BACKGROUND:Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges in the intensive care setting. These are resultant from specific physiological responses to critical illness in this population and the nature of the interventional therapies used in the intensive care environment. An additional challenge arises for this population when considering the social stigma that is attached to being obese. Intensive care staff therefore not only attend to the physical and care needs of the critically ill morbidly obese patient but also navigate, both personally and professionally, the social terrain of stigma when providing care. AIM:To explore the culture and influences on doctors and nurses within the intensive care setting when caring for critically ill morbidly obese patients. DESIGN AND METHODS:A focused ethnographic approach was adopted to elicit the 'situated' experiences of caring for critically ill morbidly obese patients from the perspectives of intensive care staff. Participant observation of care practices and interviews with intensive care staff were undertaken over a four month period. Analysis was conducted using constant comparison technique to compare incidents applicable to each theme. 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/m(2). FINDINGS:Interactions between intensive care staff and morbidly obese patients were challenging due to the social stigma surrounding obesity. Social awkwardness and managing socially awkward moments were evident when caring for morbidly obese patients. Intensive care staff used strategies of face-work and mutual pretence to alleviate feelings of discomfort when engaged in aspects of care and caring. This was a strategy used to prevent embarrassment and distress for both the patients and staff. CONCLUSIONS:This study has brought new understandings about intensive care situations where social awkwardness occurs in the context of obesity and care practices, and of the performances and behaviours of staff in managing the social awkwardness of fat-stigma during care situations.

译文

背景:重症病态肥胖患者在重症监护环境中构成了相当大的医疗保健交付和资源利用挑战。这些是由于该人群对危重疾病的特定生理反应以及重症监护环境中使用的介入疗法的性质而导致的。当考虑与肥胖相关的社会耻辱时,该人群面临另一个挑战。因此,重症监护人员不仅要照顾病重的肥胖症患者的身体和护理需求,而且要在提供护理时亲自和专业地了解污名化的社会领域。
目的:探讨重症病态肥胖患者在重症监护环境中的文化及其对医生和护士的影响。
设计与方法:采用集中的人种志方法从重症监护人员的角度引发了护理重症病态肥胖患者的“现场”经验。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人员进行了访谈。使用恒定比较技术进行分析,以比较适用于每个主题的事件。
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 / m的重症患者的护理和管理。
结果:由于围绕肥胖症的社会污名化,重症监护病房人员和病态肥胖患者之间的相互作用具有挑战性。当照顾病态肥胖的患者时,社交尴尬和应对社交尴尬的时刻很明显。重症监护人员在从事护理和护理工作时,采用了面对面工作和相互装扮的策略,以减轻不适感。这是用于防止患者和医务人员陷入尴尬和困扰的策略。
结论:本研究对在肥胖和护理实践中发生社交尴尬的重症监护情况,以及在护理情况下员工应对肥胖柱头社会尴尬的表现和行为带来了新的认识。

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