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Support groups—a powerful voice for the bariatric practice
Abstracts: Allied Health General Session/Surgery for Obesity and Related Diseases / 1 (2005) 284 –290
for other reasons, anecdotal evidence suggests that the nurses are presented with difficult problems. There is no systematic study reported in the literature documenting these problems. Methods: Focus groups were conducted with nurses from a major medical center treating bariatric patients. Nurse participants were chosen from the rehabilitation unit, labor and delivery, and the medical intermediate care unit. A trained facilitator was used to conduct the groups. Data from the focus groups were arrayed using NVIVO software. Results: While challenges were identified by the nurses in many areas, the most frequently cited problems dealt with special equipment for care of the morbidly obese patient. Issues were the location of the equipment (centralized vs. decentralized), ease of access to equipment, delay time in obtaining equipment, problems with the size in relation to the room size, and education of nurses in the use of the equipment. Conclusions: The care of the morbidly obese patient is significantly more difficult for nurses than the care of the nonobese patient. Specialized equipment can assist the nurses, but some problems must be overcome before the equipment can be used to best advantage. Several recommendations are made concerning the use of equipment in caring for this patient population. PII: S1550-7289(05)00304-7
AH10.
NONCOMPLIANCE WITH BEHAVIORAL RECOMMENDATIONS AFTER BARIATRIC SURGERY Gary Elkins, Ph.D., Paulette Whitfield, R.N., M.S.N., N.P., Joel Marcus, Psy.D., Richard Symmonds, M.D., Joaquin Rodriquez, M.D., Teresa Cook, M.S., Scott and White Clinic and Hospital, Temple, TX. Purpose: Bariatric surgery has been increasingly utilized for treatment of severe obesity. Although initial weight loss following surgery is almost completely assured, more needs to be known about long-term outcome and patient compliance with postoperative recommendations for diet and exercise that would improve outcome. The purpose of this study was to examine the rate of noncompliance with behavioral recommendations. Methods: One hundred consecutive patients who underwent Roux-en Y gastric bypass (RYGBP) were identified and a chart review conducted at 6 and 12 months postoperatively to gather demographic data and identify the prevalence of noncompliance identified in monthly follow-up visits. Also, patients were asked about depression, relationship/sexual concerns, and medical complications. Results: 81 women and 19 men were followed for 1 year. The majority of patients reported noncompliance in at least one area, with lack of exercise and snacking being most frequently cited (41% and 37%, respectively). Most patients were compliant with eating protein first and avoiding sodas. At 12 months’ follow-up 12% reported depression, 4% reported sexual concerns, and 2% reported relationship problems. Also, 9% reported having experienced some medical complication related to their surgery. Conclusions: Noncompliance is pervasive after bariatric surgery, with lack of exercise the most likely area of noncompliance. Because of the importance of compliance with behavioral recommendations for the successful outcome of bariatric surgery, additional research is
287
warranted to clarify further the factors that impact long-term outcome and to design interventions to improve compliance. PII: S1550-7289(05)00305-9 SESSION III AH11.
SUPPORT GROUPS—A POWERFUL VOICE FOR THE BARIATRIC PRACTICE Jackqueln K. Smierta, R.N., Bloomfield Hills, MI. Purpose: Our patients come to us for help. Obesity surgery, known to be the most viable treatment for this deadly disease, appears to be the only answer for millions of individuals all over the world. Our most important responsibility following the preoperative educational process and safe surgery is the process of continuing education. This paper will cover topics that will focus on the necessity of strong support groups and how they can prove to be a powerful voice for the bariatric practice. Methods: This presentation will be based on 64 patient surveys that provide information for promoting the success of a support group program. Results: The response of the survey indicates the necessity of a strong educational program that in turn becomes a powerful promotional tool for the bariatric practice. The answers to the survey address four specific areas of focus that bariatric patients believe to be of importance. 1. Psychological issues, including body image, eating disorders and long-term emotional assistance. 2. Physiological issues relating to metabolic monitoring. 3. Nutritional education for proper eating habits. 4. Exercise instructions and how to establish regular exercise programs. Conclusions: Establishing a strong support group that is enhanced by a multidisciplinary concept is vital for the patient as well as the practice. If the support group is well established and active within their educational meetings as well as socially active the benefits to the practice are limitless. The educational support the members request revolves around nutrition, exercise, psychological and physiological good health. They are not looking at short term results but rather a life time of freedom from the disease. PII: S1550-7289(05)00306-0 AH12.
