The Bariatric Population: A New Challenge in Patient Care Ergonomics

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The Bariatric PopulationA New Challenge
in Patient Care Ergonomics
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Acknowledgements

• Bay Pines VA
• Loria Menousek
• Diane Sanchez
• VISN 8 Patient Safety Center
• KCI
• Hill-Rom
• ARJO/Diligent

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Obesity Trends Among U.S. Adults 2001
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
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Obesity Trends Among U.S. Adults
For viewing change in demographics over time, go
to CDC/NIOSH website
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Bariatric Statistics

• National Health and Nutrition Examination Survey
  (NHANES III) conducted from 1988-1994 reported
  that 59.4 U.S men 50.7 women are overweight
  or obese (Barr Cunneen, 2001).
• Obesity has risen 60 since 1991 and continues to
  rise
• Obesity is 2nd leading cause of preventable death

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Bariatrics Defined

• Overweight by 100 200 lbs.
• Body weight greater than 300 lbs.
• BMI greater than 40 (or 50)

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What is BMI?

• Obesity is defined according to BMI
• BMI patient weight (kg) /by height squared
  (m2).
• Internationally,bariatrics is defined by BMI over
  40 (Kuczmarski Flegal, 2000)

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Defining Obesity
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BMI is not the Same as Body Fat
BMI is ONE measurement of health
http//www.cdc.gov/nccdphp/dnpa/bmi/bmi-means.htm
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Patient Care in Bariatric Population

• Managing obese patients is challenging for
  caregivers
• Makes difficult tasks more difficult turning a
  patient in bed, lateral transfers, transferring
  from bed to chair, lifting a limb to bath area,
  etc..
• Risk of injury increases when caring for obese
  patients

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Bariatric Algorithms

• Chapter 12 Patient Care Ergo Resource Guide
• Algorithms can assist caregivers in selecting
  safest equipment and techniques based upon
  patient characteristics

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Bariatric Algorithms

• Bed-chair, chair-toilet, chairchair
• Lateral transfers
• Repositioning in bed
• Repositioning in a chair

• Sustained holding of a limb
• Transport in a stretcher, wheelchair or walker
• Toileting
• Transferring up from floor

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Technology Resource Guide for Bariatric Patients

• Developed by bariatric workgroup
• Offers various technological options to assist in
  care of bariatric patients
• Lists equipment by categories
• Under each category is product name
  manufacturer, product description and the key
  advantage
• www.patientsafetycenter.com

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Technology Resource Guide Categories of Equipment

• Ambulatory/mobility aids
• Bathing equipment
• Beds/mattresses/ transportation
• Ceiling lifts
• Commodes/shower chairs

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Categories Continued.

• Lateral transfer aids
• Multi-use lifts
• Powered lifts
• Standing assist aids
• Transfer/Geri chairs cushions
• Wheelchairs

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Which device do I choose?

• Look in appropriate category
• Use summary sheets for more information
• Key advantage allows you to quickly assess
  product
• Manufacturer website address/link is available

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Evaluation Checklist for Bariatric Equipment
Ch. 12

• Hospital bed
• Weight Capacity of bed frame and mattress
• Weight Capacity of side rail support
• Weight Capacity of Bed scale
• Width of bed appropriate for specific patient

• Length of bed appropriate for specific patient?
  
• Mattress type
• Pressure relief
• Pressure reduction
• Alternating
• Rotational

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A-10 Bariatric Equipment Safety Checklist
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Helpful Tips

• Know weight capacities of existing equipment
• Use body dimensions when ordering beds
• Consider motorized transport devices or motorized
  beds
• Empower staff nurses to lease or procure
  necessary equipment

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Helpful Tips

• Keep Bariatric Binder in nurses station
• Admissions process/flowchart
• Weight capacities of all equipment, etc.
• Procedure for acquiring bariatric equipment
• Vendor contact information for acquiring
  bariatric equipment
• Location of bariatric gowns/BP cuffs
• More

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Helpful Tips

• Ensure appropriately weight-rated equipment is
  available either on-site or easily acquired
  through local vendor.
• Basic equipment to consider
• Beds/specialty support surfaces
• Ceiling Lifts
• Positioning devices
• Stretchers
• Commodes
• Wheelchairs, walkers
• Abdominal binders

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Decision to Buy Versus Rent Equipment

