Hello Janet

I used to work with people with continence problems (which included other stigmatised conditions) and taught other staff about the subject. I used to think that if those who were treating patients who may feel embarrassed, were confident, knowledgeable but also understanding, the patients felt more positive and comfortable with themselves.  

These papers discusses training available, although I was unable to access the full texts:

Falker, A. J., & Sledge, J. A. (2011). Utilizing a bariatric sensitivity educational module to decrease bariatric stigmatization by healthcare professionals. Bariatric Nursing and Surgical Patient Care, 6(2), 73-78.

http://online.liebertpub.com/doi/abs/10.1089/bar.2011.9974

Vacek, Lauren. "Sensitivity training for nurses caring for morbidly obese patients." Bariatric Nursing and Surgical Patient Care 2, no. 4 (2007): 251-253.

http://online.liebertpub.com/doi/abs/10.1089/bar.2007.9953

While I was very aware of the various professional bodies related to continence, urology and colorectal nursing, I was unaware that there was a  National Association of Bariatric Nurses until I found this paper:

McGinley, L. D., & Bunke, J. (2008). Best practices for safe handling of the morbidly obese patient. Bariatric Nursing and Surgical Patient Care, 3(4), 255-260.

http://www.plambechogbogedal.dk/dokumenter/Best_Practice_for_Safe_Handling_marts_09.pdf

The more information available, the better; these papers are written sensitively and informatively:

Gallagher Campden S. (2009). Obesity: an emerging concern for patients and nurses.The online journal of issues in nursing 14 (1)

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No1Jan09/Obesity-An-Emerging-Concern.html

Thomas SA & Lee-Fong M (2010) Maintaining Dignity of Patients with Morbid Obesity in the Hospital Setting Bariatric Times. 8(4):20–25

http://bariatrictimes.com/maintaining-dignity-of-patients-with-morbid-obesity-in-the-hospital-setting/

This is a self assessment tool for nurses, regarding this speciality.

Harris, H. (2008). Nursing care of the morbidly obese patient. Nursing made Incredibly Easy, 6(3), 34-43.

http://journals.lww.com/nursingmadeincrediblyeasy/Fulltext/2008/05000/Nursing_care_of_the_morbidly_obese_patient.9.aspx

I will be interested to read the answers from other RG members,

Very best wishes

Mary

Teaching in a two-year  nursing program we do not have any specific content on morbid obesity. There is  a ton of discussion related to risk factors for certain diseases and obesity impact.  It is something that I have the opportunity to spend time on being on a clinical unit that provides bariatric surgeries and nursing care. It is an area that we need to focus on more.

The care of the morbidly obese patient is embedded in my critical care course for BSN students. I treat it like any other risk factor for each disease process that we cover in my critical care course.  For example, when discussing myocardial infarction/cardiac arrest/cardiogenic shock, I talk about the increased risk to obese patients (increased demand on an impaired pump and decreased peripheral circulation).  I include discussion about why many patients in these higher risk groups are unable to maintain a cardiac diet and exercise regimen.  (Dependence upon others for meals, limited financial resources, physical debilitation, fear/anxiety/depression, etc.).  Therefore, the importance of setting realistic goals for each patient and involving caregivers is included.  I also discuss the use of specialty beds and lifts in maintaining skin integrity, mobility, and decreasing the risk of infection.  I discuss the need to match the physical ability of the nurse to perform CPR to the size of the patient he or she is attempting to compress.  (At 120 lbs., I often found it difficult to provide adequate compressions to obese patients, despite correct technique. I didn't have the strength or mass to be effective.  I make sure the students understand that asking for help with compressions provides better patient outcomes; it's about the patient not your pride).

