Uniquely Yours

Safety & Sensitivity in Caring

for the Bariatric Population

By Tracy M. Morris, BSN, RN-BC, Clin. IV

Rucker 4 Clinical Educator

Overview

• Introduction

• View the objectives

• Discuss specific issues bariatric patient’s

encounter

• Discuss issues hospitals face providing

care to the bariatric population

• Conclusion

Objectives

Increase awareness of what weight bias

is, it sources and consequences

Verbalize the safety and sensitivity

needs of caring for the bariatric patient

Understand your role and how important

it is in caring for the bariatric population

Ultimate Goals

• Be inspired to make changes in your practice

• Make adjustments in your perceptions toward caring for the bariatric population

• Better outcomes for our patients

Introduction

• Quick Stats: – Between 1962-2000, the # of obese people

in the U.S. increased from 13% to an alarming 31% (American National Center of Health).

– Today, ~63% of Americans are overweight (BMI of 25 or >) (American National Center of Health).

– 93 million Americans are obese, with the # predicted to climb to 120 million in the next 5 years (Obesity Action Coalition).

– The U.S. spends $147 billion per year on obesity related illnesses (CDC’s Weight of the Nation).

– In Virginia (2006), 20-24% are obese (BMI =or>30).

Introduction

• Based upon:

The escalation of obesity rates + The

# of co-morbid conditions related with

obesity = healthcare providers in

most all practice settings can expect

to care for bariatric pts.

• Providing safe, quality care to this

population can present many

challenges to healthcare providers

and their organizations.

Obesity & Bariatrics Defined

• Obesity – A disease characterized by excessive body fat. – People who are medically obese usually are

affected by behavior, genetic and environmental factors that are difficult to control with dieting (OAC).

• Bariatrics - branch of medicine that deals with the causes, prevention and treatment of obesity. Encompasses dieting, exercise and behavioral therapy approaches to weight loss, as well as pharmacotherapy and surgery (en.wikipedia.org/wiki/Bariatrics).

Obesity & Bariatrics Defined

• Body Mass Index (BMI) r/t ―ideal body weight‖

– 25-29.9 = overweight

– 30-34.9 = obese

– 35-39.9 = severely obese

– 40 & over = morbidly obese

Reasons for Obesity Epidemic?

Issues the Obese Patient Faces

• Weight loss difficulties

• Mounting medical problems

• Psychological stigmas—research has found that obese pts. will often avoid seeking medical care for fear of insensitive handling or that the healthcare facility will NOT be able to accommodate their needs.

Issues/Concerns Hospitals Face in

Providing Care to the Obese Patient

• Financial Impact—the CDC estimates care for the overweight/obese pts. costs an average of 37% more than for people of normal weight adding an average of $732 to the annual bill of each American.

• Daunting safety implications for both the pt. and caregivers.

• Typically, obese pts. need more care than the average-sized person.

What Do You Find to be Different in

Caring for the Bariatric Population?

Areas of Impact with Increase in

the Physical Size of Our Patients

• Skin care

• Respiratory challenges

• Assessment

• Resuscitation measure

• Altered drug absorption

• IV access

• Mobility issues

• ?Injury to patient or you (equipment, workload, etc.)

What is Weight Stigma/Bias?

• Weight stigma is bias and discrimination

aimed at overweight people based on a

series of social attitudes that people

develop overtime, that assumes that there

is something wrong with overweight

people and they deserve to be punished

for their condition. – Rudd Institute

Video

Sources of Weight Bias/Stigma

• Frustration in helping obese pts. to lose weight to no avail

• Fear of injuries

• Aggravation in completing a difficult task

• Challenges associated with providing care to the bariatric pt. can be overwhelming and may elicit feelings of inadequacy, powerlessness, and fear – feelings may be projected on the pt. in subtle and implicit ways and may be experienced by the pt. as bias.

Snuffing Out Bias and

Stigma Associated with Obesity

• Education is the key!

– Project Implicit (Implicit Association Test)

• https://implicit.harvard.edu/implicit/demo

• ―It is well known that people don’t always ―speak their minds,‖

and it is suspected that people don’t always ―know their minds.‖

– Advance Fat Acceptance www.naafa.org

– Obesity Action Coalition www.obesityaction.org

– Rudd Center for Food Policy & Obesity – Yale

University www.yaleruddcenter.org

– American Society for Metabolic & Bariatric Surgery

www.asbs.org

Safe Patient Handling

• The best way to ensure safe pt. handling is through the use of special equipment manufactured to meet the size/weight requirements of the obese pt.

