Struggling to care: nurses' perceptions of caring for obese patients in an Australian bariatric ward.(Case study)

ABSTRACT

With a virtual epidemic of obesity worldwide, the number of obese patients receiving acute care and other services is expected to increase sharply. This study explores nurses' perceptions and experiences of caring for obese patients in the context of an acute general surgical ward. This ward, within a major metropolitan private hospital in Australia, specialises in bariatric surgery. Ten semi-structured interviews were conducted and thematic analysis employed to analyse the transcripts. From this analysis, several themes emerged: competing perceptions of obesity, ambivalence to weight-loss-surgery (WLS), and obese patient responsibility. Three particular discourses were identified: discourses of medicine, nursing and neo-liberalism. Each offers a different mode of caring for the body, and this study reveals how nurses, in caring for obese patients, function within these competing and often contradictory discourses.

KEY WORDS

nursing; obesity; sociology; bariatric surgery; responsibility; medicalisation

Introduction

Obesity has rapidly become an epidemic of the Western world, with the greatest proportion of individuals becoming obese over the last twenty years. In the United States for example, the prevalence of obesity in the population has risen from 15% in 1980, to 30.9% in 2000, with Australia's rates of obesity comparable to the United Kingdom at 20% of the population (Cameron et al 2003:427; Chang and Christakis 2002:152). Nurses, as health care professionals, are placed under enormous strain with the global nursing shortage, the ageing of the nursing population, and increasing workloads (AIHW 2002:316; Reto 2003:146). With the increasing body size of the general population, medical intervention in the form of bariatric surgery (meaning weight treatment), including gastric bypass, bilio-pancreatic diversion and laparoscopic banding, is now performed to provide a cure for obese individuals (Blackwood 2004:27; Hahler 2002:240; Roedel Ferraro 2003:924).

Previous research into the role of nurses in the treatment and care of obese patients has mainly focused on the logistics of managing an obese patient in a clinical setting and the apparent stigmatisation these patients encounter (Armburu-Algeria-Drury 2002:555; Carryer 2001:90; Hahler 2002:249). Lawler (1991:18) conducted observational work supplemented by 34 semi-structured interviews with mainly registered nurses in her research on the way nurses manage the body. From this research Lawler (1991:143) has postulated that nurses adopt a discourse of 'fatalism' when caring for patients. However semi-structured interviews, although offering 'rich accounts' and significant data, can provide a challenge for the interviewer (Green and Thorogood 2004:90-91). Green and Thorogood (2004:90) suggest that when interviewing professional groups, public accounts that delineate socially acceptable views, or those which reproduce the dominant moral or socialised meanings of health in wider society, are more likely to be generated by such groups. What this current study found is that while public account discourses of fatalism were present when discussing the nurse-obese patient relationship, there are other significant discourses operating which also influence nurses' perceptions and experiences of caring. This study will show how discourses of fatalism and stigma only tell part of the story in relation to the nurse-obese patient relationship. The significance of this research is that it offers a greater understanding of the complex social and cultural position in which nurses as health care professionals are situated, and shows that nurses' perceptions and experiences are the result of the multiple and complex sets of relationships which exist between themselves and obese patients.