I have been a nurse for almost a year and currently work on a women's gyn and med/surg floor at a major hospital. The last few weeks I have been assigned a couple patients who are very morbidly obese. I am working very hard at maintaining compassion for this special patient population but am already finding it frustrating. I am not a tiny person myself but am trying to find information on how a person becomes this obese. It seems like if eating was the only cause, the condition would be somewhat self limiting...if you can't walk to the kitchen or drive a car, then it would seem your calorie consumption should decrease and you would at least stop gaining weight. So what other metabolic situations are at play...or is it more a psychiatric eating disorder?
It may have just been these two patients but they seemed to believe the nursing staff was there to be their personal assistants for everything...I am not sure how they managed to readjust themselves in bed at home if they need constant help when in our specialized bariatric beds. One patient kept risking falling out of bed because she always wanted to be somewhere else...her biggest goal was a tiny chair that she never would have fit in. She didn't understand that couldn't just help her into the chair myself...that I needed help...and if she had managed to get in that chair, she didn't have the strength to stand up and get herself out. I finally got a hoyer lift so I could move her alone and she kept ignoring me and crawling out of the sling that we needed to leave under her so that we could lift her as needed. The minute she wiggled to somewhere else on the bed, she eliminated my ability to help her alone.
I also have a problem with these patients being considered "one" on our patient load...to care for a severely obese patient takes the time of caring for at least two regular patients. Just assessing skin takes a long time and these patients usually have a lot of skin care needs. I had a confrontational patient last night (I wouldn't assist her to the little wooden chair that she was so obsessed by) so I didn't have time to clean the skin folds and change the dry flo sheets like I should have...and she was pissed so she wouldn't let me assess her coccyx pressure ulcer.
Another patient told me about something she wanted to do at home but her husband told her if she sat on the floor, they would never get her up. Her "solution" was that they would call the EMTs because they would lift her. I am working hard to not let that entitled mentality to not harden my heart against her because I have been told she is a frequent visitor to our unit. She was also a very informed patient which I admire but at the same time, I think being a medical patient has almost become her "career". She like to come to the hospital. She has "isolation history" so always gets a nice private room...and the nursing staff means guaranteed "visitors" and a social circle.
Does anyone have any resources that they can suggest so that I can read to understand this special patient population better. I hope to not become hardened to their plight because I know it can't be easy...but every thing I have found so far concerning the morbidly obese focuses on those doing bariatric surgery and not just general medical patient needs. My heart bleeds for the one woman who started to freak out as she realized that this time her cellulitis and vascular problems were not probably going to heal all the way and she may be facing permanent damage (related to a crushed vascular system) and she was still relatively young.
I am also interested in info on just general care of the very obese...like trying to place a foley or dealing with stools that are so large they clogged the plumbing if you try to empty the bedside commode in there.
Before anyone criticizes me and my attitude, I am just being honest about the conflicted feelings I am having. I never gave subpar treatment. I always smiled when I went into their rooms. And concerning the obnoxious pt, I know she was just a difficult person and her weight issues just complicated it. I even did most of my charting in her room so I could allow her the freedom to sit on the side of her bed and at least watch her for safety (she was going to sit on the side of the bed with or without me but at least when I was aware, I could get her a foot stool so she didn't slide out onto the floor and I could lift her legs back in when she got tired. It was a safety risk but I couldn't legally force her to stay in the bed either. I really do want to be an advocate to all my patients regardless of their personal lives. I may have just been a bit mentally worn out by another patient earlier this week who was attempting to get her narcotic addiction needs met by our hospital...but that is a different story.
If I didn't enjoy your posts so much I would have just clicked "like" but I have my own compulsions to deal with.
Hahahahahaha!!!!! When I typed that out, my iPad didn't underline it but it didn't look right to me AT ALL. Is "bazaar" the one that is like, "join us for our church bazaar where we will sell all of your grandma's old junk for 50 cents!"
I completely appreciate compulsive spelling and grammar correction needs. Spelling/grammar error noted. :)
Hahahahahaha!!!!! When I typed that out, my iPad didn't underline it but it didn't look right to me AT ALL. Is "bazaar" the one that is like, "join us for our church bazaar where we will sell all of your grandma's old junk for 50 cents!"
