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Abstract
This project described prospectively obese, critically ill patients and the resources critical care nurses used to care for these challenging patients. It also examined the relationship between resources used by nurses and patient outcomes, including complications and length of stay. Forty-three participants were enrolled. Patients with a body mass index (BMI) 40 kg/m2 used the majority of equipment and personnel resources and experienced a prolonged length of stay. The most common equipment used was a specialty bed or mattress; the most common complications were related to the pulmonary system. Initial use of multiple resources may indicate a patient at risk for adverse outcomes. Nurses can use findings to anticipate care needs and develop interventions, such as optimal positioning, to avoid adverse outcomes.
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Makic MBF, Rauen C, Watson R, Poteet AW. Examining the evidence to guide practice: challenging practice habits. Crit Care Nurse 2015; 34:28-45; quiz 46. [PMID: 24692464 DOI: 10.4037/ccn2014262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Nurses are the largest segment of the nation's health care workforce, which makes nurses vital to the translation of evidence-based practice as a practice norm. Critical care nurses are in a position to critically appraise and apply best evidence in daily practice to improve patients' outcomes. It is important for critical care nurses to continually evaluate their current practice to ensure that they are applying the current best evidence rather than practicing on the basis of tradition. This article is based on a presentation at the 2013 National Teaching Institute of the American Association of Critical-Care Nurses. Four practice interventions that are within the realm of nursing are critiqued on the basis of current best evidence: (1) turning critically ill patients, (2) sleep promotion in the intensive care unit, (3) feeding tube management in infants and children, and (4) prevention of venothromboembolism…again. The related beliefs, current evidence, and implications for practice associated with each topic are described.
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Porter RM, Thrasher J, Krebs NF. Implementing a pediatric obesity care guideline in a freestanding children's hospital to improve child safety and hospital preparedness. J Pediatr Nurs 2012; 27:707-14. [PMID: 22178030 PMCID: PMC3607510 DOI: 10.1016/j.pedn.2011.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 08/29/2011] [Accepted: 11/15/2011] [Indexed: 11/30/2022]
Abstract
Medical and surgical care of children with severe obesity is complicated and requires recognition of the problem, appropriate equipment, and safe management. There is little literature describing patient, provider, and institutional needs for the severely obese pediatric patient. Nonetheless, the limited data suggest 3 broad categories of needs unique to this population: (a) airway management, (b) drug dosing and pharmacology, and (c) equipment and infrastructure. We describe an opportunity at the Children's Hospital Colorado to better prepare and optimize care for this patient population by creation of a Pediatric Obesity Care Guideline that focused on key areas of quality and safety.
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Affiliation(s)
- Renee M Porter
- Section of Nutrition, Department of Pediatrics, University of Colorado Denver, School of Medicine, Aurora, CO, USA.
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Whittemore AD, Kelly J, Shikora S, Cella RJ, Clark T, Selbovitz L, Flint L. Specialized Staff and Equipment for Weight Loss Surgery Patients: Best Practice Guidelines. ACTA ACUST UNITED AC 2012; 13:283-9. [PMID: 15800285 DOI: 10.1038/oby.2005.38] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To provide evidence-based guidelines on the specialized personnel, equipment, and physical plant required for safe and effective care of severely obese weight loss surgery (WLS) patients. RESEARCH METHODS AND PROCEDURES We examined MEDLINE (Ovid and PubMed) and the Cumulative Index of Nursing and Allied Health Literature for articles on facilities resources for care of WLS patients published in English between January 1980 and March 2004. We queried several web sites for appropriate references; these included the Agency for Healthcare Research and Quality and the American College of Surgeons. The majority of reference material was descriptive and not specific to facilities resources for WLS patients. We identified a substantial body of literature on the general subject of patient safety; three of these articles were used to develop recommendations on the use of technology for medical error reduction. All other recommendations are based on 11 expert opinion reports. RESULTS We recommended adequate training and credentialing for all medical staff; dedicated support and administrative personnel; and specialized interventional, diagnostic, operating room, and transport equipment. We specified needed adaptations to the physical plant and developed evidence-based guidelines for medical error reduction and systems improvements. DISCUSSION Specialized resources and dedicated staff are needed to protect the health of WLS surgery patients and staff. Adaptations include preoperative preparation for safe means of patient transport; techniques of anesthesia and intraoperative exposure; provisions for postoperative recovery; and measures to assure postoperative patient safety, hygiene, and comfort.