EXPANSION OF BARIATRIC PROGRAM ACROSS HOSPITAL NETWORK Ruth M. Davis, R.N., B.S.N., Alexian Brothers Hospital Network, Elk Grove Village, IL. Purpose: Even a long-standing, comprehensive bariatric surgical program needs thoughtful, thorough planning to expand services. With nearly 700 surgeries in 2003, one network hospital could not accommodate the projected future volume. Plans were implemented to broaden services to another network hospital. Emphasis was placed on reproducing services while ensuring continued excellent outcomes. Methods: A corporate administrative plan provided direction and support. A bariatric medical director was selected from the surgical group to lend expertise and oversee process. The bariatric clinical coordinator was responsible for developing staff, supporting patients and facilitating communication. Staff training was detailed and comprehensive, focused on prevention and early detection of postoperative complications. Novice RNs and assistants were
for other reasons, anecdotal evidence suggests that the nurses are presented with difficult problems. There is no systematic study reported in the literature documenting these problems. Methods: Focus groups were conducted with nurses from a major medical center treating bariatric patients. Nurse participants were chosen from the rehabilitation unit, labor and delivery, and the medical intermediate care unit. A trained facilitator was used to conduct the groups. Data from the focus groups were arrayed using NVIVO software. Results: While challenges were identified by the nurses in many areas, the most frequently cited problems dealt with special equipment for care of the morbidly obese patient. Issues were the location of the equipment (centralized vs. decentralized), ease of access to equipment, delay time in obtaining equipment, problems with the size in relation to the room size, and education of nurses in the use of the equipment. Conclusions: The care of the morbidly obese patient is significantly more difficult for nurses than the care of the nonobese patient. Specialized equipment can assist the nurses, but some problems must be overcome before the equipment can be used to best advantage. Several recommendations are made concerning the use of equipment in caring for this patient population. PII: S1550-7289(05)00304-7
AH10.
NONCOMPLIANCE WITH BEHAVIORAL RECOMMENDATIONS AFTER BARIATRIC SURGERY Gary Elkins, Ph.D., Paulette Whitfield, R.N., M.S.N., N.P., Joel Marcus, Psy.D., Richard Symmonds, M.D., Joaquin Rodriquez, M.D., Teresa Cook, M.S., Scott and White Clinic and Hospital, Temple, TX. Purpose: Bariatric surgery has been increasingly utilized for treatment of severe obesity. Although initial weight loss following surgery is almost completely assured, more needs to be known about long-term outcome and patient compliance with postoperative recommendations for diet and exercise that would improve outcome. The purpose of this study was to examine the rate of noncompliance with behavioral recommendations. Methods: One hundred consecutive patients who underwent Roux-en Y gastric bypass (RYGBP) were identified and a chart review conducted at 6 and 12 months postoperatively to gather demographic data and identify the prevalence of noncompliance identified in monthly follow-up visits. Also, patients were asked about depression, relationship/sexual concerns, and medical complications. Results: 81 women and 19 men were followed for 1 year. The majority of patients reported noncompliance in at least one area, with lack of exercise and snacking being most frequently cited (41% and 37%, respectively). Most patients were compliant with eating protein first and avoiding sodas. At 12 months’ follow-up 12% reported depression, 4% reported sexual concerns, and 2% reported relationship problems. Also, 9% reported having experienced some medical complication related to their surgery. Conclusions: Noncompliance is pervasive after bariatric surgery, with lack of exercise the most likely area of noncompliance. Because of the importance of compliance with behavioral recommendations for the successful outcome of bariatric surgery, additional research is
287
warranted to clarify further the factors that impact long-term outcome and to design interventions to improve compliance. PII: S1550-7289(05)00305-9 SESSION III AH11.
SUPPORT GROUPS—A POWERFUL VOICE FOR THE BARIATRIC PRACTICE Jackqueln K. Smierta, R.N., Bloomfield Hills, MI. Purpose: Our patients come to us for help. Obesity surgery, known to be the most viable treatment for this deadly disease, appears to be the only answer for millions of individuals all over the world. Our most important responsibility following the preoperative educational process and safe surgery is the process of continuing education. This paper will cover topics that will focus on the necessity of strong support groups and how they can prove to be a powerful voice for the bariatric practice. Methods: This presentation will be based on 64 patient surveys that provide information for promoting the success of a support group program. Results: The response of the survey indicates the necessity of a strong educational program that in turn becomes a powerful promotional tool for the bariatric practice. The answers to the survey address four specific areas of focus that bariatric patients believe to be of importance. 1. Psychological issues, including body image, eating disorders and long-term emotional assistance. 2. Physiological issues relating to metabolic monitoring. 3. Nutritional education for proper eating habits. 4. Exercise instructions and how to establish regular exercise programs. Conclusions: Establishing a strong support group that is enhanced by a multidisciplinary concept is vital for the patient as well as the practice. If the support group is well established and active within their educational meetings as well as socially active the benefits to the practice are limitless. The educational support the members request revolves around nutrition, exercise, psychological and physiological good health. They are not looking at short term results but rather a life time of freedom from the disease. PII: S1550-7289(05)00306-0 AH12.
EXPANSION OF BARIATRIC PROGRAM ACROSS HOSPITAL NETWORK Ruth M. Davis, R.N., B.S.N., Alexian Brothers Hospital Network, Elk Grove Village, IL. Purpose: Even a long-standing, comprehensive bariatric surgical program needs thoughtful, thorough planning to expand services. With nearly 700 surgeries in 2003, one network hospital could not accommodate the projected future volume. Plans were implemented to broaden services to another network hospital. Emphasis was placed on reproducing services while ensuring continued excellent outcomes. Methods: A corporate administrative plan provided direction and support. A bariatric medical director was selected from the surgical group to lend expertise and oversee process. The bariatric clinical coordinator was responsible for developing staff, supporting patients and facilitating communication. Staff training was detailed and comprehensive, focused on prevention and early detection of postoperative complications. Novice RNs and assistants were