Caring for Obese Patients

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Hello everyone! I am an NP currently working as full-time faculty in an ADN program, and doing per diem work in an occupational health setting. I have been asked to present at a hospital-based healthcare conference on the topic of "bariatric sensitivity" in nursing, and I am looking for your input. This topic is so important, but it is also so broad! Caring for obese patients is certainly challenging, and sometimes even back-breaking. However, there does seem to be a great deal of "acceptable" prejudice toward obese patients (I have even heard nurses make derogatory comments right in patients' rooms, not to mention the talk that goes on at the nurses' station). I would welcome your thoughts and observations on this topic as I plan this presentation. I want to make it relevant to the nurses and other health care providers who will be listening. Thank you in advance for your input!

My level of care does not change based on the size of a client. BUT, my empathy level does when an obese resident in my facility does NOTHING to help himself. Non-compliant with medications, non-compliant with the special diet that he requested to be on. Refuses to do the minimal exercises that therapy has instructed him on. Dictates his own personal cares and treatments to areas of skin breakdown. Because, you know, its his RIGHT to do so. He will make demands as far as which staff is "allowed" to be in his room (for ANYTHIHG: meal delivery, cares, toileting, passing linens/waters) and then gets furious when he has to wait for his call light to be answered because his favorites are completing other tasks.

All at the courtesy of Medicaid, BTW.

Taking care of a patient like this certainly is challenging. But all the non-compliance stuff...Realize, he is there for himself, not for the facility or any care providers. His health/disease/care needs is the reason he is there. To the extent that he does not, for whatever reason, choose to follow the particular medication, diet, exercise, care, and treatements orders, IS his right to choose. None of those care or treatment plans are worth anything if the patient will not get on board with it. Sometimes we just have to meet the patient where they are, and hope through education and understanding to help them "help themselves." When that's not possible, you just do everything you can, on his (reasonable) terms, and document when that forces you to not meet the standard of care.

YOU have a right to choose, within the standard of care, what you will accept and not regarding his behavior. If he is being abusive or demanding staff leave other patients, then that behavior should not be accepted. Aside from helping with his emotional/mental/psychological needs, you can't really do anything about his anger. He is allowed to be furious; he's not allowed to hurt anyone else.

I have a hard time with patients who are mean or do not seem to appreciate the care I give them because I take it personally. But that is a fault of mine, not theirs. I don't have to be their friend, I just have to be their nurse.

Regarding the Medicaid thing thrown in at the end: Do you think that because the patient receives public funds for his treatment he is obligated to comply with his treatment plan in a way that someone who was private pay or insurance would not be?

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Specializes in HH, Peds, Rehab, Clinical.

Obligated to follow treatment? Not sure. SHOULD he be provided with the special, costly diet that he refuses to follow? Not sure about that either. I'm QUITE certain though that there are plenty of un/underinsured citizens out there that would give their right arm for the healthcare that this indivdual recieves, yet cares so little about.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
that doesn't make any sense. Differences in religion/race/sexual orientation don't require 5-6 workers to accomplish even the simplest care task.

But does that make that patient any less worthy of respectful care?

We all need to be cognizant of how we treat others for you Never know when the shoe will be on the other foot.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
You beat me to it!

Also, if I have a coworker that has a problem with their patient's race, religion, sexual orientation, or color, I could switch with them and take that patient for them. No harm, no foul. But... when we are talking about morbidly obese patients, there is no one that can safely care for them alone. None of our nurses are bodybuilders, and even if they were, there's a difference between bench pressing 400+ pounds of a stable, solid bar and rolling a sedated 400+ person adequately and somehow holding them up and bathing them alone. It's just not possible for one person to do.

The ultimate problem is staffing, not the patient, but I really don't see upper management letting us redo our staffing based on daily average patient weight instead of HPPD. They should, but there's no way anyone will approve that.

So it is OK to treat this population of patients with less respect and care because they are fat?

I just can't understand the resentment and mistreatment of fat people. I can say fat because I am fat.

At what weight is it permissible to be disrespectful and administer substandard care?

I am here to say there is no weight that deserves to be treated unfairly and lack of respect.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
My level of care does not change based on the size of a client. BUT, my empathy level does when an obese resident in my facility does NOTHING to help himself. Non-compliant with medications, non-compliant with the special diet that he requested to be on. Refuses to do the minimal exercises that therapy has instructed him on. Dictates his own personal cares and treatments to areas of skin breakdown. Because, you know, its his RIGHT to do so. He will make demands as far as which staff is "allowed" to be in his room (for ANYTHIHG: meal delivery, cares, toileting, passing linens/waters) and then gets furious when he has to wait for his call light to be answered because his favorites are completing other tasks.