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Affiliation(s)
- Anthony D Whittemore
- Division of Vascular Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston MA 02115, USA.
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Baskerville JR, Moore RK. Morbidly obese patients receive delayed ED care: body mass index greater than 40 kg/m2 have longer disposition times. Am J Emerg Med 2011; 30:737-40. [PMID: 21855252 DOI: 10.1016/j.ajem.2011.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 04/22/2011] [Accepted: 05/19/2011] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Our study compares treatment times of morbidly obese patients (body mass index [BMI]>40 kg/m2) with patients having BMI less than 35 kg/m2. METHODS We used an institutional review board-approved, retrospective, sequential, cohort, data analysis of emergency department (ED) medical records from our county teaching hospital (January 2010). Our data set of 102 morbidly obese patients (World Health Organization class 3 [BMI>40 kg/m2]) was compared with that of 195 normal or mildly obese patients (World Health Organization class 0 or 1 [BMI<35 kg/m2]). Inclusion was limited to patients of Emergency Severity Index level 2 and 3 who presented for triage. The primary outcome variable was total length of stay for patients discharged home from the ED. RESULTS Morbidly obese patients take significantly longer to disposition than normal or mildly obese patients (difference, 101 minutes [95% CI, 55-146]; P<.0001). The mean length of stay for patients with BMI less than 35 kg/m2 was 287 minutes in contrast to 388 minutes for patients with BMI greater than 40 kg/m2. Computed tomography use was significantly less likely in the BMI class 0 and 1 groups compared with the BMI class 3 group (0.41 [79/195] vs 0.56 [57/102]; difference, 0.15 [95% CI, 0.03-0.27]; P=.012). CONCLUSIONS In our institution, morbidly obese patients take significantly longer to disposition home than patients of more normal weight.
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Affiliation(s)
- Jerry Ray Baskerville
- CHRISTUS Spohn Memorial Hospital, EM Residency Program, Corpus Christi, TX 78405, USA.
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VanHoy SN, Laidlow VT. Trauma in obese patients: implications for nursing practice. Crit Care Nurs Clin North Am 2011; 21:377-89, vi-vii. [PMID: 19840716 DOI: 10.1016/j.ccell.2009.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recently, the impact of obesity on the outcomes of trauma patients has been the focus of several investigations. There have been several studies addressing the impact of obesity on trauma patients. These studies have explicated the impact of obesity on negative outcomes of trauma patients. Several studies have identified a relationship between obesity and injury pattern, increased complications in outcomes related to surgical procedures, and increase mortality and morbidity rates in obese trauma patients. However, the literature in nursing management in this patient population is virtually nonexistent and vague. The purpose of this article is to delineate the nursing implications of obesity in trauma patients and to provide guidelines for care of obese trauma patients.
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Affiliation(s)
- Sherry N VanHoy
- Department of Emergency Medicine, Sinai Hospital of Baltimore, 2401 W. Belvedere Avenue, Baltimore, MD 21215, USA.
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Abstract
Obese patients in the ICU present unique challenges to the health care team and specific challenges to nurses. This article reviews the science and art of resource use for obese patients in the ICU. Staff nurses and advanced practice nurses can make important contributions in evaluating optimal resource use and improving outcomes in this population of vulnerable patients.
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Abstract
Achieving pain control in critically ill patients is a challenging problem for the health care team, which becomes more challenging in morbidly obese patients. Obese patients may experience drug malabsorption and distribution, which may lead to either subtherapeutic or toxic drug levels. To manage pain effectively for the critically ill obese patient, nurses must have an understanding of how obesity alters a patient's physiologic response to injury and illness. In addition, nurses must be knowledgeable about physiologic pain mechanisms, types and manifestations of pain, differing patterns of drug absorption and distribution, pharmacokinetic properties of analgesic medications, and pain management strategies. This article explores factors affecting pharmacokinetics in obese patients, trends in pain management, and treatment strategies for the obese patient.
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Affiliation(s)
- Sonia M Astle
- Department of Critical Care, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA.
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McAtee M, Personett RJ. Obesity-related risks and prevention strategies for critically ill adults. Crit Care Nurs Clin North Am 2011; 21:391-401, vii. [PMID: 19840717 DOI: 10.1016/j.ccell.2009.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In America today, more than one third of adults are obese. Increasingly, obese patients are admitted to critical care units. Critical care nurses must have additional knowledge and skills to identify health risks to obese patients and implement interventions to prevent untoward problems. Critical care nurses are also at risk when taking care of obese patients. The purpose of this article is to identify risks to both patients and nurses and to provide recommendations to address those risks.
