I am looking for existing guidelines on the management of bariatric patients in a hospital setting (not in terms of weight loss surgery, but everyday management of the larger patient). We are looking at formalising a guidelines and hope to learn from other services - while there are some available through online searches, it would be great to review a wider range.
I oversee the end-of-life and postmortem practice of a trauma hospital in a high-risk, inner city community of Los Angeles. We devote particular attention to the needs of our over-sized patients and the unique challenges they bring to their famlies when they die. As most of my families have little if any resources to provide a traditional funeral, much less the added funerary expenses involved with larger persons, we developed a protocol for maintaining their dignity, preservation, and privacy that mirrors the care of patients with a lesser habitus (we call our expired patients 'patients' after they die,because they are stil in our care). We have a cooling protocol if they are unabe to be placed in traditional morgue drawer the first 24-30 hours after death; we have contracted with a local mortuary with a room refrigeration system to hold them after that window, especially if the family needs a bit more time. We do not charge the families for this service.
Families appreciate having referrals to mortuaries who offer emotional support and reduced rates, knowing cremation is often their only option. It took time and patience to put it all in place -i.e. shaping the use of language and behavior, artfully crafting step-by-step instructions, and partnering with the funeral homes. The driving force behind the practice is love and acceptance - of the living and the dying, of the small and the not-so-small. If you have any questions, jet me an e-mail.
Hi Elizabeth - thank you very much for your reply, this has raised additional aspects of care which I must acknowledge I had not given sufficient thought to. It is a very significant issue, and I am now going to review our mortuary capacity and processes and identify what current practice has been. It is suprising how easily aspects of care can be overlooked, even with careful planning. The hospital in which I work is currently looking at a rebuild (following our series of earthquakes 3 years ago) and even now something as straight forward as considering the size of door frames had been overlooked.
I will raise several of the issues you mention within the working group, and may e-mail you at some time in the future to clarify aspects of your service. Thank you again for the care and compassion towards your patients tht is demonstrated in your response - it is heartening to see this!
We have to change the culture of care to incude those we cannot heal and those who are left behind - their families still think of them as the person they treasure. If you like I could send you a presentation we made at the Compassionate Care Coalition conference last spring, to bring this perspective to light. This was presented by a patient family member, our CNO and I, This came on the heels of our teaching this perspective at the International Patient Family Centered Care conference in Washington, D.C. Most hospitals think of the dead as unwanted cargo, not peple with a history of their own.
Send me your e-mail address and we can make it happen.
Thank you so much for your contribution Elizabeth and thanks for raising such question Sandra. I am not in hospice care nor have to do with end of life issues but I just appreciate that there is specific care for the size challenged patients at end of life, things could really be frustrating to their family who are sad for losing their loved one, then having to give them needed dignity and respect at death is another issue all together. Having a fore knowledge about dealing with such challenge and proffering solution is a great knowledge gained from you both. Who knows I might find myself working in such environment in the future. I think communication is another aspect to consider, both verbal and body language. As nurses we need to consider this aspect as being important, so as to use proper language to meet the needs of the family members and they see the love and respect we have for their dead not treating the body as a piece of trash to be dislodged.
..yes...in healthcare the patient who dies is treated more like unwanted lugagge to be taken away from our sight, because it's a reminder of our own mortality. If we treat them more like a beloved storybooks, with their own unique content, it has more meaning and can help us to be grateful for our own story.
WOW!!! Elizabeth, you have great compassion, and you express it with such eloquence!
I would love to have a look at your presentation you made at the Compassionate Care Coalition conference, if possible.
I will contact you via your profile.
thank you for your contributions - I think this is an important area of practice and one that will affect all aspects of nursing and care provision. Working in an emergency department, we see people with such a variety of conditions and concerns, while we may not be expert in all aspects of care, I feel as nurses we can be experts in providing compassionate care -with respect and mindfulness that it is the patient's perceptions we should be seeking, rather than imposing our own expectations.
Hi Sandra,
The PowerPoint presentation is realy a arge file, so I'm gong to get some help compressing it so it sails through to you, others are now requesting the piece as well, so good to have that nailed together.
Thank you for your kind words.
Liz
Sorry for the typos, sprained my 4th digit in the palm while gardening.
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