• Specialized equipment will be required to move,
  transport, and care for the bariatric patient
• Facilities need to evaluate their situation -
  purchase or rent necessary equipment

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Patient-Specific Materials

• Linens
• Patient gown
• Abdominal binders
• BP Cuffs

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Other Considerations

• Patient/Resident room door widths
• Elevator door widths
• Radiology tables
• Surgical tables
• Consider motorized transport devices

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Resources

• www.patientsafetycenter.com
• Technology Resource Guide for Bariatric Patients
• Patient Care Ergonomics Resource Guide Ch. 12
• http//www.cdc.gov/nccdphp/dnpa/bmi/bmi-means.htm
• Products for sale various vendors
• Products for rent - http//www.sizewise.net
• Facility design assistance
• www.arjousa.com
• www.hillrom.com

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SensitivityCulturally Competent Care A
Patients Perspective

• Diane Sanchez, RN, MSN
• Loria Menousek, RN, MN
• VAMC Bay Pines FL

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What is Sizism

• A form of size (weight) prejudice
• It is derived from the term racism
• It is a form of discrimination against obese
  individuals.

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Social Stigma Sensitivity

• Stereotypes are lazy, stupid, dishonest, lacking
  in self control ambition (Allison Saunder,
  2000).
• Obese persons make less money than non-obese for
  same jobs (Sargent Blancheflower, 1994)

• Frequent stigma exposure is associated with
  psychological distress, coping efforts, more
  severe obesity (Myers Rosen, 1999).
• They are subjected to negative public response

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Society Views Overweight Individuals as

• Emotionally Impaired
• Weak willed
• Socially Incompetent and Isolated
• Lazy
• Dirty and Unkempt
• Intellectually Impaired
• Worthless

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A Visit to the Doctor- An ExperienceObstacles
and Challenges

• Transportation
• Parking
• Waiting Room (space and chairs size)
• Magazines
• Restroom / stall size
• Weighing in privacy
• Small BP Cuffs

• Scales with wide base and appropriate weight
  limits.
• Narrow doors hallways
• Size of examination tables
• Assistance getting on and off table.
• Small paper exam gowns
• Reaction of other patients
• Reactions of staff

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CultureBehaviors- Attitudes- Beliefs

• Culture influences all aspect of ones life.
• Culture is a learned system of beliefs, values,
  and rules that people use to guide their
  activities.
• Culture shapes behaviors attitudes and beliefs
  about fatness, thinness, eating, food,
  nutrition, activity and exercise.

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Culture and Body Weight

• Culture provides the foundation for how you view
  the human body (your body and others).
• What is considered fat is influenced by
  culture.
• Body weight values and beliefs varies from one
  culture or ethnic group to another.

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Attitudes of Health Professionals

• Negative Bias from Healthcare Professionals
• towards the obese patient can result in
• The patients perception of these negative
  attitudes and the related rejection.
• Reluctance of the obese patient to seek medical
  assistance

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Non- Verbal Communication

• Gestures Reflect Feelings of non- acceptance
• Fear
• Anger
• Frustration
• Doubt

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Language - Terms

• Non- threatening Accepting
• Bariatrics
• Obese
• Overweight
• Dignified Care

• Offensive and Undignified
• Fatso/Chubby
• Plump/Tubby
• Stocky/Corpulent
• Stout/Big or Large Frame
• Rotund/Heavy Set
• Bulky/ Well Fed

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• Terminology used by the Mayo Clinic,
• Rochester, Minnesota
• Use of initials EC (Expanded Capacity) is used
  to describe specific bariatric equipment .
• Equipment is marked with initials EC in the
  back right hand corner followed by weight
  capacity.

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• Identifying equipment with EC avoids the
  offensive maximum weight or Big Boy labels.
• EC equipment is identified at a glance with
  its weight capacity
• The EC identifier and weight capacity ensures
  safe and appropriate use of equipment.

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See the Person Not the Size

• Sensitive treatment of obese patients involves
  attending to their needs of comfort, safety, and
  self-esteem.
• The person, not the obesity, should be the focus
  of treatment.
• Ensures that care is provided in a manner that
  enhances dignity, acceptance and a sense of
• worth

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See the Person Not the Size

• ..obesity does not create a psychological
  burden. Obesity is a physical state. People make
  it a psychological burden.
• Stunkard and Sobal