All at the courtesy of Medicaid, BTW.

But wouldn't you have issues with this behavior if they were thin? So it has nothing to do with his weight but his behavior.
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Specializes in HH, Peds, Rehab, Clinical.

Who says they aren't receiving respectful care?

But does that make that patient any less worthy of respectful care?

We all need to be cognizant of how we treat others for you Never know when the shoe will be on the other foot.

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Specializes in HH, Peds, Rehab, Clinical.

Nope, same thing. BUT, this thread is about obese clients!!

But wouldn't you have issues with this behavior if they were thin? So it has nothing to do with his weight but his behavior.
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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
But wouldn't you have issues with this behavior if they were thin? So it has nothing to do with his weight but his behavior.

If the behavior is the problem and not the weight, why go on and on about the weight and the problems it causes?

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Specializes in ICU.
Our responsibility as health care providers is to provide the standard of care for the patients in our care. Period.

If you CANNOT provide the standard of care to ALL patients, because your staffing/environment/lack of equipment does not allow you to safely do so, then that is an issue that should immediately be taken up the chain.

Unit management - Facility Management - Risk Management - TJC - OSHA

Who does it help to stand around rolling your eyes, sighing, and thinking angry thoughts about your fat patients? It certainly doesn't help the patient.

I'm curious....when you only managed to turn your patient twice during the shift, did your charting reflect that? Did you document that you failed to meet the standard of care?

I did, actually, and I put that there was inadequate staffing to help turn and reposition the patient in the comments.

Regarding respectful care - I have had many of my patients, obese and non-obese alike, tell me that I was one of the few people that seemed to really care about them. Even the most obese patients get respectful care from me... as long as you define respectful care as the patient believing I really care based on my words and actions, and you don't take into account how I actually feel about the situation I've been put in by the hospital.

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But does that make that patient any less worthy of respectful care?

if you can find a place in this topic or any other where i've literally said that obese patients don't deserve respect or quality care, do quote it. you might be projecting your experiences with and/or perceptions of care providers IRL onto people here.

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Obligated to follow treatment? Not sure. SHOULD he be provided with the special, costly diet that he refuses to follow? Not sure about that either. I'm QUITE certain though that there are plenty of un/underinsured citizens out there that would give their right arm for the healthcare that this indivdual recieves, yet cares so little about.

If he refuses to follow the special, costly diet, why does he keep getting it? Could it just be a matter of him saying, Nope, I aint ever gonna eat that, not ever, and then you quit ordering it? That's like when you have the thin, cachectic failure to thrive patients that have stacks and stacks of boost or ensure that they could run a grocery store, and dietary keeps on bringing them. It's a waste. Like I said, if the patient isn't going to get on board with it, despite all the encouragement and education they are given, then it's useless to continue.

There's a big difference between a patient that refuses a turn, and a patient that can't be turned because the hospital is not staffed and equipped to provided them proper safe care.

As for the allocation of resources, you are right, it is totally unfair. That's why even though people have different opinions on what the solution should be, almost everyone agrees that healthcare in this country is broken. And it is really frustrating to see that. But whether someone is grateful for the treatment they receive, or a helpful participant in their own health/healthcare doesn't really matter, except in a few situations where compliance is a condition of treatment, such as organ transplant recipient candidates and pain management clinics, and others I'm sure.

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I did, actually, and I put that there was inadequate staffing to help turn and reposition the patient in the comments.

Since I don't know your work environment I cannot speak to whether or not you did *everything* you could to get the help you needed. I am guessing that you probably did. If it were me in the hospital I work in, I would have scheduled times for NAs from adjoing units to come and help me on the even hours or whatever if staff on my unit were too swamped. Other resources could be charge nurses from sister units, rapid response nurses if there is a dedicated team, transport nurses, NAs from the ED, nurses on orientation or student nurses on nearby units, etc. Yes, it takes a lot of planning to get it done, but I would argue that rounding up 4 other individuals every 2 hours is possible in most hospitals. If not, then your facility/unit needs better equipment, like, yesterday.

Maybe you could champion for ceiling lifts in a few of your rooms. Those rooms could be reserved, or shuffled around, for large and/or immobile patients as the need arises.

As for charting your staffing issue in the comments section, I'm curious what a risk managment team would think about that? Are there any legally inspired nurses who can offer some insight into whether or not inadequate staffing is a valid reason for not providing proper care?

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