March 2004 Newsletter ********************************************** IN THIS ISSUE: Treating Obese Patients with Dignity & Respect Obese Employees Weigh In Tips to Make Bathing a Better Experience for Residents Humor Bonus: Three Nurses and a Genie ===================================================== WORKFORCE 21 TOOL KITS ARE 15% OFF UNTIL MAY 1 The Workforce 21 tool kit is a "meat and potatoes"¯ program developed to help you learn how to find, select and keep top quality staff. It is possible to reduce turnover to lower than the national average"¦in a short period of time! The kit includes a Manual/Workbook, 6 videotapes, 6 CD's and 6 Cassettes of Clint's live seminar, plus a Proven Solutions cassette set and In Charge cassette set on nursing leadership. Also included are the Manual/Workbook on CD's, 200 BMG buttons and 2 copies of Team Basics, a book outlining strategies for team success. When One Size Doesn't Fit All"¦ Accommodating Obese Patients "The patient was too large to fit inside the facility's MRI machine. The only other option was to call the National Zoo and schedule a session with their MRI machine."¯ "The patient was escorted to the loading dock where she was weighed like a piece of freight before being admitted to the hospital."¯ "The patient was so obese that the staff had to call the fire department to lift him onto a stretcher with hoisting equipment."¯ The examples above illustrate the startling effects a growing obese population is having on the healthcare profession. Not only do these types of situations pose a problem to healthcare staff, but perhaps more importantly, they prove to be humiliating to the obese patients seeking medical care. No Room for the Obese? While the healthcare community has come a long way in regards to treating overweight and obese individuals, the fact is Americans are getting fatter. According to the National Institutes of Health, nearly two-thirds of the population is overweight or obese. The nation's obesity epidemic is creating a nightmare for healthcare facilities, both medically and economically, and it's no picnic for patients either. Overweight patients often experience unpleasant situations when visiting a healthcare facility" gowns that are too small, waiting room chairs they cannot squeeze into, weight scales placed in public view, exam tables that tip over. In addition to these types of embarrassing situations, large patients say they often face hostility and discrimination from health professionals. Some studies suggest this is because they believe the health system doesn't want to deal with them, or is out to humiliate them. Unfortunately, these feelings are not pure paranoia. Much research indicates that doctors and nurses do in fact, harbor negative feelings toward obese patients. One study of Canadian nurses that appeared in the journal Perceptual and Motor Skills, showed that nearly a third of those queried said they preferred not to care for the obese at all" 24 percent labeled the obese "repulsive." Other studies suggest that doctors see obese people as lacking in self-control, or as just plain lazy. On the flip side, many healthcare professionals feel that their advice and best efforts to help overweight patients are in vain. And with the growing number of overweight Americans, their feelings of frustration are not completely unfounded. Furthermore, professionals know that obese patients are going to need extensive treatment due to the complications of their weight" medications for diabetes, hypertension, cholesterol, and not to mention the operations that will most likely be needed such as bypass surgeries, hip and knee replacements, etc. In many cases, the best medicine for these patients is to achieve an appropriate weight. While healthcare professionals can help and advise patients on how to lose this weight, the ultimate responsibility lies within the individual. Overweight individuals have to make a lifelong commitment to stay at a healthy weight. Many professionals feel frustrated when they see a lack of participation or results among the patients. Of course, as any person trying to lose weight would tell you, it's much easier said than done! So it appears that finding a middle ground is posing to be quite a challenge. While obese patients say the healthcare system is hostile and discriminatory, professionals express that patients are not doing enough to help themselves. Plain and simple, there is no magic bullet. But there are a variety of steps medical staff can take to do their part in accommodating, and improving relationships with this specific population. Expanding the Level of Care There's really no way around it. Larger patients require more equipment, more staff, and more staff training. Simple everyday routines can be transformed into a dangerous predicament" moving a 400-lb resident from the bed to a shower gurney or placing a morbidly obese patient into a standard wheelchair are just two examples. If your