Caring for Obese Patients

[vdodili]

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!

[Delicate Flower]

Good afternoon. I am interested in your presentation of this topic since American is very obese country and we very often get obese patients (TX). To be frank, obese patients have very bad notion with the nurses that I worked with or encountered. If they are not my patients, who cares? But I am the one to risk chronic injury assisting them or pulling them up, and this is where people get irritated and mark them as lazy, irresponsible, and undisciplined; not alone mentioning that obesity is serious risk to health and we all start rolling our eyes when we find out that our patient for hyperglycemia or cp is 200lbs overweight, non-compliant and just freely brewing his/her own demise. There are many compassionate nurses out there, but as soon as we get to the patient that is obese, whether I am giving report or receiving it, we start with "this lady is very obese" and we roll our eyes and make comments about it.

Personally I was a chub, and I lost all the weight and am physically fit, lean and healthy through strict diet and exercise. I don't see why anyone cannot do it. Science is science; amount of excess calorie goes in, then that turns into excess weight. The solution? Eat less, start working out. It's THAT simple really and people don't do it. We know it's hard, who doesn't know that? But good healthy, fit body doesn't fall out of sky.

I see that my opinion can't really help you in your presentation of infusing compassion for obese patients, but I do think that most of the "obesity-bashing" especially in nursing come from "making my job harder", "your laziness is killing you, so your own fault", and of course our precious backs that will dwindle and crush as years pass by thanks to all the obese people. I do wonder if my ideology is accurate for nurses that dislike obesity in patients. By the way, I think nurse practitioners are awesome and know I will be one one day. Thank you for paving our roads!

The lack of respect that obese patients experience is because of attitudes like this.

You may think that you are hiding your feelings if you do resent them, but most fat people have dealt with societal disapproval and resentment for long enough to sense it when it is there, even if you are overtly "nice" to them.

[BuckyBadgerRN, ASN, RN]

Oh, he eats the special diet AND all of the snacks he desires. It's not a matter of saying he won't eat the costly diet. Take out from anywhere that delivers, a flat of 8 oz sodas might last 2 days---MIGHT.

This resident doesn't reposition, by choice, but if he DID, he's made so many demands on who can and can't enter his room, that inadequate staffing is an issue by his own doing.

[Delicate Flower]

I'm curious: what is the special diet that he gets? Why is it so expensive?

If it is high in nutrient rich fruits and vegetables, then the snacking that he is doing probably does not negate the positive effects of the nutrition he is getting.

If the diet is merely restrictive of calories and fat, why would it cost more? Why can't they just give him less food? Diabetic diets aren't usually more expensive than regular, as far as I know?

This sounds like an extremely difficult patient, not indicative of the typical fat person. He sounds obnoxious. And he's fat. I just wish you didn't post about him in the obesity discussion, because it's not really about that. I think when people have a difficult patient like that who also happens to be fat, the resentment takes on a new form.

This JUST happened, right here, a few minutes ago:

There is a fat patient on my floor. He ordered food, and the dietary tech/"host" delivered it. As the host was walking past the nursing station, he stopped and made this pronouncement: "He just keeps eating and eating. He is going to die."

[Karou]

I understand how caring for obese patients can be difficult and exhausting at times. With the proper staffing and equipment it doesn't have to be impossible though. After reading all of these comments I feel even more appreciative of the unit that I work on. Here are some of the ways we make this easier...

First, we do try to staff based off of acuity. It is taken into consideration how many patients require total care, are bariatric, need wound care, are on isolation, ect... This is more so on day shift, on night shift we usually end up with the 5 or 6 rooms in a row that we are assigned. Our teamwork is really great though so we work together well to help with high acuity patients.

We have specialized beds that we can get with a physicians order. Many of these beds have features to turn patients (we still try to manually turn with pillows, but that's not always possible), low air loss to help with skin integrity, ect... We have bariatric beds for obese patients and even larger beds for the patients over 500lbs. We also have Bari recliners, wheelchairs, shower chairs.

