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.
Watch the series My 600 Pound life. Then you'll get it. Family and friends provide them with the food and enable them. Dr. Nowzaradan flat out, during the first patient appointment, asks those sitting with her, "So which of you are the enablers? He doesn't accept excuses, and it seems like when someone gets that big, there are always excuses. Not legit reasons. Excuses. I know once you get that big, it's gotta be incredibly difficult. A simple sit to stand requires help. Solely because of the massive amount of weight and all the weight THAT puts on your musculoskeletal system. Ouch. But it's life or death.
Watch the series My 600 Pound life. Then you'll get it. Family and friends provide them with the food and enable them. Dr. Nowzaradan flat out, during the first patient appointment, asks those sitting with her, "So which of you are the enablers? He doesn't accept excuses, and it seems like when someone gets that big, there are always excuses. Not legit reasons. Excuses. I know once you get that big, it's gotta be incredibly difficult. A simple sit to stand requires help. Solely because of the massive amount of weight and all the weight THAT puts on your musculoskeletal system. Ouch. But it's life or death.
I actually do watch that show and lived around the corner from that hospital in Houston.
I can walk away from a verbally complaining patient. I just haven't perfected the art of walking away from an obese pt who puts themself in harms way by attempting to get out of bed alone or perching themselves precariously on the side of the bed. Actually, that isn't entirely true either...I have now forced myself to educate the patient on their need to cooperate and then documented that along with non-compliant behavior. However, I still have to drop everything when an obese patient refuses to get off the toilet and walk back to their bed. As for bariatric chairs, we simply don't have room for them in the semi-private rooms...expecially after putting in a bariatric bed and a bariatric bedside commode. I wish we could get a cushion that could be placed on the bariatric bedside commode (lid top down, of course) that would allow patients to just sit there. However, the last two patients I had hated the bedside commodes because they were too tall and the patient's feet couldn't reach the ground for stabilize or the ease of sitting down.
I had one patient that I was working very well with in spite of her temper-tantrums and emotional breakdowns...until I had to get in her face and force her to walk back to the bed from the toilet...4 person assist and I was the one in the front convincing her to take each step (yes, she was in pain). This was all happening while I was rapid responding another patient who turned out to be having an active brain bleed. The rapid response team had taken over but they were still consulting me for information and I was trying to do handoff to MICU, do a safety report (this should have been caught before she got to our floor), and finish her admission work while they are rushing her off to things like cat-scans while waiting for a bed assignment). I just didn't have the energy to face her again. I know her face fell when I walked in her room several days later to ask her assigned nurse a question and she found out that I wasn't her nurse again. I addressed her psych needs when I had her but I just didn't have the energy to volunteer to take her again. She was a nice lady...a bit self-centered and emotionally immature, but a nice lady.
SleeepyRN
1,076 Posts
Watch the series My 600 Pound life. Then you'll get it. Family and friends provide them with the food and enable them. Dr. Nowzaradan flat out, during the first patient appointment, asks those sitting with her, "So which of you are the enablers? He doesn't accept excuses, and it seems like when someone gets that big, there are always excuses. Not legit reasons. Excuses. I know once you get that big, it's gotta be incredibly difficult. A simple sit to stand requires help. Solely because of the massive amount of weight and all the weight THAT puts on your musculoskeletal system. Ouch. But it's life or death.