facility is not doing its part to prepare and accommodate these patients, you will undoubtedly face catastrophe. Below are some of the most frequently encountered obesity issues in the healthcare setting and more importantly how to best deal with them while ensuring the rights of the patient. Mobility. The facility's primary focus should remain on maintaining the safety of both staff and patients. There are many safety issues related to moving large patients and or residents from a bed to a commode or a shower gurney, or weighing them safely. It's critical to make sure that the equipment staff is using for a given patient or resident can handle the given weight. Standard wheelchairs accommodate people weighing 250 pounds or less, and standard lifts can handle about 300 to 350 pounds. While attaining the appropriate equipment may be costly, it's a well-made investment. Not only will the facility have to worry as much about accidents, but the larger patients will feel more comfortable and satisfied with the facility when they see that you're not scrambling to find equipment that will accommodate their size. Acquiring armless chairs, extra large beds and walkers are a few other things a facility can do to ensure safety and comfort for obese individuals. Other nuances that can help a patient's mobility and aid in comfort include Goretex sheets that allow for skin to breathe easier and a device called "AirPal" that helps heavy patients slide from one bed to another. Nutrition. Simply feeding obese patients can be a problem, because they require thousands of calories a day. While a patient may be on a special diet as advised by their doctor, compliance is really up to the resident. For example, they might go to vending machines to buy snacks, or they might ask family or friends to pick up food from outside the facility. Staff must respect the right of the patient to choose to follow that diet or not. Whether it's good for them or not, it's their right. Acting disgusted or making comments like, "it's no wonder you're that way"¯ is not the route to go. Hygiene. Some residents are so extremely obese that caring for their own personal cleanliness is extremely challenging. They can't reach everywhere that needs washing because they're so large or because they lack the range of motion required. Even all the adaptive equipment does not allow some residents to bathe thoroughly. Some residents will be embarrassed about being unable to take care of their own bathing and grooming and may be reluctant to receive help. Staff must walk a fine line between allowing the right to choose how often they'll bathe while not creating a problem for other residents. It's important to have staff remind these patients that it's not their fault and that you just want them to have the opportunity to be as clean as their neighbors. Weighing In On the Matter Above all, it's important to stress that all healthcare personnel should avoid any display of frustration or distaste when dealing with overweight and/or obese patients. People who are obese crave what anybody else craves, which is just respect and dignity. The good news that might help your staff drop the stigma are the recent discoveries that point to the biological and genetic causes for obesity"“there is less of a perception that this is just a matter of willpower. "There are only four kinds of people in this world. Those who have been caregivers, those who are care givers, those who will be care givers, and those who will need care givers."¯ " Rosaylnn Carter When the Overweight Aren't Your Patients Treating Obese Co-Worker with Respect Sometimes there is an underlying attitude in the workplace that people who are overweight are lazy, uneducated, stupid, or not capable of carrying a job through to completion. This simply is not the case and some simple rules need to be reinforced: "¢ Everyone needs to be treated with respect. "¢ Weight has nothing to do with intelligence. "¢ Job skills can be and are developed by people of all shapes. If you think stereotypes and disrespectful behavior is a thing of the past, think again. Take a look at some of these recent testimonials. They have been posted on The Associations for Morbid Obesity Support's website by overweight individuals who are frustrated and disgusted about how they are treated by some co-workers. "I do not want to be treated any differently because I am overweight. I sometimes feel that people don't think I am as smart or on top of things as they are. This is probably my low self-esteem taking over most of the time. However, there are definitely people out there who have very negative attitudes towards overweight individuals."¯ "We are overweight not handicapped. Were not lazy, shiftless, greedy etc. We are just like you. Good manners are always appropriate, pick it up, hand it to me, assist me, open the door, the same you would do for me if I were a size 5. Don't do it because I am obese do it because you are being kind hearted. Don't think you are offensive unless those are your intentions. Our lives are not centered around our weight, if so you wouldn't know us, you wouldn't see us."