Abstract
As a result of the changing healthcare landscape and the increasing prevalence of obesity, the discipline of bariatric nursing is one that is evolving out of necessity. Disciplines are characterized by a unique, rather than global, perspective. 1 The relationship between a discipline and clinical practice is important to appreciate; while the two are interrelated, they are distinct in their goals and objectives. Nursing practice describes the services and skills that nurses provide to patients, while the discipline of nursing should ideally determine how practice is implemented and governed. 1 The same should be true when defining bariatric nursing practice and defining the discipline of bariatric nursing. Conceptual models and nursing theories are essential to this discussion, as they can assist the discipline of bariatric nursing in defining how practice should be realized and governed.
Nursing models were identified in the early 1950s as a way to define nursing practice and to bring legitimacy to the profession. While there are multiple definitions that attempt to define conceptual models, it is commonly accepted that conceptual models represent general concepts or phenomena and then describe the links or associations between the concepts and phenomena. 2 Conceptual models are abstract and philosophical by design. They exist to provide a frame of reference or a perspective for questioning and problem solving. Nursing has several conceptual models that seek to describe nursing practice including, but not limited to, Roy's Adaptation Model, Orem's Self-Care Model, and Levine's Conservation Model.
Theories, on the other hand, are less abstract and exist to provide a framework for inquiry. Fawcett defines theory as “a specific set of relatively concrete and specific concepts and the propositions that describe or link those concepts.” 2 In contrast to models, theories tend to be narrower in scope and are often used as a foundation for empirical research. Theory provides the structure for investigating the relationship between characteristics, behaviors, and outcomes. 2
Bariatric Nursing and Surgical Patient Care is entering its seventh year of publication. During this time, the obesity epidemic has worsened and the impact of obesity on the healthcare system is being realized. Studies that originate from multiple disciplines, including medicine, economics, and public health, are publishing research studies describing the impact of obesity on the healthcare delivery system and on the reimbursement and payment policies that finance healthcare. Seven years ago, the term bariatric nurse was used solely to describe nurses who cared for patients undergoing bariatric surgery, but it can be argued that today, the term bariatric nurse needs to be applied more broadly and that a discipline of bariatric nursing with an articulated set of standards and expectations for clinical practice needs to be defined.
In the last 6 years of publication, Bariatric Nursing and Surgical Patient Care has published three best practice guidelines that describe the standards and expectations of care for patients with obesity in relation to the issues of skin care, 3 safe patient handling, 4 and sensitive care. 5 During this same time, a total of six manuscripts have explained or aligned the work of the bariatric nurse with conceptual models or theories, including Erikson's Theory of Human Development, 6 Transitional Theory, 7 and the Theory of Unpleasant Symptoms. 8 This is a good start, but given the prevalence of obesity and the expected impact of this population in the healthcare environment, there is more work to be done.
In this issue, Ms. Rochin not only describes the potential impact to nursing of Value-Based Purchasing, a new incentive payment program created by the Patient Protection and Affordable Care Act of 2010 but, more importantly, she describes how the experiences of bariatric and non-bariatric surgical patients differ and the potential impact that this may have on reimbursement. This difference highlights a point made earlier: while there are some universal truths and methods in nursing practice, there are also differences for subgroups of patients. To highlight further the issue of differences between patient subgroups, Ms. Budak's paper, entitled “A Framework of Food Cravings and Weight Loss after Bariatric Surgery: Application of the Cognitive Processing Model,” is an excellent example of using a conceptual model as a way to explain the issue of weight gain in a subset of bariatric surgery patients. The use of models and theories to describe the problem and to propose and test interventions, is critical for advancing the standard of care for patients with obesity.
Articulating the unique role that nurses play in healthcare is a prerequisite to nursing autonomy and owning one's nursing practice. With the increasing prevalence of obesity and the increasing number of patients choosing weight loss surgery as a mechanism to cure obesity, the use of models and theories to research the phenomena and requisite nursing care associated with all aspects of obesity is essential. The current healthcare environment is increasingly multidisciplinary in nature, and while this is ultimately a positive trend in healthcare, it may unintentionally obscure the role of the nurse. The use of applicable theories, and the development of new theories, may help bariatric nurses define and validate their distinct role in the care of patients with obesity. 9 As healthcare changes and the roles and responsibilities of caregivers evolve, it is theory that allows various disciplines to define that which is unique and specific to each of them. Therefore, it is the utilization and development of models and theory that will ultimately give relevance to a discipline of bariatric nursing.