What New Graduate Nurses Need to Know About Caring for Bariatric Patients

Introduction

In a 2-year span, there were 22 new graduate registered nurses (RN) hired to University of California Davis Medical Center's Vascular and Gastrointestinal Telemetry Unit. With bariatric surgery a primary focus of this unit, it was imperative to ensure these new graduate nurses understood the complexities of bariatric care. When interviewed, it became apparent that while these nurses were highly capable, they did not receive any significant instruction about caring for the morbidly obese during school. This same finding and theme was also established by Rowen. ¹ Rowen states that with the increasing prevalence of obesity, nursing curricula should adapt to cover more concepts related to bariatric care. Rowen suggested the idea that if obesity were presented in nursing school as a disease model, students would have a more in-depth understanding of the causes, risks, assessments, interventions, and treatments of patients who are obese. ¹ Until these topics are incorporated in nursing schools, hospital units must include bariatric care as a core component of orientation.

Materials and Methods

To assess the needs of these new graduate RNs, the unit leadership organized a meeting called the Rising Stars workshop. It was held in February 2011 and was attended by the new graduate nurses, the assistant managers, and the department manager. One of the primary goals of this workshop was to brainstorm ways to improve the nursing orientation as it pertains to the care of bariatric patients. A roundtable discussion allowed each new graduate RN to offer input about what they thought would be helpful during training within their unit. In addition, each participant was given the opportunity to write down ideas, questions, comments, and/or concerns anonymously. This information was given to management and taken into consideration.

The new graduate RNs were also given a survey that asked two questions about each of the 13 topics. The first question asked the participant to rate how important each topic was relative to the care of bariatric patients. The second question asked the participant to rate his/her understanding of the topic. The following subjects were addressed: details of the three types of bariatric surgery, criteria for becoming a candidate for bariatric surgery, obesity sensitivity, bariatric equipment options, safe bariatric patient handling, signs/symptoms of postoperative complications, nutritional requirements immediately after bariatric surgery, guidelines for all diet stages after surgery, late complications of bariatric surgery, postoperative nursing considerations, discharge criteria, discharge teaching, and nursing care of the readmitted bariatric surgery patient.

Results

The survey information was useful in determining the participants' perceptions about what was most and least important for providing bariatric patient care. The possible options for their responses were “very important,” “important,” “moderately important,” “of little importance,” and “unimportant.” “Signs and symptoms of postoperative complications” and “discharge teaching” were among the topics ranked “very important.” “Criteria to qualify for bariatric surgery” and “late complications” ranked as just “important.” No topic was ranked as less than “moderately important.” The second aspect to the survey was to assess the nurses' understanding of each subject. The possible responses were “excellent,” “above average,” “average,” “below average,” and “extremely poor.” Some of the topics that were mostly rated as “excellent” were “obesity sensitivity” and “postoperative care.” Topics that had more responses in the “below average” and “poor” categories were “late complications” and “general diet guidelines.” See Table 1 for a survey summary.

With the leadership team deeming all the topics in the survey as very important, their goal was to ensure this information was effectively presented during a new nurse's orientation. Two educational tools were created to outline this information: the Bariatric Care Resource Binder and a poster titled What New Graduate Nurses Need to Know about Caring for Bariatric Patients.

The Bariatric Care Resource Binder is now maintained in a central location in the report room where it can be easily accessed by all nursing staff. Some of the topics within this binder include postoperative care, discharge criteria, obesity sensitivity, as well as policies about ordering bariatric beds and equipment. This binder functions as an additional teaching tool during a nurse's orientation, as well as a quick reference for all nurses in case a question arises.

The poster gives a description of the Rising Stars workshop and an outline of the survey. There are several color illustrations of the different types of bariatric surgery. It also lists key factors about the topics mentioned in the survey in a bullet point format. Across the top are pictures of all the new graduate RNs on Davis 12 that were involved.

The participants at this workshop also conveyed the desire for an in-service provided by the Bariatric Coordinator. At this in-service, nurses were provided with the latest information on bariatric patient care and had the opportunity to ask questions. Management set the goal to have these meetings every 6 months. The Bariatric Coordinator now also provides an in-service to first semester nursing students at California State University, Sacramento, on the topic of bariatric sensitivity and safe patient handling of bariatric patients.

Another constructive outcome of the Rising Stars workshop was that it ignited the interest of four new graduate RNs to submit abstracts and attend the Eighth Annual National Association of Bariatric Nurses Conference in Nashville, TN. Each abstract was accompanied by a poster created by the new graduate RNs. One topic is the one being described herein, while the others focused on the process of how to conduct a research study focused on bariatric patients, and the proper way to mobilize bariatric patients. As a result, our unit now has three posters that can be used as additional educational tools for new graduate RNs.

Discussion

This unit recognized that some of the current nursing school curricula are not adequately addressing bariatric patient care. The unit leadership was able to develop an orientation program, as well as other educational tools, that can compensate where some schools may be lacking. With close to 33% of the United States' adult population considered obese in 2009–2010, ² it would seem necessary that nursing schools add more concepts related to obesity to their programs. Patients with obesity and the comorbidities that accompany obesity can be found on every hospital unit. The question is how to convey this need for curriculum change to the nursing schools. One possibility could include hospital nurse educators meeting with the deans of nursing schools to discuss the importance of increasing the coverage on the topic of obesity. Recent graduates could also make an impact by participating in these discussions.

Conclusions

Since the program started, 11 more new graduate RNs have been hired. These nurses feel better equipped to care for bariatric patients due to the more extensive orientation program. In summary, the new changes to this department include a new Bariatric Care Resource Binder, several informative posters, and ongoing in-services provided by the Bariatric Coordinator.