¯ "I have found that because I am overweight that I must be lazy. I am quite good at most things I do and usually find myself working circles around co-workers. However, I have seen so much what I call fat discrimination in the workplace. I am not working right, but will need to soon and am hoping to after the surgery (if approved), am actually not wanting to look for a job with the way I feel about my looks. Co-workers in any situation should work as a team and be courteous to each other in any situation."¯ Bathing"¦ Is Your Facility Awash? Bathing. It may undoubtedly be the most dreaded task among long-term healthcare facilities. Baths must be scheduled and accomplished quickly to ensure that all residents have a chance to bathe. And due to staff's hurry to get the job done, bathing facilities tend to be noisy, cramped and, ironically" unhygienic. The hustle and bustle and monotonous routine could give residents the impression that they are just a moving part on a conveyor belt. In these types of environments, it should come as no surprise that residents say they feel agitated and uncomfortable during bathing time. A complete renovation of your facility's bathing area might be out of the question, however there are some simple and inexpensive steps you can take to improve the experience for you, as well as the residents. In fact, getting started may not require more than a visit to a home dĆ©cor store, or perhaps the bathroom in your own home. Shower massagers, fragrant candles, aromatherapy, and an abundant assortment of bath products have all become the norm in private homes. Think beyond traditional, long-term care bathing, and provide residents with the experience that bathing has come to mean in mainstream America. Here are some tips to make the bathing experience a better one: "¢ Begin with the end in mind. Remember that the purpose of bathing is to fulfill the physical, mental, and emotional needs of the residents. Try to think of how you feel when you're done with a nice shower or bath. You probably feel refreshed or relaxed" and you most likely weren't rushed or had other people in the same room, waiting for you to finish. While staying on schedule and getting everyone a chance to get through this activity is important, a comfortable and relaxed attitude will allow you and the residents to talk about what they are unable to do, and what type of assistance they might need from you. "¢ Appeal to and encourage the use of all senses. Visit your local bookstore" there are hundreds of books on aromatherapy and therapeutic oils and herbs. Learn how you can incorporate oils, incense and candles to heighten the sense of smell. Also, try experimenting with light (perhaps dimming them will create a more enticing environment) and relaxing music, to create an atmosphere that residents will find soothing, relaxing, and nourishing. "¢ Bathing time could also be a time for activities such as foot, hand, and neck massage. Perhaps while one person waits to bathe he or she could receive a massage. Many people find the sight and sound of running water to be soothing, so other options to make this time more relaxing could include the purchase of a waterfall apparatus. They can be found at most home stores, are small and portable, and reasonably priced. While it's easy to fall into the trap of "just getting it done"¯ bathing should become more than a purely hygienic activity for residents and rather serve as an experience that completes them as a unique person. Humor Bonus Three Nurses and a Genie A nursing assistant, floor nurse, and charge nurse from a small nursing home were taking a lunch break in the break room. In walks a lady dressed in silk scarves and wearing large polished stoned jewelry. "I am 'Gina the Great'," stated the lady. "I am so pleased with the way you have taken care of my aunt that I will now grant the next three wishes!" With a wave of her hand and a puff of smoke, the room was filled with flowers, fruit and bottles of drink, proving that she did have the power to grant wishes before any of the nurses could think otherwise. The nurses quickly argued among themselves as to which one would ask for the first wish. Speaking up, the nursing assistant wished first. "I wish I were on a tropical island beach, with single, well-built men feeding me fruit and tending to my every need." With a puff of smoke, the nursing assistant was gone. The floor nurse went next."¯ I wish I were rich and retired and spending my days in my own warm cabin at a ski resort with well groomed men feeding me cocoa and doughnuts." With a puff of smoke, she too was gone. "Now, what is the last wish?" asked the lady. The charge nurse said," I want those two back on the floor at the end of the lunch break." 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