I completely appreciate compulsive spelling and grammar correction needs. Spelling/grammar error noted. :)
Ohhhhh Thank you, thank you for another chance.
The story of the Bizzare Bazaar. A serial killer in Kansas City from the late 80's. Lived a couple of houses down the street from me. He seduced, kidnapped, tortured and dismembered his male victims then disposed of their body parts in dog food bags put out on the curb for pick up. His other job was owning a small curiosity shop in the Westport district of town named "Bob's Bazaar Bizzare".
The story of the Bizzare Bazaar. A serial killer in Kansas City from the late 80's. Lived a couple of houses down the street from me. He seduced, kidnapped, tortured and dismembered his male victims then disposed of their body parts in dog food bags put out on the curb for pick up. His other job was owning a small curiosity shop in the Westport district of town named "Bob's Bazaar Bizzare".
Of course we're still friends! I'll never take offense to spelling and grammar corrections. As much as I hand them out myself, I'd be quite a jerk if they offended me! :)
Specializes in LTC, CPR instructor, First aid instructor..
I suffered a PE and status asthmaticus in 2001. I was a thin person at the time. I was administered massive doses of Solu-Medrol (prednisone to reverse the effects of the status asthmaticus. I got enormously heavy from the injections, and even suffered steroid induced myopathy. I was hospitalized for 7 and 1/2 weeks. Since then, I have been in a motorized wheelchair with a crooked foot, and was diagnosed with chronic asthmatic bronchitis as well the following year caused by making phonograph needles w;ith super glue and epoxy in an unventilated area.. I am still very obese, but do try to help myself as much as possible even though I have a daily caregiver. I am also on oxygen 24/7. So please don't condemn me for being heavy. I eat a healthy diet g=for the most part, and since I'm unable to exercise very much (although I have tried) I am unable to lose this extra poundage.
I have a 640 lb. patient who wants bariatric surgery but believes there will be no need to change her eating habits - if she has the surgery she can just keep eating whatever and be thin. I have tried educating, family sees no need to change anything (fast food, pizza, beef jerky, anything.) Also believes is not diabetic ("just borderline" - kind of like "a little bit pregnant.") But you are correct - it requires family complicity - they cannot grocery shop for themselves, and usually cannot stand enough to cook anything. I am overweight myself - a "stress eater" so I understand to an extent - but I believe sometimes fat is kind of a shield from the world, not letting anyone in.
Thank you for sharing Fran. I will look for diagnoses that would have included long term steriod use next time. I am night shift and don't pass the majority of the medications...but I know even after the med is no longer give, the effects can remain. It is quite possible that this particular lady obesity might have been steriod related. I was pondering how someone makes it to 77 with these kind of weight issues. She also was a bit of a puzzle because she didn't seem to realize that she was a such a large woman which also leans toward a potential weight increase related to treatments of her extensive medical history. I am personally living with a very high level of stress in my life and know that regardless of my diet, that losing weight has been an almost impossible feat so I realize that it isn't always bad eating habits.
I hear you. I worked ortho for 10 months with morbidly obese patients. I learnt a long time ago never to judge a person because I wouldn't have walked in their shoes..
By the 5th month I had 4 patients all over 85 -140kg (sorry can't convert) who had their catheters removed on the same morning. I still had a 5th patient that I never actually saw due to having to get these patients into a showerchair to the toilet for my 8 hour shift.
All they did was pee!
An hour before my shift ended my arm also ended with a patient in a shower chair who I could not push. I had torn the ligaments and tendons in my arm.
It was pretty much the beginning of the end of my nursing career. And judgemental. I just cannot control the way I feel about people who are obese because I can no longer perform the job I loved.
I didn't report the incident to the NUM one of my patients did!
NUM and I had no love between us so she spoke to me and told me off for not asking for help.. Yes there are definately fairy nurses available on morning shifts.
I went on workers compensation for 3 months but she made sure I still worked my 40hr week for those 3 months. It became a permanent injury and eventually I had to leave.
I cannot shake the way I feel no matter how hard I try, I am now having counselling to try and work on it but stirring a cup of coffee then not being able to pick it up to drink, it takes me right back to the very minute my arm basically snapped.
Previous to that day I'd never had a problem with obese patients. They were great and I'd do anything for them. Most were my fav patients.
I have just started studying again but I miss night shift. The challenges, team closeness, having to depend on each other, patients who appreciated having me look after them and I never walked off the ward without a smile.
