So here's my bio. I have my declosures, and I have no conflicts of interest on this topic. So the topic is doing the heavy lifting, nursing challenges and tips for the successful care of patients with severe obesity. So my objective is I'll be reviewing unique nursing challenges of caring for the orally obese ICU patient, including strategies for successful wound and device care, tips on early mobilization, creative approaches to pressure ulcer prophylaxis. So nursing challenges. I'm going to start off with the definition severe obesity is defined, and this talk is going to be defined as BMI of greater or equal to 40. And like my colleagues said, there's a population that's growing with patients, adult patients living with obesity. In combination, we're seeing this with the nursing shortage. And so a combination of both increasing population with obesity and nursing shortage has been a big barrier in the ICU. So patients with obesity, of course, require increased or more frequent nursing assessment and monitoring. Patients with obesity have a high risk of comorbidities, and you'll see that with an increase with nursing assessments and monitoring. And you also see increased prevalence of obesity, increased patient-related musculoskeletal injuries. Studies show that 86% of surgical nurses fear of experiencing back pain, fear of dropping patients, inadequate staffing, and inadequate equipment. So we wanted to see, looking at the barriers of what's going on with our nursing and nursing challenges whenever we come with taking care of patients with obesity. So one of them is awareness of stigma, awareness of impaired body image. Studies show that patients with obesity have a fear of seeking health care. And so our attitude about caring for obese patients can be easily transmitted to the patient, and it can be detrimental to a patient's care if the patient feels like the staff resents caring for them or is repulsed by their body habitats, and that contributes to that stigma of obese patients seeking health care. So nursing workload, the characteristics that impact nursing workload are BMI, body shape, patient acuity, and dependence. Also like I mentioned before, nursing staffing shortages. We saw that with the pandemic, and even now we're still experiencing staffing shortages, which is a big problem that we're facing across the country and even internationally. So in a recent article that was a review article showed that nursing care with severe obesity, there was three main themes for this article with care for patient obesity, which was knowledge and training related to equipment, patient care, and opportunities to improve care. And within that article, these were the sub themes. Circulation issues, elimination, which was personal hygiene needs, mobility issues, maintaining patient comfort and dignity, maintaining patient safety, nutritional assessment to ensure adequate caloric intake, pain and symptom management, patient care plan, which was daily routine, patient education about their own self-care, patient's psychosocial care and needs, and respiration issues, and skin integrity issues. And out of all these sub themes, the gait mobility issues, maintaining patient safety, patient care plan, psychosocial care, and respiration issues were the biggest ones, and I'm going to go in depth with that. So the maintaining patient safety, there was a significant correlation between nursing activity time and total nursing staff needed for bathing and positioning. And this was compared to patients with a BMI less than 30 and increased time for assistance to walk and increased total nursing staff for bathing and assistance to walk compared to patients with BMI less than 30 and BMI greater than 45. The same study, our new studies show that ICU workload found in patients with severe obesity required significant higher nursing workload compared to the less severe obesity patient. So we saw that in conjunction with the nursing staffing shortage, that these nursing workloads and assistance with staff is increased. So as we have an increase in patients with obesity, that doesn't correlate with how we're going into our nursing staff, so we need more nursing staff with these patients. Our skin integrity issues, our extreme obese patients were about two times more likely to experience an ulcer compared to the normal weight patients. And immobility is a marked risk factor for pressure ulcers in ICU patients and obesity decreasing mobility in patients increasing the risk for pressure ulcers. So with patients, with obese patients, they were highly able to get pressure ulcers a lot more frequently than compared to the normal weight patients. So with pressure ulcer prevention, anticipate bariatric patient needs from door to door. So during our shift, if we know that we're getting a bariatric patient, having the safe patient handling equipment nearby, and having the things that we need for our bariatric patients prior to receiving the patient, enlisting the patient and family for tips on how to move in and out of bed. So who better to know on how the care is for the patient than the patient and the family? And this kind of speaks