Greetings,

These are all excellent contributions to the topic. Regarding advanced nursing education and medical; the definition of morbid obesity must be presented in content so that diagnosis and treatment plans appropriate will be applied. For example in wt loss, there are specific medication use for morbid obesity treatment, which are FDA approved for morbid obesity applications. This folds into content related to diabetes management plans. The overall goal is to address morbid obesity to decrease chronic disease risk. Education on this topic is required content, to pass board examination and practice proficiently, knowing how to measure outcomes.

Janet:  thank you for recognizing the special needs of the bariatric population and also the stigma/attitudes that exist.  The stigma and attitudes is a huge barrier to reaching desired patient/population outcomes.  

In the pathophysiology, medical surgical, and prevention courses I teach, it is included.  This is set up so learners can learn about the health concerns of bariatric patients  and study the pathophysiology.  In medical surgical we study the nursing care of bariatric patients, including bariatric surgery.  This includes special equipment, such as bariatric toliets, wheelchairs, and skin care needs, and medication needs.  We use the terminology bariatric instead of obesity.   In preventation care, we study how to prevent obesity in populations and how to intervene with those who need to improve their health status.  We do refrain from using the words morbidly obese when working with populations as this is a barrier to effective communication that may evoke many emotions in the community that are detrimental to the outcomes.  We use the approach to promote health in the community--and refer to this as healthy lifestyles for all.  Since anyone can become overweight at any point in the lifespan, our focus is on establishing healthy lifestyles habits for life.  We use the 5 4 2 1 program and have adjusted it for use with those of all languages.  

Thank you for the concern and for recognizing the special needs of special population. This topic is taken care in medical-surgical nursing but not to a large extent.  The classification and management is dealt plus when we teach nutrition and dietetics, some components are discussed.

It is a very good idea, if we can develop a course specially for this concern and help people in dealing with this program effectively.

I teach in and AD program and this content is included--briefly.  We talk about it with our nutrition content (TPN) and focus on the special needs of this individual and also the needs for the nurse.  Much focus is on the complications of the obesity and of course prevention and education to decrease obesity.   

Denise

Congratulation Janet D'Arcangelo for raising health concern on obesity. This is great.

I strongly agree with you to address obese group as special population because of the risk associated with obesity such as diabetes, hypertension and other cardiovascular diseases, osteoarthritis and certain cancers. The upswing of obesity statistics is very alarming. In the pacific island some people perceived that the island is obese island, diabetes island and renal dialysis island due to the increasing incidence of obesity and diabetes.

What are the training/ educational needs for health care professionals when they come across this type of patient? Health care professionals in various settings (education, practice, and research) should address obesity in all levels of health care; primary, secondary, and tertiary level of health care. Obesity is a multi-factorial disorder. Health care professionals need to understand the link of obesity with genetic, metabolism, neurotransmitters, behavioral drives, environment, food habits, physical activity, and socio-cultural factors. Prevention and treatment of obesity should be done in all levels of health care; primary, secondary, and tertiary level of health care.

Hope attachment will provide significant and relevant information to address the need for training, development and education for health care professionals in the management of obesity.

On our pre registration in nursing programme we use simulation to raise awareness of the lived experience of people with obesity problems.

Some of the most important qualities nursing students should possess are those of empathy and compassion. However, it is very difficult to teach these and so they are best developed by students expanding their range of experiences and reflecting upon how these can  impact upon their professional practice.

The level of morbid obesity within the UK has risen significantly in the last decade. It can be difficult to appreciate the impact of these on lifestyle and activity. We have invested in old age and bariatric simulation suits which enable students to experience some of the limitations that can come with age or with obesity.

Students are asked to put on the suits and then carry out everyday activities which they then video. Students are then asked to reflect on their experiences and have been able to discuss both the physical and psychological impacts of ageing or being overweight and link this to how they can adapt their future nursing practice. Students have evaluated these simulation sessions very positively and we now plan to carry out a more formal research project to evaluate the impact these sessions have on student learning.

I've added a short You Tube video that demonstrates the empathy suits in action which might be of interest.

https://www.youtube.com/watch?v=tqvm00Tc-T8