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Working with Patients Living with Obesity

Our current featured article is titled “Working With Patients Living With Obesity in the Intensive Care Unit: A Study of Nurses’ Experiences” by Jacqueline Marie Shea, RN, BScN, MScN and Marilou Gagnon, RN, PhD.  This article article is available “open access,” meaning that it is permanently available for download without charge. The authors provide sections in conclusion that address the implications of their study for research, nursing theory, and education – sections that I am sure ANS readers will find useful and interesting.  Dr. Gagnon has provided this background information about their work:

This article presents the findings of a thesis project examining the experience of ICU nurses who work with people living with obesity (PLWO). The idea for this project was first discussed in 2011 when the first author (Jacqueline Shea) was taking an advanced nursing practice course with the second author (Marilou Gagnon), who later became her thesis supervisor. For the purpose of the course, she completed a concept analysis on

L-R: Jean Daniel Jacob, Jacqueline Shea, Marilou Gagnon

L-R: Jean Daniel Jacob, Jacqueline Shea, Marilou Gagnon

Othering after reflecting on the experience of taking care of PLWO in the ICU context. Building on this assignment and a decade of clinical experience in acute care, the two of them embarked on a journey together and conducted a qualitative study on two ICU units in a large urban centre in eastern Ontario (Canada). With the support of a strong thesis committee (Dr. Jean Daniel Jacob and Dr. Christine McPherson) as well as the support of staff and nurse educators on both ICU units, the study was completed at the beginning of 2014 and the thesis was successfully defended in the summer of 2014 (see picture).

PLWO are thought to be at a higher risk for developing a number of illnesses and diseases. PLWO who are admitted to hospital are also more likely to develop complications. As a result of complications and more complex health issues, PLWO have longer lengths of stay in ICU and require mechanical ventilation for longer periods of time. In addition, they have a higher mortality rate than patients with lower BMIs. When PLWO are critically ill, they present an increased rate of morbidity and mortality. This not only impacts their overall physical health but also the type of care required and the level of complexity that needs to be addressed when planning nursing care in the ICU context. At times, this may result in increased difficulties providing safe, competent, supportive and high quality nursing care to this patient population as well as increased in workloads for nurses.

It is important to point out that ICU nurses in the United States and in Canada encounter a growing number of PLWO in clinical practice. This trend is consistent with the increasing weight and BMI of the general population. Many authors suggest that the number of PLWO who are admitted to the ICU will continue to increase as this trend continues to increase. The rise in the number of PLWO admitted to the ICU, and its implications for nursing practice, have been reported in the media in Canada, more specifically in an article entitled “Caring for obese patients poses daunting challenges: Intensive care units are reporting a rise in the number of patients with extreme body weight,” published in The Montreal Gazette in 2011. Yet, there has been very limited research on the experience of nurses providing care to PLWO and no study conducted in the ICU specifically. To our knowledge, this was the first study conducted in this setting.

The goal of the study was to look specifically at the experiences of ICU nurses and how these experiences affect the way nurses provide care to PLWO. More specifically, it was designed to describe and explore both inclusionary and exclusionary practices (as defined by Dr. Mary K. Canales) developed by nurses who provide care to PLWO. The study was guided by Canales’ theoretical framework on Othering in nursing practice which was originally published in ANS in 2000. The findings presented in the article contribute to the application (new context and new population) and critique of the original Othering framework. It also addresses many of the limitations identified by Canales in her 10-year analysis (published in ANS in 2010) and by Canadian scholars who used this framework to understand the experiences of South Asian immigrant women in health care (Johnson and colleagues, 2004). Lastly, it adds to the original framework by exploring structural and contextual dimensions of Othering that have not, to our knowledge, been clearly described in the literature to date.

The study findings suggest that the experience of nurses who provide care to PLWO in the ICU environment is much more complicated than nurses simply having negative attitudes, perceptions and feelings toward this patient population. Therefore, if nurse researchers focus predominantly on these negative attitudes, perceptions, feelings and individual behaviours, they only observe a small aspect of the larger picture and, by extension, a small portion of the problem. As this study has shown, there are social, situational, organizational and institutional factors that have not been acknowledged to date in the literature, despite the fact that they contribute to exclusionary Othering; these unacknowledged factors influence nurses themselves and the way they provide care to PLWO as a result. Exploring these influences in a subsequent study could provide insight into how this phenomenon takes place in the ICU, and might raise important questions on the role of macro-level influences in shaping nurse–patient interactions.

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