Research by the Health & Social Care Information Centre has identified a sharp and substantial increase in obesity levels amongst adults and children between 1993 and 2011
Having worked with plus-size persons for several years, I have noticed that year on year the assessment referrals I receive are increasing dramatically from the occasional referral to several a week.
The prevalence of obesity is well documented with the population of the UK being the most obese in Europe. The foresight report (2007) concluded that half of the UK population could be obese by 2050 at a cost of £50 billion per year.
Worryingly, upward trends in obesity levels suggest that this could be exceeded by 2050.
Although health and social care organisations are improving and some care environments have safe systems of work in place we still have a long way to go. Ownership is needed by everyone involved in the patient journey bottom up, top down to effectively manage and maintain a person’s dignity. This will have a major impact on organisations’ resources both human (number of carers required to undertake the care) and financial (cost of equipment etc.), resulting in a reactive approach to meeting the persons need rather than being proactive.
While obesity is linked to a range of serious, life-threatening conditions, it can also affect individuals in ways that are not life-threatening, but which can nevertheless have a serious impact on quality of life (Rush and Muir 2012). Lots of plus-size persons dislike their own body image; this affects their self-esteem and discrimination (“it’s your own fault”) means loneliness and being socially isolated is sadly the norm in this group.
Nurses should not be judgmental: we need to have empathy, and be prepared to listen to the person, understand what has occurred in their life experiences that has lead them down this pathway. Independence is key to their lives so don’t disable them by focusing on the negatives, encourage and embrace what they can do.
The first lesson I learnt is that managing plus size persons is not a one person task, it requires a multi-disciplinary team approach that includes the ambulance and fire services and in some cases the suppliers of plus size equipment and surveyors. Co-ordinating all these special services to be at the same place at the same time is more than a challenge, it is a miracle, but more often than not it works out. The patient journey requires precision planning and the planning needs to start from the initial contact: GPs are key to this as they usually see the patient first.
Research undertaken by Hignett and Griffiths in 2009 identified five generic risk factors in the bariatric patient pathway:
- Individual factor: body shape (somatotypes), mobility, pain co-operation, privacy, comfort and dignity
- Building (or vehicle) space and design, ie circulatory and physical space, environmental constraints, safe working, load of the flooring
- Equipment provision: size of the equipment (footprint), safe working load of the equipment, compatibility of the equipment ie bed, hoist slings, do they work together to ensure safe practice?
- Communication between all organisations involved in the person’s journey from the point of contact
- Organisation and staff concerns ie policies, procedures, culture, and training especially availability
The re-organisaton of health and social care service provision in England (Department of Health, 2013) and the imminent Health and Social Care Bill 2014 will require a person-centred approach that promotes patient independence, supports practitioners in their daily practice, and enables a culture of safety and harm-free care (Muir and Rush, 2013).
Time will tell, in real terms, how organisations will interpret the social care bill and implement partnerships working between health and social care to improve the persons journey. The fact that budgets will be integrated should give organisations more flexibility in meeting that need.
The purpose of my workshop at Naidex National is to discuss the management of a plus size person using a systematic approach that can be applied within any health and social care environment.
Encouragingly there is evidence of joint health and social care funding for specialist plus size equipment.
Using a systematic approach will provide organisations with the mechanism for identifying, assessing and managing the foreseeable risks associated to handling heavy people and reduce the potential exposure of injury to both care-givers and plus size person. The creations of integrated solutions will manage risk, enhance patient quality of life and efficacy of care.
Anita Rush is a clinical nurse specialist equipment from Berkshire West PCT
Anita is speaking at Naidex National (www.naidex.co.uk) onThursday 1st May in the Multidisciplinary Theatre (register online for free ticket).
Department of Health (2013) Guide to the healthcare system in England. London, DH
Health & Social Care Information Centre (2013) Statistics on obesity, physical activity and diet (England)
Hignett S, Griffiths P (2009) Manual handling risks in the bariatric (obese) patient pathway in acute, community and ambulance care and treatment. Work; 33: 2, 175
Muir M, Rush A (2013) Moving and Handling of Plus Size People an illustrated guide. Professional Series Vol 3 National Back Exchange ISBN 978-0-09564838 3-6
Rush A, Muir M (2012) Maintaining skin integrity in bariatric patients. British Journal of Community Nursing; 17: 4, 154-159