Abstract
This well written study probes the barriers to optimal moving and handling practices for bariatric patients in acute hospital settings. Clinical nurse managers (CNMs) from multiple sites were invited to complete a novel questionnaire anonymously based on their assumed decision-making roles and expertise related to patient care. An overwhelming majority of respondents reported that bariatric patients frequented their departments.
The choice of CNMs as the target group for the reviewed study is an interesting decision made by the authors. While nursing staff are acknowledged as intimately involved in patient care, the CNM position is evolving internationally into a more administrative role, sometimes with less emphasis on clinical aspects. Significantly though, the present study highlights the fact that the majority of CNMs recognised the existence of multiple barriers to the moving and handling of bariatric patients and hence demonstrated substantial clinical awareness in relation to this topic.
The novel questionnaire employed in the study is well described thus allowing readers easily and critically to assess the results and conclusions presented by the authors. The key issues explored within this paper focus on ownership and timely access to suitable moving and handling equipment, although identification of bariatric patients by patient data collection (processes for weighing), and other factors (such as insufficient staff, training and guidelines) are discussed.
Overall the reviewed study focuses on the physical nature of bariatric care in terms of barriers regarding equipment provision. Less than half of the participants (41%) reported reliable access to equipment, as delineated by the categories of equipment as ‘always’ or ‘usually’ available. This aligns with numerous earlier studies investigating equipment availability as reported by nurses providing direct patient care. However, it is surprising that the participants in this study declared low levels of equipment availability while simultaneously reporting that most CNMs themselves (88.5%) were responsible for ordering bariatric equipment. Clearly there are additional factors that contribute to insufficient procurement of necessary items although this is not expanded on within the current paper.
The authors posit that insufficiencies relating to equipment (75%), staff (65.2%) and training (57.6%) are the principal barriers to effective bariatric moving and handling care. The study also revealed a high percentage of facilities lacking guidelines for bariatric care (74.4%), although it is unclear why this category was not similarly considered a principal barrier, despite being included in the results and discussion sections.
A focus on equipment and associated training can unintentionally reinforce an emphasis on easily identifiable physical constraints at the expense of interrogating organisational and sociopolitical influences. Two further barriers are reported in the study: ‘lack of clinical support’ (38.6%) and ‘lack of management support’ (20.5%) are included in Figure 1 but are not discussed. While a detailed understanding of physical barriers to optimal moving and handling care of bariatric patients is desirable, our exploration must not be limited to these factors only. Future research examining these other influences on care, particularly the sociopolitical organisational barriers, would complement this excellent study and take further the prospects of advancing practices.