The worst part was that I was early into a career that I had been waiting 30 years to do.
You know what's awesome about this site? It's okay to have frustrations that we can't voice to our patients, friends, or family. I think it's safe to say that very obese patients with limited mobility are a bit harder to care for. It's not that I have any ill will towards obese patients. I just hate that resources aren't always readily available for these folks. Night shift is a problem because of staffing, not attitudes. I want to keep my patient safe, healthy, and clean. I also want them to be able to have a degree of independence when I can. I do not want my patient to be forced to use a bedpan because it takes two or three nurses/techs to get him/her out of the bed and the powers that be don't realize that. I want my patients to strive to get better. It took me forever (well, it seemed like it to me) to round up the only other nurses on the floor to help me transport my patient safely at my last job, any guess what? Some patients can't wait.
I don't know what it will take to change the minds of those in power. I wish my patients could see things from a nurse's perspective. They know we're busy, and while I have had every size of aggravating patient, many hate asking for help. This is especially true for some obese patients who are embarrassed by their weight and hate to ask for help when they know it'll take several of us to perform a task. Of course, there are insensitive people. You know who they are. There's a difference between being insensitive and feeling frustrated due to lack of resources--and those resources include time and people, as well as proper facilities and supplies.
Patients who don't seem to care about their health is another complication. If there are any psych nurses reading my nonsense, I would love suggestions on how to approach the problem of preparing a patient for discharge when possible underlying psychiatric issues are present. Sadly, I see some patients' faces entirely too much for the same or similar reasons--specifically, substance abuse, depression, and obesity. Had anyone had success with programs that incorporate behavioral therapy alongside medical therapy post-discharge? I just feel like the current "patch the hole" take on patient care isn't enough. I would greatly like to utilize such a program at my new place of employment.
Specializes in LTC, CPR instructor, First aid instructor..
I hear you. I worked ortho for 10 months with morbidly obese patients. I learnt a long time ago never to judge a person because I wouldn't have walked in their shoes..
By the 5th month I had 4 patients all over 85 -140kg (sorry can't convert) who had their catheters removed on the same morning. I still had a 5th patient that I never actually saw due to having to get these patients into a showerchair to the toilet for my 8 hour shift.
All they did was pee!
An hour before my shift ended my arm also ended with a patient in a shower chair who I could not push. I had torn the ligaments and tendons in my arm.
It was pretty much the beginning of the end of my nursing career. And judgemental. I just cannot control the way I feel about people who are obese because I can no longer perform the job I loved.
I didn't report the incident to the NUM one of my patients did!
NUM and I had no love between us so she spoke to me and told me off for not asking for help.. Yes there are definately fairy nurses available on morning shifts.
I went on workers compensation for 3 months but she made sure I still worked my 40hr week for those 3 months. It became a permanent injury and eventually I had to leave.
I cannot shake the way I feel no matter how hard I try, I am now having counselling to try and work on it but stirring a cup of coffee then not being able to pick it up to drink, it takes me right back to the very minute my arm basically snapped.
Previous to that day I'd never had a problem with obese patients. They were great and I'd do anything for them. Most were my fav patients.
I have just started studying again but I miss night shift. The challenges, team closeness, having to depend on each other, patients who appreciated having me look after them and I never walked off the ward without a smile.
The worst part was that I was early into a career that I had been waiting 30 years to do.
I too had become a nurse as a second career choice. I was 55 when I received my license. Unfortunately, I had an anaphylactoid reaction to niacin,} the vitamin of choice for lowering cholesterol} at only half the recommended dosage. I lost my second career also, and I was in nursing school when I tore my rotator cuff. So while I was on public assistance due to the inability to work, I had open rotator cuff surgery. My muscle had a huge tear in my armpit. my So I have a screw holding the tissue and tendons onto my scapula. I was eventually placed on Social Security disability, and am now old enough to be on regular disability. So I do understand your plight.
ixchel
4,547 Posts
Hahahahahaha!!!!! When I typed that out, my iPad didn't underline it but it didn't look right to me AT ALL. Is "bazaar" the one that is like, "join us for our church bazaar where we will sell all of your grandma's old junk for 50 cents!"
I completely appreciate compulsive spelling and grammar correction needs. Spelling/grammar error noted. :)