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Affiliation(s)
- Margaret McAtee
- Education Department, Baylor All Saints Medical Center, 1400 Eighth Avenue, Fort Worth, TX 76104, USA.
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Physiological rationale and current evidence for therapeutic positioning of critically ill patients. AACN Adv Crit Care 2009; 20:228-40; quiz 241-2. [PMID: 19638744 DOI: 10.1097/nci.0b013e3181add8db] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prolonged bed rest is common in critically ill patients, and therapeutic positioning is important to prevent further complications and to improve patient outcomes. Nurses use therapeutic positioning to prevent complications of immobility. This article reviews therapeutic positions including stationary positions (supine, semirecumbent with head of bed elevation, lateral, and prone) and active repositioning (manual, continuous lateral rotation, and kinetic therapy). The physiological rationale and current evidence for each position are described. Applicable evidence-based practice guidelines are summarized. Special considerations for therapeutic positioning of critically ill obese and elderly patients are also discussed.
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11
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Abstract
Bed rest is a common intervention for critically ill adults. Associated with both benefits and adverse effects, bed rest is undergoing increasing scrutiny as a therapeutic option in the intensive care unit. Bed rest has molecular and systemic effects, ultimately affecting functional outcomes in healthy individuals as well as in those with acute and critical illnesses. Using empirical sources, the purpose of this article was to describe the consequences of bed rest and immobility, especially consequences with implications for critically ill adults in the intensive care unit. This review uses body systems to cluster classic and current results of bed rest studies, beginning with cardiovascular and including pulmonary, renal, skin, nervous, immune, gastrointestinal/ metabolic, and skeletal systems. It concludes with effects on muscles, a system profoundly affected by immobility and bed rest.
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Affiliation(s)
- Chris Winkelman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA.
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Rose MA, Drake DJ, Baker G, Watkins FR, Waters W, Pokorny M. Caring for morbidly obese patients: safety considerations for nurse administrators. Nurs Manag (Harrow) 2008; 39:47-50. [PMID: 19155854 DOI: 10.1097/01.numa.0000340819.13647.6d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Mary Ann Rose
- East Carolina University College of Nursing, Greenville, N.C., USA
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Abstract
Since the implementation of the Moving and Handling Operations Regulations (Health and Safety Executive, 1992) there has been considerable effort to reduce back injury among nurses by developing patient handling policy that eliminates actual manual handling. Recently, however, there have been challenges to 'no manual handling' policies by patients as an issue of dignity and human rights. This article offers a literature-based discussion of patient handling in relation to safety and dignity for both patients and nurses. The literature does not offer a solid evidence base for handling practice, and research, involving patents, is limited. However, nurses' handling practice is governed by legislation and NHS Trust policies. Patient handling that is safe and dignified for both patient and handler is a vital skill that requires knowledge and competence. This article suggests ways of developing practice that is safe and dignified for both patient and handler.
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Affiliation(s)
- Glynis Collis Pellatt
- Faculty of Health and Social Science, University of Luton, Aylesbury Vale Education Centre, Stoke Mandeville Hospital
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Abstract
The increase in prevalence of obesity in older individuals and the association of obesity with increased morbidity, functional decline, hospitalization, and complications is expected to increase the number of individuals who have obesity requiring nursing home care, particularly subacute and short-term rehabilitation. Providing appropriate nursing home care to residents who have obesity requires environmental modifications, specialized equipment, and staff training. Effective nursing home care of residents who have obesity is interdisciplinary and requires special nursing, medical, nutritional, psychosocial, and rehabilitation considerations.
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Abstract
Obesity has become the number one health problem in the United States. The patients who is obese and undergoing a surgical procedure that results in the formation of fecal or urinary diversion requires advanced skills of a multidisciplinary healthcare team. Patients who are obese carry a high risk of wound and cardiopulmonary complications and often present a serious challenge in terms of stoma creation and management. The purpose of this article is to examine the risk factors that face the patient who is obese and undergoing stoma surgery, the challenges of stoma creation, and the resultant stoma management problems.
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Affiliation(s)
- Janice C Colwell
- Clinical Nurse Specialist, University of Chicago Hospitals, IL 60637, USA.
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