchairs
– Gowns
– Blood pressure cuffs
– Lift systems
– Scales
– Bedside commodes
– Stretchers
Other Essentials
• Sturdy armless chairs specially designed
bariatric chairs.
• Scales with a wide base, located in a
private area.
• Sturdy stool when assisting patient on/off
stretcher.
• Trapeze bars above beds
A Model for the Sensitive
Treatment of the Bariatric Patient
• R-E-S-P-E-C-T Model is the key to providing
quality, patient-centered, sensitive care to the
bariatric patient.
– R-rapport
– E-Environment/Equipment
– S-Safety
– P-Privacy
– E-Encouragement
– C-Caring/Compassion
– T-Tact
Bejciy-Spring, S. (2008) Respect: A Model for the Sensitive Treatment of the
Bariatric Patient. Bariatric Nursing and Surgical Patient Care.
A Model for the Sensitive
Treatment of the Bariatric Patient
The sensitive treatment of bariatric patients
involves recognizing and attending to their:
Comfort
Needs
Safety
Needs Self-esteem
Needs
In combination with addressing their health problems.
A Model for the Sensitive
Treatment of the Bariatric Patient
This appreciation for and responsiveness
to the unique
Physical
Characteristics
Psychological
Characteristics
Social
Characteristics
of the bariatric patient is integral to optimal patient
care and positive clinical outcomes.
Your Very Important Role
• Rapport:
– Acknowledge each of your patients as an individual
– Include the patient’s family/friends in their care
– See the person, not the pounds
• Environment:
– Get the room ready before the patient/family arrives
– Appropriate sized gown, BP cuff, toiletry needs (floor
mounted toilets), and equipment (trapeze bar, properly
mounted grab bars, sturdy step stool)
– Appropriate furniture in room (sturdy & armless chairs)
Your Very Important Role
• Safety: – Ensure safe pt.
handling by the utilization of special equipment manufactured to meet the size/weight requirements of the obese pt.
Your Very Important Role
• Provide privacy
– Procedures for weighing patients
• Ensure weighing takes place in a private setting,
the weight is recorded silently, and free of judgment
• Ensure scale is sufficient to accommodate
• Encouragement:
– Acknowledge to your pts. how difficult it is to
lose weight, focus on the pts. health
modification behaviors, not the number on the
scale
Your Very Important Role
• Reveal you care – Show compassion:
– Touch your patient!
– Treat obese pts. with gentleness, tact and
concern
• Tact:
– Avoid any display of frustration or distaste
when doing difficult examination
– People who are obese crave what anybody
else craves, which is just respect and dignity
Reality
• Only 1/11 physicians have a scale that goes over 300 pounds.
• Research studies have found that healthcare professionals, including those specializing in the care of the bariatric patient, have strong negative associations and attitudes toward obese persons (Bejciy-Spring, 2008).
These pts. feel unwelcome & mistreated in healthcare settings, where they encounter negative attitudes and remarks, discriminatory behaviors, and challenging physical environments.
Health
Problems/
Co-morbidities
Need for Health Care/
Interventions
Exposure to Bias in
Health Care
Negative Feelings/
Emotional Responses
Avoidance of
Healthcare
Unhealthy Behaviors/
Self-care/Esteem
OBESE
CONDITION
Bejciy-Spring, S. Bariatric Nursing, vol. 3, no. 1, 2008
Preparing Hospitals
• Educating staff
• Having a policy to address attainment of bariatric equipment
• Utilize bariatric equipment (purchase or rent)
• Facility renovations
• Promote a culture of sensitivity!
Take Home Message
• The bariatric pt. has the right to be treated as a unique individual and receive competent healthcare and medical treatment with the same attention to quality, comfort, safety, privacy, and dignity as all other patients (Bejciy-Spring, S. 2008).
Remember in your practice:
"Too often we underestimate the power of touch, a smile,
a kind word, a listening ear, an honest compliment, or the
smallest act of caring, all of which have the potential to turn a
life around." --Dr. Leo Buscaglia