Obesity in the hospital

[dietersmanifesto]

Last month ABC news did a series on obesity titled "Critical Condition" one of the segments they was on how obesity has affected hospital care. Hospitals are under the gun to provide among other things bigger beds and wheelchairs. The wheel chairs are enormous! There is even a company that specializes in humongous coffins and busines has been very brisk.

How has obesity affected all of you in the workplace?

I recently spoke to an ER docotr who told me that it takes twice as much effort and time to care for an obese patient. She even said that she had to treat several emt workers for injuries to their wrists and back after carrying an obese person down a 6 story walk up.

Do you find similar situations where you work?

[Kiwi, BSN, RN]

I once enjoyed working in the ICU as a nursing student. But we became inundated with people getting gastric bypasses (about 3 at all times in our 8 bed ICU). Gatric bypass pts are natural king/queens bees who need a lot of attention: the fans need to be blowing, they always need ice, they are whiney. But what got me was turning these people. My God. I stopped working until I'm an RN because I was afraid to be put on disability from turning these people, who were so big they barely looked human. At one point we had this guy in who was 21 years old... he was so lazy and wouldn't assist with holding the trapeze while we turned him. When the Dr. saw his behavior, he told him how ridiculous he was acting, and to help the nurses. This doctor called the hospital CEO and demanded some aide for it's nurses or they will soon burn out.

[LPN-n-2005]

obese patients when i was working in the hospital were very rude and thought the world revolved around them. on top of that they always stunk even after getting a bed bath. I only encountered one obese woman who was nice. the rest of them always wanted a extra pillow,extra cup of ice, blah blah blah. one even wanted someone to rub their gross stinking feet like 5 times a night with lotion!!! after a while i should have entered the room saying, "hello welcome to the cranky obese spa. am i enga your servant how may i appease your every want?"

[VivaLasViejas, ASN, RN]

OK, I'm going to 'weigh in' on this one.........I feel so conflicted about dealing with the super-obese, mainly because while I myself have never been in that category, I have weighed as much as 340#, and I know how this sort of thing happens to a person. So my sympathies lie with those whose weight defies medical management, and if they tend to be difficult personality-wise, well, think what it must be like to actually LIVE every day in a body that looks and feels like something alien. It's an assault on your dignity to be unable to perform the simplest personal care properly.......no matter WHAT caused the condition, when you can't wipe your own backside, you lose something of your personhood.

That said, I also know how very difficult it is to care for people who weigh 400, 500 pounds or more. It is exhausting both physically and emotionally; it is frustrating, because nothing we can do for them medically will 'fix' them; it is even infuriating, because the vast majority have gotten that way through the 'traditional' means---eating far too much and exercising far too little--- rather than any glandular problem, and as soon as you turn them loose into the community they will almost invariably return to the eating patterns that led to their extreme obesity and its attendant health problems......diabetes, heart disease, skin breakdown, immobility and the like.

All I know is, we're going to be seeing much more of this in the future, as supersized kids become supersized adults and those who are already morbidly obese themselves continue to grow ever larger. Years ago, those who weighed 300 pounds were considered freaks; now it's not at all unusual to see people who weigh twice that and more. Super-obesity is here to stay; that means we health-care providers must adapt to that reality.

Now, the fact that humans are becoming larger and larger doesn't change the laws of physics, nor have nurses evolved to the point where we can manage these heavy patients without some form of mechanical assistance! This is where assertiveness and activism come in: We MUST protect our own health in order to care for the health of others, and that means changing the culture of our workplaces. Think about it: can you imagine caring for a fresh post-op patient without access to monitoring equipment, such as a BP cuff or a pulse oximeter? Well, why should you be expected to care for a 500-pound patient without a Hoyer lift and an appropriately sized bed? Why should you wreck your back, or risk the safety of other patients on the floor because it takes all available staff to turn this one? It simply doesn't make sense.