We have hoyer/total lifts including one bariatric one. These still have a weight limit that some of our patients exceed, but it can be used on the majority of our patients. We also have stand up lifts, a few ceiling lifts, and "ergo nurses" that are frames over the bed that use bars and a lift sheet to move patients up in bed. Every different piece of equipment has a weight limit that is important to know.

My favorite thing we have are hover mats! Mats go under the patient (they have to be positioned properly to work), and are inflated with air. It makes it so much easier to move patients up in bed, turn them, do incontinent care, ect... It is best if the patient can hold onto the side rail.

I agree what another poster said about coordinating so you can get staff together to help with care. If I have to do a foley or complicated wound care on a patient , this is what I do. We plan the time and make sure we have enough staff members.

I recognize the most difficult issue to fix is understaffing. With better equipment, you need less staff, but it can still be difficult to get enough people at times. Please if this is an issue continue to advocate for your patients! Ask for better equipment, staffing, ect... I know this is difficult but please, for the sake of your patients, do not stop asking and advocating. Make it a unit project and gather articles and EBP on the ways staffing/equipment affect patient care. Instead of complaining, advocate and do something about it.

When you start to get frustrated, please try to think of it from the patients perspective. Imagine yourself laying in a bed, relying on staff members to turn and clean you. Imagine knowing that this makes you "difficult" to care for. You can tell when your care providers are frustrated, and when they are judging you. You already rely on them, how does it feel to know what they think about you? You are in the hospital for a reason, so you are already sick and feel bad. You just want to be home. You might have to lay in urine for a while so they can get the staff together to clean you. How does that urine feel on your skin? Do you think anyone wants to feel like that?

These patients deserve the same compassion and quality of care that every other patient deserves.

[Karou]

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.

Wow! That is a really difficult patient to care for, overweight or not. If he were in the hospital I would get patient advocate involved... Anytime a patient/resident wants to hand pick their care providers it makes things really difficult. It's really important to document his refusals and the education you provided. Documenting what you did about it ( education) is just as important as documenting refusals. It might be time to get a meeting arranged between the pt, administration, and social worker.

There are patients with behavior like this in all shapes and size, and NONE of them are easy to care for. I wish I knew a better solution...

[Esme12, ASN, BSN, RN]

Who says they aren't receiving respectful care?

Whether we realize it or not...our feelings show.

There are so many different quotes as they applied to the original posts. Even I am confused now.

All I am saying is that I see how patients who are obese are treated. I have seen it in my career and I experience it now personally. I don't think that patients should be treated differently because of race, religion, sex, sexual preference, social-economic/financial status or size. Yet somehow it's OK to bash the patient because they are obese.

It just is not right.

All I am asking for is respect. These patients can hear you. Their obesity doesn't affect their hearing or vision. They can see your distaste and lack of empathy. Patients hear more than you think.

Manipulative patients come in all sizes, shapes and color.

Just take the time to see things from their point of view once in a while....consider how you (not you you the collective you) would feel in their position.

I know what I feel is not of any importance...but I do not feel I, or anyone else, should be treated any different because of his/her BMI.

In the bigger scheme of things does it really matter? I guess not. But it doesn't take the hurt and humiliation away.

Just food for thought.

There but for the Grace of God go I.

[A&Ox6, MSN, RN]

Honestly I am at the other end of the spectrum. I am small 5'6 and 120lbs. I can not gain weight. Even with increased calories and protein drinks (ensure high cal) I hover. I get weird looks because I'm bony. My doc lectures me about my intake. Truth be told that doesn't help at all. I would guess that it's the same for those on the other end.

In my work experience I have had some clients who were much larger than me. I don't think I ever made their weight an issue except when I physically could not lift/roll/assist without putting us both at risk. In that case it was as simple as letting the client know "I'm going to need your help"

I worked with geriatric clients and those who are carrying extra weight need MORE caring and MORE empathy. Not only are they hurt, weak or ill, they also have many more places which they can not access that can break down. If it's a problem just ask yourself how would I behave if this were my mother or father?

It is not ok to tear someone else down no matter what your reason is.

can I like this twice?