BACKGROUND:Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges. However little is known about the care of these patients in intensive care. OBJECTIVE:To explore medical and nursing practices and attitudes in intensive care when caring for critically ill morbidly obese patients. METHODS:A focused ethnographic approach was adopted. Participant observation of care practices and interviews with intensive care doctors and nurses were undertaken over a four month period. Qualitative analysis was conducted using constant comparison. SETTING:An 18 bedded tertiary intensive care unit in New Zealand. PARTICIPANTS:Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40kg/m2. FINDINGS:Morbidly obese patients present significant physical and language challenges for intensive care practice. The physical shape of morbidly obese patients did not appropriately fit the different equipment used. Staff used specific knowledge of the patient's body size and shape to adapt care practices and keep patients safe and comfortable. There were also specific language challenges where staff expressed concern about what words were most appropriate to use to describe body mass when in the presence of morbidly obese patients. CONCLUSIONS:Bariatric care pathways need to be developed that use more suitable body measurements to inform the use of bariatric equipment. Intensive care staff need to engage in debate about what is acceptable, respectful, and appropriate language in the delivery of bariatric patient care.

译文

背景:重症病态肥胖患者构成了相当大的医疗保健交付和资源利用挑战。然而,对于重症监护中这些患者的护理知之甚少。
目的:探讨重症病态肥胖患者的重症监护中的医疗和护理实践及态度。
方法:采用集中民族志方法。在四个月的时间内对参与者的护理习惯进行观察并与重症监护医生和护士进行了访谈。使用恒定比较进行定性分析。
地点:新西兰一个拥有18张床位的三级重症监护室。
参与者:67名重症监护护士和13名重症监护医生参与了7例体重指数≥40kg / m2的重症患者的护理和管理。
结果:病态肥胖的患者在重症监护实践中面临着重大的身体和语言挑战。病态肥胖患者的身体形状不适用于所使用的不同设备。工作人员使用了有关患者身体大小和形状的特定知识,以适应护理习惯并保持患者安全舒适。在存在特定的语言挑战时,工作人员对在病态肥胖患者在场时最适合用来形容体重的词语表示关注。
结论:需要制定B病护理途径,使用更合适的身体测量方法来告知减肥设备的使用。重症监护人员需要就减肥患者护理的提供中可以接受的,尊重的和适当的语言进行辩论。

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