If your facility doesn't have a lift with 1,000-pound capacity and at least one bariatric bed that can be ordered at a moment's notice, DEMAND IT! If you have the equipment, but haven't been trained in its use, DEMAND IT! These patients aren't going away, and you must protect yourself......we haven't a single nurse to waste. So speak up: your safety, and that of your patients, depends on it.

Getting off my soapbox now.

[saskrn]

I'm not thin. My family is not thin, and I know and see many people (including nurses) every day who are not thin. I don't find that obese patients are more of a challenge, or ruder than any other patient. But my opinion doesn't really matter because I am an RN, and as an RN, I should not judge my patients. I also feel I should not insult, humiliate or condemn my patients.

Really, you guys, this thread is embarrassing...I always considered our profession to be above this.

[Tweety, BSN, RN]

never mind

[Tweety, BSN, RN]

One of the nicest, nicest, nicest most appreciate patients I had was a post-gastric bypass with a PE. He died. He continually thanked me for the care and for being "nice".

I'm a bit disappointed and embarrassed at a couple, only a couple, of the posts above as well.

[angel337, MSN, RN]

the hospital i work at is also making present and future plans to accomodate larger sized people. i do find that when a patient is obese, their care is compromised greatly. i don't have anything personal against obese people. i try my best to provide equal care to all my patients, but i do get frustrated when i HAVE to use 3 or 4 other people to help me with a patient that normally would only require two people at most. i don't find obese people more demanding or "whiny", they are people just like everyone else, but i do have a problem with patients ( "normal" size people are guilty of this too) that expect me to lift them by myself. but when people are sick, it is expected that they will make demands that they probably wouldn't under different circumstances. yes, hospitals should accomodate larger people and i always tell nurses NOT to try to lift people alone. once you damage your back it is never the same and its just not worth the pain and agony.

[Brickman]

We are staffed according to "acuity". I find it interesting that there is nothing in the Van Slyke acuity system to capture the care and time that it takes to move and care for an obese patient on orthopedics. However a heparin lock gives us 15 points for just sitting there in the arm! The acuity system is a farce and naturally in favor of the hospital. Does anyone else use such an acuity system?

I agree that taking obesity into account as far as staffing and acuity is concerned is something that needs to be added to the software.

[HJBeans]

Well, it has affected me by causing me to miss over 1 month of work 2 different times for a slipped disk (L3 to L4).

This could probably happen with any patient though. But the only 2 times I have been hurt was caring for an obese patient.

[Katnip, RN]

I have had many, many extremely obese patients and never hurt myself. The key is to get the right number of people to help. I have had some patients who are resistant to helping themselves, same as I've had teeny patients resist doing for themselves. If they are capable, I let them know I will assist, but it's in their best interest to do as much for themselves as they can. Most give it their best shot.

Yes, very, very large patients do require more time and more manpower. But I don't see a difference in the amount of complaining and whining.

I think sometimes we have hidden prejudices, even hidden from ourselves, that we automatically assign certain negative traits to people. I know I've caught myself doing it more than once. It's hard to be objective sometimes.

[cnyrn]

Some of my most rewarding nursing experiences have been with bariatric pts. Some will take their hospital admission (usually a problem that is secondary to their obesity) as an opportunity to make real changes in their lifestyles, are highly motivated and succeed. Others are just miserable.

[traumaRUs, MSN, APRN]

I work at a large hospital where we do a lot of bariatric surgery. However, as one poster stated - all of America is getting bigger. I work in the ER and our hospital has a bariatric care (1000 lb capacity) based in the ER, we have two bariatric beds (650 lb and 1000 lb capacity) at all times in the hospital. We also have lifts for 1000 lbs always available. It is safer for the patients as well as the staff to use lifts and not rely on "people-power." I do not mean this as disrespectful to large people - I'm no 110 pounder myself, believe me. However, as I would deal with any patient, I want to keep the patient as well as myself safe. The hospital needs to help ensure this is the case.