• Essential bariatric items -----------------

– Beds

– Wheelchairs

– Gowns

– Blood pressure cuffs

– Lift systems

– Scales

– Bedside commodes

– Stretchers

Other Essentials

• Sturdy armless chairs specially designed

bariatric chairs.

• Scales with a wide base, located in a

private area.

• Sturdy stool when assisting patient on/off

stretcher.

• Trapeze bars above beds

A Model for the Sensitive

Treatment of the Bariatric Patient

• R-E-S-P-E-C-T Model is the key to providing

quality, patient-centered, sensitive care to the

bariatric patient.

– R-rapport

– E-Environment/Equipment

– S-Safety

– P-Privacy

– E-Encouragement

– C-Caring/Compassion

– T-Tact

Bejciy-Spring, S. (2008) Respect: A Model for the Sensitive Treatment of the

Bariatric Patient. Bariatric Nursing and Surgical Patient Care.

A Model for the Sensitive

Treatment of the Bariatric Patient

The sensitive treatment of bariatric patients

involves recognizing and attending to their:

Comfort

Needs

Safety

Needs Self-esteem

Needs

In combination with addressing their health problems.

A Model for the Sensitive

Treatment of the Bariatric Patient

This appreciation for and responsiveness

to the unique

Physical

Characteristics

Psychological

Characteristics

Social

Characteristics

of the bariatric patient is integral to optimal patient

care and positive clinical outcomes.

Your Very Important Role

• Rapport:

– Acknowledge each of your patients as an individual

– Include the patient’s family/friends in their care

– See the person, not the pounds

• Environment:

– Get the room ready before the patient/family arrives

– Appropriate sized gown, BP cuff, toiletry needs (floor

mounted toilets), and equipment (trapeze bar, properly

mounted grab bars, sturdy step stool)

– Appropriate furniture in room (sturdy & armless chairs)

Your Very Important Role

• Safety: – Ensure safe pt.

handling by the utilization of special equipment manufactured to meet the size/weight requirements of the obese pt.

Your Very Important Role

• Provide privacy

– Procedures for weighing patients

• Ensure weighing takes place in a private setting,

the weight is recorded silently, and free of judgment

• Ensure scale is sufficient to accommodate

• Encouragement:

– Acknowledge to your pts. how difficult it is to

lose weight, focus on the pts. health

modification behaviors, not the number on the

scale

Your Very Important Role

• Reveal you care – Show compassion:

– Touch your patient!

– Treat obese pts. with gentleness, tact and

concern

• Tact:

– Avoid any display of frustration or distaste

when doing difficult examination

– People who are obese crave what anybody

else craves, which is just respect and dignity

Reality

• Only 1/11 physicians have a scale that goes over 300 pounds.

• Research studies have found that healthcare professionals, including those specializing in the care of the bariatric patient, have strong negative associations and attitudes toward obese persons (Bejciy-Spring, 2008).

These pts. feel unwelcome & mistreated in healthcare settings, where they encounter negative attitudes and remarks, discriminatory behaviors, and challenging physical environments.

Health

Problems/

Co-morbidities

Need for Health Care/

Interventions

Exposure to Bias in

Health Care

Negative Feelings/

Emotional Responses

Avoidance of

Healthcare

Unhealthy Behaviors/

Self-care/Esteem

OBESE

CONDITION

Bejciy-Spring, S. Bariatric Nursing, vol. 3, no. 1, 2008

Preparing Hospitals

• Educating staff

• Having a policy to address attainment of bariatric equipment

• Utilize bariatric equipment (purchase or rent)

• Facility renovations

• Promote a culture of sensitivity!

Take Home Message

• The bariatric pt. has the right to be treated as a unique individual and receive competent healthcare and medical treatment with the same attention to quality, comfort, safety, privacy, and dignity as all other patients (Bejciy-Spring, S. 2008).

Remember in your practice:

"Too often we underestimate the power of touch, a smile,

a kind word, a listening ear, an honest compliment, or the

smallest act of caring, all of which have the potential to turn a

life around." --Dr. Leo Buscaglia