back to our ABCDEF SECM guideline. And assess the skin of inpatients twice daily. Frequent assessments is definitely beneficial for this patient population. Follow sound hygiene practices. Be gentle with the skin folds. Expect to see changes in the skin's appearance. Observe for pressure ulcers in unusual places. Treat dermatitis appropriately. And do not assume the bariatric patients are well nourished. Remain emotionally sensitive when caring for bariatric patients. So wound care, there's a lot of factors that play into the wound care. And that includes decreased tissue perfusion and oxygenation, increased risk of flea, lymphatic disease of the lower extremities, increased abdominal pressure, and the amount of tissue disrupted to perform surgery. Muscle injury and muscle associated skin damage, poor nutrition, proper equipment and resources for care delivery, and immobility. So all these factors play into how we intervene for wound care for these patients. So gait and mobility issues, early mobilization. We have a number of devices that we use for mobilizing our patients. Here's just a number of them. We have a non-powered sit-to-stand, a power sit-to-stand device, power sit-to-stand and ambulation device. And we have a couple that are specific for our bariatric population, which are our Tolos and our Viking. We have our MaxiMove, Govo. And ceiling lifts, I've seen this in a couple organizations, more so for ICUs that have been renovated or new ICUs. The ceiling lift is very beneficial. And they can move around the room. You can get from the door to the bed. You can help with nurses as far as turning the patient and transferring the patient. And total lift bed and cowl lift bed, I've seen this more often in ICUs. And this has been very beneficial for our patients. As this bed is a vertical bed, it basically trends the patient up, verticalized, and gets them used to carrying their own weight. So I've seen more and more of this in the ICU. And I'm going to go a couple of slides from now. I'm going to go into the type of things I've been seeing with these beds. So here is an assessment that we use as far as when it comes to the different devices for ambulation and mobilization and the types of things that we can use for helping the nurses out. We use a level of function at my organization. You see a level of function four is our independent. And the level of function one is our max assist. So the nurses will do their assessment. And based on their assessment, they'll choose the device to help with the movement and helping with the mobilization of the patient. Some barriers to mobilization. So some ways to overcome some of the barriers to mobilization is starting off with using the high-fowler position so the patients feel more normal. Basically sitting up the patient in the bed, having the bed into the high-fowlers gets them in that position that they're going to ventilate better. Using hover mats to move the patient from the bed to the chair. This one's big. Location of devices. I've seen this in multiple organizations and seen this in even mine, that the location of the device really depends, really helps out with how often they use the safe patient handling device. If they're so far away that the nurses that don't really use it as much. So when they have it in a place that they're easily attainable, the use of the devices goes up. Having a champion staff on each shift also helps out. Whenever you have someone who's very knowledgeable on those devices really increases the use of those devices. And you'll see that does even less staff injuries whenever you do have a champion staff. Training staff on usability of devices. This is another way of, we do an annual assessment and teaching of the safe patient handling devices, but the more staff that you have on the comfortability and using these devices helps out with using it and they are also, you'll see a decrease in staff injury while they're using the safe patient handling devices. So future state of early mobilization in ICU. So the newer tools of mobility, and I'm going to talk about that bed, the verticalization bed that increases mobility, it stands the patient upright and the patient is strapped in at the legs and chest and the bed is gradually moved into a more upright position. So they're increasing their strength in the legs and it improves the ventilation and it weans from supplemental oxygen or ventilator. And not just with the obese population, but with the patients that have devices such as ECMO or the balloon pump, I've seen the patients have been a lot more mobile and decreasing length of stay with these types of beds. And it's really beneficial for the patient and something that I've never seen before where you walk into an ICU and all the patients are standing up and this is fairly new to our organization. We've been seeing this and hearing a lot more. We're getting some more data on it and we're going to look at how we can publish that. But it's something that has been very beneficial and it helps out with their early mobilization in our ICU. Okay. So here are my references. Sorry. All right.

nurses

severe obesity

ICU

challenges

care